ACUSON Origin Z6T Transesophageal (TEE) Presentation

SIEMENS Healthineers SIEMENS Healthineers ... ACUSON Origin ultrasound system: Z6T Transducer 2.0 Software version Unrestricted © Siemens Healthineers, Unrestricted © Siemens Healthineers 20245 Notes No. 1 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Define and review the benefits, indications and contraindications of transesophageal echocardiography (TEE) • Review technical specifications, configuration, and imaging features of the Z6T transducer • Evaluate clinical images obtained with the ACUSON Origin ultrasound system and Z6T transducer • Identify care and cleaning procedures for the Z6T transducer 2 Unrestricted © Siemens Healthineers, 2025 Notes No. 2 SIEMENS Healthineers SIEMENS. Healthineers ... Transesophageal echocardiography Benefits, indications and contraindications 3 Unrestricted © Siemens Healthineers, 2025 Notes No. 3 SIEMENS Healthineers What is transesophageal echocardiography? SIEMENS. Healthineers ... Transesophageal echocardiography (TEE) is an invasive cardiovascular ultrasound imaging modality of the heart and great vessels that provides important information in the management of patients with a wide variety of cardiovascular disease.1 Diagnostic TEE: imaging performed to address a specific diagnostic question Intraprocedural TEE: imaging performed during surgical- or catheter-based procedures ...... 1. https://www.asecho.org/wp-content/uploads/2018/08/ASE-TEE-Scope- 4 Document.pdf Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The American Society of Echocardiography defines transesophageal echocardiography (TEE) as, an invasive cardiovascular ultrasound imaging modality of the heart and great vessels that provides important information in the management of patients with a wide variety of cardiovascular disease. • It is an essential imaging tool for cardiac surgeons, anesthesiologists, cardiac interventionalists, and clinical cardiologists. • TEE has proven utility in several clinical areas, including the operating room, intensive care unit, interventional laboratory, and outpatient setting and can be further classified into two areas: diagnostic and intraprocedural TEE. • Diagnostic TEE is performed to address a specific diagnostic question. • Intraprocedural TEE is imaging performed during surgical- or catheter- based procedures. Notes No. 4 SIEMENS Healthineers Benefits of transesophageal echocardiography SIEMENS . Healthineers ... 06 01 Improves patient outcomes: Quickly Superior visualization: Provides clearer provides valuable information and at low risk, which can improve patient ......................... views of the cardiac structures compared ......................... to transthoracic echo due to proximity of outcomes and survival the esophagus to the heart1 TT 05 02 Procedural guidance: Facilitates High-quality images: Acquire detailed assessment of device candidacy, mid-esophageal, upper-esophageal, procedural planning and intra- transgastric and deep trans-gastric procedural image guidance views with electronic steering that cannot be obtained on TTE imaging + 04 03 Assess cardiac structure & function: Diagnose conditions: Can help diagnose Evaluate valve function & wall ............. a variety of conditions, including motion before & after hemodynamic instability, cardiac cardiopulmonary bypass in the CVOR thrombus, aortic dissection & infective endocarditis 5 1. J Am Soc Echocardiogr 2013;26:921-64. Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • TEE imaging has many advantages, including: 1. For patients that are difficult to scan using transthoracic echo due to body habitus or access limitations, scanning from the esophagus offers an unobstructed view of the heart & great vessels with superior visualization of cardiac structure and function. 2. The position of the TEE transducer is constrained inside the esophagus, so it is important to have the ability to adjust the imaging plane relative to the position of the probe to allow the user to obtain different views of the anatomy without having to physically manipulate to probe. Electronic steering gives the ability to acquire high-quality images from cardiac views that cannot be obtained from TTE imaging. 3. TEE is able to help diagnose a variety of conditions including hemodynamic instability, cardiac thrombus, aortic dissection, and infective endocarditis. 4. It provides surgeons an assessment of valve function and wall motion before and after cardiopulmonary bypass in the CVOR to ensure the patient is ready for chest closure. 