ACUSON Origin Vascular Application Presentation

SIEMENS Healthineers SIEMENS Healthineers .. ACUSON Origin Ultrasound System Vascular Applications 1.0 software version Unrestricted © Siemens Healthineers 2023 Speaker Notes: This presentation is focused on the vascular applications for the ACUSON Origin ultrasound system. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 2 SIEMENS Healthineers Primary vascular applications SIEMENS ... Healthineers' ... Carotid Imaging Vascular Access Renal Artery Imaging Peripheral Vascular Imaging Aorta Imaging Transcranial Doppler Imaging 3 3 Restricted © Siemens Healthineers 2022 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this presentation, we will focus on vascular applications, that is performed in cardiovascular labs. These include: • Carotid Imaging • Vascular Access • Aorta Imaging • Renal Artery Imaging • Peripheral Vascular Imaging • Transcranial Doppler Imaging Notes No. 3 SIEMENS Healthineers Transducers > peripheral vascular / vascular access SIEMENS . Healthineers ... ACUSOM ACUSON MOSTON Transducer 10L4 7L2 14L5 Primary Application Vascular Transducer Deep Vascular (Legs) Vascular Transducer Depth 1 -14 cm 1 - 20 cm 1- 8 cm Bandwidth 2.9 – 9.9 MHz 1.7 – 8 MHz 4.8 – 13 MHz Transducer Design Multi-D, Piezoceramic 1D, Single Crystal Multi-D, Piezoceramic Trophon Compatible Yes* Yes* Yes* Gesture Detection Yes Yes Yes *See disinfectant chart for specific cleaners 4 Unrestricted @ Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: There are three primary transducers for peripheral vascular imaging. The 10L4 transducer is the primary used for carotids and peripheral vascular imaging. The 7L2 transducer is used for deep legs. The 14L5 transducer is primarily used for superficial vascular imaging (e.g. small necks for carotids, saphenous vein mapping), and upper extremity (e,g, brachial, radial). Notes No. 4 SIEMENS Healthineers Abdominal Vasculature / TCI Transducers SC1 SV1 DAX 4V1 Mosnow Transducer 5C1 5V1 9C2 DAX 4V1 Primary Application Abdominal Vascular / Cardiac High Frequency Deep Abdominal Abdominal Deep Vascular /Abdominal Abdominal Vascular Transducer Vasculature (Legs) Vascular (small adults, pediatrics) Depth 1 -14 cm 1- 8 cm 1 - 20 cm 1-55 cm 1-30 cm Bandwidth 1.0 – 5.7 MHz 1.1 – 4.9 MHz 1.4 – 8.5 MHz 1.0- 3.5 MHz 1.4 -5.1 MHz Transducer Design 1D, Single Crystal 1D, Single Crystal 1D, Single Crystal Multi-D, Hanafy, Piezoceramic Piezoceramic Trophon Compatible Yes* Yes* Yes* Yes* Yes* Gesture Detection Yes Yes Yes Yes No *See disinfectant chart for specific cleaners 5 Unrestricted @ Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: Depending on the patient type and application needed, there are several choices of transducers. These include: 5C1 transducer - primary transducer for abdominal vascular (aorta, renal exams) when a curved array transducer is preferred, but can be used for deep legs in larger patients. 5V1 transducer - this transducer can be used for aorta and renal imaging when the user prefers a single transducer for both cardiac and abdominal vasculature. Presets will need to be created for a aorta or renal exam depending on the application. This is also the transducer used for transcranial Doppler imaging. 9C2 transducer - this is the transducer used for small adults and pediatrics for abdominal and abdominal vascular imaging. Please note - the pediatric and neonatal cardiac transducers (8V3 and 10V4) can be used as a single transducer for cardiac and abdominal vasculature for pediatrics when a single solution is needed depending on the patient size. Presets will need to be created for the abdominal vasculature applications. Notes No. 5 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 6 SIEMENS Healthineers Vascular imaging controls SIEMENS .. : Healthineers ... Touch Screen SV1 521 CW2 Workflow Patient Imaging Biopty Review LR FIP UID Flip Off Report End Exam Trapezoid Auto TEQ Live Dual Harmonics ompounding InFocus ne Deraity Steer Control Panel Soft keys 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Vascular imaging may be optimized using the: • Control Panel • Soft keys • Touch Screen Notes No. 7 SIEMENS Healthineers Control panel SIEMENS .. ; Healthineers ... Soft key rotary controls Power Major modes DGC User-defined Control Imaging Update controls Text, Body Marker, Arrow Capture Forward/ Freeze Backward Pointer Delete Measurements Home base 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The primary controls on the Control Panel are: Power control powers on or off the ultrasound system. Orange lighting indicates the ultrasound system is powered on, and blinking orange lighting indicates the ultrasound system is plugged in, but not powered on. No lighting indicates the ultrasound system is powered off and not plugged in. U1 key is a user-defined key and can be customized to the user's preference. (System Configuration > System settings > Display) ABC control provides access to the Text Annotation, Body Marker and Arrow feature. Pointer controls the pointer and is used to highlight or select an area of interest. Delete control has several functions: • During the measurement function, deletes the measurement in progress in reverse sequence • During the annotation function, deletes the annotation in progress in reverse chronological sequence • Deletes the selected image in review Measure key provides access to the generic measurements and vascular calculation packages. Intima media thickness (IMT) package for Carotid imaging is accessed under Measure when in the Carotid application. Home base includes: Trackball and set keys size and position an object on the image screen, for example, the region of interest, Doppler cursor, and measurement - markers. DGC or depth gain compensation slide pods manually adjust brightness and gain at depth. Move to right to increase and to the left to decrease. The recommended placement is in the center. This is adjustable on a live or frozen image. Major mode controls (2D, C, PW, CW) activate the operating mode and adjust the gain. Press the operating mode control on the Control Panel to activate the operating mode. Rotate the operating mode control to adjust the gain for the operating mode. CW Doppler is available only on the CW5 Auxiliary transducer. Imaging Controls provide access to Zoom / HD Zoom, Depth control and Dual imaging. Capture allows the user to store a clip or when in Freeze, a static image. Freeze control: • Freezes or unfreezes the acquisition of an image, sweep, or spectrum • Enables or disables CINE playback Notes No. 8 SIEMENS Healthineers • During clip capture, ends the capture Notes No. 8 SIEMENS Healthineers Touch screen layout SIEMENS. Healthineers' ... 5V1 10L4 Carotid 521 CW2 Workflow Patient 2D Color PW Imaging 13 Review Report Auto Trace Auto Trace Above Baseline End Exam Invert Auto TEQ Live/Live × Frequency Filter Gate Size Sweep Speed Scale 1.5 mm 60 mm/s Baseline PRE HPAE 60 Angle Correct 60 0 60 Steer -26 26 0 26 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: This is an example of the Touch Screen when using all Doppler modes. In Doppler, multiple modes are used, so it may be necessary to access each mode individually. The Tab controls across the top allows the user to move easily between modes. For example, while in split mode, the user can freeze the image, select the Color tab, then cine back to a frame of choice, zoom and pan the image. The active tab is highlighted in orange. The user can customize the user-defined controls for the Touch Screen. There are two. In this example, Full Screen mode was selected and service image. Go to System Configuration > System Settings > Display to select on option. Additional frequently used controls are accessed directly from the Touch Screen. In this example, accessing UltraArt for PW Doppler, Doppler TEQ, Display size, or changing frequency, filter or audio volume are available. The controls options vary based on transducer, preset and mode. The soft key controls at the bottom of the Touch Screen are different based on the mode. There are two pages but the most commonly used ones are on Page 1. Press the arrow key or swipe across the Touch Screen to access page two. Notes No. 9 SIEMENS Healthineers B-mode controls on the touch screen SIEMENS. Healthineers ... 5V1 1014 Carotid ( 2 ) 521 CW2 Workflow Carotic 521 X CW2 Workflow Patient 2D Patient 2D Imaging L/R Flip UID Flip Biopsy Imaging Timer Review Review Report Report hage Size nd Exam End Exam Trapezoid Capture By Seconds Auto TEQ Live Dual Capture Type Clip Length Prospective 2 sec Harmonics Compounding Frequency DR InFocus e Density Steer Transmit Power Clarity Maps H Mid 60 dR 10 9 10 Page One Page Two 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the Touch Screen controls for B-mode when using the 10L4 transducer for a carotid exam. Active selections are highlighted in orange. Available selections are gray and dithered out is not available for the mode, transducer or preset. We will discuss the optimization later in the presentation. Notes No. 10 SIEMENS Healthineers B-mode controls on the soft keys SIEMENS. Healthineers ... 