ACUSON Origin 4D Fundamentals Presentation Part 2

SIEMENS Healthineers SIEMENS Healthineers® ACUSON Origin ultrasound system Fundamentals of 4D cardiac imaging; part II 2.0 software version Unrestricted © Siemens Healthineers, Unrestricted © Siemens Healthineers 2025 Notes No. 1 SIEMENS Healthineers Prerequisite SIEMENS . Healthineers Prerequisite: Read and review ACUSON Origin ultrasound system Fundamentals of 4D imaging part one content. SIEMENS Foundational concepts covered in part one are Healthineers essential for understanding the material in part two. A thorough understanding of previously covered ACUSON Origin topics will ensure a smoother learner experience and better comprehension of advanced concepts. ultrasound system Fundamentals of 4D cardiac imaging; part I 2.0 software version 2 Unrestricted © Siemens Healthineers, 2025 Notes No. 2 SIEMENS Healthineers Objectives SIEMENS . Healthineers • Identify 4D imaging multiplanar reconstruction (MPR) layouts and manipulation tools • Manipulate 4D volume datasets using cropping tools 3 Unrestricted © Siemens Healthineers, 2025 Notes No. 3 SIEMENS Healthineers 4D Image acquisition SIEMENS . Healthineers • 4D echocardiographic image acquisition can be divided into four areas: 1 2 3 4 ET Optimization Mode selection Cropping Display and analysis • 2D • Bi-plane • MPRs • 4D • Live 4D • Fixed • Color Doppler • 4D Zoom • Focused • 4D+Color • Free 4 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • Part one reviewed basic principles and concepts of 4D cardiac imaging, along with the clinical applications, image optimization, 4D modalities and acquisition techniques. Please refer to the ACUSON Origin ultrasound system Fundamentals of 4D imaging part one presentation for information related to any of these topics. • Cropping and manipulation of the volume dataset is an important part of 4D echocardiography. This can be performed during live acquisition or post-processing. In addition to multiplanar reconstruction, fixed tomographic planes, focused crop tools and Free Plane are all techniques to achieve the optimal visualization of the structure(s) of interest. Notes No. 4 SIEMENS Healthineers SIEMENS. Healthineers ... 4D Cardiac imaging Multiplanar reconstruction and layouts Click to add footnote 5 second line Unrestricted © Siemens Healthineers, 2025 Notes No. 5 SIEMENS Healthineers Multiplanar reconstruction SIEMENS . Healthineers ... Multiplanar reconstruction (MPR) is a technique that extracts and displays 2D images from a 3D volume dataset • After acquiring a volume dataset, virtually any 2D slice or cut plane can be obtained and visualized through multiplanar reconstruction -2GB DRE • This allows for precise analysis of cardiac structures from different angles and planes, enhancing diagnostic accuracy • Measurements can be performed on selected 2D imaging planes, avoiding inaccuracies of direct measurements on 3D displays due to parallax artifact • Parallax artifact refers to the distortion or misrepresentation of an object's position or size due to viewing position or direction relative to the object, causing object to appear slightly shifted or distorted when viewed from different angles 6 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Multiplanar reconstruction (MPR) is a technique that extracts and displays 2D images from a 3D volume dataset. • This allows for precise analysis of cardiac structures from different angles and planes, enhancing diagnostic accuracy. • After acquiring a volume dataset, virtually any 2D slice or cut plane can be obtained and visualized through multiplanar reconstruction. • Measurements can be performed on the selected 2D imaging planes, avoiding inaccuracies of direct measurements on 3D displays due to parallax artifact. • Parallax artifact refers to the distortion or misrepresentation of an object's position or size due to viewing position or direction relative to the object, causing the object to appear slightly shifted or distorted when viewed from different angles Notes No. 6 SIEMENS Healthineers Multiplanar reconstruction SIEMENS . Healthineers ... Multiplanar reconstruction: • Provides precise measurements of cardiac 88 Z6T : 38.7ºC structures Cardiac TIS:0.42 Allows for better assessment of valves, chambers MI:0.98 • 13.6vps 95% and hemodynamic data 4D Mid Supports pre- and intra-procedural planning and 3dB/DR60 • S2 real-time guidance MPR: MapD/T5 Vol: • Enhances detection of abnormalities MapA/T8 How it works: • 3D/4D volume is acquired • Volume is sliced into different planes to examine specific regions of interest • Planes can be adjusted to manipulate orientation and position of slices to obtain best view for diagnosis or intraprocedural guidance 7 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Multiplanar reconstruction enables clinicians to analyze the heart from multiple perspectives, improving diagnostic accuracy and treatment planning. • Clinical advantages of multiplanar reconstruction include: • Providing precise measurements of cardiac structures. • Allowing for better assessment of valves, chambers and hemodynamic data. • Aids pre-procedural planning and provides real-time intra-procedural guidance. • Enhances detection of abnormalities. • After a volume rendered image is acquired the volume is sliced into different planes to examine specific region(s) of interest. • Planes can be adjusted to orientation and position of slices to obtain best view for diagnosis or intraprocedural guidance Notes No. 7 SIEMENS Healthineers Multiplanar reconstruction SIEMENS . Healthineers Imaging planes Imaging planes: Each MPR plane is represented by a letter and color Lateral: left-to-right Elevation: front-to-back • coordinated border and MPR line for identifying views A B when manipulating the dataset • MPR A = lateral plane • Border/MPR line color: red • Manipulates dataset width (left-to-right) • MPR B = elevation plane • Border/MPR line color: green • Manipulates dataset depth (front-to-back) • MPR C = axial plane • Border/MPR line color: blue • Manipulates dataset height (top-to-bottom) C Axial: top-to-bottom Volume rendered image 8 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • Each MPR plane is represented by a letter and color coordinated border and MPR line for identifying views when manipulating the dataset • MPR A corresponds to the lateral plane • Border/MPR line color: red • Manipulates volume dataset width (left-to-right) • MPR B corresponds to the elevation plane • Border/MPR line color: green • Manipulates volume dataset depth (front-to-back) • MPR C corresponds to the axial plane • Border/MPR line color: blue • Manipulates volume dataset height (top-to-bottom) Notes No. 8 SIEMENS Healthineers Multiplanar reconstruction SIEMENS . Healthineers ... Manipulation To accurately visualize a specific cardiac structure the dataset should be properly aligned in all three (3) MPRs 278 • Default orientation of MPRs are positioned at 90° Z6T : 38.9ºC Cardiac TIS:0.64 orthogonal relationships to one another MI:1.37 12.7vps 95% When a structure of interest is not well visualized in -1dB/DR60 • default planes, adjust MPRs for optimal viewing MPR: MapDITS Vol • To view a structure of interest, intersect MPR lines MapA/T8 C through structure of interest in all three (3) planes and Low OdB P1/LD2 rotate or tilt MPR lines to be parallel with the structure Pri MPR: When evaluating color Doppler or blood flow, intersect Color • Vol: MapA MPRs through the region of interest and align one MPR 2D + Color line with the direction of flow 9 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • To accurately visualize a specific cardiac structure the dataset should be properly aligned in all three MPRs. The default orientation of the MPRs are positioned at 90° orthogonal relationships to one • another. • When a structure of interest is not well visualized in the default planes, adjust the MPRs for optimal viewing. • To view a structure of interest, intersect the MPR lines through the structure of interest in all three planes and rotate or tilt the MPR lines to align with the structure’s natural orientation. • When evaluating color Doppler or blood flow, intersect the MPRs over the region of interest and align one MPR line with the direction of flow Notes No. 9 SIEMENS Healthineers MPR manipulation SIEMENS . Healthineers ... Simplified workflow 1. Hover 2. Click 3. Move 4. Click Position pointer over hover area Press trackball arbitration control Use trackball to reposition MPR Press trackball arbitration control to within an MPR viewport to display to select MPR line line(s) set position and release the MPR MPR tool icon • Displayed MPR line(s) will or rotate  line(s) • Drag • MPR line(s) will display as a change from a dashed to solid dashed line when pointer is line when selected located within the hover area • Tool icon no longer displayed 10 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: • To create a specific To adjust the position or rotation of any MPR line or MPR C image z- rotation: 1. Position pointer over hover area within an MPR viewport to display pan/rotation tool icon. • MPR line(s) will display as dashed line when in hover area for a specific tool. 2. Press trackball arbitration control to select MPR line(s). • MPR line(s) will change from dashed to solid line. 3. Use trackball to reposition MPR line(s). • Drag or rotate the line(s). 4. Press trackball arbitration control to set and release MPR line. Notes No. 10 SIEMENS Healthineers MPR manipulation SIEMENS . Healthineers ... Tools and icons Vertical line pan Horizontal line pan Intersection pan MPR line rotation MPR image Z-rotation Reposition MPR line along Reposition MPR line along Reposition intersection Rotate MPR line around Rotate MPRs around z-axis vertical/y-axis of horizontal/x- axis of point of two (2) MPR lines intersecting axis of another of MPR C intersecting MPR line intersecting MPR line MPR line Position pointer over Position pointer over Position pointer over Position pointer over outer Position pointer over outer middle 90% of horizontal middle 90% of vertical MPR intersection point of any 10% of either end of MPR 10% of MPR C viewport to MPR line in any viewport to line in any viewport to two (2) MPR lines in any line in any viewport to display MPR image Z- display vertical pan line display horizontal pan line viewport to display display MPR line rotation rotation icon icon icon intersection pan icon icon .................................................................. .................................................................................... ............................................................ ..................................................................... G ------ 1- ........... ............ T ... ........ 11 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Vertical and horizontal line pan tools reposition the selected MPR line along the vertical (y- axis) and horizontal (x-axis) of the intersecting MPR line. • Plane intersection pan tool reposition the intersecting point of the selected MPR lines. • MPR line rotation tool rotates MPR line(s) around intersecting axis of another MPR. • If MPR Lock: Lock All is active, this action will rotate all three MPR lines simultaneously. • If MPR Lock: Bi-Plane Lock is active, selecting an MPR line in MPR viewports A or B will result in simultaneous rotation of both MPR lines in that viewport. • If MPR Lock: Unlocked is active, this action will only rotate the selected MPR line. • MPR image Z-rotation tool rotates MPR C around the Z-axis; this tool is only available within the MPR C viewport. Notes No. 11 SIEMENS Healthineers MPR manipulation SIEMENS . Healthineers Tools and icons Vertical line pan Horizontal line pan Intersection pan MPR line rotation MPR image Z-rotation ................................................ ............................................................. ........................................................................... .......................................................................................... ............................................................................................... G 1- ........... ............ ............ 12 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: • Vertical and horizontal line pan tools reposition the selected MPR line along the vertical (y- axis) and horizontal (x-axis) of the intersecting MPR line. • Plane intersection pan tool reposition the intersecting point of the selected MPR lines. • MPR line rotation tool rotates MPR line(s) around intersecting axis of another MPR. • If MPR Lock: Lock All is active, this action will rotate all three MPR lines simultaneously. • If MPR Lock: Bi-Plane Lock is active, selecting an MPR line in MPR viewports A or B will result in simultaneous rotation of both MPR lines in that viewport. • If MPR Lock: Unlocked is active, this action will only rotate the selected MPR line. • MPR image Z-rotation tool rotates MPR C around the Z-axis; this tool is only available within the MPR C viewport. Notes No. 12 SIEMENS Healthineers MPR Lock SIEMENS . Healthineers ... Lock Bi-Plane Unlocked Lock All Lock Bi-Plane 88 76T : 38.7ºC Cardiac D TIS:0.42 MP ck MI:0.98 13.6vps 95% 4D 3dB/DR60 S2 teresa MPR MapD/T5 Vol: MapA/T8 Lock Bi-Plane • Locks MPR Lines in MPR planes A and B; MPR lines in MPR C plane are unlocked • Locks the angle between MPR planes A and B; rotates the two MPRs simultaneously and maintains the relative positions of the two planes during rotation • This is the default MPR Lock setting 13 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Lock Bi-Plane locks reference planes A and B, making it so rotating MPR lines for in MPR planes A or B will maintain relative positions to each other, but not affect the MPR lines in MPR C plane. • This setting maintains an orthogonal orientation of A and B planes when either MPR line is rotated (or at the angles positioned when MPRs locked Notes No. 13 SIEMENS Healthineers MPR Lock SIEMENS . Healthineers ... Unlocked ZAT: 30.7"C Unlocked Lock All Lock Bi-Plane Cardiao TIS.0.42 MI:0.98 13,6vps MPR Lock Unlocked ZBT:38.9'C Cardiso TIS.0.64 MI:1.37 12.7vps 95% Mid -1dB/DR60 52 MPR MapD/T5 Vol: MapA/T8 Unlocked • Unlocks all planes • Enables individual manipulation of each MPR line in all MPRs without affecting position/rotation of another MPR Line 14 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Unlocked setting unlocks all MPR planes and enables individual manipulation of each MPR line in all planes without affecting position/rotation of another reference plane. Notes No. 14 SIEMENS Healthineers MPR Lock SIEMENS . Healthineers ... Lock All 5Z1 Cardiac TIS:0.43 Unlocked Lock All Lock Bi-Plane MI:0.97 14.0vps 95% MPR Lock 4D H Mid Lock All 3dB/DR57 MPR: T4 Vol: T7 Lock All • Locks all MPR lines in all reference planes (A, B, and C) • Rotation of any MPR line will affect the other two reference planes • All MPR lines maintain same position relative to each other; when one line is rotated, all rotate in tandem to retain a strict orthogonal relationship (or at the angles each were positioned when MPRs were locked) Author | Department 15 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The pan line rotation tool works differently depending on the active MPR Lock setting. • MPR Lock locks or unlocks rotation of the MPR lines relative to one another in the MPR views. • Lock All locks all MPR lines on all reference planes enabling the manipulation of one reference plane to affect the other two MPRs respectively. Notes No. 15 SIEMENS Healthineers 4D Layouts SIEMENS . Healthineers ... 