5. TEE imaging facilitates the assessment of device candidacy, procedural planning and devices deployed inside the heart can be visualized in relation to relevant cardiac anatomy, allowing the clinician to monitor progress of the procedure in real-time in the interventional lab. 6. Most importantly, it provides clinicians with valuable information at a low risk Notes No. 5 SIEMENS Healthineers with improves patient outcomes and overall survival. Notes No. 5 SIEMENS Healthineers Indications for transesophageal echocardiography SIEMENS. Healthineers ... General indications for TEE1 General indication Specific example 1. Evaluation of cardiac and aortic structure and function in situations a. Detailed evaluation of the abnormalities in structures that are typically where the findings will alter management and TTE is nondiagnostic or in the far field such as the aorta and the left atrial appendage. TTE is deferred because there is a high probability that it will be non- b. Evaluation of prosthetic heart valves. diagnostic. c. Evaluation of paravalvular abscesses (both native and prosthetic valves). d. Patients on ventilators. e. Patients with chest wall injuries. f. Patients with body habitus preventing adequate TTE imaging. g. Patients unable to move into left lateral decubitis position. 2. Intraoperative TEE. a. All open heart (i.e., valvular) and thoracic aortic surgical procedures. b. Use in some coronary artery bypass graft surgeries. c. Noncardiac surgery when patients have known or suspected cardiovascular pathology which may impact outcomes. 3. Guidance of transcatheter procedures. a. Guiding management of catheter-based intracardiac procedures (including septal defect closure or atrial appendage obliteration, and transcatheter valve procedures). 4. Critically ill patients. a. Patients in whom diagnostic information is not obtainable by TTE and this information is expected to alter management. 1. J Am Soc Echocardiogr 2013;26:921-64. 6 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • This table provides the general indications for performing TEE imaging according to the American Society of Echocardiography. • They include non-diagnostic TTE, intraoperative TEE, transcatheter procedures and critically ill patients. Notes No. 6 SIEMENS Healthineers Contraindications for transesophageal echocardiography SIEMENS. Healthineers ... List of absolute and relative contraindications to transesophageal echocardiography1 Absolute contraindication Relative contraindication • Perforated viscus • History of radiation to neck and mediastinum • Esophageal stricture • History of GI surgery • Esophageal tumor • Recent upper GI bleed • Esophageal perforation, laceration • Barrett’s esophagus • Esophageal diverticulum • History of dysphagia • Active upper GI bleed • Restriction of neck mobility (severe cervical arthritis, atlantoaxial joint disease) • Symptomatic hiatal hernia • Esophageal varices • Coagulopathy, thrombocytopenia • Active esophagitis • Active peptic ulcer disease GI, Gastrointestinal. 1. J Am Soc Echocardiogr 2013;26:921-64. 7 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The safety of TEE has been documented in multiple studies and to mitigate risk of TEE-related complications, the American Society of Echocardiography lists the conditions found on this table as absolute and relative contraindications for performing a TEE. Notes No. 7 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Define and review the benefits, indications and contraindications of transesophageal echocardiography (TEE) • Review technical specifications, configuration, and imaging features of the Z6T transducer • Evaluate clinical images obtained with the ACUSON Origin ultrasound system and Z6T transducer • Identify care and cleaning procedures for the Z6T transducer 8 Unrestricted © Siemens Healthineers, 2025 Notes No. 8 SIEMENS Healthineers SIEMENS . Healthineers ... Z6T Transesophageal echo transducer Technical specifications, configuration and features Click to add footnote 9 second line Unrestricted © Siemens Healthineers, 2025 Notes No. 9 SIEMENS Healthineers Technical specifications SIEMENS . Healthineers ... Frequency Distal tip Imaging scan Field of Maximum Trophon Design bandwidth Imaging modes articulation plan rotation view imaging depth compatible • Phased array, • 2.6 – 5.8 MHz • 2D • Anterior: 120° • 0° – 359° • 90° x 90° • 26 cm • Yes* multiplane (matrix) • Color • Posterior: 60° • 2304 elements • M-mode • Left: 45° (48x48) • PW • Right: 45° • 11,404,800 processing • CW channels • PW TDI • 15.5mm x 10.8mm • Biplane footprint • Volume/4D • Volume/4D Color B-Mode Color PW / TDI CW • Pen (5.0 MHz) • Low (3.3 MHz) • Low (3.3 MHz) • Low (3.3 MHz) 2D Frequencies • Mid (5.5 MHz) • Mid (4.0 MHz) • High (5.0 MHz) Default Setting • Res (5.8 MHz) • High (5.0 MHz) • H Mid (2.6 MHz) 4D Frequencies • Default Setting • Mid (5.0 MHz) Low (3.3 MHz) • Mid (4.0 MHz) 10 *See disinfectant chart for specific cleaners Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Z6T is a multiplane TEE transducer optimized for visualizing both cardiac anatomy and devices used within the heart for structural heart procedures that supports all standard modes for diagnostic and interventional imaging. • With