ACUSON Origin 4D Heart Presentation

SIEMENS Healthineers ACUSON Origin Ultrasound System 4D HeartAI 1.0 software version 1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The purpose of this presentation is to provide an overview of the benefit and workflow of the 4D HeartAI feature that is available on the ACUSON Origin ultrasound system. Notes No. 1 Objectives SIEMENS Healthineers' ... • Overview of 4D HeartAI application • Review 4D HeartAI configuration and touch screen layout • Illustrate imaging for 4D HeartAI • Review 4D HeartAI workflow • Evaluate 4D HeartAI analysis and report --- 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: We will begin with an overview of the 4D Heart application. Notes No. 2 4D HeartAI – clinical relevance and benefit SIEMENS .... Healthineers .. • Clinical guidelines recommend 3D evaluation for cardiac size and function1 • 3D strain analysis is faster with good reproducibility compared to 2D2 • 3D strain is more accurate with less variability due to entire LV cavity detection3 • AI-enabled analysis: 1 • Chamber contouring for size and function • 4D strain analysis of left heart RICES • Assessment: • All visible chambers in TTE • Visible ventricles in TEE Ze ES • Available without ECG Sources | 1. Mitchell, Carol, et al., Journal of the American Society of Echocardiography (2019) 32;1 S 2. Hasanfatta, Naeem et al., ACTA Scientific Clinical Case Reports (2022) 3;6: 45-56 3 3. Kosarju, Ateet, et al., Left Ventricular Ejection Fraction. StatPearls Publishing (2023) Jan Unrestricted © Siemens Healthineers 2023 Speaker Notes: Let’s begin by highlighting the relevance and value of performing 4D imaging as part of an echocardiogram. Clinical guidelines recommend 4D evaluation of cardiac chamber size and function as part of a comprehensive exam. Assessment of myocardial mechanics is also recommended. Reports have shown that 4D strain analysis can be more beneficial than 2D strain analysis. 4D strain analysis is faster and more accurate with good reproducibility and less variability. 4D strain enables analysis of all left ventricular wall segments from a single 4D dataset that is not limited by geometrical assumptions that are inherent with 2D strain. The 4D HeartAI feature performs analysis of cardiac chamber size and function. AI-powered analysis includes ejections fractions, volumes, 4D strain of the left heart, left ventricular (LV) cardiac output, and LV mass. The application performs analysis of all visible cardiac chambers when scanning with the 5Z1 transducer in 4D transthoracic imaging, and performs analysis on visible ventricles when scanning with the Z6T transducer in 4D transesophageal imaging. 4D HeartAI is available on imaging with or without an ECG. Notes No. 3 Objectives SIEMENS Healthineers' ... • Overview of 4D HeartAI application • Review 4D HeartAI configuration and touch screen layout • Illustrate imaging for 4D HeartAI • Review 4D HeartAI workflow • Evaluate 4D HeartAI analysis and report --- 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will review 4D Heart configuration and touch screen layout. Notes No. 4 4D HeartAI configuration SIEMENS Healthineers ... Contours Default Direction for Speckle Tracking System Configuration Left Ventricle LV Epicardium Longitudinal Left Atrium Show O Circumferential Right Ventricle Default Curve After Speckle Tracking > System Settings Right Atrium Measurement Results Volume Workflow Enhancement Chambers Measurements O Segmental Strain O Global Strain > Imaging Settings Left Ventricle (max 6) O Left Atrium (max 4) EF (%) Default Timing/Phase After Speckle Tracking Measurement & Report Right Ventricle (max 4) GLS (%) End Systolic Strain Right Atrium (max 4) Mass (g) O Peak Systolic Strain O Time to Peak > Annotations CO (U/min) O Post Systolic Strain Indexed Features EDV (mL) ESV (mL) Protocols SV (mL) Stress Echo Note: Capture sends all available measurements to the report. 4D Heart Nl [] Display measurements as BSA indexed (BSA suffix in above table) 2D Heart Al Number of Beats I Assist O 2 O 3 04 0 5 Results Format Transducer Individual Beat > Connectivity & Network Average of Beats Peripheral Devices System Management Restore Defaults 5 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To access the configuration menu for 4D Heart, select System Configuration > Features > 4D HeartAI . Default parameters can be configured to display the cardiac chambers’ contours, and the cardiac chambers’ measurement results. 4D HeartAI measurement results can be configured to display as indexed to body surface area (BSA). The left ventricle (LV) epicardial contour can be set as default to show or hide. The LV epicardial contour must be showing in order to see LV mass analysis. Default displays are available for 4D strain direction, curve, and timing. Note that End Systolic Strain is the recommended default timing parameter for 2D strain from the global strain task force. 4D HeartAI analysis can be configured for up to 5 cardiac cycles, displaying results by beat, or as an average. Apart from the measurement results selected for display, all other options can be changed during an exam from the touch screen or soft keys. Selecting Restore Defaults will restore factory settings for the feature. Note: All performed measurements are sent to the report upon image capture. Notes No. 5 System configuration – left ventricle (LV) chamber options SIEMENS Healthineers ... Measurement Results Measurements available for the left ventricle Chambers Measurements include: • O Left Ventricle (max 6) Ejection Fraction (EF) O Left Atrium (max 4) EF (%) • Global Longitudinal Strain (GLS) O Right Ventricle (max 4) GLS (%) • Mass O Right Atrium (max 4) Mass (g) • Cardiac Output (CO) • CO (L/min) End Diastolic Volume (EDV) • End Systolic Volume (ESV) MI EDV (mL) • Stroke Volume (SV) ESV (mL) • SV (mL) Maximum display of 6 measurements for LV Note: Capture sends all available measurements to the report. [] Display measurements as BSA indexed (BSA suffix in above table) Note: All measurements are populated to the report regardless of the options selected for on- screen display in system configuration. 