501 1014 Carotid(2) 521 x CW2 Workflow SV 1014 521 CW2 Workflow Patient 2D Patient Imaging maging L/R Flip UID Flip Timer Review Off Redorg Review Report Report Image Size End Exam End Exam Trapezoid Capture By Seconds uto TEQ Live Dual Capture Type Clip Lengt Prospective 2 sec Harmonic Compounding Frequency H Mid DR InFocus Line Density Steer ransmit Power Clarity persis Map Tint 50 dB O O O O O O O O O 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The soft key rotary controls are located on the Control Panel and lie beneath and correspond to the controls listed on the bottom of the Touch Screen. The active control is highlighted in white. Press to activate the control, then turn the rotary control clockwise / counterclockwise to adjust. If the image is frozen, the controls available in freeze will be white on the Touch Screen. Controls that are not available will appear dithered. Soft key controls are not customizable but change as you move from live to frozen. Only the items available as post-processing will be displayed in white when frozen. Notes No. 11 SIEMENS Healthineers Color Doppler controls on the touch screen SIEMENS. Healthineers' ... SVT 1014 Carotid 521 X CW2 Workflow Sv Carotic 521 X CW2 Workflow Patient 2D Color Patient Color Imaging UR Flip WD Flip Biopsy Imaging Review Off Review Report Report End Exam End Exam D + Color 2D Only Color Only Invert Live Dual urto Doppler Low General High Color Power Filter requency Baseline Scale Line Density Smooth Persist Maps Priority Pen Page One Page Two 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the Touch Screen controls for Color Doppler when using the 10L4 for Carotid imaging. There are two pages. Optimization will be discussed later in the presentation. Notes No. 12 SIEMENS Healthineers Power Doppler controls on the touch screen SIEMENS. Healthineers' ... 0 0 0 9 521 SV1 Carotid SC1 Workflow Sv Carotic 521 X CW2 Workflow Patient 2D Colar Physio Patient Color Imaging UR Flip Biopsy Imaging UND Flip Review Off Review Report Report End Exam End Exam 2D + Color 2D Only Color Only Live Dual Auto Doppler Dir Power Low General High Color Power Filter Frequency Scale ine Densit Steer Smooth Persist Maps Priority 20. Page One Page Two 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the Touch Screen controls when Power Doppler is activated. Directional Power will appear on the Touch Screen once Power is selected. Notes No. 13 SIEMENS Healthineers PW controls on the touch screen SIEMENS. Healthineers ... SV TOL4 Carotid 521 X CWZ Workflow Carotid 521 CW2 Workflow Patient 2D Color Patient 2D Color Imaging 13 imaging Review Review Report Auto Trace Auto Trace Above Baseline Report and Exam End Exam Invert Auto TEQ LivelLive Frequency Filter weep Speed Baseline Scale Angle Correct Steer Maps 1.5 mm 60 mm/s 60 60 0 60 -26% 25 0 26 Page One Page Two 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the Touch Screen controls for Spectral (PW) Doppler. There are two pages. Optimization will be discussed later in the presentation. Notes No. 14 SIEMENS Healthineers Touch screen and soft keys for CW Doppler SIEMENS .. ; Healthineers ... 7L2 10L4 SCI / Aterial Workflow CWS -50 Patient CW :45 40 D AuxCW Imaging -35 Mid 14 -5dB/DR60 MapE/T5 Review DE- GS 1.0 PRF 5000 -25 F 80 Report -20 15 End Exam Invert -cmis Auto TEQ Filter Sweep Speed 67 minis Baseline scale 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The systems does support the non-imaging Continuous Wave Doppler for vascular exams. The transducer is the Aux CW5 transducer. This is a trace of the brachial artery. Select the transducer and press CW on the Control Panel to activate. Sweep Speed, Baseline and Scale can be adjusted. Notes No. 15 SIEMENS Healthineers Workflow control SIEMENS. Healthineers ... TOLS Carotid(2) 521 x CW2 Workflow Patient Workflow Imaging LAR Flip LUID Flip Biopsy Timer Review Off Panoramic Protocols Report End Exam Trapezoid Modality Compare Physio Auto TEQ Live Dual Stress Echo Harmonies Compounding Frequency InFocus Line Density Steer H Mid OR 60 de 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Workflow Control is available on the Touch Screen. It provides access to some of the advanced applications and options for Cardiology and Vascular imaging. For vascular applications, Protocols and Panoramic Imaging can be accessed. Options will be displayed as white if available and dithered out if not available for a specific transducer, mode or if the option does not have an active license. To access, select Workflow, then the specific application required. Notes No. 16 SIEMENS Healthineers Protocols SIEMENS .. : Healthineers' ... a] OfflineProtocolEditor.exe System Configuration System Configuration Systwin Settings . System Settings mon and ven . Inuging Seting . Inuding Seting . Menerenest & Bagort . Meinerenest & Baport . CARDIAC 2 Www 2 . Cartac Atwarzed . Cartec Atrarand Caiste COPY COPY Apply to ail views RE PHERECA Delete . Transducer Transducer BC RIVER CCA BC KPNEs ECA BC RIVER CCA INDN NOx ECA · Periphera Device · Periphera Devices BCRPIDE ICA BCRNICKCA leport 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A protocol is a pre-defined checklist that guides you through a clinical workflow. This pre-defined checklist includes automated imaging mode changes, automated text and body markers, as well as automated measurements. There is a default Carotid protocol, but additional protocols can be created for other vascular exams. To edit or create a protocol in the configuration menu, go to System Configuration > Features > Protocols. To use an existing protocol as a template for creating a new protocol: 1. Select the default protocol (i.e. Carotid). 2. Select Copy. 3. Change the Protocol Name. 4. Add and/or modify views. • Protocols and views can be viewed, created, copied, deleted, or moved. Protocols can be imported and exported using a USB device. To Import / Export: 1. Select Import / Export. 2. Select media location. 3. Select desired protocols. 4. Select OK. Offline customization is available from a computer once a protocol has been exported. For offline customization: 1. Select the protocol editor file (OfflineProtocolEditor.exe) from the USB. 2. Create and modify protocols using the same interface that is available from the system (this can be done from a desktop or laptop). 3. Save the new protocol in the same folder as all the extensions are required to upload back into the system. Protocols can then be imported back onto the system. If there are multiple ACUSON Origin systems, once created, custom protocols can be uploaded from system to system. For complete understanding of Protocols, review the ACUSON Origin Workflow Protocols Presentation. Notes No. 17 SIEMENS Healthineers Protocols SIEMENS .. ; Healthineers ... 2D rotocols TIS:0.76 MI:0.39 Pause Protocol Exit 21fps 95% 2D H Mid OdB/DR60 BGH DIE OGA LD 1 UA 2 Patient Reg B R Prox CCA BC R Prox CCA BCD R Prox CCA B R Mid CCA BC R Mid CCA MapC/T5 P ACD It Dist CCA 1dB/ General Dist CCA PRF 3472 BCD R Mid CCA 3 R Dist CCA BC R Dist CCA BCD R Dist CCA B R Bulb BC R Bulb BCD R Bulb B R Prox ECA BC R Prox ECA BCD R Prox ECA B R Prox ICA BC R Prox ICA BCD R Prox ICA B R Mid ICA BC R Mid ICA BCD R Mid ICA B R Dist ICA BC R Dist ICA ............................. Add View Rename View Reorder Delete Progression Automatic Remain Frozen 18 Restricted © Siemens Healthineers 2022 Restricted © Siemens Healthineers 2023 Speaker Notes: This is an example of the Touch Screen and Image Screen when using a Protocol for a carotid exam. For complete understanding of Protocols, review the ACUSON Origin Workflow Protocols Presentation. Notes No. 18 SIEMENS Healthineers Panoramic imaging SIEMENS. Healthineers ... 0 0 0 7 521 SV1 1014 Carotid 5C1 Workflow Arterial 9-1 14 Patient 2D Panoramic 20 Imaging H High Flex Rule Restore Sedisplay Exit Review Report est Fit End Exam Cine 19 19 Restricted © Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: Panoramic imaging offers an image with a larger field of view (FOV) to visualize and measure structures in their entirety or to better visualize and understand spatial relationships between anatomy / pathology. Panoramic imaging is a technique where the user moves the transducer along the patient's anatomy and the system blends the multiple images together to form one long image with an extremely wide field of view. It compares consecutive images, rotating and stitching them together to form the final image. Panoramic Cine can be used to recall single frames for review. Panoramic imaging allows acquisition and display of grayscale and Power Doppler images up to 60 cm in length and up to 360° when the depth is less than the radius of the target area being scanned. It is available on curved and linear transducers. All color data is preserved during image acquisition and the peak of the signal is saved for the color panoramic image. Clinical applications for use may include: Vascular (anastomoses, varicose veins, saphenous vein mapping, vessel orientation). This is an example showing a long segment of a superficial femoral artery in the leg. Notes No. 19 SIEMENS Healthineers Panoramic imaging SIEMENS. Healthineers' ... 14L6 Venous SZ SV Workflow TIB:0.14 Carotid TIC.0.33 TIS:0.14 ML:0.91 Patient 20 Panoramic 2dB/DR60 Imaging Flex Ruler Restore Redisplay Exit Review Report Rest Fit End Exam Cine 20 20 Restricted © Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: To activate, select Workflow > Panoramic tab (appears on the Touch Screen when a linear or curved array transducer is active and the system is unfrozen). • Press the Update key to acquire the image. • Move slowly up the vessel segment you wish to acquire. • Press Freeze or one of the Set keys to end acquisition. • Unfreeze to reactivate acquisition if desired. • Use Panoramic Review controls after completing the acquisition to resize, restore, rotate, pan, zoom or measure the Panoramic image. • Use the Panoramic Cine function to recall single frames for review. • To scale the image to fit the image area, select Best Fit. • Select Exit to exit Panoramic Review. This is an example of the saphenous vein using the 14L5 transducer. Notes No. 20 SIEMENS Healthineers Panoramic imaging SIEMENS. Healthineers' ... SZ1 SV Carotid 5C1 Workflow 10L4 Venous TIS:1.11 MI:1.08 Patient 2D Color anoramic 95% 2D Imaging H High Flex Ruler Restore Redisplay Exit 1.dB/DR60 Review 1540 LD 1 Compound Report All Power Color Capture Best Fit UA 3 MapD/T5 P2 End Exam Flow Acquisition Fraction OdB General P4/LD1 PRF 1131 S4/Pr4 X MabA/F3 2D Color 21 21 Restricted © Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: Panoramic imaging is also available in Power Doppler. All color data is preserved during image acquisition and the peak of the signal is saved for the color panoramic image. To activate, select Power Doppler from the Color Touch Screen. • Select Workflow > Panoramic tab (appears on the Touch Screen when a linear or curved array transducer is active and the system is unfrozen). • Place the transducer on the required location and do not move the transducer, the select Color Capture. • After the color data is captured, you can begin moving the transducer. • To display or remove color data in the image, select Flow. • To adjust the selection of the color region of interest • To maximize the selection area and display 100% of the region of interest, select Acquisition Fraction. • To minimize the selection area and display 30% of the region of interest, select Acquisition Fraction again. • Unfreeze to reactivate acquisition if desired. • Select Exit to exit Panoramic imaging Notes No. 21 SIEMENS Healthineers Objectives SIEMENS . Healthineers .. • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 22 Unrestricted @ Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 22 SIEMENS Healthineers 2D optimization SIEMENS. Healthineers' ... 