over 2300 elements, this matrix volume imaging transducer supports The Z6T matrix TEE transducer is an imaging solution with over 2300 elements offering 2D, M-mode, color, PW, CW & PW tissue Doppler, in addition to biplane, 4D and 4D color imaging capabilities. • It has four (4) 2D frequencies, including one (1) harmonic (HMid: 2.6 MHz) and three (3) fundamental (Res: 5.8MHz, Mid: 5.5MHz, Pen: 5.0 MHz) and one (1) 4D fundamental frequency (Mid: 5.0 MHz). Notes No. 10 SIEMENS Healthineers Device specifications SIEMENS . Healthineers ... Flexible shaft Articulating section Controls Distal tip Strain relief for handle Strain relief for handle Cable Strain for the connector Handle Connector Electrical component on connector 11 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • This image defines the different components of the Z6T transducer. • There are also depth markers indicated every 10cm from 20cm -100cm along the flexible shaft of the transducer, which are not seen in this picture. • The surface of the transducer in contact with the patient includes the flexible shaft, the articulating section and the distal tip. Notes No. 11 SIEMENS Healthineers Transducer articulation controls SIEMENS . Healthineers ... Right / left flex control (White) Left / right flex control raised reference line Anterior / posterior flex Anterior / posterior flex control control raised reference line (Gray) Transducer handle raised reference line Friction brake (one located User-configurable smart on each side of handle) controls (two located on each side of handle) 12 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The flex controls, smart controls, and friction brakes are located on the handle of the transducer. • Siemens performed design evaluations to gain feedback from users prior to the release of the ACUSON Origin system. Based on feedback the following changes were implemented into the design of the handle and controls for the Z6T TEE transducer: • A/P control is located is larger and located on the bottom due to the higher frequency of use. • L/R control is located on top and smaller in size. • Increased separation between the two controls allows users to maneuver each individually without accidental movement of the other control. • Curved edge design of controls follows the shape of users’ hands / fingers more naturally. • Friction brakes are also located on the handle for both flexion controls Notes No. 12 SIEMENS Healthineers Flex controls SIEMENS. Healthineers Anterior Posterior Deflection Deflection (Anteflexion) (Retroflexion) ≤120° ≤60° ≤45° ≤45° Flex to the Flex to the Right Left Transducer Lens Neutral Neutral 13 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Flex controls manipulate movement of the distal tip of the transducer. • The WHITE, or TOP control manipulates left & right movement of the distal tip, and the GRAY, or BOTTOM control manipulates anterior & posterior or forward & backward movement of the distal tip. • The top of the control is labeled to indicate in which direction to rotate to manipulate the tip in the correct direction. For example, rotating the gray flex control toward ‘A’ marking moves the tip anteriorly, while rotating the white control toward the ‘L’ marking would move the tip to the left. • To place the distal tip in the neutral position, rotate both the left/ right & anterior/ posterior flex controls to align the raised reference lines with one another and with the raised reference line on the on the handle of the transducer (not visible in this image; see prior slide). • Always ensure both flex controls are in the neutral alignment position & both friction brakes are unlocked prior to any advancement or withdrawal the transducer, including during introduction and when further advancement or when necessary for the acquisition new echocardiographic views, so the transducer can bend to accommodate the path of the esophagus. • Advancing or withdrawing the transducer while controls are bent and / or rigid can result in injury or death. Notes No. 13 SIEMENS Healthineers Friction brakes SIEMENS. Healthineers O Raised tactile Flat portion of button in indicator in unlocked position locked position Right / left friction brake Anterior / posterior friction brake 14 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Friction brakes lock the deflection positions of the distal tip. • When the brakes are engaged, the scan plane can be changed without losing acoustical contact. • A friction brake is located on each side of the transducer handle. The friction brakes are color-coded to match their corresponding flex control. • Always ensure both friction brakes are unlocked & both flex controls are in the neutral alignment position prior to advancing or withdrawing the transducer, including during introduction and when acquiring new echocardiographic views & necessitating further advancement or