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis of the left ventricle can be selected in system configuration. A maximum of six left ventricular measurements can be selected for on-screen display. When the analysis page is captured, all available measurements go to the report. Left ventricular measurements that can be indexed to the patient’s BSA are Mass, EDV, ESV and SV. Patient’s height and weight must be entered on the demographics page to obtain BSA indexed measurement results. Measurements available for the left ventricle include: • Ejection Fraction (EF) – measurement of the percentage of blood leaving the LV with each contraction • Global Longitudinal Strain (GLS) – deformation/change in length of LV myocardium from diastole to systole • Mass – weight of the LV; can indicate LV hypertrophy • Cardiac Output (CO) – quantity (liters) of blood pumped by the heart per min • End Diastolic Volume (EDV) – volume of the LV at end diastole, which is the largest volume • End Systolic Volume (ESV) – volume of the LV at end systole, which is the smallest volume • Stroke Volume (SV) – volume of blood pumped out of the LV with each contraction Notes No. 6 System configuration – left atrium (LA) chamber options SIEMENS Healthineers ... Measurement Results Measurements available for the left atrium include: Chambers Measurements • Ejection Fraction (EF) • O Left Ventricle (max 6) Global Longitudinal Strain (GLS) O Left Atrium (max 4) EF (%) • End Diastolic Volume (EDV) O Right Ventricle (max 4) GLS (%) • End Systolic Volume (ESV) O Right Atrium (max 4) MI EDV (mL) MI ESV (mL) • Maximum display of 4 measurements for LA Note: Capture sends all available measurements to the report. [] Display measurements as BSA indexed (BSA suffix in above table) 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis of the left atrium can be selected in system configuration. A maximum of four left atrial measurements can be selected for on-screen display. When the analysis page is captured, all available measurements go to the report. Left atrial measurements that can be indexed to the patient’s BSA are EDV and ESV. Measurements available for the left atrium include: • Ejection Fraction (EF) – measurement of the percentage of blood leaving the LA with each contraction • Global Longitudinal Strain (GLS) – deformation/change in length of LA myocardium from diastole to systole • End Diastolic Volume (EDV) – volume of the LA at end diastole, which is the smallest volume • End Systolic Volume (ESV) – volume of the LA at end systole, which is the largest volume Notes No. 7 System configuration – right ventricle (RV) chamber options SIEMENS Healthineers ... Measurement Results Measurements available for the right ventricle Chambers Measurements include: • O Left Ventricle (max 6) Ejection Fraction (EF) O Left Atrium (max 4) EF (%) • End Diastolic Volume (EDV) O Right Ventricle (max 4) EDV (ml) • End Systolic Volume (ESV) O Right Atrium (max 4) MA ESV (ml) • Stroke Volume (SV) SV (ml) • Maximum display of 4 measurements for RV Note: Capture sends all available measurements to the report. [] Display measurements as BSA indexed (BSA suffix in above table) 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis for the right ventricle can be selected in system configuration. A maximum of four right ventricular measurements can be selected for on-screen display. When the analysis page is captured, all available measurements go to the report. Right ventricular measurements that can be indexed to the patient’s BSA are EDV, ESV and SV. Measurements available for the right ventricle include: • Ejection Fraction (EF) – measurement of the percentage of blood leaving the RV with each contraction • End Diastolic Volume (EDV) – volume of the RV at end diastole, which is the largest volume • End Systolic Volume (ESV) – volume of the RV at end systole, which is the smallest volume • Stroke Volume (SV) – volume of blood pumped out of the RV with each contraction Notes No. 8 System configuration – right atrium (RA) chamber options SIEMENS Healthineers ... Measurement Results Measurements available for the right atrium Chambers Measurements include: • O Left Ventricle (max 6) Ejection Fraction (EF) O Left Atrium (max 4) EF (%) • End Diastolic Volume (EDV) Right Ventricle (max 4) MI EDV (ml) • End Systolic Volume (ESV) O Right Atrium (max 4) ESV (ml) • Maximum display of 4 measurements for RA Note: Capture sends all available measurements to the report. Display measurements as BSA indexed (BSA suffix in above table) 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements displayed upon analysis of the right atrium can be selected in system configuration. A maximum of four right atrial measurements can be selected for on-screen display. When the analysis page is captured, all available measurements go to the report. Right atrial measurements that can be indexed to the patient’s BSA are EDV and ESV. Measurements available for the right atrium include: • Ejection Fraction (EF) – measurement of the percentage of blood leaving the RA with each contraction • End Diastolic Volume (EDV) – volume of the RA at end diastole, which is the smallest volume • End Systolic Volume (ESV) – volume of the RA at end systole, which is the largest volume Notes No. 9 4D HeartAI touch screen layout SIEMENS Healthineers ... Review Patient 4D Heart Al Imaging Hide Contours Hide VR Hide Model Exit Review Report Reset Home Reset Orientation Analyze End Exam RV LV Exclude Beat Beats Analyzed RA LA Delete Contour Add Contour Undo Edit Contour ED-ES View Detailed View Bullseye View LV Epi Average Result ED ES Rotate SAX View Cine -Move- Set) Go To X Y Z Slice Enable Frs Beats 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 4D HeartAI touch screen layout includes: Hide Contours – hides the contours drawn within the application (available when Edit Contour is disabled) Hide VR – hides the volume render (VR) within the model display Hide Model – hides the 4D chamber model that is within the VR Exit – quits the application at any given state Reset Home – resets 4D HeartAI to the last state of successful detection irrespective of changes made Reset Orientation – resets the axis markers and view orientations to default state for the current layout Analyze – select to start analysis on a different beat or set of beats that was not analyzed; also used to propagate contour edits to surrounding frames when the user performed contour edits on end diastolic and/or end systolic frames RV / LV / RA / LA – used to enable or disable chamber analysis display (left heart chambers must be selected for Bullseye View to be available) Exclude Beat – used to exclude a beat’s contour and results within the average of beats calculated (when beats analyzed is more than 1) Beats Analyzed – used to change the number of heart beats analyzed (from one to five) Delete Contour – option to delete and redraw a specific cardiac chamber’s contour on an analyzed frame Add Contour – option for adding a contour to a cardiac chamber on a specific frame; ED or ES Undo – control to reverse up to edits made by the user Edit Contours – Enables trackball pointer for adaptive regional edits ED-ES View & Detailed View – User can go between the default ED-ES dual view or a detailed layout by key frame with more views LV Epi – enables or disables left ventricular epicardial contour and its corresponding LV mass analysis Average Result – option to display measurement results as an average of the beats analyzed Note: This is the layout in review workflow. When 4D HeartAI is launched in cine workflow, Bullseye View is not available. Notes No. 10 Objectives SIEMENS Healthineers' ... • Overview of 4D HeartAI application • Review 4D HeartAI configuration and touch screen layout • Illustrate imaging for 4D HeartAI • Review 4D HeartAI workflow • Evaluate 4D HeartAI analysis and report --- 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Now we will illustrate imaging for 4D Heart. Notes No. 11 Volume acquisition SIEMENS .... Healthineers ... • Optimal 2D imaging is essential