5Z1 and Z6T Workflow Imaging L Mitral Valve MPR Lock ock Bi-Plane Reset Orientat End Exam 30 Calper Capture Type Prospective Line Density Unrestricted © Siemens Healthineers 2025 Speaker Notes: • There are eight 4D layouts for the 5Z1 and Z6T transducers. The initial display layout for MPRs and volume during and after volume acquisition is configurable in the system settings menu. • The first four (4) are combined 2D MPR and volume layout options. • The 3:1 stacked and 2:2 layouts display all three MPRs, in addition to the 4D volume viewports. • The 2:1 vertical and 2:1 horizontal layouts display MPRs A and B and the 4D volume viewport. SIEMENS Healthineers 4D Layouts SIEMENS . Healthineers ... 5Z1 and Z6T A B Workflow Imaging Mitral Valve MPR Lock ock Bi-Plane B C Reset Orientat MARC End Exam LI L Lines C 30 Calper Capture Type Prospective Line Der Unrestricted © Siemens Healthineers 2025 Speaker Notes: • The bottom four (4) are single image display layout options. • A, B, and C layouts display each indicated MPR viewport individually in a single display format. • The volume layout displays the volume viewport in a single display format. • The volume viewport is synchronized to MPR A, B, or C. SIEMENS Healthineers 4D Layouts SIEMENS . Healthineers ... Lumos Workflow Patient Imaging En Face MPR Lock pck Bi-Plane Reset Orientati End Exam 30 Caliper Capture Type Prospective Line Density ,Capture Unrestricted © Siemens Healthineers 2025 Speaker Notes: • There are also eight 4D layouts on the Lumos catheter. • The first four (4) include combined 2D MPR and volume or multiple MPR layout options. • The 2:2 stacked and 3:1 layouts display all three MPRs, in addition to the 4D volume viewports. • The 2:1 horizontal layouts display MPRs A and B and the 4D volume viewport. • The MPR A/B layout is biplane view for use while in an MPR layout. SIEMENS Healthineers 4D Layouts SIEMENS . Healthineers ... Lumos A B Workflow Patient OD Imaging En Face MPR Lock pck Bi-Plane A B C Reset Orientat End Exam L so Unes C 30 Caliper Capture Type Prospective Line De Unrestricted © Siemens Healthineers 2025 Speaker Notes: • The bottom four (4) are single image display layout options. • A, B, and C layouts display each indicated MPR viewport individually in a single display format. • The volume layout displays the volume viewport in a single display format. • The volume viewport is synchronized to MPR A, B, or C. SIEMENS Healthineers Sync to MPR SIEMENS . Healthineers ... Workflow Patient Physio Sync Imaging Multislice Sync Sync MPR A Sync MPR A MPR B MPR C Reset Orientation Reset Croppin C End Exam 4D Likes Sync MPR B Auto TEQ Harmonics Syn Line Demity MPR C Unrestricted © Siemens Healthineers 2025 Speaker Notes: • The volume rendered image can be synchronization to a new viewing direction to align with the orientation of any of the multiplanar reconstructions using the Synchronization functions on page one (1) of the 4D touch screen. • To synchronize the orientation of the volume with MPR A, select Sync MPR A. • To synchronize the orientation of the volume with MPR B, select Sync MPR B. • To synchronize the orientation of the volume with MPR C, select Sync MPR C. • Factory default 4D display for both live imaging and in review is the 3:1 Stacked layout, with volume viewport Sync MPR A. SIEMENS Healthineers Show MPR Lines SIEMENS . Healthineers ... Patiera Show MPR Lines Cardiac regina TIS.0.43 MI:0.90 C 29.1vps 95% Reset Orientation Reset Cropping 4D H Mid 0dB/DR60 Q Mid V 64" Th15 Op70 Cut Plane S2 Br-8 Capture Type Con50 Line Dersity Show MPR Lines • Displays graphic overlay to indicate position of MPR lines within each 2D rendered image plane • Enables MPR reference line position on 2D MPRs to be shown or hidden, as needed • Select Show MPR Lines button on page one (1) of 4D touch screen to activate/deactivate the feature 21 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When active, Show MPR Lines overlays a display graphic on the 2D MPRs to indicate the position of the MPR lines within each 2D rendered image plane. • This feature allows the user to show/hide the MPR reference line positions on the 2D MPRs, as needed. • Show MPR Lines is not available when Single V or Dual V feature is active. • Select the Show MPR Lines button on page one (1) of the 4D touch screen menu to active or deactivate the feature. Notes No. 21 SIEMENS Healthineers 4D Lines SIEMENS . Healthineers ... Potere Z6T:37.5ºC Cardiac Mulsudice TIS:0.49 AM1 0.80 MI.0.81 29.1vps 13.7vps Reset Orientation Reset Cropping 4D 4D Lines 95% H Mid 4D 0dB/DR60 Pen Q Mid 0dB/DR60 V 64- MPR Th 15 Op70 Auto TEQ Cat Fare T5 Vol Br-8 Capture Type T8 Con50 MPR MapE/T4 Vot MapE/T7 4D Lines • When 4D Lines is enabled, a graphic overlay showing the position of the MPR lines is displayed on the volume rendered image • Independent of displaying MPR lines on 2D MPRs, 4D Lines applies only to the volume image Lead IN • Select the 4D Lines button on page one (1) of the 4D touch screen to enable/disable the feature 22 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When active, 4D Lines displays the position of the MPR lines on the volume rendered image. • This feature is independent of displaying MPR reference lines on the 2D MPRs and applies only to the volume image. • Show or hide the intersecting MPR reference lines on the volume rendered image by selecting or de-selecting the 4D Lines button on page one (1) of the 4D touchscreen. Notes No. 22 SIEMENS Healthineers Slice Sync SIEMENS . Healthineers 5Z1 Slice Sync Cardiac TIS:0.43 MI:0.97 14.0vps $5% 4D HMd 3dB/DR57 MPR T Lire Barsky iVal: 1 1 T7 Slice Sync • Select Slice Sync button on page one (1) of • Activates 4D Lines/MPR point of the 4D touch screen intersection on volume rendered image and • The system automatically arbitrates arbitrates the trackball for repositioning the trackball to the 4D Lines intersection intersecting planes without having to position and MPR lines point of actively select an MPR line intersection becomes active • 4D Lines must be active to enable Slice Sync • Roll trackball to adjust the position of the feature intersecting MPR lines on the volume and MPR images 23 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Slice Sync activates the 4D Lines/MPR point of intersection on the volume rendered image and arbitrates the trackball for repositioning the intersecting planes without having to actively select MPR lines. • Select 4D Lines on page one (1) of the 4D touch screen. • 4D Lines must be active to be enable Slice Sync feature. • While 4D Lines are active, select the Slice Sync button. • The system automatically arbitrates the trackball to the 4D Lines intersection position once feature is activated and the MPR point of intersection becomes active. • Roll the trackball to adjust the position of the MPR intersection. • The volume rendered image can be synced to any of the MPRs while Slice Sync is enabled to adjust MPR line location in all views. • Slice Sync only adjusts the MPR vertical/horizontal pan line locations, it does not perform MPR line or plane rotation. • However, the volume rendered image can be rotated to move the MPR Line to a desired location. • The feature is unavailable when Single V, Dual V, Free Plane or 3D Caliper are active. Activation of another cropping tool automatically disables Slice Sync. Notes No. 23 SIEMENS Healthineers Color (4D) SIEMENS . Healthineers ... Display 1 2 2D + Color 2D Only Color Only 2D + Color 2D Only 3 There are three (3) modes for displaying color Doppler on 4D images: 1. 2D+Color displays both B-mode and color Doppler 2. 2D Only is a color suppression mode and only displays B- mode data in the MPRs and volume rendered image 3. Color Only is a B-mode suppression and only displays Color Only Color Doppler data on the volume rendered image; B- mode and color Doppler data are displayed in the MPRs 24 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are three (3) modes for displaying color Doppler data on the 4D images. 1. 2D+Color will display both B-mode and color Doppler. 2. 2D Only is a color suppression mode which displays only the B-mode portion of the volume rendered image. 3. Color Only is a B-mode suppression which only displays the color Doppler portion of the volume rendered image. 24 SIEMENS Healthineers Magnify SIEMENS . Healthineers ... 5Z1 Cardiac TIS:0.43 MI:0.97 14.0vps H Mid 4dB/DR50 Q Mid V 64. Th15 Con50 MPR MapD/T5 Vol: MapE/T7 • Rotate the Zoom dial on the control panel to adjust AZ the magnification level of an area of interest within the volume viewport • The letter Z will be displayed in the lower left • When layout contains volume viewport, corner of image screen when image has been magnification applies only to volume rendered magnified image; it will not magnify 2D MPRs • To cancel magnification, press the Zoom dial 25 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Magnification of an area interest in the 4D volume can be performed during acquisition or review. When a layout containing a volume rendered image is displayed, magnification only applies to the volume. It will not apply to the 2D MPRs. • 2D images can be magnified when setting up for a 4D acquisition. • Rotate the Zoom dial on the control panel to adjust magnification of an area of interest within the volume viewport. • The letter Z will be displayed in the lower left corner of the image screen when image has been magnified. • To cancel magnification, press the Zoom control dial. Notes No. 25 SIEMENS Healthineers Pan SIEMENS . Healthineers ... SIEMENS Healthineers 5Z1 Cardiac O TIS:0.43 ME.D.97 14.0vps 4D H Md 44B/DR50 Op70 Conso MapO/TS MapE/T7 111 • To pan to an area of interest on a volume, press left/right trackball arbitration control keys on the control panel to select Pan on trackball display graphic, if needed @ Pan Roll trackball to reposition the volume image within the • Press left/right trackball arbitration control key to set the • viewport position of the panned image 26 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Once a volume image has been magnified, use the trackball to pan to the area of interest. • To pan to an area of interest on a volume, press left/right trackball arbitration control keys on the control panel to select Pan on trackball display graphic, if needed • Roll trackball on control panel to reposition volume image within the viewport to view structure of interest. • Press left/right trackball arbitration control keys on the control panel to set the position of the panned image. Notes No. 26 SIEMENS Healthineers SIEMENS . Healthineers 4D Cardiac imaging Cropping tools and orientation Click to add footnote 27 second line Unrestricted © Siemens Healthineers, 2025 Notes No. 27 SIEMENS Healthineers 4D Image acquisition SIEMENS . Healthineers • 4D echocardiographic image acquisition can be divided into four areas: 1 2 3 4 Optimization Mode selection Cropping Display and analysis • 2D • Bi-plane • MPRs • Volume orientation • 4D • Live 4D • Fixed • 3D measurement • Color Doppler • 4D Zoom • Focused tools • 4D+Color • Free 28 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • The final stage of 4D cardiac imaging is determining the ideal method for displaying the 4D data and performing any analysis or quantification. Notes No. 28 SIEMENS Healthineers Visualizing and displaying volumetric datasets SIEMENS . Healthineers ... Volume rendered images can be manipulated either live or ZET: < 37"C Cardiac post-processing through orientation, slicing, and cropping TIS:0.33 MI:1.03 32.0vps 95% 4D Orientation: • Manipulation of MPR planes and rotation of the volume helps visualize anatomical structures and determine position of crop planes/boxes to shape volume for optimal visualization of the structures of interest Slicing: • Most commonly indicates creation and evaluation of several tomographic sliced images created from the 4D dataset Cropping: 18cm • Removes redundant data to enable visualization of structures of interest within the volume 3D Rotate Free Plan 29 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Volume rendered images can be manipulated either live or post-processing through orientation, slicing, and cropping. • Orientation is most intuitive and consists of moving the pyramidal image around a fixed point to obtain optimal visualization for a structure of interest. • Slicing most commonly indicates the creation and evaluation of several tomographic sliced images created from the 4D volume dataset. • The concept of cropping is a critical component of 4D echocardiography. Cropping removes redundant data to enable visualization of the structures of interest within the volume. • Cropping technique of datasets depend on the structure(s) of interest or chamber(s) requiring quantification. Notes No. 29 SIEMENS Healthineers Orientation indicator SIEMENS . Healthineers Default viewpoint positions at time of acquisition: MPR A: MPR B: MPR C: The orientation indicator identifies the orientation of the volume rendered image relative to the cut planes and MPR axes • Each colored box represents the corresponding cut plane and MPR axis position on the volume • As MPR planes and volume are repositioned the MPR A: Upper-right MPR B: Upper-left MPR C: Lower-right boxes/planes on the indicator will update to reflect corner; viewing from corner; viewing from corner; viewing from the change relative to the other planes front of cut plane