withdrawal of the transducer or change in deflection, so the transducer can bend to accommodate the path of the esophagus. • Advancing or withdrawing the transducer while controls are bent and / or rigid can result in injury or death. Notes No. 14 SIEMENS Healthineers Smart controls SIEMENS . Healthineers There are four (4) Smart Control buttons on the transducer handle • Two (2) right-sided buttons and two (2) left- O sided buttons • Each button can be programmed to perform tasks such as acquiring an image or activating Right side: Smart Control A Right side: Smart Control B Doppler directly from the transducer Available options include: • Not assigned • PW On/Off • Capture • Freeze • Color On/Off • Rotate Forward • Increase Depth • Rotate Backward O • Decrease Depth • Increase Tilt Angle • BiPlane On/Off • Decrease Tilt Angle • CW On/Off • 4D On/Off Left side: Smart Control A Left side: Smart Control B 15 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are four (4) smart control buttons on the handle of the Z6T transducer, two (2) left-sided & two (2) right-sided. Each button can be programmed according to user preference for quick access to perform the equivalent function of a feature normally performed from the control panel or touch screen. • The available options are: • Not Assigned • Capture • Color On/Off • Increase Depth • Decrease Depth • BiPlane On/Off • CW On/Off • PW On/Off • Freeze • Rotate Forward • Rotate Backward • Increase Tilt Angle • Decrease Tilt Angle • 4D On/Off Notes No. 15 SIEMENS Healthineers Z6T system configuration SIEMENS. Healthineers ... Smart controls System Configuration System Settings 3 Workflow Enhancement 1 Workflow Z6T Imaging Settings S21 Lumas > Measurement & Report Assign function to controls Annotations y Tat Cool Down Features No restrictions Reset Orientation Reset Cropping 2 Transducers End Exam Volume Transducers 4 Not Assigned · Peripheral Devices Increase Depth (press-and-hold function) System Management Decrease Depth (press-and-hold function) Free Flare Violarme Enhance Catsuit Sinner Rotation Angle LAILA Color On/Off CW On/Off PW On/Off Distal Tip Freeze Mr Thickness Rotate Forward (press-and-hold function) Rotate Backward (press-and-hold function) Increase Tilt Angle (press-and-hold function) Decrease Tilt Angle (press-and-hold function) 4D On/Off Restore Detacita 16 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: 1. To assign a function to a Smart Control button, select the System Configuration menu from the touch screen. 2. Under the Transducers menu & select Volume or Matrix Transducers. 3. Select the Z6T tab. 4. In the Assign function to controls section of the Z6T tab, click the drop-down menu under the Smart Control button to be configured & click on the desired function to assign the selection. SIEMENS Healthineers Z6T system configuration SIEMENS. Healthineers ... BiPlane+ settings ZGT SZ1 1 3 270˚ BiPlane+ Settings 270º 1 otation 4 ree Tilt 90˚ Rotate at 360" O No restrictions 359 180 O Limit rotation to 180" O Perpendicular on tilt Increase Decrease BiPlane+ BiPlane+ angle angle 2 ilt Cursor Display Auto hide after 1.5 seconds Rotation Default BiPlane+ Rotation Angle with Right Plane Angle at 90˚ & 270˚ 3 Default BiPlane+ Rotation Angle 2 4 O Left 0º, Right 90" 60€ 120º No Restrictions 90 90º O Left 0', Right 270* Perpendicular on Tilt 270 Tilt Cursor Display Free Tilt 17 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The BiPlane+ Settings are also found under the Z6T tab of the System Configuration menu from the touch screen. • These settings include: 1. Rotation: Rotate at 360˚ or Limit rotation to 180˚; allows BiPlane+ angle to 2. Free Tilt: No restrictions or Perpendicular on tilt; with no restrictions, the left and right planes can be at any angle to one another when using the tilt function and with perpendicular to tilt the left and right planes would always remain at right angles to one another when using tilt function. 3. Tilt Cursor Display: Auto hide after 1.5 seconds (On or Off); icon below the reference plane & turquoise line indicating tilt plane location/ direction. 4. Default BiPlane+ Rotation Angle: Left 0˚, Right 90˚ or Left 0˚, Right 270˚; selecting Left 0˚, selecting the Right 270˚ option invert images in the right image plane on the image screen from the 90˚ orientation. SIEMENS Healthineers System configuration SIEMENS . Healthineers' ... Image display System Configuration ouch Screen User Defined Buttons Monitor Screen Saver System Settings 3 Wait Time 120 - Minutes (1~ 120) General Patient 1 Display Imaging Imaging Settings Review Control Panel User Defined Buttons Measurement & Report Repor U1 Annotations End Exam Features 4 O Hide Banner > Transducer Connectivity & Network Peripheral Devices Full Screen System Management 2 Eject USB 18 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: Additional System Configurations helpful for transesophageal imaging environments include image Display & Transfer settings. 