to a 5Z1 Cardiac TIS:0.43 quality volume acquisition MI:0.93 15.3vps 95% 4D • Prior to acquisition it’s important to H Mid 2dB/DR65 evaluate all reference planes for structural Q Mid V 20 Th15 boundaries Op70 S2 Br-8 Con50 Alignment is important for assessment of MPR: • MapD/T5 Vol: specific anatomy MapE/T7 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 4D image quality is a reflection of the two-dimensional (2D) image quality. Thus, it’s essential to begin with the best 2D image possible. If the 2D image is not appropriately optimized, then the 4D image could be clinically nondiagnostic. Prior to acquisition it’s important to evaluate the multiplanar rendered (MPR’s) imaging planes to ensure areas of interest remain within the field-of-view. To adjust the MPR’s, the user can adjust the axis markers within each plane. It’s best to adjust the axis markers in the lateral and elevational planes. Use the axial plane for reference as it displays both the lateral and elevational plane simultaneously. In this example, the axis markers are aligned through the apex of the left ventricle in both the lateral and elevational planes. Notes No. 12 Volume acquisition SIEMENS . Healthineers ... Optimize the 2D image 1. Press 4D • Further optimize 4D image as needed 1 Update 2. To acquire a volume, select 2 Capture key Tip: Ensure entire chambers are in field of view and have patient perform a breath hold to reduce motion of the heart. 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once the desired image has been identified and properly optimized, press 4D on the control panel and further optimize the 4D image as needed. Next, select the Capture key on the control panel to obtain a full volume data acquisition. Tip: Before clip capture, ensure the entire cardiac chambers are in the field of view and have the patient perform a breath hold to reduce motion of the heart. Notes No. 13 4D volume acquisition: physio vs. non-physio SIEMENS Healthineers ... Acquisition with ECG (physio) Acquisition without ECG (non-physio) • Use a beat capture – must have at least one • Use a time capture full R-R capture • ED/ES key frames are set by user and • Ensure ECG tracing is optimal and clean proceeds to analysis • Multiple heart cycles can be analyzed and • Only one cardiac cycle can be analyzed averaged (up to five) • Exclude Beat, Beats Analyzed and Average Result are therefore not available • Tracking is available for all visible chambers in TTE, and visible ventricles in TEE 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are two methods of acquisition for 4D HeartAI analysis: 1. Acquisition with an ECG (physio) • Set capture to beats; this is configured by default but can be changed from the soft keys during an exam • At least one full R-R interval must be captured to analyze the minimum of one beat; the user can either acquire one extra beat or acquire with an extended R-R capture to ensure sufficient data is captured for analysis • Up to five heart cycles can be analyzed and averaged 2. Acquisition without an ECG • Set capture to time (seconds); this can be done from the soft keys during an exam • The user defines the ED and ES key frames and analyzes to get results • Only one beat can be analyzed without an ECG; touch screen controls for Exclude Beat, Beats Analyzed and Average Result are not available • Tracking is available for all visible chambers in TTE and visible ventricles in TEE Notes No. 14 Acquisition for 4D strain analysis – volume rates SIEMENS .... Healthineers ... 4D bullseye analysis on a dataset >15vps [%] Longitudinal Strain 138 12.3vps • (volumes per second) results in a cautionary display within the viewport -10 Low Volume Rate < 15vps -15 201 • To optimize vps 100 200 300 500 • Decrease line density Low Volume Rate < 15vps LV End Systolic Strain [%] - Beat 1 of 1 Beat 1 of 1 HR. (bpm) 91 • Reduce depth Anterior LV EF (%) Reduce lateral and/or elevational field of 46.9 00 (l/min) 13.5 E&V (mi) 168.2 • GLS (%) -164 EDV (ml) 3168 Mass (g) 337.7 16 19 LA view when needed 17 EDV (ml) 108.4 .GLS-Res.(%). 25.0 31.3. GLS Cond (%) GLS Cont.(6) -B.o. ES (PAI) . .1.446. Lateral • Acquire steady beats, without any changes -16 Septal .13 to field of view – have patient hold breath -16 -16 if needed L14 20 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Since there are no to date published guidelines of recommended volume rates for 4D strain analysis, our internal consensus led to us implementing a minimum of 15 volumes per second (VPS) when performing 4D bullseye analysis with the 4D HeartAI clinical application. Low vps will not limit the ability to perform 4D strain analysis, but the performance of the analysis may be reduced because the algorithm may not adequately track the motion of the myocardium and erroneous estimation may occur. Note that when an analyzed 4D image is less than 15vps, a low volume rate caution displays within the viewport. Notes No. 15 Objectives SIEMENS Healthineers' ... • Overview of 4D HeartAI application • Review 4D HeartAI configuration and touch screen layout • Illustrate imaging for 4D HeartAI • Review 4D HeartAI workflow • Evaluate 4D HeartAI analysis and report --- 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will review 4D Heart workflow. Notes No. 16 Launching 4D HeartAIfrom cine SIEMENS .... Healthineers .. • Ability to launch 4D HeartAI while imaging A4C ED A4C ES 15.0vps • During live 4D imaging, select Freeze • At least one R-R cycle must be in cine • Select 4D HeartAI on touch screen AZC ED A2C ES Beat 1 of 1 HR (bpm) 45 LV EF (%) 63.1 EDV (ml) 114.5 GLS (%) 21.9 ESV (ml) 42.3 Freeze 4D Heart A) CO (I/min) 3.2 Mass (g) 117.7 LA EF (%) 63.6 EDV (ml) 18.4 GLS (%) 46.4 ESV (ml) 50.6 RV EF (%) 51.9 ESV (ml) 41.7 EDV (ml) 86.7 SV (ml) 45.0 RA Note: Bullseye analysis is ONLY available EF (%) 49.5 ESV (ml) 30.1 EDV (ml) 15.2 in Review workflow. 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The 4D HeartAI feature may be launched during live imaging. • Select Freeze on the control panel • At lease one full cardiac cycle must be within the frozen cine clip • Select 4D HeartAI on the couch screen Note: Bullseye analysis can only be performed on a 4D dataset from Review. Notes No. 17 Launching 4D HeartAIfrom review SIEMENS .... Healthineers .. • From Review, select one 4D dataset A4C ED A4C ES 15.0vps • Select 4D HeartAI on touch screen • Visible cardiac chambers are analyzed • All four chambers in transthoracic 4D imaging • Left and right ventricles in AZC ED A2C ES Beat 1 of 1 HR (bpm) 45 transesophageal 4D imaging LV EF (%) 63.1 EDV (ml) 114.5 GLS (%) 21.9 ESV (ml) 42.3 CO (I/min) 3.2 Mass (g) 117.7 LA EF (%) 63.6 EDV (ml) 18.4 Review 4D Heart Al GLS (%) 46.4 ESV (ml) 50.6 RV EF (%) 51.9 ESV (ml) 41.7 EDV (ml) 86.7 SV (ml) 45.0 RA EF (%) 49.5 ESV (ml) 30.1 EDV (ml) 15.2 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To launch 4D HeartAI from Review: • Enter Review and select a single 4D dataset • Select 4D HeartAI from the touch screen • Visible contours are detected • All four chambers in transthoracic 4D imaging • Left and right ventricles in