axis behind cut plane axis front of cut plane axis • The yellow sphere corresponds to where the volume • Orthogonal • Orthogonal position to MPR A position to MPR A is being viewed from relative to the displayed plane of the synced MPR view O When indicator is in front of the plane, the view position is from the anterior 50% of the volume When indicator is behind the plane, the view position is from the posterior 50% of the volume 30 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The orientation indicator identifies the orientation of the volume rendered image relative to the cut planes and MPR axes. • Each colored box represents the corresponding cut plane and MPR axis position on the volume. • As MPR lines are repositioned the orientation indicator boxes/planes will update to reflect the change relative to the other planes. • The yellow sphere corresponds to where the volume is being viewed from relative to the displayed plane of the synced MPR view. • When indicator is in front of the plane, the view position is from the anterior 50% of the volume. • When indicator is behind the plane, the view position is from the posterior 50% of the volume. Notes No. 30 SIEMENS Healthineers Orientation SIEMENS . Healthineers ... L/R Flip 5Z1 Cardiac TIS:0.43 Workflow MI:0.97 14.0vps 4D Patient L/R Flip Physio H Mid 4dB/DR50 Imaging Q Mid V 64* Th 15 Op70 Reset Orientation S2 Reset Cropping Br-8 Con50 MPR: MapD/T5 Vol: Free Flare Volume trance MapE/T7 • L/R Flip rotates the volume 180° around the vertical • Watch the position of the yellow sphere on the (y-) axis of the cut plane and displays the concealed orientation indicator as it moves position from the plane of the volume upper-right corner, in front of the cut plane, to upper-left corner and behind the cut plane after activating L/R Flip 31 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When cut plane is active, selecting L/R Flip rotates the volume 180º around the vertical axis of the cut plane to display the concealed plane of the volume. • Watch the position of the yellow sphere on the Orientation Indicator. It moves position from the upper-right corner, in front of the cut plane to upper-left corner and behind the cut plane after L/R Flip is activated. • Note: selecting Reset Orientation does not deactivate L/R Flip. Notes No. 31 SIEMENS Healthineers Orientation SIEMENS . Healthineers ... U/D Flip SIEMENS 521 Cardiac 22 Lomos Workhow TIS:0.43 MI:0.97 14.0vps Patient UID Flip 4D H Mid imaging 4dB/DR50 Q Mid V 64" Th15 D Reset Orientation Reset Cropping Op70 Ind team S2 Br-8 Con50 MPR: MapD/T5 Free Hace Vol. MapE/T7 mit Thickness • U/D Flip rotates the volume 180° around the • Watch the position of the yellow sphere on the horizontal (x-) axis of the cut plane and displays the orientation indicator as it moves position from the concealed plane of the volume upper-right corner, in front of the cut plane, to lower- left corner and behind the cut plane after activating U/D Flip 32 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When cut plane is active, selecting U/D Flip rotates the volume 180º around the horizontal axis of the cut plane to display the concealed plane of the volume. • Watch the position of the yellow sphere on the orientation indicator. It moves position from the upper-right corner, in front of the cut plane to lower-left corner and behind the cut plane after U/D Flip is activated. • Note: selecting Reset Orientation does not deactivate U/D Flip. Notes No. 32 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 33 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Rotating the volume enables visualization of an anatomical structure from any angle. The volume rotates independently of the multiplanar reconstructions. • An axis is a single line representing a direction in 3D space. • In each multiplanar reconstruction, the rotation of a plane occurs along the intersecting axis of another plane. • 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. 33 SIEMENS Healthineers X-, Y-, Z-rotation SIEMENS . Healthineers 7 Cardiac Cardias 40 4D H Mid H Mid 4dB/DR.50 4dB/DR.50 Q Mid Q Mid V 64" V 64* Th 15 Th15 Op70 Op70 52 S2 Br-B Br-B X Con50 Con50 MPR: Y Z MPR: MapD/T5 MapD/T5 Vol Vor MapE/T7 MapE/T7 CW 20 99 O O 34 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The In each multiplanar reconstruction, the plane rotates along the intersecting axis of another plane. The position of the volume can be synchronized to the position of any multiplanar reconstruction using the Sync to MPR feature. • The volume can be manually rotated along the fixed tomographic crop planes using the control panel dial. • To rotate the volume around the horizontal, or x-axis, rotate the CW/X dial on the control panel. • To rotate the volume around the vertical, or y-axis, rotate the PW/Y dial on the control panel. • To rotate the volume clockwise/counterclockwise around the z-axis, rotate the 2D/Z dial on the control panel. Notes No. 34 SIEMENS Healthineers X-, Y-, Z-rotation SIEMENS . Healthineers ... GET Cardiac 24 676T:40.1'C Cardiac T13:0.43 ML:0.84 26.6vps 95% 40 Mid -3dB. DR60 MPR Vol Ca Pointer 3D Rotate 3D Rotate Pointer • Press trackball arbitration key to select 3D • Press Update key to select pointer; or Rotate, if necessary press pointer key on the control panel • Or position pointer over inner 90% of • Position pointer over outer 10% of volume viewport to activate 3D volume viewport to display Z-rotation rotation icon and then press trackball icon arbitration key • Press trackball arbitration key and roll • Roll trackball Inner 90% Outer 10% trackball 35 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The volume can also be manually rotated along the fixed tomographic crop planes using the trackball. • To rotate the volume around the horizonal/x-axis or vertical/y-axis, using the trackball: • Press trackball arbitration key to select 3D Rotate, if necessary. • Or position pointer over inner 90% of volume viewport to activate 3D rotation icon and then press trackball arbitration key. Then roll the trackball. To rotate the volume around the z-axis, using the trackball: • Press Update key to select pointer from the trackball arbitration icon; or press pointer key on the control panel. • Position pointer over outer 10% of the volume viewport to display Z-rotation icon. • Press a left/right trackball arbitration key and roll trackball Notes No. 35 SIEMENS Healthineers Reset Orientation SIEMENS . Healthineers 76T:38.7"C Cardiac TIS:0.49 MI:0,90 9.3vps Workflow Reset Orientation LR FIP Volume Enhance MPR Thicknas Reset Orientation will restore the original acquisition position • To restore position, rotation, and slice to the acquisition • and orientation settings of volume rendered and MPR images settings, select Reset Orientation button on the 4D touch screen 36 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Reset Orientation will restore the original acquisition position and orientation settings of the volume rendered and MPR images. • To restore the position, rotation, and slice to the acquisition settings, select the Reset Orientation button on the 4D touch screen. Notes No. 36 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers ... Cropping Fixed tomographic Focused crop planes cropping Free Plane • Cropping performed along x-, y-, • MPR-guided quick-crop tools • Cropping performed in any and z-planes that display structure of interest arbitrary direction by a freely • Cut Plane within the 4D dataset without adjustable cropping plane • Multislice the need for manual cropping • Free Plane • Cut Plane • Color Crop • Mitral Valve • En Face • Single V • Dual V 37 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Notes No. 37 SIEMENS Healthineers Cut Plane SIEMENS . Healthineers ... 27 76T: 38.9'C Cardiac .ET: 38,7 C Cardiac T15:0.43 M:0.83 TIS:0.49 MI.0.90 18.0vps 9.3vps 40 22 turmes 40 Physio Maticice Show MPS lives Mit Lack lock &-Pure Cut Plane ICI Single V • Cut Plane automatically remove/crops • To reset Cut Plane, allowing for entire approximately 50% of the anterior portion of pyramidal dataset to be displayed, select Cut the volume dataset to enable visualization of Plane button on page one (1) of touch screen anatomy within the volume upon acquisition • The plane from which the data is cropped is dependent upon which MPR is actively synchronized with the volume rendered image 38 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Cut Plane automatically removes approximately 50% of the data to enable visualization of the anatomy within the dataset upon acquisition. • The plane from which the data is cropped, or cut, is dependent upon which MPR is actively synchronized with the volume rendered image. If the volume changes synchronization from MPR A to MPR C, the active Cut Plane will update to reflect the plane to which the volume is currently synced. • To reset the Cut Plane and allow the entire pyramidal dataset to be displayed, select the Cut Plane button on page one (1) of the 4D or Color (4D) touch screen. Notes No. 38 SIEMENS Healthineers Wireframe SIEMENS . Healthineers .. • A wireframe, or border, 76T:38.7 C representing the synchronized MPR Cardiac TIS:0.49 MI:0.90 plane is displayed around volume 9.3vps Physio rendered image Cool Down • Color of wireframe identifies MPR Reset Orientatio Reset Cropping to which the volume rendered image is currently synchronized Cut Plane To hide the wireframe from volume Wireframe • rendered image, select Cut Plane Wireframe button on page two (2) of the touch screen menu • Deactivating wireframe does not disable Cut Plane 39 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • A wireframe, or border, representing the synchronized MPR plane is displayed around the volume rendered image. The color of the wireframe identifies the MPR to which the volume rendered image is synchronized. • To hide the wireframe from the volume rendered image, select the Cut Plane Wireframe button on page two (2) of the touch screen menu to deactivate. • Deactivating the wireframe does not disable Cut Plane. Notes No. 39 SIEMENS Healthineers Color Crop SIEMENS . Healthineers • Color Crop activates a Cut Plane for 15 78T:39.1ºC the color Doppler data on the Cardiac TIS:0.76 ME1.36 000 7. 15.5vps volume rendered image 95% Color (40) synchronized with 4D/B-mode Cut Plane Color Crop • This skips manually cropping the PRE 809 20 Oxy Coter Duty Tifo afallEs D volume to visualize color Doppler information • To enable or disable Color Crop Cut Plane, select Color Crop button on page one (1) of Color (4D) touch screen 40 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Color Crop activates a Cut Plane for the color Doppler data on the volume rendered image synchronized with the 4D/B-mode Cut Plane. • This allows the user to skip the manually cropping the volume to visualize the color Doppler information. • Color data will stick out in front of the volume rendered cut plane when active. • To enable or disable the Color Crop Cut Plane, select Color Crop button from page (1) of the Color (4D) touchscreen menu. Notes No. 40 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Multislice creates unique, simultaneous uniformly spaced tomographic parallel cuts across multiple levels of a dataset from a single cardiac cycle Q Evaluate coronary Isolate scallops Assess for device artery disease/wall when evaluating leaks post- motion mitral regurgitation procedure abnormalities, LV and prolapse thrombus Provides accurate assessment of chamber dimensions, valves, and defects 41 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • Multislice creates unique, simultaneous uniformly spaced tomographic/parallel cuts across multiple levels of a dataset from a single cardiac cycle. It provides an accurate assessment of chamber dimensions, valves, and defects. • This tool can be used to evaluate coronary artery disease, wall motion abnormalities, LV thrombus, isolating scallops when evaluating mitral valve prolapse or MR, MPV/MR, assessing for device leaks post-procedures. • The Multislice tool is available in Cine playback and from clip review. • Multislice images can dynamic or static. • Multislice is available on all 4D cardiac imaging transducers and catheters. Notes No. 41 SIEMENS Healthineers Multislice SIEMENS . Healthineers Align MPRs 5Z1 Cardiac TIS:0.43 14.0VDS 4D H Mid 6dB/DR50 MPR 267 ap Lumos Workflow MapD/T5 Vol: MapE/T7 Patient Ptrysio Imaging Multislice Show MPR Line MPR Lock Review Lock El- Plane D Report Reset Orientation pping A MPRA End Exam Bi-Plane+ D Lines Cut Plane 3D Caliper Single V 1D Zoom Frequency Line Density Size Position Cip Capture Md 42 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • It is important all MPRs are aligned with the region/structure of interest to be interrogated prior to launching Multislice to properly view slices. • After aligning all MPRs with the structure(s) of interest, select the Multislice button on page one (1) of the 4D touch screen. • Note: Zoom/Magnify control is disabled when Multislice is active. Notes No. 42 SIEMENS Healthineers Multislice SIEMENS . Healthineers Touch screen layout Image display Reference plane ........ Review Patient Review Imaging Mulherice Review Report General Parasternal Apical C ...................... Position of Slices End Exam Distance Slices ........ Distance Position of Slices Playback Cine 2 mm 0 mm Frs Beats Range Position ........ Range Position 43 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • The Multislice tool is intended to present multiple tomographic slices of a region of interest to both appropriately convey a story regarding a patient's condition and in a manner from which the reviewer can read and determine a diagnosis. • The system operator must decide, based on the clinical need, how to display the data using various parameters and layouts. • It is important to align MPRs to the region/structure of interest prior to launching Multislice to properly view slices. • Once all MPRs are aligned with structure of interest, select the Multislice button on page one (1) of the 4D touch screen. • The Multislice tool is available in Cine playback and from clip review. • Multislice images can viewed or acquired as clips or static images. Use the 3rd rotary dial control, Playback, on the touch screen from the touch screen • to freeze or play images. 