10L4 521 x CW2 Workflow TIS:0.33 MI:1.14 52fps Patient 20 95% 2D H High -6dB/DR58 Bu Gewur LUR Flip Review UID Flip Biopsy Timer c=1540 LD 1 Compound UA 2 Report MapC/T5 P2 End Exam Trapezoid Auto TEQ Live Dual Harmonic Compounding Frequency DR InFOCUS Line Density Steer H Mid 23 Unrestricted © Siemens Healthineers 2023 Speaker Notes: We will now review some of the optimization controls for B-mode imaging available on the Touch Screen and soft key controls. Notes No. 23 SIEMENS Healthineers InFocus coherent image formation SIEMENS .. ; Healthineers' ... CAROTIDLG 2D H High 4dB/DR60 c-1540 LD 1 InFocus Compound UA 3 MapC/T3 24 Unrestricted © Siemens Healthineers 2023 Speaker Notes: InFocus is a patented technology, known in academia as retrospective dynamic transmit. With the power of the image beamformer, the system is able to transmit broader beams than a conventional system, using massive parallel image-formation to collect many different angles simultaneously. The beams are then corrected, creating a more tightly focused image from near field to far field. There is no longer a need to transmit at multiple depths to maintain image uniformity or have a transmit focus control. InFocus technology is always in use and is noted on the image screen by the icon. There will be no focal zones on the image screen. In some cases, users may want to enhance further a specific area of interest, so a selectable focus can be applied. To activate the selectable focus, select InFocus soft key and select the selectable focus Icon. The image screen displays an icon on the depth scale to indicate the location of the focal zone. Rotate the InFocus soft key to position the focal zone at or below the area of interest. Notes No. 24 SIEMENS Healthineers UltraArt™ universal image processing SIEMENS. Healthineers ... SVT Speckle Patient Optimization Review Edge and Ridge Report Enhancement End Exato Contrast Enhancement Gain and Dynamic Range 25 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A unique capability available on the system is UltraArt universal image processing. Image post processing parameters can be selected with a single touch to instantly optimize images for different patient types. This allows quick and easy matching of the systems acoustic DNA parameters to individual patients in the specific scanning window. The effect of numerous parameter changes before they are applied can be seen on the Touch Screen display. By unifying multiple parameters into optimal settings for each individual patient, the effect of UltraArt patient specific image processing improves contrast resolution of different organs and visualization of small or isoechoic lesions. In the end, UltraArt improves exam quality and consistency across different users by avoiding combinations of individual post processing parameters that do not provide the result the user needs. Reading physicians can look forward to better exam quality standardization. Some of the settings that are optimized include Speckle, Edge, Contrast, Gain and Dynamic Range. This is acquired during real-time, so the changes can also be applied on a frozen image. Note: The images displayed on the Touch Screen do not represent the actual image quality but are representative images to select from. The Touch Screen is designed for graphics and text display. The image screen is a high-resolution monitor designed for viewing images. The image shown above was a screen capture that shows the actual imaging. The image should be viewed and selected based on the image displayed on the image screen. Notes No. 25 SIEMENS Healthineers UltraArt universal image processing SIEMENS .: Healthineers' ... SVT Patient Report Off 26 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To change the setting: • Select the UltraArt icon on the Touch Screen. • Selections are Off-3. • Off represents the natural image. • 1 is a low amount of speckle reduction and low range of Edge enhancement. • 2 is a standard amount of speckle and mid-range of Edge enhancement. • 3 is a higher amount of speckle reduction and Edge enhancement. Once you activate UltraArt, the four images are displayed on the Touch Screen. The Touch Screen resolution is designed for text and graphics, so the actual image representation is best reviewed from the high-resolution image on the monitor as you make the changes. The image above of the carotid artery displays the four actual images that were captured from the Touch Screen and the image from the Imaging screen. The UltraArt presets default to 2. Although the changes are subtle in the frozen image, once displayed on the high-resolution monitor, the changes are more apparent. Notes No. 26 SIEMENS Healthineers Auto TEQ image optimization SIEMENS. Healthineers ... Auto TEQ 10L4 Venous TIS:0.31 MI:1.14 60fps 95% 0 0 0 9 521 SV1 1014 Carotid SC Workflow 2D H High 0dB/DR60 Patient Physio c=1540 2D Compound Imaging L/R Flip UWD Flip Biopsy Timer Review Report End Exam Trapezoid Auto TEQ Live Dual Harmonics Compounding requency DR InFocus Line Density steer H Mid 10 0 10 27 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto TEQ (Tissue Equalization Technology) optimizes the overall field of view (FOV) image brightness uniformity by changing the depth gain compensation and overall gain. Auto TEQ continuously applies the TEQ technology to a B-mode image (as shown in this 2D image of the sagittal view of the femoral and profunda artery). To activate Auto TEQ, select Auto TEQ from the Touch Screen. The default is off. When active, the Auto TEQ control on the Control Panel is backlit in orange and a white icon display appears on the image screen. Press to activate or deactivate. Notes No. 27 SIEMENS Healthineers Compounding / line density SIEMENS. Healthineers ... CAROTIDLC TIS:0.31 MI:1.14 60fps Compounding 95% 2D H High 4dB/DR60 c=1540 D 1 compound JA 3 ATapC/T3 P1 O Line Density 28 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To access compounding, select Compounding on the Touch Screen. It will be displayed in orange when activated. The default is on. Compounding combines multiple images acquired at different steering angles (multiple lines of sight) to produce a compounded image with less noise, increased contrast resolution and improved border delineation. When Compounding is on, the user adjusts the Line Density to increase level of compounding. This is especially useful in Abdominal Aorta imaging and to bring out subtle plaque in Carotid imaging and enhance visibility in venous imaging for DVT exams. When Compounding is off, Line Density adjusts the balance between the image line density (resolution) and the frame rate (speed). Settings are one (low resolution / high frame rate) to three (high resolution / low frame rate). Please note: Compounding is not available on cardiac transducers. Notes No. 28 SIEMENS Healthineers Clarify™ vascular enhancement (VE) technology SIEMENS . Healthineers' ... • Uses Power Doppler to 2D enhance B-mode imaging • Reduces artifacts in vessels and improves Power vessel wall definition Clarify 29 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Clarify vascular enhancement (VE) technology is a real-time, adaptive, pixel-by-pixel analysis which provides exceptional contrast resolution for clear delineation of vessels. It reduces noise and artifacts, improves visualization of micro and macro-vasculature, and increases contrast resolution within tissue and between tissues. It is a patented technology that uniquely utilizes power Doppler flow information to enhance B-mode imaging. Use Clarify VE to reduce noise and artifacts within macro-vascular structures (larger vessels) such as the carotid artery, aorta and femoral vein as well as in micro-vascular structures such as the small vessels found in the kidney. Use it on vessels to help delineate surrounding structures. Clarify VE does not change the B-mode image in nonvascular structures (e.g., within the gallbladder or urinary bladder). To activate / deactivate, select Clarify on the Touch Screen. Rotate the Clarify control to adjust Clarify sensitivity levels: (Selections are 1 – 5) • Select a higher level to increase sensitivity • Select a lower level to decrease sensitivity Note: Clarify VE is accessed from the soft keys on the second page. Notes No. 29 SIEMENS Healthineers Clarify VE technology SIEMENS. Healthineers' ... Abdomen 5C1 TIB:1.41 Abdomen TIB-1.19 TIC:3.64 TIS:1.41 MI:1.35 TIS 1.19 13fps MI-1,34 95% 2D H Md 0dB/DR65 1dB/DRES c=1540 Compound Clarify 1 UA 3 MapD/T5 P2 Clarify 1 30 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The image on the left is an excellent use of Clarify VE to remove the artifact from the aorta. The image on the right is a sagittal view of the aortoiliac bifurcation. Note how well the vascular structures are seen using Clarify VE. Notes No. 30 SIEMENS Healthineers Maps SIEMENS. Healthineers' ... Abdomen Transmit Power Persist Maps 