1.Display settings are located under System Settings menu, configures the touch screen & image screen settings. 2. There are two (2) Touch Screen User Defined Buttons which will always be displayed in the left-hand panel of the touch screen during an exam. These add or remove touch screen buttons for direct access to frequently used controls. Some of the available selections include: • Full Screen: activates full-screen format on image screen, hiding the thumbnail panel & patient banner and enlarging the display area of the ultrasound image. Note: always acquire an image of any measurements or annotations on-screen prior to entering or exiting Full Screen mode as this action will automatically delete the on-screen information. • Hide Banner: temporarily hides the patient banner on the image screen, for example if storing an image for educational purposes. Note: this does not anonymize the study or remove patient information from the DICOM data, it only hides the information on the image itself. • Lock Screen: locks the touch screen & trackball. Pressing Freeze unlocks the touch screen & trackball. • Job Status: displays job status dialog box. • Eject USB: disconnects the USB from the system, quick access to eject if downloading files. 3.Monitor Screen Saver: Specifies the number of minutes before activating the screen saver. This can be set between 1 – 120 minutes. It is recommended setting Wait Time to the maximum 120 minutes for interventional imaging to ensure the screen does not enter screen saver mode if monitoring a procedure. Touching any control or trackball will return the system to imaging. 4. Control Panel User Defined Button U1 is a programmable key located on the control panel for direct access to frequently used controls, in addition to the touch screen controls. A few options include: • Full Screen: (See touch screen user defined button section above for functionality) • Hide Banner: (See touch screen user defined button section above for functionality) • Lock Screen: (See touch screen user defined button section above for functionality) Notes No. 18 SIEMENS Healthineers • Send to Store Server: sends images & clips to all DICOM storage servers configured for transfer at the end of the exam. • Job Status: (See touch screen user defined button section above for functionality) Notes No. 18 SIEMENS Healthineers System configuration SIEMENS.: Healthineers ... Image transfer SIEMENS System Configuration System Configuration Service Software 2 DICOM Service Local Service Hospital City Workflow Enhancement . Imaging Settings Compass Ultrasound System SN: Servir Type · Megstirement & Report Install Software Sequoia VA40A Annotations DICON Storage View Service Images . Features Default › Transducer Capture Service Logs 1 Connectivity & Network View Ucemes 4 System Management 6 MonitorTest Padernis Network Status Event Log Wireless Network System Information Restore All Defaults DICOM Configuration Driebe Security Monitor Settings . Peripheral Devices Service Restore NOTE: All monitor setting Systern Management changes require a reboot to tak 5 Local Service effect You are responsible for Danster Oningresoun initiating the reboot after C) JPEG Losy changing these settings Cl Explot Little Endian 7 V Enable Monitor GSDF Explot y Endan Black Test Comvert Mal he Mono@mm 3 Transfer 8 Ambient Light: Send/Receive Acoustic Data Fection · DarkRoom Enable DICOM GSDF Bedside OperatingRoom Graybar Te 19 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The next System settings to configure are the image Transfer settings. This is to ensure images will display similarly in the reading room as they do on the image screen, whether the exam is being performed in the OR, interventional lab or a patient’s bedside. • It is important to set up the image transfer setting properly when sending to a DICOM PACS monitor, especially for demonstrations. • This requires selecting and adjusting settings in two (2) locations in the System Configurations. 1. The first setting is found in the Connectivity & Network menu under DICOM Configurations settings. 2. Select the to select DICOM Service tab & under the Transfer menu. 3. Ensure Enable DICOM GSDF (grayscale standard display function) is selected. This option should always be activated when transferring images to a DICOM PACS monitor. • Next, access the monitor GSDF settings by navigating to the Local Service page. 4. Under System Management, select Service. 5. Next, select Local Service & press OK. 6. Select Monitor Test Patterns. 7. Ensure Enable DICOM GSDF (grayscale standard display function) is selected. 