43 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Slice group graphic Point of intersection/center .... Reference image ..... slice Number of slices in 5Z1 Cardiac front of center slice Additional slices TIS:0.43 MI:0.97 9.4vps ......... not currently displayed 4D H Mid 6dB/DR50 Q High View direction S2 MPR: Slices displayed on MapD/T5 ......... Vol: image screen MapE/T7 Active slice Number of slices behind center slice Active slice Center slice 44 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • The slice group graphic overlay on the reference image provides information related to the selected Multislice settings. • The point of intersection corresponds with position of MPR lines within the ROI and is the location of the center slice. • The center slice is relative to the selected reference plane. Zero represents the center slice. • Number next to lines are number slices in the entire slice group on either side of the center slice. They correspond to the number in upper right corner of the slices displayed on the image screen. • Negative numbers are positioned below center slice and positive numbers are positioned above center slice. • Arrows indicate view direction and align with MPR lines of the selected reference plane • The yellow line indicates position of active slice. The corresponding slice is displayed on image screen with a white outline. • Solid white lines represent the currently displayed slices from the slice group. • Number and position of solid lines is determined by number of slices in the slice group, the selected layout and range position. • Dashed white lines represent additional slices not currently displayed on the image screen. • Number and position of dashed white lines is determined by number of total slices in the slice group, the selected layout and range position. Notes No. 44 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Reference planes Reference image Reference image SIEMENS Apical C 5Z1 Cardiac TIS:0.43 MI:0.97 9.4vps 95% 4D Center slice H Mid 6dB/DR50 S2 MPR MapD/T5 Vol: MapEST7 Reference plane Apical C reference plane = MPR C • Default reference plane • Center slice = Intersection point of MPR lines • Slices are parallel to MPR C • Reference image = MPR A • It is orthogonal to the reference plane (MPR C) for positioning the slice group 45 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The parameter to determine when using Multislice is the reference plane. • Slices can be obtained from any of the three MPRs, or reference planes. • Apical C is the default reference plane. • The center slice correlates to the intersection point of the MPR lines in MPR C and creates tomographic slices parallel to the C plane, therefore the reference image graphics are horizontal. • The reference image is represented by MPR A, as it is orthogonal to the reference plane for positioning the slice group. Notes No. 45 SIEMENS Healthineers Multislice reference planes SIEMENS . Healthineers ... Parasternal Reference image Reference image 8 521 Parasternal Cardiac TIS:0.43 MI:0.97 14.0vps 4D H Mid Reference plane Center slice 6dB/DR50 MPR: MapD/T5 Vol: MapE/T7 Parasternal reference plane = MPR B • Center slice = Intersection point of MPR lines • Slices are parallel to MPR B • Slices represent planes in-front-of and behind the center slice • Reference image = MPR A • It is orthogonal to reference plane (MPR B) for positioning the slice group 46 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Parasternal reference plane correlates to MPR B. the intersection point of all MPR lines. • The center slice is the intersection point of all MPR lines. In the Parasternal plane is, the center slice is represented by and creates tomographic slices parallel to MPR B, therefore the reference image graphics are vertical. • All slices represent planes in-front-of and behind the central slice in MPR B. • The reference image is represented by MPR A, as it is orthogonal to the MPR B for positioning the slice group. Notes No. 46 SIEMENS Healthineers Multislice reference planes SIEMENS . Healthineers ... General Reference plane Reference image 5Z1 Cardiac General TIS:0.43 MI:0.97 14.0vps 4D H Mid 6dB/DR50 Reference image Center slice MPR: MapD/T5 General reference plane = MPR A • Center slice = Intersection point of MPR lines • Slices are parallel to MPR A • Slices represent planes in-front-of and behind the central slice • Reference image = MPR B • It is orthogonal to reference plane (MPR A) for positioning the slice group 47 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The General reference plane correlates to MPR A. • The central slice in the General reference plane is represented by and creates tomographic slices parallel to MPR A, therefore the reference image graphics are vertical. • All slices represent planes in-front-of and behind the central slice in MPR A. • The reference image is represented by MPR A, as it is orthogonal to the MPR B for positioning the slice group. Notes No. 47 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Layouts Imaging Review Report End Exam Distance 2mm Runge Position Unrestricted © Siemens Healthineers 2025 Speaker Notes: • Regardless of the number of 2D slices being evaluated from the MPR, the number of slices displayed on the image screen at one time is determined by the selected Layout. • To change the number of slices displayed on the image screen, select the layout button on the Multislice tab of the 4D touchscreen menu. • The 4:4 layout displays the refence slice + 15 parallel slices. • The 3:3 layout displays the refence slice + 8 parallel slices. • The 2:2 layout displays the refence slice + 3 parallel slices. • The 2:1 layout displays the refence slice + a selected slice. • The single image layout displays just the selected, active slice in full-screen layout. • Choose the appropriate layout based on the clinical use case. The 4:4 and 3:3 layouts in the Apical C reference plane are suitable when evaluating for LV wall motion abnormalities. • While in the Parasternal reference plane with color of the mitral valve, the 4:4 layout is useful for assessment of leaflets and scallops in a patient with mitral valve regurgitation or prolapse. • Selecting a 2:2 layout while in the General reference plane can display apical 4-, 5-, 3-, and 2- chamber views simultaneously. SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Slices 5Z1 Cardiac TIS:0.43 MI:0.97 14.0vps 40 PIN H MPR: MapD/T5 Vol: MapE/T7 Slices Less slices 5 • Slices define number 2D tomographic cuts • Select appropriate number of slices to ensure being evaluated from the MPR slice group will cover and characterize the • Use 1st rotary dial on the Multislice tab to ROI, based on clinical scenario modify the number of Slices • Slice number adjusts by pairs on either side • Selections are: 1, 3, 5, 7, 9, 11, 13, 15, or 17 of the center slice More slices 49 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Slices define the number of 2D tomographic cuts, or slices, are being evaluated from the MPR. • Modify the number of Slices to ensure the slice group covers and characterizes the entire region of interest. • They are in pairs on either side of the of center slice. • Use the 1 st rotary dial control on the Multislice tab of the 4D touch screen to adjust the number of selected Slices. • Selections are: 1, 3, 5, 7, 9, 11, 13, 15, or 17. Notes No. 49 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Layout + Slices Review Patient imaging Multislice Review Report General Parasternal Agical C End Exam Slices 5 osition of Slices -10.8 mm KM 11 +4 En zum) Range Position 50 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Here there are five (5) slices in the slice group. In addition to the reference image, all five (5) slices are displayed because the selected 3:3 layout can display a maximum of nine (9) images at a time. • Three (3) image slots are empty because the is no data in the slice group to fill all nine images of the layout format. Notes No. 50 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Layout + Slices Review Patient imaging Multislice Review Report General Parasternal Apical C End Exam Slices 17 osition of Slices -30.5 mm Cine Range Position 51 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are seventeen (17) slices in this slice group. However, in addition to the reference image, just eight (8) of the selected seventeen (17) slices are shown because only a maximum of nine (9) images can be displayed in the selected 3:3 layout. • The number of slices in a slice group do not determine the number of images displayed on the image screen. The number of images display on screen is determined by the layout. Notes No. 51 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Distance 521 Cardiac TIS:0.43 MI:0.97 14.0vps 40 H Mid 6GB/DR50 MPR: MapDITS Vok: MapE/T7 Distance Less distance 8.5 mm • Distance defines a specific, uniform • Ensure enough differentiation between slices measurement between each sequential slice while maintaining adequate characterization within the slice group of target structures Use 2nd rotary dial on the Multislice tab to • • ↓ Distance to reduce area between slices and adjust Distance provide greater detail • Adjust in 0.5 mm increments (0.5 mm to 50 • ↑ Distance to spread out displayed slices to mm) More distance obtain a more global view of ROI 52 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Distance defines a specific uniform measurement between each sequential slice within the slice group. • Decrease the distance to reduce the area between slices and provide greater detail. Increase the distance to spread out the displayed slices to obtain a more global view of the region. • Distance is adjusted to ensure enough differentiation between slices while maintaining adequate characterization of the target structures. • Use the 2 nd rotary dial control on the Multislice tab of the 4D touch screen to adjust Distance. • Distance can be adjusted in 0.5mm increments from 0.5 mm to 50 mm. Notes No. 52 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Position of Slices T MaDD/T5 VOL Position of Slices 29 mm Slice group position • Position of Slices determines placement of • Change Position of Slices to ensure slice entire slice group within the MRP reference group is able to characterize the ROI plane • Position of Slices moves when General or • Defines ROI to be interrogated by slice group Parasternal reference planes are selected and Adjust 3rd rotary dial on the Multislice tab to • when in Apical C reference plane move Position of Slices within the reference • Active slice remains at the same location plane Slice group position within the slice group when moving Position of Slices 53 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Position of Slices determines the placement or location of the entire slice group within the MPR reference plane. • This defines the ROI to be interrogated by the slice group. • Change Position of Slices to ensure the slice group is in a location to properly characterize the ROI. • The active slice remains in same location within the slice group when moving Position of Slices. In this example, the active slice is zero; as the slice group is moved across the MPR, the active slice remains on slice zero. Use the 3 rd rotary dial control on the Multislice tab on the 4D touch screen to adjust • Position of Slices. • Moves the slice positions from -80.5 mm to 80.5 mm (in 1 mm increments). Notes No. 53 SIEMENS Healthineers Multislice SIEMENS . Healthineers ... Range Position 5Z Cardiac TIS:0.43 MI:0.97 14.0vps 4D Multislice H Mid BdB/DR50 MPR MapD/T5 Vol stapE/T7 Range Position ............. Range Position • Range Position defines the subset of slices within the slice group currently displayed on image screen for review • Slice group location within the MPR and total Equivalent to scrolling through available number of slices remain the same • slices • Active slice location does not change on image • Rotating Range Position rotary dial on the screen layout Multislice tab changes which slices within the • Image displayed at that layout location will slice group are displayed on image screen update to reflect the new active slice based Range Position on Range Position within slice group 54 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Range Position defines the subset of slices within the slice group currently displayed on the image screen for review. • This is equivalent to scrolling through the slices. • Slice group location within the MPR and total number of slices remain the same. On the two static image examples, the position of lines -8 through 8 do not change within the reference image. • The position of the solid white lines and the active slice (yellow line) move location within the slice group. The location of the active slice (yellow line) remains relative to its position within the slice group as Range Position changes. • The position of the active slice, depicted with a white outline in the layout displayed on screen, does not change as the Range Position is moves within the slice group. • The active slice image will update to reflect the slice within the slice group when moving Range Position. • In the video example, the active slice starts at zero and changes from slice -1 to slice +1, depending on which subset of slices are within the new the Range Position of the slice group. Use the 6 th rotary dial on the Multislice tab of the 4D touch screen to adjust Range Position. • • To exit Multislice, select Multislice button on the 4D touch screen. Notes No. 54 SIEMENS Healthineers Reset Cropping SIEMENS . Healthineers ... Reset Cropping restores Z6T:39.2ºC all cropped data and Cardiac TIS:0.43 MI:0.81 displays the original 24.5vps 4D acquired rendered volume image Reset Cropping Select Reset Cropping C • button on 4D touch screen to display the original acquired rendered volume 55 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When working with 4D volumes images, the acquired data is never lost or erased after manipulating or cropping the dataset. It can always be recovered and returned to the volume rendered image. • To remove all cropping and display the original acquired volume rendered image, select Reset Cropping on page one (1) or two (2) of the touch screen. Notes No. 55 SIEMENS Healthineers Surgical orientation SIEMENS . Healthineers ... In cardiac volume imaging, surgical orientation displays the heart as it appears to a surgeon during open-heart ZGT:40.3'C Cardiac procedures TIS:0.43 MI:0.80 17.8vps This standardized view helps bridge the gap between echo Aorta 95% • imaging and intraoperative anatomy, improving communication between imaging specialists and cardiac