95% D 31 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Play Clip Maps may be adjusted on a live or frozen image. A gray map determines how dark or light you prefer to show each level of gray based upon the strength of the ultrasound signal. Settings range from A-G. Maps A-F display low to high contrast and Map G is a linear map (primarily used in research) . They are also gain balanced except for Map G. Maps are available on page two of the 2D Touch Screen and are also adjustable by rotating the soft key. • The image on the left display a nice image of a carotid with plaque using Map C. • The middle image is the sagittal aorta with Map D enhancing the contrast. • The image on the right demonstrating the right renal artery coming off the transverse aorta using Map D to provide additional contrast. Notes No. 31 SIEMENS Healthineers Tint SIEMENS .. ; Healthineers' ... OH High 6-1540 Transmit Power Persist Maps Tint 95% 32 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Tint individually colorizes the grayscale image to aid in visualization of subtle tissue differences. There are 10 tints. Six with different shades of gray, as well as blue, inverted rainbow, sepia, and gold. Tint 1 is a true gray and Tints 2-6 are additional gray shades. Tints 7-10 are the color options. They are also gain balanced. • The image on the left display a nice image of a carotid with plaque using Map C and Sepia tint. • The middle image of a Dual image of the saphenous vein is using the Blue tint. • The image on the right of the superficial femoral artery and vein is using the Gold tint. Notes No. 32 SIEMENS Healthineers B-mode post-processing features SIEMENS . Healthineers' ... Carotid TIS:0.17 • DR • Gain MI:1.20 42fps 95% H Mid GB/DR60 • Map • M-mode Gain DI Compound UA 2 MapC/T7 • Tint • UltraArt P2 • Image Size • L/R Flip • DGC • U/D Flip 33 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When the image is frozen, the available post-processing features will be displayed on the Touch Screen or soft keys. Available post-processing features on the Control Panel will be backlit in white. The following optimization controls may be adjusted after the image is frozen: • DR • 2D Gain • M-mode gain • L/R Flip • U/D Flip • Image Size • UltraArt • Map • Tint • DGC Notes No. 33 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 34 SIEMENS Healthineers Doppler modes SIEMENS. Healthineers ... PS-BB.84 cm/s ED-22.83 cm/s Carded CW5 Anterial TIS:0.58 MI:0.06 95% D AuxCW Mid CB/DREO MapE/TS MIGO/T GS 1.0 PRF 5000 F 80 $100 P2/LD2 PRF 3125 8:3/ PY4 MapF /F3 60 2D . Color GS 1.5 PRF 8250 son Color and PW Doppler AUX CW5 Doppler Directional Power Doppler 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The system supports Color, Power and Directional Power, Spectral (PW), and non-imaging CW Doppler (CW5) for vascular applications. The left image is an example of the 10L4 transducer with color in the Carotid Artery and PW Doppler in the Internal Carotid artery using Auto Trace. The color displays excellent spatial resolution and hemodynamics. The middle image demonstrates the brachial artery using the CW5 Auxiliary transducer. This is sometimes used in vascular exams to obtain an ankle/brachial index or ABI measurement. The right image shows the Power Doppler capability using a blue map. The image of the carotid is displayed in the Dual format. Note how the color stays within the vessel. Notes No. 35 SIEMENS Healthineers Color Doppler SIEMENS .: Healthineers ... 712 TOL 5C1 Abdome X CW Workflow 501 Abdomen Patient 20 Color TIB:1.18 TIC.3.35 TIS:1.18 Imaging MI:1.38 17fps L/R Flip U/D Flip Review off Asdois 2D 0dB/DR65 PW H Report c=1540 LD 2 Compound End Exam UA 3 MapD/T5 2D + Color 2D Only Color Only Invert -5.50B Aorta Kidney Aorta Live Dual P1/LD1 PRF 2451 S3/Pr4 MapF/F3 2D + Color Low General High Color Power Filter Frequency Baseline Scale ine Density Auto 36 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Color Doppler velocity applies colors to vascular structures based on velocity and direction of flow as displayed here in the aorta with renal arteries. Color Doppler controls include: • Color Display: activates / deactivates the color display (ROI remains on the image) without unfreezing the image. Choices are 2D + Color, 2D Only and Color Only. • Flow States: optimize multiple parameters for specific flow states . Choices are Low, General, High and in some presets, Aorta and Renal. • Invert: reverses the colors depicting flow towards or away from the transducer in the color ROI and the color bar (located on the left side of the image). • Color or Power: activates color Doppler velocity or Power Doppler. Once Power is selected on the Touch Screen, Dir Power will appear on the Touch Screen. • Live Dual: displays the same image side-by-side with and without color when in Color mode. Notes No. 36 SIEMENS Healthineers Doppler controls on the control panel SIEMENS . Healthineers' ... Soft key rotary controls Doppler Modes (40) Zoom Update Measure Capture Home Base AI Depth and Dual Measurements Update 37 37 Restricted © Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: The primary Doppler controls on the Control Panel are: • C enters / exits color Doppler • PW enters / exits pulsed wave Doppler • CW enters / exits Continuous Wave Doppler (CW is available in vascular imaging using the CW5 auxiliary transducer) Pressing PW or CW activates the Doppler cursor. • Press PW again to enter PW (pulsed wave) Doppler • Rotate PW to adjust overall spectral Doppler gain • Press PW or 2D to exit • Press Update (located above the trackball) to cycle between the image and Doppler spectrum CW (continuous wave) activates for the auxiliary CW5 pencil transducer. Note: Dual, Zoom and HD Zoom are available in color Doppler. Zoom is available for the B-mode reference image in spectral Doppler. Roll the trackball and press the right or left Set key (located adjacent to the trackball) to perform functions in Doppler such as: • Position the color Doppler ROI • Size the color Doppler ROI • Position the spectral Doppler cursor • Cine the Doppler image or spectral Doppler waveform in freeze • Position the Pointer Utilize the Update key to toggle between the imaging and Doppler. Notes No. 37 SIEMENS Healthineers Color / power Doppler controls on the soft keys SIEMENS .. ; Healthineers' ... Abdomen TIB:1.15 TIS 0.64 TIC.3.14 AS.0.64 TIS:1.15 ME1.12 13fps 98% 20 H High OdB/DR60 1dB/DR65 c=1540 LD 2 LD 1 UA 2 Compound MapD/T4 UA 2 P3 MapC/T5 P2 High 2dB/ Aorta P2/LD2 PRF 5000 MapF/F4 PRF 3088 S2/P14 20 + Color S3/P14 20 + color 10.1cm HD 2 Filter Baseline Scale Line Density Smooth Persist Maps Priority 2 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler soft key rotary controls work the same as in 2D. There are two pages. Notes No. 38 SIEMENS Healthineers Color / power Doppler > soft keys SIEMENS .. : Healthineers ... 1.5cm Filter Frequency Line Density Smooth Persist Maps Priority 3 Pen Baseline Scale 2 Page One Page Two 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Color / Power Doppler soft key controls include: • Filter adjusts the color wall filter. • Setting are 1-4 (low to high). • Frequency adjusts the range of frequencies or amplitudes and are independent of the 2D. Decrease to increase Color penetration and increase for greater sensitivity. In the image on the left PEN was used to reduce the frequency to increase the flow visualization. • Choices are Pen, Med and High and RES. • Baseline adjusts the range of flow velocities or amplitudes displayed above and below the baseline. • Scale adjusts the pulse repetition frequency (PRF) - the color velocity range or the power frequency range. • Line Density adjusts the balance between the image line density (resolution) and the frame rate (speed). • Settings are 1 (low resolution / high frame rate) to 3 (high resolution / low frame rate). • Smooth adjusts the level of spatial (both axial and lateral) averaging used to smooth the flow pattern display. • Settings are 1-4 (low to high). • Persist (persistence) adjusts the time that the color flow data remains in the ROI before being replaced by another color. • Settings are 1-4. • Maps selects a processing curve that assigns the velocity / variance range for (Color) or flow amplitudes (Power) to a range of colors. • Choices are A-G. • Priority adjusts the threshold for overlaying color pixel information on the B-mode image. • Setting are 1-4. Many settings are available as post-processing. See complete list later in the presentation. Notes No. 39 SIEMENS Healthineers Velocity variance map SIEMENS .. : Healthineers ... 10L4 Velocity variance map provides a variance in color Carotid TIS:0.65 flow display for differentiating complex flow patterns MI:1.10 19fps 95% 2D H High • Available in Color Doppler velocity mode -6dB/DR58 c=1540 LD 1 Compound Map H – General & Vascular UA 2 • MapC/T6 P2 c • Available on all transducers and presets 40 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Velocity variance map provides a variance in color flow display for differentiating complex flow patterns. It has been demonstrated that turbulent flow in stenotic areas can be better visualized with velocity variance colorization. This can be useful in demonstrating flow in a stenosis in an arterial vessel or demonstrating turbulent flow. This map provides additional shades of green in the color bar for displaying and differentiating complex flow patterns. It is available on all transducers and presets while using color Doppler velocity mode. Color Map H is the variance map for General imaging and vascular. This is an example in a carotid artery demonstrating the variance in the laminar flow. . 