transesophageal 4D imaging Notes No. 18 Non-physio workflow example SIEMENS ..... Healthineers' ... Ability to launch application without physio 5Z1 Cardiac TIS:0.43 MI:0.95 15.9vps 95% • Use soft key to define key frames (ED & ES) 4D H Mid and tap Analyze to proceed with analysis 9dB/DR52 S3 MPR T5 Vol: T6 • Only 1 cardiac cycle is analyzed with non- physio workflow • Controls for Beat Analyzed, Exclude Beat and Average Result will not be available ZA 100% Fr 48 Lead Off Pointer ED ES < Go To > Set < Move -> Set 19 19 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When no ECG is utilized, the user has to define key frames for end diastole and end systole. To launch 4D HeartAI on a dataset without an ECG: • Enter Review and select a single 4D dataset • Select 4D HeartAI from the touch screen • Rotate the ED soft key to an end diastolic frame • Press the ED soft key to set the ED frame • Rotate the ES soft key to verify end systolic frame within the same cardiac cycle • Press the ES soft key to set the ES frame • Tap Analyze on the touch screen • Visible cardiac chambers are analyzed Note that controls for multibeat analysis (Beats Analyzed, Exclude Beat, Average Result) will not be available. Notes No. 19 Analysis display (ED-ES View) SIEMENS ..... Healthineers ... • Contours display on key frames ED & ES: A4C ED A4C ES 16.1vps • Apical 4 • Apical 2 or PSAX or Coronal • Viewports include • ED Viewport • ES Viewport SAX ED SAX ES Beat 1 of 1 HR (bpm) 69 LV Volume render with contours EF (%) 67.9 EDV (ml) 186.7 • GLS (%) 19.2 ESV (ml) 60.0 8.7 Mass (g) 235.9 • Results Table LA EF (%) 52.4 EDV (mi) 20.7 GLS (%) 21.2 ESV (ml) 43.5 • Freeze button is disabled; use Cine soft key RV to scroll between frames or beats EF (%) 50.3 ESV (ml) 71.7 EDV (ml) (44.3 SV (ml) 726 RA EF (%) 49.6 ESV (ml) 56.7 EDV (ml) Detailed Bullseye 28.6 ED-ES View View View 20 20 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When 4D HeartAI is launched, the ED-ES view is the default display. The views displayed can differ dependent on the chamber(s) selected for display. Viewports include: • ED Viewport • ES Viewport • Volume render with contours • Results Table The freeze button is disabled in ED-ES View. The user can use the Cine soft key to scroll between either frames or beats. Notes No. 20 Analysis display (Detailed View) SIEMENS ..... Healthineers ... Provides multiple views for one frame, to 3C ES AZC ES A4C ES 3 @ 15.0vps • give better representation of the contours • Layout can differ depending on chamber(s) selected for display • LV: Apical 3, Apical 2, Apical 4 and SAX • LA: Apical 3, Apical 2, Apical 4 and SAX SAX ES Beat 1 of 1 HR (bpm) 45 RV: Apical 4, Coronal, SAX LV • EF (%) 60.2 EDV (ml) 118.3 GLS (%) 16.7 ESV (ml) 47.1 RA: Apical 4, RH A2, SAX CO (l/min) 3.2 Mass (g) 119.1 • LA Freeze button is available and users can play EF (%) 57.7 EOV (ml) • GLS (%) 33.8 ESV (ml) 18.3 43.3 RV image or use Cine soft key to scroll between EF (%) 49.5 ESV (ml) 43.7 EDV (ml) 86.5 frames or beats RA EF (%) 48.3 ESV (ml) 30.0 EDV (ml) 15.5 ED-ES View Detailed Bullseye View View 21 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To see additional views of contours, select Detailed View on the touch screen. This provides multiple views for one key frame at a time. The display layout can differ depending on the chambers selected for display: • LV: Apical 3, Apical 2, Apical 4 and SAX • LA: Apical 3, Apical 2, Apical 4 and SAX • RV: Apical 4, Coronal, SAX • RA: Apical 4, RH A2, SAX The freeze button is available and the user can play image or use Cine soft key to scroll between frames or beats. Notes No. 21 Changing end diastole (ED) and end systole (ES) frames SIEMENS .... Healthineers .. ED and ES frames are depicted as purple A4C ED A4C ES 83 CC 18.6vps markers on physio line as well as label on viewports Move ED or ES frames with soft keys (per heart beat analyzed) A2C EDI A2C ES Beat 1 of 1 HR (bpm) 53 IV • Rotate ED soft key – press to set EF (%) 52.2 EDV (ml) 173.6 GLS (%) 13.7 ESV (ml) 82.9 4.8 Mass (g) • Rotate ES soft key – press to set LA EF (%) 45.5 EDV (ml) GLS (%) 34.2 ESV (ml) 39.4 72.3 Er (70) 47.1 EDV (ml) 159.5 -16.5 ESV (ml) 84.3 EF (%) 50.7 EDV (ml) 53.8 ESV (ml) 40.5 82.2 ED ES Go To > Set < Move -> Set GO TO ES 22 Unrestricted © Siemens Healthineers 2023 Speaker Notes: End diastolic and end systolic key frames are depicted as purple markers on the physio tracing. The ED and ES key frames are also labeled within the viewports. To change an ED/ES key frame: • Rotate the ED soft key to the desired frame; pressing the ED soft key will set the new marker position • Rotate the ES soft key to the desired frame; pressing the ES soft key will set the new marker position Note: ED and/or ES key frame changes do not propagate to other heart beats analyzed. In multibeat analysis, user must change key ED and ES frame for each heart beat as needed. Frame marker(s) turn yellow when using the ED/ES soft keys for changing cardiac timing. Notes No. 22 Deleting contour SIEMENS .... Healthineers' ... Ability to delete any chamber on ED or ES key frames RV example MAC ES " SAX ES 01 2 14.7vps • If performed during ED-ES View, users are Coronal ES automatically taken to Detailed View and prompted to place manual points • Deletion occurs for the active key frame Average (2 beats) HR (bpm) 94 • Deleting a contour removes analysis from results table LV LA RV RA Delete Contour 23 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The user has the ability to delete a contour. Deletion is performed one key frame per heart chamber at a time. Select Delete Contour and then the desired cardiac chamber to remove contour of the selected chamber from the ED or ES frame within the active viewport. Deleting a contour will remove the analysis from the results table. In the example seen on the right hand side of this slide, the right ventricle (RV) is selected for deletion within the ES frame first. Note that the prompts appear in the bottom left to replace six points for the right ventricular contour. Pressing the update key on the control panel cancels the placement of contour points. We see that continuing to delete contours on key frames for each beat changes the results displayed. Notes No. 23 Adding contour SIEMENS Healthineers ... • Available when a chamber contour is missing on ED and/or ES key frame (due to deletion or detection failure) • Once launched, viewport will change to Detailed View • On-screen guide at bottom left of monitor prompts user for point placement • Workflow consist of semi manual contouring with 3 points for LV, LA, RA, and 6 points for RV • LV: Anterior Septal, Posterior, Apex • LA: Anterior Septal, Posterior, Roof • RA: Anterior Septal, Freewall, Roof • RV: Septal, Freewall, Apex in Apical view and Posterior, Infundibulum, Lateral in SAX view 24 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Adding a contour is a manual placement of points workflow. It’s used to create a cardiac chamber contour if the algorithm has detection failure. Selecting Add Contour on the touch screen enables on-screen prompts to guide the