surgeons Provides common and consistent anatomical landmarks for Anterior MV leaflet • imager, interventionalist and surgeon for orientation and facilitating better understanding of directionality for guidance during transcatheter and surgical interventions Posterior MV leaflet • MV: from LA, viewed from above; with anterior leaflet at 12:00 and LAA at 9:00 • TV: from RA oriented for clear visualization of all leaflets; typically, with septal leaflet at 6:001 IAS: from LA, en face to aid in TSP or septal defect closure 4D 2 V67bpm • procedures2 Surgical orientation of MV • En face refers to structure being displayed in the direction of the observer 1. JACC: Cardiovascular Imaging, Vol. 12, No. 3, 2019 Muraru et al. March 2019:500 -1 5 56 2. J Am Soc Echocardiography , Vol. 23, No. 11,2020 Saric et al. November 2020:1128-35 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Surgical orientation in cardiac volume imaging displays the heart on screen as it appears to a surgeon during open-heart procedures. • This standardized view helps bridge the gap between echo imaging and intraoperative anatomy, improving communication between imaging specialists and cardiac surgeons. • It provides common and consistent anatomical landmarks for imager, interventionalist and surgeon to orient to anatomy and facilitates better understanding of directionality for guiding transcatheter and surgical interventions. • MV: from LA viewed from above, with anterior leaflet at 12:00 and LAA at 9:00. • TV: from RA oriented for clear visualization of all leaflets; typically, with septal leaflet at 6:00. • IAS: from LA, en face to aid in TSP or septal defect closure procedures. • En face refers to structure being displayed in the direction of the observer. SIEMENS Healthineers Mitral Valve SIEMENS . Healthineers' ... Z6T Mitral Valve is a single-click, 76T:38.8'C Cardiac TIS:0.43 MIO.80 focused cropping tool that 30.5vps 95% 4D repositions the MPRs and 34B/DR60 MPR volume rendered image to Mitral Valve Vol display the mitral valve en face, in the direction of the observer, simulating surgical orientation of the anatomy • Only available on Z6T Single-click: • Synchronizes volume to MPR C • Acquire or select 4D volume from • To return to previous orientation, select • Repositions MPR lines for optimized view of mitral valve Review containing the mitral valve Reset Orientation button on touch • • Rotates volume rendered image Select the Mitral Valve button from 4D screen in the direction of the observer touch screen • Perform adjustment to rotation/orientation, if necessary 57 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Mitral Valve is a single-click, focused cropping tool that repositions the MPRs and volume rendered image to display the valve en face, in the direction of the observer, simulating surgical orientation of the anatomy. • Regardless of MPR synchronization and volume orientation, Mitral Valve is activated, the system will rotate the volume to display see the mitral valve from the left atrial perspective and the volume viewport will be synchronized to MPR C. • This tool is only available on the Z6T transducer. • Using Z6T transducer, acquire a 4D volume containing the mitral valve anatomy, or select appropriate volume from Review. • Select the Mitral Valve button on page one (1) of the 4D touch screen. • The system will automatically synchronize the volume to MPR C, reposition the MPR lines for an optimized view of the mitral valve and rotate the volume rendered image in the direction of the observer. • Perform adjustment to rotation/orientation, if necessary. • To return to previous orientation, select Reset Orientation button on touch screen. Notes No. 57 SIEMENS Healthineers En Face SIEMENS . Healthineers ... Lumos En Face is a focused cropping tool that automatically performs an en face crop of the volume rendered image to display any n Face Show UPK Lines MIR Lock structure in the direction of the C Los & Pare observer • Can be performed during live imaging or in review • Only available on Lumos Single-click: • • • Synchronizes volume to MPR C Acquire or select 4D volume from To return to previous orientation, select Reset Orientation button on touch • Rotates volume rendered image Review • in the direction of the observer Select the En Face button from 4D touch screen screen • Perform adjustment to rotation/orientation, if necessary 58 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • En Face is single-click, focused cropping tool for use with volume ICE imaging that performs an en face crop of the volume rendered image to display any structure in the direction of the observer. • This tool is only available on the Lumos catheter. • Using the Lumos catheter, acquire a 4D volume, or select appropriate volume from Review. • Select the En Face button on page one (1) of the 4D touch screen. • The system will automatically synchronize the volume to MPR C and rotate the volume rendered image in the direction of the observer. • Adjust rotation/orientation, if necessary. • To return to previous orientation, select Reset Orientation button on touch screen. Notes No. 58 SIEMENS Healthineers Single V SIEMENS . Healthineers Single V is a focused cropping tool that allows Cardiac users to quickly define and display an ROI in 25. Jups the volume viewport dBUDR69 @ Mid • Crops volume rendered image to display only Bra necessary anatomy or structure(s) of interest MapE/T4 Vol to be interrogated MapE/T7 • Single V can be performed during live imaging or in review and is available on 4D cardiac transducers 456pm Lead 11 59 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Single V is a focused cropping tool that allows users to quickly define and display an ROI in the volume viewport . • Single V is a tool to crops volume rendered image to display only necessary anatomy or structure(s) of interest to be interrogated. • It can be performed during live imaging or in review and is available on 4D cardiac transducers Notes No. 59 SIEMENS Healthineers Single V SIEMENS . Healthineers ... kerk Overavion Reset Comowing Racat to Start Single V Box Width 1 1 1 1 11 Accept Set Start Set End • Acquire or select 4D volume from Review Use 6th rotary dial on touch screen to adjust • • Use trackball to navigate to desired position • Select Single V button from 4D touch screen crop box width • Press trackball arbitration control key to Set Start Single V icon will display in MPR A and define direction/viewpoint of the crop • • Always keep anatomical landmark (usually the aorta) in crop box for spatial orientation • Use trackball to define direction of cropping box • ⚫ on icon is the reference point for where the crop box is positioned within the volume Press Update to Accept box size/position and distance between Start and End points • Select Reset to Start to reposition crop box • •  indicates direction from which cropped Trackball arbitration control keys allow toggling • structures will be viewed • Select Single V button to return to default 4D between Set Start and Set End • state and remove cropping ⚫ and  change position when switching between Set Start/End 60 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Acquire or select 4D volume from Review. • Select the Single V button from 4D touch screen. • Single V cursor icon will display on MPR. • Use trackball to reposition cursor to alternate MPR box, if desired. • MPR where cursor is located will be always highlighted. • System will carry over the selected layout unless single volume was selected, in the case system will automatically switch to 3+1 layout. • Use trackball to navigate to desired position. • Press a trackball arbitration control key to Set Start and define viewpoint of the crop box. • ⚫ on the icon is the reference point for where the crop box is positioned within the volume. • Use trackball to define the direction of cropping box and distance between Start and End position of cropping area. •  indicates direction from which cropped structures will be viewed. • System will auto switch trackball arbitration to Set End and creates a small offset between Start and End position. • Set keys now allow user to toggle between Set Start and Set End. Use 6th rotary dial on the touch scree to adjust the width of crop box. • • Press Update to Accept box size/position. • Select Reset to Start to reposition crop box. • Select Single V button to return to default 4D state and remove cropping. Notes No. 60 SIEMENS Healthineers Dual V SIEMENS . Healthineers ... Dual V is a focused cropping simultaneously Z6T : 39.3ºC Cardiac displays two (2) views of a defined ROI within TIS:0.77 MI:1.34 the volume from opposing viewing angles 8.3vps 95% Mid Working in tandem with Single V, this tool -4dB/DR56 • S2 creates a cropped volume rendered image and MPR: MapD/T5 displays only structure(s) of interest with an IVol: MapA/T8 additional opposing viewpoint of the anatomy C LOW Dual V can be performed during live imaging OdB • General or in review and is available on all 4D cardiac PRF 5208 h15/Op70 transducers 4D Z 60bpm 61 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Dual V is a focused cropping simultaneously displays two (2) views of a defined ROI within the volume from opposing viewing angles. • It works in tandem with Single V to create a cropped volume rendered image and displays only necessary anatomy or structure(s) of interest with an additional viewing perspective of the anatomy. • Dual V can be performed during live imaging or in review and is available on all 4D cardiac transducers. Notes No. 61 SIEMENS Healthineers Dual V SIEMENS . Healthineers ... ap Lume Workflow 24 76T: 40.1ºC Cardiac TIS:0.43 Physio MI:0.84 Imaging 26.5vps 4D Reset Cropping MIPR LOCK Lock Si-Plana Mid Report -3dB/DR60 MPR: End Exam MapD/T5 Bi-Planes 4D Lines Vol: MapA/T8 Dual V Capture Type Prospective Box Width Dual V can only be enabled upon activation of Single V • After completing Single V workflow, select Dual V button on page one (1) of the 4D touch screen • Select Dual V button to return to Single V state • To return to the default 4D acquisition state and remove cropping, select Reset Cropping from the 4D touch screen 62 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Dual V is enabled after activation of Single V. • After completing Single V workflow, select Dual V button on page one (1) of the 4D touch screen. • Return to Single V state by selecting Dual V button on the touch screen. • To return to remove cropping and return to original acquired volume, select Reset Cropping button on 4D touch screen to return to default 4D state and remove cropping. Notes No. 62 SIEMENS Healthineers Free Plane SIEMENS . Healthineers ... Free Plane is cropping tool that allows the pyramidal dataset to be cropped in any arbitrary direction by a freely adjustable Z6T: < 37ºC Cardiac cropping plane Free Plane TIS:0.33 MI:1.03 32.0vps 95% • Enables visualization of structures visible in MPRs but not on the surface of the volume • As Free Plane is repositioned, the system crops volume rendering to visualize structures of interest • To activate Free Plane, select Free Plane within the volume dataset button on page two (2) of the touch screen • Cut Plane is disabled when Free Plane is active 63 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Free Plane allows the pyramidal data set to be cropped in any arbitrary direction by a freely adjustable cropping plane. • It Enables visualization of structures visible in MPRs but not on the surface of the volume. • This is the most advanced cropping application allowing users to cut into datasets from non-traditional angles. • As free plane is repositioned, system crops volume rendering to visualize structures inside of the volume dataset. • Consider the structure(s) of interest to be viewed as a statue in a block of granite. The portions of granite not contributing to the sculpture need to be carved away from the volume. • The free crop plane is a sheet of sandpaper floating in 3D space and can be manipulated to any angle/oblique angle necessary to visualize the structure(s). • To activate Free Plane, select Free Plane button on page two (2) of the touch screen • Cut Plane is disabled when Free Plane is active. SIEMENS Healthineers Free Plane SIEMENS Healthineers ... Orientation 571 Z6T: < 37ºC Cardiac Cardiac TIS:0.33 TIS:0.43 MI:1.03 MI:1.02 32.0vps 95% 18.0vps 4D 4D TURQUOISE = In front of volume ORANGE = Behind volume Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Free Plane will display to the left of the volume upon activation of the feature. • The system displays reference graphic overlay in each individual MPR indicating the position of the Free Plane relative to the 4D volume dataset to for guidance and to allow for alignment of the Free Plane with the structure of interest during when manipulating the Free Plane. • The color of the line displayed in the MPRs is synced with color of the Free Plane in the volume viewport. • The color of the plane indicates orientation of the volume. Green indicates the tool is in front of the volume, (crop plane facing away from the direction of the observer) and ORANGE indicates the Free Plane is behind the volume (crop plane facing the direction of the observer). SIEMENS Healthineers Free Plane SIEMENS . Healthineers ... Workflow Z6T: < 37ºC Cardiac TIS:0.33 MI:1.03 32.0vps Physio 95% LE FRO RC Position Plane 111 • Rotate the Potion Plane dial to move the crop Use MPRs to guide crop plane position within Use trackball, X, Y, and Z and 1st and 2nd rotary • • plane in its current angle/orientation volume and identify what data is being dials to position the cut plane and crop away • To tilt plane angle on x- or y-axis, press Rotate removed to ensure all structures of interest data obscuring view of anatomical structures Plane dial to select an option then adjust remain intact • Rotary dials offer more fixed control of cut rotary dial to rotate crop plane plane movement and trackball allows for more • X rotates crop plane around x-axis freedom to move quickly when positioning • Y rotates crop plane around y-axis crop plane 65 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: Use trackball and 1st and 2nd rotary dial to crop and position the cut plane and crop away • data obscuring view of anatomical structures. • Rotary dials offer more fixed control of cut plane movement and trackball allows for more freedom to move quickly when positioning the cut plane. • Rotate the Potion Plane dial to move the crop plane within the viewport