40 SIEMENS Healthineers Auto flash artifact suppression SIEMENS .. ; Healthineers ... Auto flash artifact suppression applies flash 10L4 Carotid suppression relative to user motion TIS:0.64 MI:1.16 16fps 95% 2D H Mid 0dB/DR60 c=1540 LD 1 Compound UA 2 MapC/T5 P2 C Pen OdB General P2/LD2 PRF 3086 S3/Pr4 MapF/F3 2D + Color 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto flash suppression is a patented technology in color Doppler. In color Doppler, auto flash artifact suppression: • Reduces motion artifacts • Enhances color sensitivity • Allows high quality scanning at a fast pace Notice how the color Doppler, in the clip of the innominate and subclavian artery, displays excellent color sensitivity without motion artifacts. 41 SIEMENS Healthineers Color Doppler display modes / flow states SIEMENS . Healthineers ... 2D + Color 2D Only Color Only Compare C Pen 5.548 High PJ/LD2 P37102 RF Sie8 PRF 2541 53/Po4 MapA/F3 Color Only Low General High 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are multiple display modes for color Doppler that can be changed while live and when frozen. Display modes: • 2D + Color – Displays both the grayscale image and the color Doppler information as shown in the image on the right. • 2D Only – Removes the color Doppler information. • Color Only – Removes the grayscale image within the ROI as shown in the image on the left of the carotid bifurcation using Power Doppler. Flow states optimize multiple parameters for specific flow states. They are displayed on the Color Touch Screen. Select the choice based on clinical need. In this example of the carotid artery, the setting was General which is the default as shown in this image of the Carotid artery on the right. • Low provides maximum sensitivity to low velocity flows by incorporating the lowest possible filter settings and lower pulse repetition frequency. You may experience increased flash (motion artifacts). General produces an optimal balance between flash suppression and maximum sensitivity by using an adaptive wall filter. • High optimizes the system for the high arterial flow common to pulsatile vessels and stenotic conditions. • Additional settings are available based on anatomy and transducer, for example, kidney or aorta which are similar to the low and high settings. Notes No. 42 SIEMENS Healthineers Flow state examples SIEMENS .. ; Healthineers ... domen Ho 4.16 fl:1.31 10fps 98% 20 H Low 168/DR65 c=1540 LO 2 Compound UA 3 Mapcrts MapDITS PZ 53/P14 IF920 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Clinical uses include: • Low (e.g., renal perfusion, saphenous vein, calf veins, transcranial, trickle flow in carotids, vertebral arteries) • General (e.g., carotid, splenic vein, jugular vein, main renal arteries/veins, peripheral vascular in extremities) • High (e.g., fetal heart, aorta, cardiac) • Kidney (specifically designed for the kidney- similar to the Low setting) • Aorta (specifically designed for the high flow state of the aorta - similar to the High setting) In the image on left, we are using General for the right renal artery and vein coming off the aorta. In the middle image, we are using Aorta for proximal aorta. In the image on the right, we are using Low for the vertebral artery. Notes No. 43 SIEMENS Healthineers Slow flow SIEMENS .. ; Healthineers ... SCI Abdome 2A 1014 10V4 Workflow Abdomen TIB:0.36 TIC:1.57 Patient TIS:0.36 20 MI:1.37 14fps 95% Imaging UID Flip Biopsy 20 L/R Flip Off H Low Review 1dB/DR65 c=1540 LD 2 Report Compound UA 3 MapD/T5 End Exam P2 c 20 + Color 2D Only Color Only Auto -9.5dB Slow P2/LD2 PRF 521 Slow Kidney Aorta Live Dual Dir Power S2/Pr4 MapB/F3 2D + Color Low General High Color Power Filter Frequency Jine Density Scale uto +17 Hz 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Conventional Doppler filters work well in Doppler imaging when the image clutter and blood flow signals are well separated. For most vessels of normal caliber and associated blood flow, this is often the case, allowing the user to easily generate high-quality Doppler images. As blood flow becomes weaker or slower within a region of interest, obtaining a clear and diagnostic Doppler image becomes more difficult. Visualization becomes hindered in this type of environment due to the Doppler signal blends into the clutter of the image signal. Slower blood flow in smaller vessels lacks the separation that makes a Doppler signal clean and clear. Slow Flow is a feature that extends the capability of the system to detect and separate these weaker Doppler signals. When engaged, Slow Flow technology extends the capabilities of conventional doppler techniques in the Color Doppler Energy (CDE) mode, also referred to as Power Doppler enabling better detection and improved imaging of slower flowing, smaller blood vessels. The Slow Flow feature accomplishes this improved imaging state by supplementing conventional Doppler techniques and thereby allowing for the detection of a broader range of flow signals. Slow Flow employs sophisticated wall filters, called smart filters, which extract flow out of the clutter by motion filtering, adaptive signal enhancement and flash suppression. These smart filters detect and label slower flow signals that would otherwise be mixed in with the clutter and excluded by conventional Doppler velocity cutoffs. Adaptive filters then take these weak signals and amplify them while simultaneously suppressing any flash or motion artifacts that are not true signal components. These combined processes not only produce a clear true Doppler signal, but also provide better vessel branch visualization in these difficult to image tissues. The overall result is that Slow Flow can generate high quality vascular images with better branch visualization in tissues that feature slower flow or smaller caliber vessels. Select Slow on the Touch Screen when in Power Doppler to activate. Notes No. 44 SIEMENS Healthineers Notes No. 44 SIEMENS Healthineers Dynamic MultiHertz technology SIEMENS. Healthineers ... 5C1 Abdomen TIB:0.56 TIC:1.88 Auto Manual TIS:0.56 MI:1.34 10fps 98% 2D H Mid -3dB/DR60 LD 2 Frequency Line Density UA 3 MapF/T5 P3 Auto = C 3dB/Kidney P4/LD3 PRF 772 MapA/F3 2D + Color 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dynamic MultiHertz is a workflow enhancement technology that automatically adjusts the color Doppler frequency when the region of interest depth increases or decreases. Select the workflow control under the Frequency soft key and then select Auto to activate or select Manual to deactivate. It is available on the 5C1 transducer in the Abdomen & Abd-Difficult presets and the 10L4 Venous & Arterial presets. Notes No. 45 SIEMENS Healthineers SIEMENS. Auto Doppler Healthineers' ... • Available on Touch Screen when Color or PW Doppler activated A SVI JOL4 521 Workflow Patient 20 Color Imaging • Automated placement of Color ROI 24 Review Report • Automated placement of the sample gate and 60 ° angle correct for Pulsed-wave Doppler End Exam Available on 10L4 Transducer in the carotid LiverLive Auto Doppler • and arterial preset 24 Gate Size "Angle Correct Icon located above color bar cmls 1.5 mm 60. Stoer' • 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The use of color and pulsed-wave Doppler is common in most every ultrasound department. Unlike existing methods, the Auto Doppler feature is a workflow automation tool that may reduce the cognitive load and repetitive keystrokes for the user. Auto Doppler utilizes an algorithm that automatically places and steers the color box and Doppler sample-gate within a vessel. In addition, it keeps the angle correct parameter at 60°, all without user interaction. There may be instances where manual adjustment is necessary, such as patients with severe disease or if a vessel dives deeply and is parallel to the beam. • This technology is available on the Touch Screen for the 10L4 transducer when color is active and when using the carotid or arterial presets. • There is an icon located above the color bar when the technology is activated. • If the technology is active, the icon is blue. If the technology is paused, the icon is gray. • Manually moving the trackball, adjusting color steer, or changing the Doppler angle will cause the technology to pause. Select Auto Doppler to reactivate. Notes No. 46 SIEMENS Healthineers SIEMENS . Auto Doppler Healthineers' ... SIEMENS Live TIB:1.60 TIC 1.03 TIS 1 03 MB/ DRAGO 6- 1540 MIDG/T5 27mm P2/ LD2 PRF 2976 S3/ PT4 MapF / F3 2D + Color MapD/T5 GS 1.5 PRF 5000 Recording in progress 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: This is an example using Auto Doppler. Notes No. 47 SIEMENS Healthineers Power Doppler SIEMENS .. ; Healthineers ... 5V 1014 Carotic x CW2 Workflow o . 10L4 Carotid TIS:0.74 Patient 2D Color PW MI:1.16 18fps 95% Imaging 2D L/R Flip UND Flip H Mid Review 4dB/DR60 c=1540 LD 1 Report Compound MapC/TS End Exam 2D + Color 20 Only Color Only Invert 0.5dB General Uve Duul Auto Doppler Dir Power P3/LD2 PRF 2841 S3/Pr4 MapA/F3 Low General High Color Power 2D + Color Frequency Line Density Pen Scale 48 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Power Doppler applies colors to vascular structures based on flow amplitude (versus velocity information). Power demonstrates less angle dependence than Color Doppler and is useful for low volume, low velocity flow states, and to demonstrate presence or absence of flow. Directional Power Doppler applies color based on amplitude and direction of flow (towards or away from the transducer). This is an example of a Carotid artery using directional Power Doppler. Notes No. 48 SIEMENS Healthineers Color post-processing SIEMENS .. : Healthineers ... • 2D / Color Gain 10L4 Vascular Access TIS:0.35 MI:1.20 26fps • Baseline 95% 2D H Mid 6dB/DR65 • Map c=1540 LD 1 Compound UA 2 MapE/T5 P2 • Priority C Pen -2dB • Invert General P3/LD1 PRF 1302 S2/Pr4 MapF/F3 2D + Color RIGHT RADIAL ARTERY 49 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following optimizations controls can be changed on a frozen image: • 2D / Color Gain • Baseline • Map • Priority • Invert This is an example of a radial artery using the 10L4 transducer. Note the excellent spatial resolution and sensitivity of the color Doppler. Notes No. 49 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 50 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 50 SIEMENS Healthineers Pulsed wave (PW) Doppler SIEMENS .. : Healthineers ... PW SZ1 CW2 Workflow Patient 2D Color PW Imaging 13 LO1 Review Report Auto Trace Auto Trace Pen Above Baseline General End Exam -2.00 P2/LD2 PRF 3126 Invert -1.50 53/P14 MopF / F3 1.00 2D + Color 0.50 PW Auto TEQ Livellive Low -mis 0cal/ CABO MspD/TS GS 1.5 Frequency Filter PRF 10000 ............. 