user on point placement for the selected chamber. Add Contour is performed in the Detailed View with one of the viewports on an ED or ES frame. When selected, contour placement is only available for the currently active viewport. The left ventricle, left atrium and right atrium require three points, while the right ventricle requires six points. If a chamber is not detected or if a contour is deleted, adding contours for the chamber in both an end diastolic and end systolic frame will give analysis results. Notes No. 24 Adding contour – left ventricle (LV) SIEMENS ..... Healthineers ... Views displayed in Detailed View: A3C ED A2C ED A4C ED 16.1vps • Apical 3 • Apical 2 otSept • Apical 4 • SAX SAX ED Average (2 beats) HR (bpm) 69 LV EF (%) 61.7 EDV (ml) LV LA RV RA 18.4 ESV (ml) 56.8 CO (l/min) 6.3 Mass (g) 158.3 Add Contour Place AntSept, Post, Apex points in A3C view 25 25 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select Add Contour to place a new contour on the selected chamber from the ED or ES frame within the active viewport. Manual contour points become available with prompts to guide the user in placement. Here we can see the on-screen guide message for manual contour point placement for the left ventricle. Notes No. 25 Adding contour – left atrium (LA) SIEMENS ..... Healthineers ... Views displayed in Detailed View: A3C ED AZC ED ASC ED 21 @ 15.1vps AZC ED A4C ED 21 @ 15.1vps 21 @ 15.1vps • Apical 3 3C ED A2C ED A4C ED A3C ED A2C ED MC ED 21 @ 15.1vps • Apical 2 Antsept • Apical 4 SAX SAX ED • SAX ED SAX ED SAX ED Beat 1 of 1 Hn (Com) 59 LA Manual contour points: EF (%) EDY OnD CLS(%) 17.5 [SV [i) Anterior Septal 9.3 EDV Uno • 20.1 ESV.(mi) 535 • Posterior • Roof Place AntSept, Post, Roof points in A3C view 26 26 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this example, we can appreciate the placement of points for left atrial contour in an end diastolic key frame. The on-screen guide shows the points to be placed for the selected chamber, the view in which to place the points, and the order of placement. Notes No. 26 Adding contour – right atrium (RA) SIEMENS .... Healthineers ... Views displayed in Detailed View: A4C ED RH-A2C ED RA-SAX ED 1-20 ₴ 16.1vps AC ED RH-A2C ED RA-SAX ED -20 62 16.1vp5 Apical 4 AMC ED RH-A2C ED RA-SAX ED -20 % 16.1vps • MC ED RH-A2C ED RA-SAX ED -20 @ 16.1vps • RH Apical 2 • SAX Manual contour points: Beat 1 of 1 HR: 00pm) 54 LA Septal EDV(m) • EF (N) GLS (%) 24.8 ESV (ml) Freewall GLS (95) EDV (ml> • EsV (r)) 38 9 • Roof Place Sept, FW, Roof points in A4C view 27 27 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this example, we can appreciate the placement of points for right atrial contour in an end diastolic key frame. The on-screen guide shows the points to be placed for the selected chamber, the view in which to place the points, and the order of placement. Notes No. 27 Adding contour – right ventricle (RV) SIEMENS .... Healthineers ... Views displayed in Detailed View: A3C ED AZC ED A4C ED 91 6 14.7vps • Apical 4 • Coronal • SAX SAX ED Average (0 beats) HR (bpm) 94 Manual contour points: • Septal (A4) • Freewall (A4) • Apex (A4) • Posterior (SAX) • Infundibulum (SAX) • Lateral (SAX) Place Sept, FW, Apex points in A4C view and Post, Infund, Lat points in SAX view 28 28 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here we can appreciate the placement of manual contour points for the right ventricular contour. The on-screen guide shows the points to be placed for the selected chamber, the view in which to place the points, and the order of placement. In the example seen on the right-hand side of this slide, the right ventricle (RV) is selected for adding a contour. Note the prompts that appear in the bottom left to place six points for the right ventricular contour. We see that adding contours on end diastole and end systole for the right ventricle yields RV results displayed. Clicking through each multiplanar view synchs the volume rendering to that view. Also, note that for the RV short axis points, the posterior and infundibular points will be switched depending on if the imager is performing transthoracic versus transesophageal imaging. Notes No. 28 Moving MPR axis marker SIEMENS ..... Healthineers' ... 83 . 18.6vps • Available at 4D HeartAI launch A4C ED ANCES • Not available in Edit Contour mode • In ED-ES View, one axis marker is seen for each view • In Detailed View, axis markers are displayed for each A2C ED AZC ES Beat 1 of 1 HR (bpm) 53 IV EF (%) 32.4 EDV (mi) 174.3 Hover, click and move axis marker GLS (%) 15.5 ESV (mi) 4.8 Mass ( a ) 829 • CO (Umin) 1723 LA EF (%) 45.7 EDV (ml) 39.4 • Pan tool moves axis marker left/right, up/down GLS (%) 37.3 ESV (ml) 726 EF (%) 47.7 EDV (ml) 19.4 ESV (ml) 595 83.4 • Z rotation tool allows Z rotation of axis marker EF (%) 47.5 EDV (ml) 45.9 ESV (ml) 77.2 GO To ES 29 29 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Axis markers can be manipulated and aligned to a desired cardiac chamber in 4D HeartAI results display mode. Axis marker manipulation is not available during Edit Contour mode. Notes No. 29 Editing contours SIEMENS ..... Healthineers ... Select Edit Contour on touch screen AAGED AMC ES R6 92 16.1vps • Model appears as mesh in edit mode • Perform edits on ED & ES frames only • Works in both ED-ES View and Detail View SAX ED SAX ES Beat 1 of 1 R (bom) 69 • Move between ED and ES frames for editing • Click in ED or ES viewport • Select the update key on control panel 726 EDVERO 286 • Selected contour region is highlighted RV LV Exclude Beat • When pointer is closer to contour, a smaller region becomes active RA LA Delete Contour • When pointer is further from contour, Undo Edit Contour ED-ES View Detailed Bullseye View LV Epi a larger region becomes active ED ES Rotate SAX View Cine LV Epi Offset + Move y XYZ 4-SIKE + Enable Frs Beats +Dlange+ 30 30 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To edit a contour: • Select Edit Contour on touch screen • Model will appear as a mesh • Perform edits on ED or ES frames only • Move between ED and ES frames for edit • Click in ED or ES viewport • Select the update key on control panel • Selected contour region is highlighted • When pointer is closer to contour, a smaller region becomes active • When pointer is further from contour, a larger region becomes active Notes No. 30 Editing contours – tips and tricks SIEMENS .... Healthineers ... ANCES 16 63 16.1vps • Select Edit Contour on control panel • To perform edits, enable display for right heart and left heart chambers separately Axis markers auto align to chambers SAX ES Best 2 of 3 • • If making LV contour edits, disable LV Epi EDV CD • Easier to delineate LV contour • Enable SAX View by pressing soft key • Enables slicing up/down through chamber(s) when rotating soft key RV LV • Perform edits in Detail View to see better representation of contours RA LA Undo Edit Contour D-ES View Detailed Bullseye View ED ES Rotate SAX View Cine + Go To+ XYZ Enable Frs Beats 31 31 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: While different ways can be used to edit contours, the