in its current angle/orientation • To tilt plane angle on x- or y-axis, press Rotate Plane dial to select an option then adjust rotary dial to rotate crop plane • X rotates crop plane around x-axis • Y rotates crop plane around y-axis • Use MPRs as a guide to view where the crop plane is being positioned within the volume and what data is being removed to ensure all structures of interest remain intact. • Volume dataset can also rotated to visualize anatomy/structures en face while positioning Free Plane crop plane by selecting Left/Right arbitration control key from the trackball controls to active 3D Rotate or using Pointer and clicking within the Volume viewport ( icon will appear). Notes No. 65 SIEMENS Healthineers Free Plane SIEMENS . Healthineers ... Workflow continued ZGT: < 37'C Cardiac TIS:0.33 Cardiac MI:1.03 32.0vps 95% D Reset Cropping Un Retain Crop • Select Retain Crop to save created cuts/cropping • Volume dataset can also be rotated to visualize • To restore the most recently retained cropped on the volume rendered image data, select Undo Crop anatomy/structures en face while Free Plane is • Cropping is not saved until Retain Crop has • Undo Crop is only available after retaining or active been selected saving a created crop • Select an arbitration control key to select 3D • New Free Crop plane will launch upon • Undo Crop only restores data removed from Rotate or use Pointer and click within volume retaining crop the last retained crop viewport to activate icon • Multiple crops can be performed to visualize • To remove all cropping and display the originally • Then roll trackball structure(s) of interest within the volume acquired volume rendered image, select Reset Cropping 66 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To save created crop on the volume dataset, select Retain Crop. • This will also launch a new Free Crop plane. • Cropping will not be saved on volume rendered image until Retain Crop is selected. • Multiple crops can be performed to visualize structure(s) of interest within the volume • Volume dataset can also be rotated to visualize anatomy/structures en face while positioning Free Plane crop plane by selecting Left/Right arbitration control key from the trackball controls to active 3D Rotate or using Pointer and clicking within the Volume viewport (icon will appear). • To restore the most recently retained cropped data to the volume, select Undo Crop. • Undo Crop is only available after a crop has been retained. • Undo Crop only restores the last retained crop. • To remove all cropping and display the original volume rendering, select Reset Cropping. Notes No. 66 SIEMENS Healthineers SIEMENS . Healthineers 3D Measurement tools: Distance and TraceAI measurement tools 67 Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 3D Caliper tab SIEMENS . Healthineers ... Touch screen A Rotary dial/touch screen controls 1 Clear Screen: trigger button o0 0 ֏ Cardiac 5Z1 @ Lumos Workflow 2 Edit: rotary dial Patient Physio D Caliper 3 Radius: rotary dial Imaging Exit Playback: split action rotary dial Review 4 Report Left Right Mitral 5 Cine: split action rotary dial nd Exam Inferior Superior Tricuspid 02 6 Hide/Show Results: toggle button Medial Lateral Aortic . 3 .4 Anterior Posterior Septal Pulmonar × O 3D Calig Distance 1 2 3 4 5 6 Clear Screen Edit Radius Playback Cine Fis Margina Hide Results A 68 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: Let’s review the type and function of each of the controls on the 3D Caliper tab. A. Rotary Dial Controls 1. Clear Screen: is available while live scanning, frozen and in review; selecting Clear Screen will result in deleting all measurements performed by using 3D Caliper, TraceAI or Distance tools. 2. Edit: is available while frozen or in review and only available when TraceAI is active. This rotary control dial allows user to undo and redo manual edits of TraceAI step by step. Left rotation will undo last step. Right rotation will redo last step. Allows user undo/redo multiple steps by repeating rotations. 3. Radius: is available while frozen or in review and only available when TraceAI is active. This rotary control dial allows user to scale diameter of the TraceAI (circle) prior to being placed. 4. Playback: is a split action control and available in review; rotate control to highlight selection, to either press down on the rotary dial to Play/Pause cine or rotate left to jump to the 1 st Frame or rotate right to jump to the Last Frame. 5. Cine: is a split action control; select Frs or Margin to scroll through individual frames manually. 6. Hide/Show Results: Hides MDA and 3D caliper labels on screen. Calipers will remain displayed, but TraceAI diameters will be hidden. System displays Show Results when MDA and labels are hidden. Select Show Results to restore MDA. This control is independent from Clear Screen control. SIEMENS Healthineers 3D Caliper tab SIEMENS . Healthineers Touch screen A 3D measurement tool bar 1 3D Caliper: on/off button Cardiac @ Lumos Workflow 2 TraceAI: on/off button Patient 4D Physio D Caliper 3 Distance: on/off button B 5 6 Exit Review B Annotations Report 4 Left Right Mitral 4 Labels: radio buttons nd Exam Inferior Superior Tricuspid 5 Input field: input box Medial Lateral Aortic . 3 6 Digital keyboard: on/off button Anterior Posterior Septal Pulmonar 7 Page arrows: trigger button 2 3 A 1 3D Caliper O Trace AL Distance 7 Clear Screen Edit Radius Playback Cine Fis Margina Hide Results 69 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: A. 3D Measurement Tool Bar Section 1. 3D Caliper: place single caliper on 2D MPRs to use as landmarks; 3D caliper will also display on the volume dataset; individual 3D calipers are not linked to measurements. 2. TraceAI : perform and edit measurement of an orifice/ovoid structure on 2D MPRs; system calculates the area, circumference, and maximum/minimum diameters for that orifice. Measurements will also be displayed within the 3D dataset. TraceAI contains a 3D caliper at the intersection of the maximum/minimum diameters. 3. Distance: perform linear distance measurement on 2D MPRs; built from 3D Caliper tool, Distance automatically links two 3D Calipers with a dashed line and calculates distance between them. Measurement is also displayed in the MDA. B. Annotations Section 4. Labels: Only available when a 3D Caliper or measurement tool is active; these are preset created measurement/3D caliper labels. There are three sets of labels and up to one label from each set can be selected to create desired measurement/caliper labeling. 5. Input Field: Only available when a 3D Caliper or measurement tool is active; this is where custom labels can be created for 3D calipers/measurements using the keyboard. Begin typing to overwrite existing or default label. 6. Digital Keyboard: touch screen keyboard for inputting/editing custom measurement labels in lieu of retractable keyboard. 7. Page Arrows: two independent buttons that page to available preset annotation labels; button is only available if more content is available on next or previous page. SIEMENS Healthineers 3D Caliper tab SIEMENS . Healthineers ... Touch screen A Placed 3D calipers/TraceAI list and functions 1 3D Caliper icon Cardiac 521 @ Lumos Workflow 2 TraceAI measurement icon Patient C 4D Physio D Caliper 3 Go to frame: trigger button Imaging B Exit Selected: checkbox trigger Review 4 Report Left Right A 1 4 9 5 Available: checkbox trigger nd Exam Inferior Superior Tricuspid 2 3 5 P 2 8 6 Unavailable: checkbox trigger Medial Lateral Aortic . 3 6 7 7 Pair: trigger button Anterior Posterior Septal Pulmonar 8 Unpair: trigger button X 6 9 Delete: trigger button 3D Caliper race Al istance Edit Playback Cine B Exit: trigger button* Clear Screen Radius Hide Results C 4D: tab menu *Selecting Exit closes 3D Caliper application and deletes all placed 3D calipers/performed measurements. No calipers or measurements are retained on 70 MPRs or volume dataset. Unrestricted © Siemens Healthineers, 2025 Speaker Notes: A. Placed 3D Calipers/TraceAI List and Functions: this list displays all individually placed 3D Calipers and TraceAI measurements. When Distance tool is used, the system displays the 1st and 2nd calipers as two individual, paired, 3D Calipers; selecting one of these paired calipers activates the Distance tool. 1. 3D Caliper Icon: Solid dot is associated with an individual 3D caliper or a distance measurement 2. TraceAI Measurement Icon: An open/hollow dot is associated with a TraceAI measurement; note the 3D caliper on the 3D rendered graphic at the intersection on the max/min diameters of the TraceAI measurement on the MPRs and volume dataset is still represented by a solid dot 3. Go To Frame: Available when TraceAI has been placed; will auto cine to associated frame where TraceAI measurement was performed if user navigates away from that frame 4. Selected: selects placed 3D Caliper/TraceAI measurement to perform further action (labeling, pairing, deleting, editing, etc.) 5. Available: indicates placed 3D Caliper/TraceAI measurement is available to perform additional action. 6. Unavailable: indicates placed 3D Caliper/TraceAI measurement is not available for selecting to perform additional action. For example, when a 3D Caliper or TraceAI measurement is not yet placed/confirmed, it will be listed but unavailable. 7. Pair: only available when two individual 3D Calipers are selected; this feature connects two individual calipers and calculates the distance between them. When pairing an individual 3D Caliper with a TraceAI measurement, the 3D Caliper at the intersection of the max/min diameters is the 2nd caliper. 8. Unpair: only available when two paired calipers/measurements are selected; this feature breaks the connection between two 3D calipers and deletes previously connected measurement. 9. Delete: Deletes selected 3D Caliper/TraceAI measurement. Note: when deleting Distance measurements, deleting one 3D Caliper only removes that single caliper and the linear measurement from the MDA. Unless manually deleted, the 2nd associated caliper will remain in the original anchored location on MPRs/volume dataset and in 3D caliper list as an individual 3D Caliper. B. Exit: Closes entire 3D Caliper application; Closing the application deletes all placed 3D Calipers and performed measurements and closes out of the 3D Caliper tab entirely. No calipers or measurements are retained on MPRs or volume dataset. SIEMENS Healthineers C. 4D Tab: Leaves 3D Caliper application/tab and retains all placed/confirmed 3D Calipers/TraceAI measurements on the MPRs/volume dataset. Notes No. 70 SIEMENS Healthineers 3D Caliper SIEMENS . Healthineers ... Z6T : 40.1ºC 3D Caliper is a tool for identifying structures of Cardiac TIS:0.43 interest on 2D MPRs which then translate to MI:0.84 26.5vps the anatomical position within the volume 4D rendered image -3dB/DR60 MPR D/T5 Vol: • 3D Calipers can also be labeled with customizable annotation for further identification Can be enabled during live imaging or Review XAnterior • • Available on all 4D cardiac transducers 71 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 3D Caliper is a tool for identifying structures of interest on 2D MPRs which then translate to the anatomical position within the volume rendered image. • 3D Calipers can also be labeled to further identify the structure. • 3D Caliper can be enabled during live imaging or Review • This tool is available on all 4D cardiac transducers. Notes No. 71 SIEMENS Healthineers 3D Caliper SIEMENS . Healthineers ... 24 BT:40.1ªC Cardiac T18:0.43 MI:0.84 AD Exit 99 3D Caliper Col Mare Apcada Select 3D Caliper button from page one (1) of • Roll trackball to place 3D caliper in desired To exit 3D Caliper application/tab and retain all • • the 4D touch screen to position a caliper location within any of the 2D MPRs on the placed/confirmed 3D Calipers on the MPRs/volume dataset, select 4D tab on the • System will launch a caliper in the MPRs image screen Anchor or Set position using left/right track touch screen • ball arbitration controls • Selecting Exit button from 3D Caliper tab Caliper on-screen icon will change from x to ⚫ closes application • once set • Closing application via Exit button deletes all 3D calipers; no calipers are retained on MPRs or volume dataset 72 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To place a 3D Caliper, select 3D Caliper from page one (1) of the 4D of touch screen. • Use trackball to place the caliper in desired location within any of the 2D MPRs on the image screen. • Set or anchor the position using the left/right track ball arbitration controls. • To exit the 3D Caliper application/tab and retain all placed/confirmed 3D Calipers on the MPRs/volume dataset, select 4D tab. • Selecting Exit from 3D Caliper tab closes entire application. • Closing the application deletes all placed 3D Calipers and closes out the 3D Caliper tab entirely. No calipers are retained on MPRs or volume dataset. Notes No. 72 SIEMENS Healthineers 3D Caliper SIEMENS . Healthineers ... Annotation TIS 8 42 Frview 1 Anterior Anterior To create a custom label for the caliper, • • • Or select a predefined label from the Caliper on-screen will update from the select the caliper from the 3D caliper list annotations page default label to custom label on the touch screen • Select the input field and type to overwrite existing or default label 73 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To create a custom label for the caliper, select the caliper from the 3D caliper list on the touch screen. • Annotations/custom labels can only be performed when a 3D Caliper is active. • Select the input field and type to overwrite existing or default label or select a predefined label from the annotations page. • Select the keyboard icon on the touch screen to enable digital keyboard or use retractable keyboard. • On-screen caliper label will update from the default label to custom label. Notes No. 73 SIEMENS Healthineers 3D Distance measurement tool SIEMENS . Healthineers ... 3D Distance allows user to perform linear measurements on 2D MPRs generated from Cardia TIS.0.4 MIO.9 volumetric datasets with a single tool 26.5vp 959 OdE DRE • Available on all 4D cardiac transducers • Integrated into the 3D Caliper tool • System automatically launches second caliper MapC/T. and links the two 3D calipers with a dashed line and calculates the distance between the two points ( .1, 6 2) =8.37cm • 3D rendered graphics, as well as associated labels will display in the MPRs, as well as the volume dataset *MDA and 3D caliper graphics not to scale; enlarged for training purposes. 