5. 1.50 Gate Size weep Speed Baseline Scale Angle Correct Steer 1.5 mm 60 mmis PRF MPRE 60ª 20 0 60 26 76 0 26 51 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Pulsed wave (PW) Doppler measures flow velocity within a gated sample volume (as displayed here in the subclavian artery). To activate PW Doppler: • Press the PW key on the Control Panel. • This will go directly into PW Doppler if Enable Cursor Mode is not checked in System Configuration (System Configuration>Imaging Setting>Imaging Mode). • If not, press the Update key on the Control Panel to enter split mode. • Press the Update key to toggle back and forth from the 2D / Color image and the trace. • Upon freeze, press the Color tab and roll the trackball to cine the 2D / Color image if needed. PW Doppler controls include: • Frequency adjusts spectral Doppler frequency independent of the B-mode or color frequency, maintaining spectral Doppler flow sensitivity in vessels located in the near, mid or far field. Settings are transducer and exam preset dependent. • Filter rejects signals below the selected frequency setting (e.g., signals generally caused by tissue clutter). Increase the filter to reduce clutter. • Invert reverses the Doppler spectrum (values display above / below the baseline). • Audio setting adjusts the spectral Doppler audio volume. Select the Mute control to mute the volume. • Live/Live is triplex mode. • Display modes - 1/2 B-mode - 1/2 trace ; 1/3 B-Mode - 2/3 trace ; Side by Side ; 2/3 B-Mode - 1/3 trace ; Full Screen. • Auto Trace provides real-time automatic measurements of the Doppler trace. Notes No. 51 SIEMENS Healthineers PW Doppler controls on the soft keys SIEMENS .. ; Healthineers ... 14L5 1 PS-77-28 cm/s 10L4 Venous ED=19.80 cm/s Carotid TIB:1.20 S/D-3.90 TIS:0.92 TIC:0.93 MI:1.19 TIS:0.28 6fps MI:0.35 58fps Hdd 4.20 GB/DREC PW Low GS 2.0 PRF 1488 F 52 PW Low GS 1,5 PRF 4630 F 60 2.5cm 13mm .10 I ...................................................................................... 5-15 1 ..................................................................................................= 20 26.7 sec Gate Size Sweep Speed 60 mmis Baseline Scale Angle Correct Steer DR Edge Maps Tint -26" 60 dB 52 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler soft key rotary controls operate the same as in 2D and Color Doppler and there are two pages. The left image shows the saphenous vein in spectral Doppler with augmentation. The image on the right is an example of a spectral tracing of the internal carotid artery with measurements. Note the spatial resolution of the color Doppler. To display additional or reduce parameters on the soft keys, select the System Configuration icon on the Touch Screen (System Configuration > Image Settings > Image Display Parameters) and check the desired display settings. Notes No. 52 SIEMENS Healthineers Pulsed wave (PW) Doppler – soft keys SIEMENS. Healthineers ... Gate Size weep Speed Page One Scale Angle Correct Steer 1.5 mm 60 mm/s Baseline PRF HPRF 60" 60 0 60 26" -26 0.26 DORTDRNO Compound RIGHT CFV AUGMENTATION -10 53 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To access the PW optimization controls, select on the Touch Screen or press the rotary key on the Control Panel. PW Doppler controls include: • Gate Size adjusts the sample volume size. It is transducer and exam dependent. In this example on the left, the gate size was increased to 5.0 mm to capture more of the flow in this common femoral vein. • Setting choices are 1-20 mm. • Sweep Speed adjusts the scrolling speed of the Doppler spectrum. Decrease to display more heart cycles and increase to display fewer cycles. In this example on the rid, the sweep speed was decreased to display augmentation. • Settings range from 8-200 mm/sec (8,12,16, 25, 33, 50, 67, 100, 150, 200). • Baseline adjusts the range of velocities displayed on either side of the baseline. • Scale adjusts the pulse repetition frequency (PRF) or the HPRF - High Pulse Repetition Frequency – PRF is the spectral Doppler frequency range. The PRF is dependent on the transmit frequency and depth of the Doppler gate. HPRF setting overcomes the limitations of PW Doppler when the velocity is too high and aliasing occurs. • Angle Correct depicts the degree of angle correction for the Doppler spectrum. The default angle for the carotid exam is 60°. • Press Angle to adjust the flow angle from 60/0/- 60 degrees or rotate to adjust the flow angle by 1- degree increments. When the angle is 61 degrees or greater, the system highlights the value of the angle in white as shown in the middle image of a femoral artery. • Steer steers the color Doppler ROI and the spectral Doppler cursor right / left. Steering angles for linear transducers are: • 10L4 = -30 to 30 in 2-degree increments. • 14L5 = -20 to 20 in 1-degree increments. • 7L2 -20 to 20 in 1-degree increments. = Notes No. 53 SIEMENS Healthineers Pulsed wave (PW) Doppler – soft keys SIEMENS. Healthineers ... DR Edge Maps Tint Page Two 60 dB D 8 La34 cm/s ED-4.98 cm/s Carotid TIS:0.30 ME0.42 20fps 95% 2D H High 0dB/DR57 c#1540 LD 2 Compound UA 2 MapC/T6 PRF 2551 3.5cm 2 10mm 52" 54 Unrestricted © Siemens Healthineers 2023 Speaker Notes: PW Doppler controls on page two include: • Dynamic Range adjusts the overall contrast resolution of the spectral display in 5 dB increments Lower levels are more black / white, and higher levels show a greater range of gray shades. • Settings range from 10 dB to 80 dB. • Edge increases or decreases the sharpness of the spectral trace. To increase the sharpness of the spectral trace, increase the edge. To decrease the sharpness, decrease the edge. • Maps selects a processing curve that assigns echo amplitudes to gray shades in the Doppler spectrum. • Settings range from A – H. • Tint colorizes the Doppler spectrum. • Settings are 1-10. The image on the left of the external carotid artery trace is using the default settings. The image on the right of the brachial artery is using a tint to enhanced the spectral display. Notes No. 54 SIEMENS Healthineers Auto TEQ tissue equalization technology SIEMENS .. : Healthineers ... Doppler optimization Automatic spectral Doppler Doppler Auto TEQ optimization of: Parameters Gain Dynamic Range • Gain Scale/Baseline Mode O Off • Scale / Baseline Entering Freeze Doppler Auto TEQ Target Spectral Intensity • Dynamic PW Low Range CW Medium 55 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto TEQ for Doppler is an instantaneous optimization of the Doppler spectrum. Auto TEQ for Doppler can be enabled manually at any time, or upon entering freeze which is the default for most exams. To activate Auto TEQ for Doppler, select Auto TEQ on the Touch Screen when in a live spectral Doppler trace to automatically optimize selected parameter(s). Available parameters are Dynamic Range, Scale, Baseline and Gain. For optimal workflow, listen to achieve the optimal signal, then select Freeze. Once the trace automatically optimizes, you can change multiple parameters post-processing including Dynamic range, Gain, Scale and Baseline for fine tuning. Select the System Configuration icon on the Touch Screen to select optimized parameter(s) under System Configuration > Image Settings > Imaging Mode > Doppler Auto TEQ. You can also adjust the Target Spectral Intensity for the PW and CW. Notes No. 55 SIEMENS Healthineers UltraArt SIEMENS . Healthineers ... Off LOW Mid High Mid Liveltive DAX Abdomen Abdomen TIB 4.35 TIB:4.35 TIC.2.46 TIC:2.46 TIS:1.22 TIS:1.22 ME.0.68 MI:0.66 10fps -1.00 10fps 95% 95% 2D H Low 0dB/DR60 -0.80 OdB/DR60 LD 3 UA 2 MapC/T5 P3 148/ Aorta 1dB/ Aorta P2/LD1 P2/LD1 PRF 1488 -0.20 PRF 1488 MapF/F4 MapF/F4 S2/Pr4 52/Pr4 2D + Color -m/s 20 + Color Low Low 64B/DR70 MapD/T6 High GS 2.0 PRF 3788 F 218 56 Unrestricted © Siemens Healthineers 2023 Speaker Notes: UltraArt also works in PW Doppler. • UltraArt selections are displayed as Off, Low, Medium and High, not an image as in 2D imaging. • Off is the natural image trace. • The edge and contrast enhancement is increased from Low to High. Notes No. 56 SIEMENS Healthineers Edge in PW Doppler SIEMENS . Healthineers ... W Edge -40 -30 .20 -cm/s 57 Unrestricted © Siemens Healthineers 2023 Speaker Notes: UltraArt includes edge enhancement, but the ACUSON Origin system provides additional edge control for Doppler. To increase the sharpness of the spectral trace, increase the edge. For a softer spectral trace, decrease the edge. Notes No. 57 SIEMENS Healthineers Live/Live (triplex) SIEMENS .. : Healthineers ... SV 1014 Carotin 521 x CW Workflow Patient 2D Color PW Imaging Review 13 Report Auto Trace Above Baseline End Exam Invert Auto TEQ Livellive Frequency Filter Gate Size weep Speed 1.5 mm Baseline Scale Steer PAF MPFE 60 Angle Correct 00 0 60 -26. 