8. Then select the appropriate Ambient Light setting based on where imaging will be performed & acquired. For example, if scanning in a dark imaging room, select DarkRoom. If scanning in the CVOR or on a tradeshow floor where lighting is likely to be much brighter, select OperatingRoom. • This adjusts the monitor settings so images can be visualized on-screen in the imaging environment, while not being over- or under-gained when transferring to the PACS reading room. • Please refer the GSDF presentation for more information regarding this feature. • The ACUSON Origin System Configuration presentation provides complete details regarding System Notes No. 19 SIEMENS Healthineers Configuration. • A configuration simulator is also available to support customers with questions when not at a system. Notes No. 19 SIEMENS Healthineers Imaging with the Z6T transducer SIEMENS . Healthineers Safety Instructions • Upon connecting the Z6T to the ultrasound system & selecting it as the active transducer, a safety message appears on the image screen Safety Instructions • Select OK to continue Refer to the warnings and precautions in the user manual before each use of the • As best practice, always Freeze the image when transesophageal transducer. Review instructions for leakage current testing and the transducer is idle to manage lens for inspection, proper use, and disinfection of the transesophageal transducer. temperature & prevent overheating Note: If using multiple transducers OK during an exam, the Safety Instructions message will reappear each time the Z6T is selected as the active transducer 20 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When the Z6T is connected to the ultrasound system & selected as the active transducer, a safety message appears on the image screen. • Select OK to continue. • To manage the lens temperature & prevent overheating, Freeze the image when the transducer is idle, especially prior to the start of the exam as a best practice. • If using multiple transducers during an exam, the Safety Instructions message will reappear each time the Z6T is selected as the active transducer. Notes No. 20 SIEMENS Healthineers UltraArt universal image processing SIEMENS. Healthineers ... 2D imaging ZUT:38.8ºC 26T:38.8'C Off 1 Off Cardiac Cardiac TIS:0.33 1 TIS:0.33 MI:1.08 MI:1.08 23.5vps 23.5vps 95% 95% 40 4D Mic -208/DR50 PIN -24B.DR50 Speckle SO S1 MPR: MPR T5 T6 Reduction Vol: Val TB Te Ridge Enhancement / Edge Sharpening 2 3 2 ZGT: 38.8'C 26T:38.8'C Cardiac 3 TIS:0.33 Cardiac MI:1.08 TIS:0.33 23.5vps MI:1.08 23.5vps Contrast 95% 95% 4D Mid 4D Mid Enhancement -24B DR50 -24B.DRSO $2 MPR S3 TS MPR Vol T6 Te Val Gain & Dynamic Range Control 21 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • UltraArt universal image processing is a speckle reduction technology. When applied to images, speckle is reduced while maintaining natural tissue texture. It increases continuity of specular reflectors and better delineates contours of a structure and improving image detail and contrast resolution. • UltraArt technology further enhances the overall image quality of the Z6T transducer. • The major components of image enhancement for UltraArt include speckle reduction, ridge enhancement/ edge sharpening, contrast resolution and gain & dynamic range control. • There are four (4) 2D & four (4) 4D UltraArt settings on the Z6T, giving users the control to adjust the amount of smoothing and edge enhancement applied to the image based on personal preference. Notes No. 21 SIEMENS Healthineers Temperature controls and safeguards SIEMENS. Healthineers Thermal design (6) Static Temperature - Celsius 39.0188 7.57 3.79 38.8238 - 11.4 3.05 38.6288 9.43 Thermal design components of the distal tip 38.4338 • 38.2388 housing and braid along the transducer shaft 38.0438 transport heat away from the electronic 37.8488 18.9 37.6537 components & scanning array 37.4587 37.2637 Acoustic window provides thermal insulation 37.0687 • 36.8737 28.3 between the scanning array & esophagus to 36.6787 36.4837 prevent hot spots 36.2887 36.0936 35.8986 35.7036 35.5086 35.3136 Acoustic Window 35.1186 34.9236 Plane ! Staoc Tempera 34.7285 34.5335 Front Front Back 22 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The ability to generate & utilize the maximum amount of acoustic power while managing heat dissipation is one way Siemens defines transducer efficiency. • Due to concerns regarding possible thermal injury to the esophagus due to the local buildup of heat during transesophageal echocardiography, Siemens Healthineers has incorporated novel thermal management technology in the interest of patient safety, along with targeted design optimization of the acoustic stack and transducer body to enable deeper penetration and stronger signals where possible into the design of the Z6T, all while meeting regulatory standards. • Unique thermal design components of the distal tip housing and braid along the transducer shaft of the Z6T transport heat away from the electrical components of the array to prevent excessive overheating which can be common in matrix array