74 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Performing individual distance measurements on 3D/4D images is now further streamlined with the 3D Distance measurement tool. This tool allows users to perform linear measurements on MPRs generated from 3D/4D volume images. • This tool is built from the 3D Caliper tool. 3D distance measurements can be performed in any of the 2D MPR viewports created from a volumetric dataset. • The system automatically links two 3D calipers with a dashed line and calculates the distance between the two points. • The distance value is provided in the measurement display area in real-time and the 3D rendered graphics are displayed on the 2D MPRs, as well as on the corresponding location within the volume dataset. Notes No. 74 SIEMENS Healthineers 3D Distance measurement tool SIEMENS . Healthineers .. 3D Caliper • Acquire a volume dataset or select a • Press Freeze button • Select 3D Caliper button from page one volume dataset from Review • Use trackball to cine to desired frame for (1) of the 4D touch screen performing measurement 75 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To perform a 3D Distance measurement: • Acquire a volume dataset or select a volume dataset from Review • Select 3D Caliper from the 4D tab of the touch screen. • Freeze and Cine to desired frame for performing measurement. Notes No. 75 SIEMENS Healthineers 3D Distance measurement tool SIEMENS . Healthineers ... 30 Calper --------- 111| • Select Distance button from 3D Caliper • By default, caliper will launch in MPR C • Anchor or Set the position of 1st caliper using tab of touch screen when all MPRs are visible; caliper will left/right track ball arbitration controls • System will place an active 3D caliper launch in MPR A when in a 2:1 layout within one of the 2D MPRs • Roll trackball to place 1st caliper at desired location within any 2D MPR on image screen 76 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • From the 3D Caliper page of touch screen, select the Distance tool to perform a linear measurement. • The system will place an active 3D caliper in one of the 2D MPRs, depending on the selected layout. • When all three MPRs are visible, the 3D caliper is launched in the MPR C by default, when in a 2x1 layout it will launch in MPR A. • Use trackball to place the 1st caliper in desired location within any of the 2D MPRs on the image screen. • Set or anchor the position using the left/right track ball arbitration controls. Notes No. 76 SIEMENS Healthineers 3D Distance measurement tool SIEMENS . Healthineers ... Workflow 4D X2 Caliper Imaging Review Rupert Left 12 V And Exam Lateral Aortic Anterior Pulmonar O Distance Clear Screen Hide Resuks • Once 1st caliper is set, on-screen icon changes from x • The check box next to ⚫ 1 in 3D caliper list on 3D to ⚫ and system automatically launches 2nd active Caliper tab of the touch screen is no longer dithered caliper near location of 1st set caliper out and Distance tool is still active • The two calipers are connected by a dashed line 2 nd caliper is active but not set •  in the list next to ⚫ 2 is dithered/greyed out • 77 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Once the 1st caliper is set, the on-screen icon changes from an “x” to a solid dot and the system automatically launches a 2nd active caliper near the location of the 1st set caliper. These two calipers are connected by a dashed line. • The check box next to caliper 1 in the 3D caliper list on 3D Caliper tab of the touch screen is no longer dithered out and the Distance tool is still active. The 2nd caliper is active but not set; the checkbox in the list next to caliper 2 is • dithered/greyed out. SIEMENS Healthineers 3D Distance measurement tool SIEMENS . Healthineers ... 1, . 2)=3.21cm Roll trackball to place the 2nd caliper in desired • • Anchor or Set the position using the left/right track location within any of the 2D MPRs on the image ball arbitration controls screen • The linear measurement quantification updates and displays in real-time in the MDA 78 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Use trackball to place caliper in desired location within any of the 2D MPRs on the image screen and anchor/Set position of the 2nd caliper using the left/right track ball arbitration controls. • The linear measurement quantification updates and displays in real-time in the MDA. SIEMENS Healthineers 3D Distance measurement tool SIEMENS . Healthineers ... (+1, +2)=3.21cm Workflow Patient 4D Caliper Imaging 1 Review End Beam . 2 Mondial Distance O Clear Screen Hide Results Once 2nd caliper is set, on-screen icon changes from x to ⚫ • • The check box next to ⚫ 2 in 3D caliper list on 3D Caliper tab of 3D rendered graphics associated with distance measurements are not touch screen is no longer dithered out and Distance tool is no • specific to the frame in which they were placed longer active • 3D calipers and graphics will be visible on MPRs and volume dataset on dynamic clips (cine or review playback), even after navigating away from that frame 79 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: Once the 2nd caliper is set, the on-screen icon changes from an “x” to a solid dot, the check • box next to caliper 2 in the 3D caliper list is no longer dithered out and the Distance tool is deactivated on the 3D Caliper tab of the touch screen. • 3D rendered graphics associated with distance measurements are not specific to the frame in which they were placed. • The 3D calipers and graphics will be visible on the MPRs and volume dataset on dynamic clips (cine or review playback), even after navigating away from that frame. SIEMENS Healthineers 3D Distance SIEMENS . Healthineers ... Workflow video Workflow: 1. Acquire a volume image or select image from Review 2. Freeze and roll trackball to cine to desired frame to perform Distance measurement 3. Select 3D Caliper button from touch screen 4. Select Distance button from 3D Caliper tab 5. Use trackball, to position 1st active caliper at desired location within any of 2D MPRs 6. Use left/right track ball arbitration controls to anchor or set location of 1st caliper • Once 1st caliper is set, on-screen icon changes from x to ⚫ and system automatically launches 2nd active caliper near location of 1st set caliper 7. Roll trackball to position 2nd active caliper at desired location 8. Anchor or set caliper using left/right trackball arbitration controls 80 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: 1. Acquire a volume image or select image from Review 2. Freeze and roll trackball to cine to desired frame to perform Distance measurement. 3. Select 3D Caliper from the 4D tab on touch screen, the system will place an active 3D caliper in one of the 2D MPRs, depending on the selected layout. • When all three MPRs are visible, the 3D caliper is launched in the MPR C by default, when in a 2x1 layout it will launch in MPR A. 4. From the 3D Caliper page of touch screen, select the Distance tool to perform a linear measurement. 5. Use the trackball, to position the 1st active caliper at the desired location within any of the 2D MPRs. • Active 3D calipers are indicated with an “x” icon on the image screen. 6. Use the left/right track ball arbitration controls to anchor or set the location of the first caliper. • Once the first caliper is set, the on-screen icon changes from an “x” to a solid dot and the system automatically launches a 2nd active caliper near the location of the 1st set caliper. The two calipers are connected by a dashed line. 7. Use the trackball to position the 2nd active caliper at the desired location and anchor or Set the caliper using the left/right trackball arbitration controls. • The linear measurement quantification updates and displays in real-time in the MDA. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... AI-based, semi-automated workflow for measuring ovoid/orifice-type 26T Cardiac 521 @ Lumos Workflow structures on 2D MPRs generated Patient 4D Physio 3D Caliper from volume rendered images Imaging Exit Review Integrated into 3D Caliper tool Report Left Right Mitral • 0 1 • Available on all cardiac 4D volume End Exam Inferior Superior Tricuspid transducers Medial Lateral • Reshapes and snaps the circle contour to the Aortic borders of the structure being measured Anterior Posterior Septal Pulmonar • Provides area, circumference, and min/max diameter measurements 30 Calig • Can also be linked to 3D calipers for distance measurements Clear Screen Edit Radius Playback Cine Ges Margins Hide Results 81 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: TraceAI is an AI-based, semi-automated workflow for measuring ovoid or orifice-type • structures, such as LAA, on 2D MPRs generated from volume rendered images. • It is available on the 5Z1, Z6T, and Lumos. • This tool provides a quick way to obtain area, circumference, maximum and minimum diameter measurements on orifice-type anatomic structures for 4D datasets and see the 3D rendered measurement graphics in the volume image. • This AI-assisted contour tool also offers easy border editing, customized naming of a measurement and the ability to link to individual 3D calipers for distance measurements. • TraceAI is a tender spec and unique selling point of our ultrasound systems. SIEMENS Healthineers TraceAI: SIEMENS .... Healthineers ... Simplified AI workflow overview Selected 2D MPR AI applies deep Non-AI post- + placement of learning processing Final border contour + circle contour algorithm contour refinement measurements AI model analyzes Outputs initial User can adjust border 3D rendered graphics input of 2D MPR and segmentation of the via a series of post- are displayed on MPRs initial placement of orifice using training processing steps to and volume dataset circle contour by user from deep learning AI refine segmentation and MDA shows model using editing tools calculated results Author | Department 82 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Here is simplified workflow overview: • Using input from both the selected 2D MPR and the initial placement of the circle contour defined. by the user, the AI model applies the deep learning algorithm and outputs an initial border tracing of the orifice. • The user can then adjust the shape of the border to refine the contour using editing tools in post-processing. Any editing/adjustments are non-AI steps. • The final border contour is displayed on 2D MPRs and the volume dataset and the MDA shows the calculated measurements. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Workflow 26T: < 37'C Cardiac TIS:0.43 MI:0.88 30.8vps 95% 3D Caliper C'C 11.San 40 2 • Acquire 4D dataset or select from Review • Press Freeze on control panel • Select 3D Caliper button from 4D touch • Adjust MPRs to align en face with Image must be frozen for TraceAI tool to • screen structure/orifice to be measured become available for selection on 3D • Select an MPR layout from 4D touch Caliper tab screen • Cine to desired frame for measuring structure/orifice 83 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Acquire or select a volumetric dataset from Review. • Adjust MPRs to align en face with the structure/orifice to be measured. • Select MPR layout from 4D tab of the touch screen. • Press Freeze. • Image must be frozen for TraceAI tool to become available for selection on the 3D Caliper tab. • Cine to desired frame for measuring structure/orifice. • Select 3D Caliper button on the 4D tab of the touch screen. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Workflow ZGT: < 37ºC Cardiac TIS:0.43 521 32 Lumes Workflow MI:0.88 30.8vps 95% Patient Physio 3D Caliper 4D Imaging Exit Review Report Left HighE Meral End Exam Inferior Superior Tricuspid O Septal Al Radius Clear Scree ide Results 4D 2 Fr807 Cine ID Caliper 84 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Select the TraceAI tool from the 3D Caliper tab of the touchscreen. • A circle contour will appear within a 2D MPR on the image screen, depending on selected layout. • Center the contour over selected orifice in any of the 2D MPRs. Use the Radius rotary control (3rd roatary dial) to adjust the circumference of the circle • contour. • Circumference of the circle should be just slightly larger than the borders of the structure to be measured. SIEMENS Healthineers TraceAI: SIEMENS . Healthineers ... Workflow ZGT: <37ºC Cardiac ZBT: < 37ºC TIS:0.43 Cardiac @1;A-3.14cm2, C-6. 28cm, Di-2.0Dem,02-2.00cm MI:0.88 TIS:0.43 30.8vps MI:0.88 95% 30.8vps 95% 4D e 111 Accept • Press trackball arbitration control key to Set/anchor circle contour position • Press Update key to Accept TraceAI contour 85 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Press left/right trackball arbitration control to Set/anchor position of circle contour. • Set will reshape and snap the circumference contour to the borders of the structure being measured. • Measurements for the orifice area, circumference, maximum and minimum diameters are automatically calculated in the MDA and 3D rendered graphics displayed in all available MPRs and in the volume dataset. • Edit the borders of the circumference as necessary (see Editing slides). • Press Update key to Accept the TraceAI contour. • Accepting the TraceAI contour will finalize trace and measurement quantifications, as well as de-activate the tool. • If TraceAI contour is not Accepted, all associated measurements and on-screen 3D rendered. Graphics are automatically deleted upon navigating away from the 3D Caliper tab or when de-activating the TraceAI tool. • TraceAImeasurements are only available on screen and will not appear in the structured report. • When a TraceAI contour is placed and confirmed, the measurements are specific to that frame. • Upon playback or review, TraceAI measurement graphics are only visible on the frame in which the contour was placed. • MDA and TraceAI graphics will not be available when navigating away from that specific SIEMENS Healthineers frame. Notes No. 85 SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Workflow video Workflow: Z6T: < 37ºC Cardiac 1. Acquire a volume image or select image from Review TIS:0.43 MI:0.88 30.8vps 2. Adjust MPRs to align with orifice/structure to be 95% 4D measured 3. Press Freeze 4. Scroll to desired frame for measuring orifice/structure 5. Select 3D Caliper button from touch screen 6. Select TraceAI from 3D caliper tab • Circle graphic will appear on MPR 7. Center circle contour over the selected orifice/structure 8. Use Radius dial to adjust diameter of the circle 9. Re-center circle over the selected orifice, if needed 10. Press the Set key 11. Edit the borders of the trace as necessary 11.9 cm 40 12. Press Update key to accept contour 30 Rotate 86 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: 1. Acquire a volume image or select volume image from Review. 