58 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Live/Live enables or disables the simultaneous live display (i.e., duplex or triplex mode ) of the B-mode, color image and / or Doppler spectrum in real time. Select Live/Live on the Touch Screen to activate / deactivate. In triplex, the frame rate will be lower. A video of the carotid artery using the software DVR in Live/Live (triplex) mode is displayed here. Notes No. 58 SIEMENS Healthineers Auto Trace SIEMENS .. : Healthineers ... Above Baseline Below Baseline Above and Below ED-20.30 cm/s Auto Trace Auto Trace MSD Above Baseline_ P2/102 PHF 3125 MapFIF3 20 . Color TAMx Show cmis D.O Time [] Show ms Tr Semi Major Axis Show cm D.OO Vei cm/s 0.0 Velocity Ratio 0.00 Vmax Show cm/s D.O Vmean Show cm/s 0.00 59 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Auto Trace function automatically traces the spectral Doppler waveform and records several measurements in PW Doppler (as displayed here in the internal carotid artery). The sensitivity and accuracy of Auto Trace flow statistics can be improved with gain control after the display is frozen. When gain optimization is enabled in the system configuration page, the gain is optimized at the start of Doppler scanning. Clinical scanning has shown this significantly improves user adjustments by instantaneously putting weak signals in a good range. To activate Auto Trace, select Auto Trace on the Touch Screen. Selecting Auto Trace (Above Baseline) control expands to allow you to choose, above and below the baseline or both) Auto Trace enables the display of Doppler statistics including beats per minute (bpm), pulsatility index (PI), resistive index (RI), systolic / diastolic ratio (S/D), peak systole (PS), end diastole (ED) time average max (TAMx),and time average mean (TAMn). Select settings for data above, below or on both sides of the baseline. Select the System Configuration icon on the Touch Screen to select the measurement display for Auto Trace for under System Configuration > Measurements and Reports > Measurement > Exam Package. Auto Trace is available on live and frozen images. Measurements populate to the report once entered in the measurement package. Notes No. 59 SIEMENS Healthineers Tint SIEMENS .. ; Healthineers ... 14L5 Carotid TIS:0.15 MI:0.34 10LA 21fps Tisolid 95% 100 MI.0.38 2D H Mid -90 95% OdB/DR65 20 LD 1 H Mid -70 4dB/DR60 Compound UA 2 -60 MapD/T5 Compound P2 -50 MapC/T5 C 40 3cm 8mm 60 D -30 OdB -20 PRF 3125 -10 PW -cm/s Low GS 1.5 10 F 60 20 cm/s 30 40 -20 50 .......... """invented" 60 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select Tint to colorize the Doppler spectrum. (Selections include 1 – 10). Adding a Tint may assist in measurements and spectral evaluation. A gold tint was used on the subclavian artery trace in the image on the left and the inverted rainbow tint was used in this full screen spectral tracing of the internal carotid artery. Notes No. 60 SIEMENS Healthineers Display modes SIEMENS .. ; Healthineers ... 10L4 Carotid TIB:1.05 TIC:0.51 TIS:0,26 MI:0.32 19fps 2D H High 8dB/DR60 c=1540 Pen -1.5dB General 15mm 60º PRF 2315 D 80 PW Mid GS 1.5 -60 PRF 3788 F 80 -40 cm/s I ................................................ 61 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are multiple display modes for Doppler that can be change live and when frozen. Display modes (1/2 B-mode - 1/2 trace ; 1/3 B-Mode - 2/3 trace ; Side by Side ; 2/3 B-Mode - 1/3 trace ; Full Screen). Select choice on the Touch Screen in live scanning or in Freeze. The default display can be set in the System Configuration > Image Settings > Image Mode. Notes No. 61 SIEMENS Healthineers Doppler post-processing SIEMENS .. : Healthineers ... • 2D / PW Gain • Ultra Art • Scale • Sweep Speed Baseline JB/DR.69 • • Dynamic Range 98B/ Genere • Invert • Maps 4.5cm • Angle Correct • Tints • Edge • Format (1/3-2/3, side-by-side, • Auto Trace 2/3-1/3, 1/2-1/2) 62 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following Doppler controls can be changed when the image is frozen: • 2D and PW Gain • Scale • Baseline • Invert • Edge • Ultra Art • Angle Correct • Sweep Speed • Dynamic Range • Maps • Tints • Format (1/3-2/3, side-by-side, 2/3-1/3, 1/2-1/2) Notes No. 62 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 63 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 63 SIEMENS Healthineers Trapezoid SIEMENS .. ; Healthineers' ... Trapezoid ED-21 76 cm/ HD2 22mm +0. BCD R PROX ICA 64 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Trapezoid angles the outer edges of the image on linear transducers to extend the far-field display. The left image is utilizing the 10L4 transducer on a small patient to visualize the proximal aorta. A tint was applied to enhanced the vessel anatomy and branches. The image in the middle is using trapezoid as well as Clarify VE to demonstrate the length of the brachial artery. The image on the right is demonstrating the use of trapezoid in PW Doppler to display a longer length of the carotid bulb and internal carotid artery. The angles are increased on each side as follows: • 10L4 transducer - 30 degrees • 14L5 transducer - 20 degrees Some common areas where trapezoid imaging is clinically used include: • Deep femoral arteries • Carotid imaging To activate / deactivate Trapezoid imaging, select Trapezoid on the Touch Screen. Notes No. 64 SIEMENS Healthineers 5C1 > wide field of view SIEMENS. Healthineers' ... 3 09 521 5V1 1014 5C1 Abdome Workflow Abdomen TIB.0.51 Patient MI:1.38 Imaging 95% UR Flip DID Flip Biopsy Timer Review 1dB/DR65 c=1540 Report LD 2 Compound UA 3 End Exam MapD/T5 P2 Auto TEQ Live Dual Harmonics Compounding Wide FOV Frequency Line Density *10cm H Mid 65 dB InFocus O 65 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Wide Field of View (Wide FOV) on the 5C1 transducer provides the ability of the imaging field of view to go from 70 cm to 100 cm without losing resolution. It is only available in B-mode. Once you enter another mode, it will revert to the original image. While this was specifically designed for measurements of a large liver or spleen or to display a larger view of a fetus, it could be useful in displaying a long segment of the aorta as shown in this image where we were able to capture the proximal aorta with renal arteries to the distal aortoiliac bifurcation. It is available on the following presets Presets: Abdomen, Abdomen difficult, Fetal Heart, OB and GYN To activate / deactivate Wide FOV imaging, select Wide FOV on the Touch Screen. Notes No. 65 SIEMENS Healthineers Dual SIEMENS .. ; Healthineers ... System Configuration System Settings Dual > Workflow Enhancement Imaging Settings General [] Enable Seamless Dual Capture Settings 21 Display all Imaging Parameters Imaging Mode Enter Full Screen When Activating Dual Image Parameter Display Measurement & Report > Annotations Dual > Features > Transducer > Connectivity & Network [] Enable Seamless Dual > Peripheral Devices System Management Display all Imaging Parameters Enter Full Screen When Activating Dual Restore Defaults 66 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dual displays two separately acquired images side-by-side. In Dual, the user can annotate, measure, add color/ power Doppler and place body markers on each adjacent image. The system can be configured for Dual imaging as well as a parameter display option. Check “Enable Seamless Dual” for seamless Dual functionality. Uncheck for conventional Dual. Conventional dual allows measurements on either the right or left image. Seamless Dual allows for measurement across the central line. Check “Enter Full Screen When Activating Dual“ to enter Full Screen mode when Dual is activated.. This will remove the patient banner, but provide a large Dual image. Uncheck for conventional Dual. To Configure , go to System Configuration > Image Settings > General. To configure hide / display image settings in Dual, select the System Configuration Icon > Image Settings > General and check or uncheck. Notes No. 66 SIEMENS Healthineers Dual SIEMENS. Healthineers' ... COMPRESSION CPV RIGHT 67 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Press Dual on the Control Panel to activate the Dual feature. Press Update to activate and toggle between images. Press 2D to exit Dual. The “a” in orange denotes the active side. One feature that is useful is once you freeze an image, you can press Dual, and the frozen image is placed on the left side of the dual image and the right side is live to do a comparative image. Examples using Dual as shown above include: • Venous imaging demonstrating compressed and non-compressed (top left) • Displaying two views of the same anatomy in 2D as shown in this image of the aorta (top mid) and carotid artery (bottom mid) • Displaying two views of the same anatomy in color Doppler as shown in this image of the carotid artery (top right) • Displaying two views of the same anatomy 2D using a tint as shown in this image of the saphenous vein (bottom left) • Using Seamless Dual to create a long segment of the carotid artery (bottom right) Notes No. 67 SIEMENS Healthineers Live dual SIEMENS .. : Healthineers' ... Live Dual 10L4 14L5 Carotid Carotid TIS:0.84 MI:1.16 TIS:0.22 MI:0.84 95% 23fps 2D 95% H Mid 2D -0dBDR60 $ 1540 H Mid LD 1 0dB/DR65 und 540 UA 2 LD 1 Gampound P2 JA 2 C Mid DIT5 2,5dB P2 Mera C PZ LD2 PRF 4167 S3/Pr4 MapF /F3 2D + Color 3cm 68 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Live Dual displays the same image side-by-side. It is accessed on the Touch Screen when doing vascular exams. Comparisons may include: B-mode, B-mode with Clarify B-mode and B-mode with color / power Doppler. Live Dual is often used to compare the B-mode image next to the color Doppler image in order to evaluate both the hemodynamics and the underlying B-mode image. On a live image, select Live Dual on the Touch Screen to activate or deactivate. The left image demonstrates the use of Live Dual of the subclavian artery using directional power Doppler. The image on the right demonstrates the carotid artery with and without color. Notes No. 68 SIEMENS Healthineers Zoom and HD Z SIEMENS ... Healthineers ... 