following are suggested methods for optimal editing. • Select Edit Contour on touch screen • When performing contour edits, select each chamber sidedness separately as the axis markers will auto align to each side • If both left and right heart chambers are selected for display during editing, axis markers will default align to the left heart • If performing left ventricular contour edits, it’s suggested to disable LV Epi on the touch screen to better visualize the LV endocardial contour • Enable SAX View on the touch screen by pressing the SAX View soft key • Rotating the SAX View soft key slices up and down through the chamber(s) • Edit Contour can be performed in both the ED-ES View and in the Detailed View • Suggest performing contour edits in the Detail View to see better representation of contours Notes No. 31 Beats analyzed SIEMENS ..... Healthineers ... • Ability to change number of beats MAG ED A4CES 91 2 14.7vps analyzed • Supports between 1 to 5 beats • If more than 1 beat is analyzed, results can be averaged AZC ED AZC ES Average (3 Beat)) HR (bom) 94 • Default number of beats analyzed at co (min 33 Mass (g) 1127 software launch is dependent on feature LOV (m 335 SVCmis configuration • Increasing number of beats analyzed after software launch results in algorithm Exclude Beat Beats Analyzed Average (3 beats) HR (bpm) 94 LV re-running EF (% 22.8 EDV (ml) 147.5 Delete Contour Add Contour GLS (%) -3.6 ESV (ml) 112.7 3 CO (I/min) 3.3 Mass (g) 1 38.4 RV Exclude Beat Beats Analyzed EF (%) 3 LV Epi Average Result 28.5 ESV (ml) 62.9 EDV (ml) 88.5 SV (ml) 25.7 32 32 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: As previously mentioned in 4D HeartAI configuration, the application can analyze 1 to 5 heart beats. Default analysis results are determined by system configuration settings, but users have the flexibility to change on-the-fly from the touch screen during analysis. To change: • Select Beats Analyzed from the touch screen • Select desired heart beats up to 5 • The amount of cardiac cycles captured in a dataset determine the available beats to analyze • Increasing the number of beats analyzed after software launch results in the algorithm re-running • When more than 1 beat is analyzed, results can be averaged by default, or by selecting Average Result on the touch screen Notes No. 32 Excluding beat SIEMENS ..... Healthineers ... • Available when number of beats Al 4D Heart A4C ED A4C ES 6 3 16.1vps analyzed is more than 1 Exit • Used to remove specific beat(s) results when multiple beats are analyzed Analyze SAX ED SAX ES • Hides contours in model for selected Exclude Beat Beats Analyzed xcluded Beat beat for exclusion Delete Contour Add Contour • Excludes selected beat(s) from results LV Epi Average Result • On-screen message displays in bottom left hand of monitor Cine Frs Beats GO To ES Current beat excluded. Contours hidden. Current beat excluded. Contours hidden 33 33 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: If more than 1 beat is analyzed, the user has the flexibility to remove beat(s) from the analysis results. To remove a beat from the analysis: • Use Cine soft key to scroll between beats • Stop on the beat wanting to remove analysis • Select Exclude Beat on the touch screen • The beat contours are hidden in the modeling • The beat results are removed from the results display Notes No. 33 Bullseye View workflow SIEMENS ..... Healthineers' ... • Bullseye View option is only available Review when 4D HeartAI is launched from Review 4D Heart Al • Left heart chambers LV & LA have to be selected for display in order to select Hide VR Hide Model Exit Bullseye View Reset Orientation • 4D strain tracking is available for LV and Timing / Phase Beats Analyzed Longitudinal = PSS RV LV Exclude Beat LA chambers Volume RA LA • While in 4D HeartAI analysis, select Bullseye View on the touch screen ED-ES View Bullseye View View LV Epi Average Result AVC Pre-A Cine + Move + 326ms < Move -> 522ms Ers Beats 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • The Bullseye View option is only available when the 4D HeartAI application is launched from Review • The left heart chambers LV & LA have to be selected for display in order to select Bullseye View • 4D strain tracking is available for LV and LA chambers • While in 4D HeartAI analysis, select Bullseye View on the touch screen In 4D strain analysis, the user has the same options for adjusting Beats Analyzed, Average Results, and Exclude Beat. Notes No. 34 4D strain cardiac timing SIEMENS .... Healthineers' ... • Flexibility to adjust cardiac timing Global Longitudinal Strain 17 i@ 19.0vps • Rotate soft keys to adjust • AVC (aortic valve closure) • Pre-A (just before mitral valve opening as a result of atrial contraction) 1000 2000 3000 LV End Systole Strain [%] - Beat 1 of 3 (ms) Average (3 beats) PR Coors) 43 GAS (%) OLS Res (%) CL5 conc (%) .156 Note: AVC and Pre-A soft keys are available for AVC Pre-A timing adjustment when the display is frozen. < Move -> 326ms Move -> 522ms 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Cardiac timing for 4D strain analysis cane be edited. • Flexibility to adjust cardiac timing • Rotate soft keys to adjust • AVC (aortic valve closure) • Pre-A (just before mitral valve opening as a result of atrial contraction) Note: AVC and Pre-A soft keys are available for timing adjustment when the display is frozen. Notes No. 35 4D strain curve display options SIEMENS ..... Healthineers ... 160 140 • Left ventricle (LV) 120 100 • Volume R . 2000 1000 • Segmental Strain Beat 3 of 3 44.1 137.3 141 2 LA • Global Strain as Cond(%) 225 21.2 (2.5 Cord (%) EDY ind 34 (45 Com /N) -14.3 volume Segmental Strain Global Strain Volume Segmental Strain Global Strain • Left atrium (LA) Curve Volume Curve Legmen. • Volume • Global Strain AV End Systolic Strain [s] - Maat 3 of 3 1000 2000 Heat 2 of 2 Volume Segmental Strain Global Strai Global Strain 36 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 4D strain analysis has the following curve display options available: • For the left ventricle (LV) • Volume • Segmental Strain • Global Strain • For the left atrium (LA) • Volume • Global Strain Notes No. 36 4D strain timing display options SIEMENS .... Healthineers ... 4D strain timing options for the left ventricle (LV) are only available with Segmental Strain curve display ==== = = TIT • Peak Systolic Strain End Systole Strain Time to Peak PSS Timing / these • End Systolic Strain • Time to Peak • Post Systolic Indexed 457 212 21.3 End Systolic Son Time to Peak End Systolic Strain Time to Peak 37 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 4D strain timing options for the left ventricle (LV) are only available during Segmental Strain curve display. Options include: • Peak Systolic Strain • End Systolic Strain • Time to Peak • Post Systolic Indexed Notes No. 37 4D strain direction display options SIEMENS ... Healthineers ... 