2. Adjust MPRs to align with orifice/structure to be measured. 3. Press Freeze. 4. Scroll to desired frame for measuring orifice/structure. 5. Select 3D Caliper button from touch screen. 6. Select TraceAI from 3D caliper tab. • A circle graphic will appear on the MPR. 7. Center circle contour over the selected orifice/structure. 8. Use the Radius dial to adjust the diameter of the circle. 9. Re-center circle over the selected orifice, if needed. 10. Press the Set key. 11. Edit the borders of the trace as necessary. 12. Press Accept (Update) key. SIEMENS Healthineers TraceAI SIEMENS . Healthineers Editing ZGT: < 37'C Cardiac TIS:0.33 MEO.91 77.8vps 95% 30 Calper Edit • Press trackball arbitration control key to After making edits, use 2nd rotary dial, • Press trackball arbitration control key to • Set/anchor circle contour position select and grab highlighted contour area Edit, to undo or redo any manually • To edit contour, use trackball to position Roll trackball to move selected border created edits prior to accepting the final • pointer and hover near area of border to segment to desired location contour be reposition until border color changes • Press trackball arbitration control key to from blue to red confirm and anchor new position 87 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Press left/right trackball arbitration controls to Set/anchor position of circle contour. • The circumference contour will reshape and snap to the borders of the orifice being measured. • To edit the contour, use the trackball to position the pointer and hover near area of border to be reposition until it changes in color from blue to red. • Moving the pointer further from the contour will select a larger section of the border to reposition. • Moving the pointer closer to the contour will select a smaller section of the border to reposition. • Press Set key using left/right trackball arbitration control to select and grab highlighted contour area. • Roll trackball to move selected border segment to desired location. • Press Set key using left/right trackball arbitration control to confirm and anchor new position. • Once edits have been made, the Edit control (second rotary dial) can be used to undo or redo any manually created edits PRIOR to accepting the final contour. • Press the Update key on the track ball arbitration controls to Accept the edits and finalize the border tracing and measurements. • TraceAImeasurements are only available on screen and will not appear in the structured report. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Editing workflow video Workflow: 40 Z6T: 39.1ºC Cardiac 1. Press trackball arbitration key to Set/anchor position of TIS:0.33 01:A-7.67cm2, Ca9. 42cm, D1-3.00cm, 92-3.00cm M.1.00 35.0vps circle contour 95% 4D 2. To edit contour, use trackball to position pointer and Mid -16dB/DR51 MPR hover near area of border to be reposition until border T5 Vol: color changes from blue to red T8 3. Press Set using trackball arbitration key to select and grab highlighted contour area 4. Use trackball to move selected border segment to desired location 5. Press trackball arbitration key to set/confirm and anchor new position Once edits have been made, the Edit control (2nd rotary • dial) can be used to undo or redo any manually created 67bpm edits prior to accepting final contour 00% Fr13 6. Press Update key to accept edits and finalize border Cine tracing and measurement 3D Caliper 88 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: 1. Press trackball arbitration control key to Set/anchor position of circle contour. • The circumference contour will reshape and snap to the borders of the orifice being measured. 2. To edit the contour, use the trackball to position the pointer and hover near area of border to be repositioned until border changes in color from blue to red. • Moving the pointer further from the contour will select a larger section of the border to reposition. • Moving the pointer closer to the contour will select a smaller section of the border to reposition. 3. Press Set using trackball arbitration control key to select and grab highlighted contour area. 4. Use trackball to move selected border segment to desired location. 5. Press trackball arbitration key to Set/confirm and anchor new position. 6. Once edits have been made, the Edit control (second rotary dial) can be used to undo or redo any manually created edits PRIOR to accepting the final contour. 7. Press the Update key to Accept the edits and finalize the border tracing and measurements. • TraceAImeasurements are only available on screen and will not appear in the structured report. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Measurement display area (MDA) legend Z6T: < 37ºC Cardiac TIS:0.43  symbol indicates 3D caliper is associated 01 |A=1.71cm2 |C=4. 66cm| D1=1. 62cm D2=1.35cm MI:0.88 • 30.8vps TraceAI measurements 95% 4D •  1: 3D caliper for TraceAI measurement calculations (intersection of D1/D2) • A = area • C = circumference • D1 = maximum diameter • Always listed as first diameter on MDA • D2 = minimum diameter ....... • Always listed as second diameter on MDA 4D Z 89 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • An open or hollow 3D caliper/dot in the MDA indicates a TraceAI measurement and is linked to the solid 3D caliper/dot located at the max/min diameter intersection of the rendered graphic. • A = Area and is represented as pale yellow border tracing on the graphic. • C = Circumference and uses the same graphic as Area. • D1 = Maximum Diameter and is represented by the purple dotted line on the rendered graphic. • D2 = Minimum Diameter and is represented by the bright yellow dotted line on the rendered graphic. SIEMENS Healthineers TraceAI SIEMENS . Hide/Show Results Healthineers ... ZGT: < 37ºC Cardiac 521 ap Lumes Workflow TIS:0.43 01:A=1. 71cm2, C=4.66cm, Di=1. 62cm, D2-1.35cm MI:0.88 30.8vps Patient Physio 3D Caliper 95% Imaging 4D Exit Review Report Left Mitral End Exam inferior Superior Tricuspid Medial Lateral Anterior Posterior Septal Pulmona Hide Results Clear Screen Playback 4D Z 90 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Toggling the Hide/Show Results button on the 3D Caliper tab of the touch screen will temporarily hide or show the MDA, as well as the max/min diameter rendered graphics on the MPRs/volume dataset without permanently deleting the graphics or results for 3D measurements. • The area/circumference rendered graphic and 3D caliper will remain on the 2D MPR and volume dataset images, even when Hide Results is active, and the MDA hidden. • Select Show Results to restore the MDA and associated 3D rendered graphics. • If a dataset is captured while Hide Results is active and the MDA hidden, the system will display, Show Results, when the dataset is pulled up in Review. • Selecting Show Results will restore the MDA and associated 3D rendered graphics on datasets captured while Hide Results was active. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Playback and Go To Frame Z6T: < 37ºC Cardiac TIS:0.33 - 521 22 Lumos Workflow MI:1.03 32.0vps Patient Physio 30 Caliper 95% , . 3) =2.33cm 14 : 53-2.21 cm 4D Imaging Exit Review Report Left Mitral End Exam inferior Superior Tricuspid Medial Lateral Anterior Posterior Septal Pulmonar Cine Clear Scree Frs Margi 18cm 4 Fr111 91 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • TraceAI is specific to the frame on which it was measured. When a TraceAI contour is placed and confirmed, the measurements are specific to that frame. • TraceAI measurements will only appear on the frame in which it was made on during playback. Upon playback or review, TraceAI measurement graphics are only visible on the frame in which the contour was placed. In contrast, the dot(s) remain in their 3-dimensional location across several/all frames during live imaging, cine playback, or review playback (all dynamic clips). • There are two options for returning to the frame in which TraceAI was performed to display the rendered graphics and TraceAI measurements. 1. To manually identify to frame, freeze the image and use the Cine control (5th rotary dial) to scroll through the individual frames until the graphics and measurement appear on screen 2. Or to quickly display the frame in which TraceAI was performed, simply select the Go To Frame button next to the corresponding 3D caliper/TraceAI measurement from the 3D Caliper tab on the touch screen. The Go To Frame button will automatically cine to the frame for that 3D caliper with the associated TraceAI measurements and rendered graphics. SIEMENS Healthineers 3D Measurements: SIEMENS . Healthineers ... Linking 3D calipers 69 76T : 39.1ºC Workflow (01, @2)=3.81cm Cardiac TIS:0.33 OT:A-11-10cm2. C.11.94cm, D1-4.10cm, D2-3. 30cm MI:1.00 35.0vps Patient Caliper 95% Imaging 0 1 V 4D Mid Review 9dBADR60 MPR Report Left . 2 V End Exam Vol: Inferior T8 Medial Lateral Anterior Posterior Septal Pulmonar 1 Clear Screen Playback ......... ...... ....... 67bpm 92 *MDA and 3D caliper graphics not to scale; enlarged for training purposes. Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Individual 3D calipers can be linked to accepted 3D measurements to create additional distance measurements. • For example, placing one additional 3D caliper in the base of the left atrial appendage and linking it to a TraceAI measurement of the LAA os will provide a depth measurement for the left atrial appendage, as the intersection of the max/min diameters of the TraceAI measurement is also a 3D caliper. • Only accepted 3D measurements and set 3D calipers can be linked. • Under the 3D caliper list on the 3D Caliper tab of the touch screen, select the Checkboxes next to the measurements/calipers to be linked • Select the Pair button • The paired 3D Caliper and TraceAI measurement are now connected by a dashed line and linked calipers will appear in the MDA as a linear distance measurement displayed as two calipers in parentheses before the measurement. • A current known behavior regarding TraceAI and linking 3D Calipers – if a TraceAI measurement is performed in an individual MPR layout and a 3D Caliper is placed in a different individual MPR layout, the 3D Caliper may not be available to link to the TraceAI measurement. TraceAI checkbox will appear greyed out/dithered on the 3D Caliper list when attempting to link the two. • For example, LAA os TraceAI measurement is performed in an individual MPR C layout and then layout switched to individual MPR A to place 3D Caliper at base of LAA in order to generate a depth measurement of the appendage, but when attempting to link 3D SIEMENS Healthineers Caliper to TraceAI measurement, TraceAI will be unavailable for selection in the 3D caliper list. Notes No. 92 SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... MDA and MPR Layout 2 .................................. 3 1 2 3 4 ......... ; QUE PRES Braging 000 A B C 30 Calper ............................... 5 5 5 5 ZST: <37"C 1 4 5 Cardiac TIS:0.43 Car MI:0.88 30.8vps ................................................ 154 95% AD 11.5cm 93 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The font size is a limitation of the renderer MDA. Location was optimized for each viewport given current limitations. • The MPR layout can be adjusted from the 4D tab on the control panel. • MPR layouts display the MDA graphic differently. • 2x2 layout moves the MDA to MPR A MDA (measurement display area) Position • When any layout containing a volume dataset is selected, the system will always display the MDA in the upper left corner or left-side of the volume viewport. The exact position may vary depending on selected probe, probe optimization and layout. • They only exception is when the 2x2 layout containing MPR A and B in the top half of the viewport and MPR C and VR in the bottom half of the viewport is selected. In this case the system will display the MDA in the upper left corner of MPR A. • When any single MPR layout is selected the system will always display MDA in the top left corner of the viewport. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Best practices 1. Only ONE orifice should be positioned within the circle circumference X 2. The circle radius should NOT be smaller than the orifice X 94 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Ensure only one ovoid structure/orifice is positioned within the circle circumference prior to setting. • The circle circumference should not be smaller than the orifice to be measured. It should be just slightly larger than the borders of the orifice. SIEMENS Healthineers TraceAI SIEMENS . Healthineers ... Best practices 3. The radius of the circle should NOT be grossly larger than the orifice X X 4. Position the circle over the center of the orifice X 95 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The circumference of the circle should also not be grossly larger than the orifice to be measured. Again, size the circle to just slightly larger than the borders of the structure to be measured. • Position the circle over the center of the orifice after sizing radius prior to setting/snapping the border contour. SIEMENS Healthineers TraceAI SIEMENS . Healthineers' ... Best practices 5. The MDA will display differently based on selected MPR layout 6. Select an individual MPR layout for largest MDA --- 96 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Capture an image in single MPR/volume viewport layouts for a larger appearing MDA on the image screen. • Adjust layouts for a more optimal MDA view as quantification results display differently in various layouts. SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS . Healthineers Questions? 97 Unrestricted © Siemens Healthineers, 2025 Notes No. 97 SIEMENS Healthineers References SIEMENS . Healthineers 1. JACC: Cardiovascular Imaging, Vol. 12, No. 3, 2019 Muraru et al. March 2019:500-15. 2. J Am Soc Echocardiography , Vol. 23, No. 11,2020 Saric et al. November 2020:1128-35. 98 Unrestricted © Siemens Healthineers, 2025 Notes No. 98 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