10L4 Carotid G 7L2 TIB:0.62 Venous TIC:1.34 TIB:0.70 Zoom TIS:0.62 TIC:1.86 MI:1.15 TIS:0.70 19fps MI:1.38 95% 2D H High 2D 8dB/DR60 H High c=1540 6dB/DR65 C c= 1540 LD 2 UA 3 MapC/T5 RF 2315 P3 -16.5dB General P3/LD2 PRF 1488 MapO/F1 $4/Pr4 20 + Color 4.5cm HDZ Zoom HD Z 69 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Zoom control activates either Zoom or HD (high-definition) Zoom. • Zoom magnifies the image on a live or frozen image. A “Z” is displayed on the image screen (as displayed here in the image of Carotid bulb when in split mode) on the left). • Rotate Zoom to increase / decrease magnification of the image. Roll the trackball to pan the image. • Zoom is available in B-Mode, Color and in Split mode, the B-mode / Color Doppler image can also be Zoomed. • Zoom is not available in Anatomic M-mode. • HD Z acquires a high-definition image indicated within the zoom ROI (region of interest) box at a higher frame rate and updates the depth value on the image screen to indicate the distance from the skin line to the top of the zoom box. • Available on live image only and at an image depth greater than 2 cm. • When selected, “HD Z” displays on the image screen (as displayed here in the image of the femoral artery and vein) • To activate: • Press Zoom once to display the zoom box (region of interest). • Adjust the size or position of the zoom box and press a trackball key, if necessary. • Position indicates the trackball is assigned to repositioning the zoom box. A solid line outlines the zoom box. • Size indicates the trackball is assigned to resizing the field of view. A dotted line outlines the zoom box. • Roll the trackball to adjust the size or position: • Press Zoom a second time to activate. • Press Zoom a third time to deactivate. • HD Z is not available in Doppler and M-mode. Notes No. 69 SIEMENS Healthineers Image size SIEMENS. Healthineers' ... Image Size Image Size Image Size 1 5 70 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Image Size changes the size of the image. The default Image Size is 4. Increase or decrease Image Size for personal display preference. Pixels may appear tighter when using a smaller Image Size (as displayed in the image on the left of the Carotid bifurcation). The field of view (FOV) width is not affected when the image size is changed (settings range from 1 – 5). This is an example of the carotid bifurcation using the inverted Rainbow tint. Notes No. 70 SIEMENS Healthineers Additional display modes– sector size and width SIEMENS .: Healthineers ... 5C1 Abdomen TIB:0.20 TIC:1.12 Abdomen TIS:0.20 TIB:0.31 MI:1.38 TIC:1.24 23fps TIS 0.31 95% Mi:1.38 35fps 2D 95% HMd 20 OdB/DR65 H Md C=1540 OdBVOR65 Compound C=1540 Compound set Size Position 71 71 Restricted © Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: An additional B-mode display mode is the ability to increase and decrease the sector size or field of view. This is useful to remove artifacts from the image or to increase the frame rate especially when using Color Doppler. To adjust the sector size, press the Update key to activate Size and use the trackball to increase or decrease the size. To adjust the position of the sector, press the Update key to activate Position and move the sector to the right or left. In this example, the field of view was decreased to remove the artifacts from the image. Notes No. 71 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 72 Unrestricted @ Siemens Healthineers 2023 Restricted © Siemens Healthineers 2022 Speaker Notes: Review Transducers Describe B-mode controls and optimization Review Explain display modes Review Doppler controls Describe Doppler optimization features Notes No. 72 SIEMENS Healthineers Annotations > text and body markers SIEMENS . Healthineers ... Exam Package - Patient Cardiac Abdomen Breast Carotid Early OB etal Echo Imaging GYN Ped Hip LEA LEV Review MSK Neo Head Report OB Pediatric Abdomen Pelvis Penile Prostate Renal End Exam TCI Testis Thyroid UEA UEV tedy Maker Patere RIGHT CCA Imaging DICHT CCA JUGULAR Clear Screen Edit Caliper LEFT SUBCLAMAN Cine Hide Results BIFURCATION ECA VERTEBRAL Clear Joven 73 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The system supports multiple packages of Text Annotations and Body Markers for vascular imaging. The top right image is an example of the Carotid Body Marker page. The user can select the option on the Touch Screen, move the transducer icon by using the transducer widget or using the trackball. The Body Marker packages are customizable in System Configuration > Annotations > Body Markers. The lower image is an example of the Touch Screen for carotid imaging. The Text packages are customizable in System Configuration > Annotations > Text. They are customizable to the user preference. Notes No. 73 SIEMENS Healthineers Using the text feature SIEMENS. Healthineers ... Text Body Marker Arrow Exam Package Abdomen 501 Abdomen TIB:0.20 Patient TIC:1.12 TIS:0.20 Title Text RIGHT SAG AORTA MI:1.38 Imaging 23fps 95% 2D Review H Mid RIGHT SAG PANCREAS AORTA PROX LATERA 0dB/DR65 c=1540 Report Compound LEFT TRV LIVER IVC MID LLD End Exam MIDLINE GB KIDNEY DIST CBD SPLEEN SUP HEPATIC V INF PORTAL VEIN MEDIAL Select Line ext Size Cine RIGHT SAG AORTAI Clear Screen Home Set Home 74 Unrestricted © Siemens Healthineers 2023 Speaker Notes: This is an example demonstrating the use of the text package. Once the Text feature is activated, the Touch Screen displays the pre-defined text. Available text on the Touch Screen is white and becomes orange when selected. Active text on the image screen is teal and becomes yellow when set. To change text, select a different word and it will replace the existing text (text replace fields only). Temporarily hide annotations by selecting the Show/Hide control. Note: The control color is orange when text is hidden. To redisplay hidden text, select the Show/Hide control again. Only one word from each group or field can be selected in a consecutive line of text. To gain a detailed understanding of the package, please refer to the ACUSON Origin Text, Body Marker and Arrow Presentation. Notes No. 74 SIEMENS Healthineers Measurements and report SIEMENS .. ; Healthineers ... Exam Package Exam Package Carotid Default Carotid Patient Cardiac Abdomen Breast Carotid Early OB Fetal Echo Patient Right Left Imaging Imaging Review GYN Ped Hip LEA LEV MSK Neo Head Review Prox CCA Prox ICA Prox ECA Bulb Subclav A Vert A. Report Pediatric Abdomen Pelvis Fenile Prostate Renal Report End Exam Mid CCA Mid ICA Mid ECA End Exar Bulb IMT YOx CCA IMT Prox ICA IMT TCI Testis Thyroid UEA LEV Dist CCA Dat ICA Dist ECA Mid CCA IMT Mid ICA IMT ist CCA IMT Dist ICA IMT Bear Screen ££ Caliper Cine Hide Resu Clear Screen Edit Calipe Hide Results Select Cine 75 Unrestricted © Siemens Healthineers 2023 Speaker Notes: For vascular exams, Measurement and Report packages for Carotid, (Abdomen/Aorta/Renal), Lower Extremity Venous and Arterial, Upper Extremity Venous and Arterial and Transcranial are available. Measurement packages can be customized. These are explained in greater detail in the ACUSON Origin Measurement and Report Configuration an On Screen Measurement presentations. Notes No. 75 SIEMENS Healthineers Measurements and report SIEMENS . Healthineers ... VASCULARB 1.24:43 PM 219/2023 BRICA 76 Unrestricted © Siemens Healthineers 2023 Speaker Notes: This is an example of the measurement report for the carotid exam (top left). The user can also add up to 20 images to the report (bottom left). The institution logo can be added in System Configuration > Measurements > Report (bottom right). There is an assessment available as part of the report (top right.) The report can be exported to a USB in pdf format or stored as part of the patient file. Notes No. 76 SIEMENS Healthineers Measurements and report > IMT SIEMENS .. : Healthineers ... Default Exam Package Carotid Patient Right Left Jimaging Review Prox CCA Prox ICA Prox ECA Bulb Subclav A Vert A. Report Mid CCA Mid ECA FOX CCA IMT Prox ICA IMT End Exam Mid ICA Bulb IMT Dist CCA Dist ICA Dist ECA Aid CCA IMT Mid ICA IMT Dist CCA IMT Dist ICA IMT Clear Screen Edit Caliper Cine Hide Results 77 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Measurement package for Carotids has an IMT measurement tool. The video demonstrates the use of the tool. The results are included in the carotid package. There is a separate presentation (ACUSON Origin Inter-media Thickness Measurement) for step-by step directions and Quick Card for IMT available. Notes No. 77 SIEMENS Healthineers Needle enhancement SIEMENS .. : Healthineers ... Venous Biopsy Before entering the biopsy function, the system will make the following changes when you click OK Compound Enable trapezoid format. Biopsy Off OK Cancel Topay Needle Guide Argh Verily the angle selected on the needle guide attached to the transducer matches the selection on the touch screen. Lock the angle on the needle guide. 2 45cm Bidpayall Minimum Needle Length 78 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The system does have a limited needle enhancement feature. Needle Enhancement manipulates ultrasound signals for increased needle visualization. To access: • Select Biopsy on the 2D Touch Screen. • This will activate a prompt to allow the system to enable trapezoid format. • Select OK. • Next, select a biopsy angle choice (any choice). The user can go out of trapezoid by turning off Trapezoid on the 2D Touch Screen. The top image is without needle enhancement on a phantom image. The bottom image is with needle enhancement. Some users have found that using 2D Steer or activating trapezoid imaging can work as well and may have less steps, but this does provide an additional option. Notes No. 78 SIEMENS Healthineers Summary SIEMENS . Healthineers ... • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports 79 Unrestricted © Siemens Healthineers 2023 Speaker Notes: • Review Key Applications and Transducers • Examine Doppler Controls • Describe B-Mode optimization • Explain Color and Power Doppler optimization • Explain PW Doppler Optimization • Examine Display Modes • Review Annotation, Measurements and Reports Notes No. 79 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, C larify, Multihertz,TE Q an d UltraArt ar e 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 80 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 80 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS . Healthineers ... Questions? 81 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. 81