4D strain direction options for the left ventricle (LV) are only available with Segmental Strain curve 1000 display LV Peak Systolic Strain [%] - Best 3 of 3 2000 Beat 3 of 3 EF (%) 44.9 co (Imin) 33 ESV (ml) 756 GL.5 (%) -15.7 EDV (ml) 1 37.3 Mass (g) 145.7 LA • Longitudinal EF (%) GLS Cond (%) -69 EDV (ml) 22.5 GLS Res (%) GLS Cont (%) -14.3 ESV (ml) 348 Longitudinal Circumferential • Circumferential Direction Longitudinal LV reak Systolic Strain [%] - Best 3 of 3 Beat 3 of 3 HR (Bpm) 34 - - -- ) 145- CLS Res (5%) 212 CLscommesse) -143 ESV(MM ) 225 Longitudinal Circumferential Direction circumferential Timing / Ph 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 4D strain direction options for the left ventricle (LV) are only available during Segmental Strain curve display. Options include: • Longitudinal • Circumferential Notes No. 38 4D strain: Bullseye View SIEMENS ..... Healthineers' ... Exclude Beat Volume • Used to remove specific beat(s) 4D strain results when 20 12 16.1 vps multiple beats are analyzed • Available when number of beats analyzed is more than 1 • Hides contours in model for the excluded beat • Excludes selected beat(s) from results 1000 2000 Excluded Beat • On-screen message displays in bottom left hand of monitor Current beat excluded. Contours hidden. RV LV Exclude Beat Beats Analyzed RA LA ED-ES View Detailed Levert best puckydad Contours hidden View Bullseye View Average Result Cine Frs Beats 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: If more than 1 beat is analyzed, the user has the flexibility to remove beat(s) from the 4D strain analysis results. To remove a beat from analysis: • Use Cine soft key to scroll between beats • Stop on the beat wanting to remove analysis • Select Exclude Beat on the touch screen • The beat contours are hidden in the modeling • The beat results are removed from the 4D strain results display Notes No. 39 Bullseye View interactions SIEMENS ..... Healthineers ... Users can use the pointer to interact with Volume 21.6vps bullseye segments and curves 2001 160 • Highlighting a segment on bullseye will 140 120 highlight corresponding segment on model 100 80 Segment(s) can be enabled or disabled 6O • by clicking in bullseye O 200 400 600 800 1000 [ms] LV End Systolic Strain [%] - Beat 1 of 1 Beat 1 of 1 HR (bpm) 51 Anterior • If segmental strain is active, disabling a DISABLE 20 EF (%) 50.6 ESV (ml) 89.9 segment removes corresponding curve GLS (%) -18.3 181.8 LA EF (%) 39.3 GLS Cond (%) -6.3 EDV (ml) 485 29 4 • Hovering over a point on the curve displays GLS Res (%) GLS Cont (%) -23.1 ESV (ml) 79.9 Lateral the value at that location -16 Septal -15 -14 Inferior 20 40 40 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Users can use the pointer to interact with bullseye segments and curves. • Highlighting a segment on bullseye will highlight corresponding segment on model • Segment(s) can be enabled or disabled by clicking in bullseye • If segmental strain is active, disabling a segment removes corresponding curve • Hovering over a point on the curve displays the value at that location Notes No. 40 Objectives SIEMENS Healthineers' ... • Overview of 4D HeartAI application • Review 4D HeartAI configuration and touch screen layout • Illustrate imaging for 4D HeartAI • Review 4D HeartAI workflow • Evaluate 4D HeartAI analysis and report --- 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Finally, we will evaluate the 4D Heart analysis and report. Notes No. 41 Accessing 4D HeartAI report worksheet SIEMENS Healthineers ... To access the 4D HeartAIreport worksheet: Patient Report Patient History 4D Heart N Select Report on the touch screen . Cardiac Last Single Beat Analysis • 4D Heart Nl LV End Systolic Strain [%] - Beat 1 of 1 IV LA GLS -19.9 GLS Res 35.0 % Select 4D HeartAI on left-hand side of report EF 56.7 GLS Cond -15.5% • Summary Comments EDV 181.0 ml GLS Cont 19.5 % ESV 78.4 ml EF 47.6 % CO 5.1 Vmin EDV 44.7 ml SV 102.6 ml ESV 85.3 ml Mass PreA 998 ms AVC 367 ms summary LV Value Method -14.7 % .9.0 -11:3 -13.3 -19.9. -19.9 Avg EF 51.1 % 46.8 46.3 49.1 56.7 56.7 EDV 169.0 ml 158.6 157.5 167.1 181.0 181.0 Summary Collapse All Note: Entering the report prompts user Store Report Thanks Report to exit the 4D HeartAI application. Edited Value . 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Recall that 4D HeartAI analysis results are saved to the report when selecting Capture on the control panel. To view the results within the report, select Report to the left of the touch screen. Then select 4D HeartAI to the left-hand side of the report. Note: Entering the report prompts the user to exit the 4D HeartAI application. Notes No. 42 Edit Report | Summary SIEMENS Healthineers ... • Worksheet opens at default for edits • Selecting Summary toggles from edit report to report summary Healthineers Patient Report SIEMENS Healthingers Patient Report Pationt History 40 1war Patient History 40 Cardiac Last Single Beat Analysis . Cardiac Last Single Beat Analysis LV End Systolic Strain [%] - Beat 1 of 1 as LA LV End Systolic Strain (%) . Beat 1 of 1 19.9 % GLS Res 35.0% GLS Cond -15.5 % Images -19.9 % GLS Res 56.7 % GLS Cond Summary Comment 181.0 ml GLS Cont 19.5% Summary Comments GLS Cont 19.5% 78.4 ml 47.6% EF 47.6% 5.1 Umihn 44.7 ml 102.6 ml FSV 85 3 ml Muss 1026 EDV ESV 186.5g PreA 998 m 367 PreA 367 on Value LA -14.7 % GLS 35.0 -13.3 .19.9 19.9 ALOS 51.1 % GLS Res 55.3 IF 56.7 567 169.0 ml GLS Cond 157.2 me CZE LOV 82.2 ml GLS Cont 20.3 % 97.9 mm 169.0 14 use6 157.5 167-1 181.0 181.0 ESV 4:4 1mm 51.0% 59.3 nl 86.9 nl EDV 50 bem Collapse All Edit Report Collaque An Store Report Store Report Edited Value . 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When accessing a patient’s report, the worksheet opens up at default to edit report. Selecting Summary toggles from edit report mode to the report summary. Notes No. 43 4D HeartAI edit report layout - bullseye SIEMENS Healthineers ... • The last bullseye captured is displayed Patient Report in the report Patient History 4D Heart N . Cardiac Last Single Beat Analysis 4D Heart Nl LV End Systolic Strain [%] - Beat 1 of 1 IV LA Bullseye displays the Timing / Phase GLS -19.9 GLS Res 35.0 % • EF 56.7 GLS Cond -15.5% value selected in system configuration Summary Comments EDV 181.0 ml GLS Cont 19.5 % ESV 78.4 ml EF 47.6 % CO 5.1 Vmin EDV 44.7 ml or during the exam from the touch SV 102.6 ml ESV 85.3 ml Mass PreA 998 ms AVC 367 ms screen • Segments cannot be removed from the bullseye in the report summary LV Value Method • 4D strain and quantification of left -14.7 % .9.0 -11:3 -13.3 -19.9. -19.9 Avg heart chambers are listed EF 51.1 % 46.8 46.3 49.1 56.7 56.7 EDV 169.0 ml 158.6 157.5 167.1 181.0 181.0 • Bullseye results cannot be edited; can Summary Collapse All only delete per chamber by selecting X Store Report Thanks Report Edited Value . 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • The last bullseye captured is displayed in the report • Bullseye displays the Timing / Phase value selected in system configuration or during the exam from the touch screen • Segments cannot be removed from the bullseye in the report • 4D strain analysis and quantification of the left heart chambers are listed • Bullseye results cannot be edited; can only delete per chamber by selecting X Notes No. 44 4D HeartAI edit report layout - worksheet SIEMENS Healthineers .. Worksheet includes last five instances captured Patient Report Patient History LV Value Method • Average Result enabled - individual beat · Cardiac GLS -14.7 % -9.0 11.3 13.3 -19.9 -196 4D Heart Nl results sent to report as a separate instance EF 51.1 % 49.1 images 46.8 46.3 56.7 56.7 Last Summary Comments EDV 169.0 ml 158.6 157.5 167.1 181.0 181.0 Avg Average Result disabled - only current beat ESV 82.2 ml 84.4 84.6 85.0 78.4 78.4 • 4.4 Mmin 3.6 5.1 5.1 result sent to report 86.9 ml 74.2 72.9 82.1 102.6 102.6 2 8 Mass 160.9 g 39.8 155.6 136.0 186.5 186.5 • Results cannot be edited, only deleted 50 bpm 51 50 51 50 Value Method • Method can be set to Last, Average, or select GLS 35.0 % 35.0 Avg the instance 1 thru 5 GLS Res 55.8 % 78.1 40.3 69.8 35.0 GLS Cond -35.5 % 57.7 -21.5 47.3 -15.5 GLS Cont Results are listed by chamber (LV, LA, RV, RA) 20.4 % E'O2- -18.8 -22.5 -19.5 • 51.0 % 48.4 55.7 55.5 47.6 47.6 210 Summary Collapse All Export to PDF Store Report Transfer Report Print Report Do you want to delete the measurement? Edited Value . OK Cancel 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The worksheet displays the last five measurement instances captured. When selecting Average Result, individual beat results are sent to the report as separate instances. When Average Result is disabled, only the current beat result is sent to the report. 4D HeartAI measurements cannot be edited in the report worksheet, only the instance can be deleted by selecting X. When deleting measurements from the worksheet, a pop-up window appears to confirm or cancel the deletion. The measurement method can be set from the drop-down to Last, Average (Avg), or the user can select any instance 1 thru 5. 4D HeartAI results are separated by cardiac chamber. Scrolling down the worksheet displays additional chambers. Notes No. 45 Report control options SIEMENS Healthineers ... • Summary & Edit Report – toggle between edit report function and report summary Summary Collapse All • Export to PDF – exports a pdf version of the Export to PDF report to a USB Store Report Transfer Report • Store Report – saves an image of the entire report Print Report • Print Report – prints the report to the configured printer Edit Report Collapse All • Collapse All – collapses all sections contained within the report Export to PDF Store Report Transfer Report Print Report 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Report control options are: • Summary & Edit Report – toggles the user between edit report function and report summary • Export to PDF – exports a pdf version of the report to a USB • Store Report – saves an image of the entire report • Print Report – option to print the report to a configured printer • Collapse All – collapsed all sections contained within the report Notes No. 46 4D HeartAI report summary SIEMENS Healthineers ... The report summary is displayed when Patient Report selecting Summary from the Patient Report Patient History 4D Heart Nl . Cardiac Last Single Beat Analysis 4D strain results 4D Heart N LY End Systolic Strain [%] - Beat 1 of 1 IV LA • GLS 19.9% GLS Res 35.0 images EF 56.7 % GLS Cond -15.5% Cardiac chamber results from 4D dataset Summary Comments EDV 181.0 ml GLS Cont -19.5 % • ESV 78.4 ml EF 47.6% CO 5.1 Mmin EDV 44.7 ml SV 102.6 ml ESV 85.3 ml • GLS, EF, and volumes Mass PreA 998 ms AVC 367 ms • LV cardiac output (CO), and LV mass Summary GLS 14.7 % GLS 35.0 15.4 43.0 % EF 51.1 % GLS Res 55.8 GLS 37.7 GLS 43.6 EDV 169.0 ml GLS Cond 35.5 EDV 157.2 ml EDV 55.2 ml ESV 82.2 ml GLS Cont -20.3 ESV 97.9 ml 97.8 ml CO 4.4 Mmin 51.0 SV 59.3 ml 50 bom SV 86.9 ml EDV 38.2 ml HR 50 bom Edit Report Collapse All Export to Por Store Report Brander Report 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The report summary is displayed when selecting Summary from the Patient Report • 4D strain results • Cardiac chamber results from 4D dataset • GLS, EF, and volumes • LV cardiac output (CO), and LV mass Notes No. 47 Summary SIEMENS Healthineers' ... • Overview of 4D HeartAI application • Review 4D HeartAI configuration and touch screen layout • Illustrate imaging for 4D HeartAI • Review 4D HeartAI workflow • Evaluate 4D HeartAI analysis and report --- 48 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 48 4D HeartAI Key Takeaways SIEMENS . Healthineers ... AI-driven analysis 4D chamber quantification Physio and non-physio plus left heart strain workflow • Semi-automated contour placement for heart • Analysis for irregular heart • Analysis for irregular heart chambers beats can be performed beats can be performed • AI-enabled size and • Ability to edit ED/ES • Ability to set ED/ES frames function analysis frames, AVC, and Pre-A • Average up to 5 beats • Ability to edit when • Average up to 5 beats • Only vendor to have non- needed physio feature! 49 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Let’s highlight a few key takeaways of the 4D HeartAI AI-powered application on the ACUSON Origin ultrasound system. 4D HeartAI provides AI-driven analysis of size and function for all visible cardiac chambers in 4D transthoracic imaging, and analysis of size and function of the visible left and right ventricles in 4D transesophageal imaging. The application is flexible allowing the user to edit chamber contours, as well as edit cardiac timing markers as needed. Measurement results are available for up to 5 cardiac cycles and can be displayed by beat, or by an average of analyzed beats. The application also provides AI-powered 4D strain analysis of the left heart. 4D HeartAI analysis can be performed on datasets without an ECG. Notes No. 49 Resources SIEMENS Healthineers ... 1. Mitchell, Carol, et al., Journal of the American Society of Echocardiography (2019) 32;1 2. Hasanfatta, Naeem et al., ACTA Scientific Clinical Case Reports (2022) 3;6: 45-56 3. Kosarju, Ateet, et al., Left Ventricular Ejection Fraction. StatPearls Publishing (2023) Jan 50 Unrestricted © Siemens Healthineers 2023 Notes No. 50 Trademarks and disclaimers SIEMENS Healthineers' ... 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. ACUSON Origin is a trademarks of Siemens Medical Solutions USA, Inc. At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare. An estimated five million patients worldwide everyday benefit from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We’re a leading medical technology company with over 120 years of experience and 18,500 patents globally. With over 50,000 employees in more than 70 countries, we’ll continue to innovate and shape the future of healthcare. --- Siemens Healthineers Headquarters Manufacturer Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 Ultrasound 91052 Erlangen, Germany 22010 S.E. 51st Street Phone: +49 9131 84-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-heathineers.com/ultrasound 51 Unrestricted © Siemens Healthineers 2023 Notes No. 51 Thank you for your enthusiasm! SIEMENS . Healthineers ... Questions? QR700000850 52 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Questions? Notes No. 52