transducers. • The acoustic window provides thermal insulation between the scanning array and the esophagus to prevent hot spots. Notes No. 22 SIEMENS Healthineers Temperature controls and safeguards SIEMENS. Healthineers ... Near thermal limit Z6T: 41.7ºC Cardiac TIS:0.42 MI:0.94 7.7vps • When lens surface temperature reaches 95% 42.0°C, system displays warning message on 4D Mid 20dB/DR60 image screen & suspends imaging O Res V 75 Th15 Wait for transducer to cool <41.0°C Op70 • $5 Bro • Or, select Override to unfreeze the system Con50 MPR. & resume live imaging MapDITS Vol: MapG/T8 Near Thermal Limit Resuming imaging risks reaching Transducer temperature is 42ºC. The system has stopped imaging. Wait A maximum thermal limit, resulting in for the transducer to cool. Or, click Override to continue imaging. rendering the system inoperable until transducer is disconnected or replaced Override 23 Unrestricted © Siemens Healthineers, 2025 Speaker Notes • There is a temperature sensor mounted in the distal tip of the transducer which monitors the scanning array temperature when the Z6T is plugged into the ultrasound system and active. • The lens temperature is displayed in the imaging parameters on the image screen. • When temperature is ≤ 37°C, system displays temperature as < 37°C. • Temperatures > 37°C, system displays actual temperature. • To prevent damage to the patient’s esophagus, the following events will occur when the Z6T lens temperature reaches certain thermal limits: • Near Thermal Limit: when the transducer reaches 42˚C the system will display a warning message on the image screen and suspend imaging. At this time, the user can: 1. Wait for the transducer to cool to below 41˚C to resume imaging. 2. Select Override, to dismiss message & resume live imaging. • Resuming imaging risks reaching maximum thermal limits for the transducer, which will result in the system becoming inoperable until the transducer is disconnected, cooled & reconnected and / or replaced. • Based on amount of imaging time remaining, mechanisms for cooling the transducer should be applied. • Note: In an effort to provide maximum notice for the transducer to be cooled before reaching maximum temperature limits, Near Thermal Limit warning message may appear before the on-screen temperature displays 42°C, based on internal Notes No. 23 SIEMENS Healthineers temperature sensor reading, which may not yet be reflected in the on-screen reading. Notes No. 23 SIEMENS Healthineers Temperature controls and safeguards SIEMENS. Healthineers ... Mechanisms for reducing lens temperature Cardia 521 22 Lumos Workflow Patient Physio • Cool Down: if temperature is high, but still 2D <42.5˚C, select Cool Down button on page 2 of Imaging Cool Down Timer 2D & 4D touch screens to manually active Review software which cools down the transducer Report • Reduces frame / volumes rates by 50% End Exam without lowering transmit power • Only available in 2D, 2D+Color, 4D, & 4D+Color imaging modes × mage Size • Reducing acoustic output can also lower surface Transfer Data temperature of the lens Transmit Power Rotate Transmit Power control 95 % Density Cropping Mode Persist Maps • R-R D Tint counterclockwise to decrease acoustic output 24 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When Near Thermal Limits warning has been displayed, or when transducer temperature is increasing, mechanisms for cooling the transducer should be applied if continuing to image. • Manually activating Cool Down mode or reducing acoustic output are two methods to lower the surface temperature of the lens while still actively imaging. • If the transducer has not yet reached 42.5˚C, or if the patient has a fever, Cool Down is a software feature which cools down the transducer by reducing frame rates & volume rates by 50%, without lower transmit power or mechanical indices. • This can be manually activated by the user prior to lens temperature reaching 42.5˚C, when the system will automatically force a Cool Down State due to reaching the temperature threshold. • This setting is available in 2D, 4D and color imaging modes. • To activate, select the Cool Down button on page 2 of the 2D touch screen. Select Cool Down to exit / deactivate the software. • The imaging parameters will display a new data field stating Cool Down & the frame / volume rate will be highlighted on the image screen when the Cool Down feature is activated while imaging. Similar to when Cool Down State is automatically activated by the system. • Reducing acoustic output can also lower the surface temperature of the lens. This can be employed at any time while imaging, before reaching maximum thermal temperature of 43.0˚C • Rotate the Transmit Power control counterclockwise (1st rotary control on page 2 of SIEMENS Healthineers the 2D touch screen) to lower Transmit Power and reduce acoustic output. • As best practice, always Freeze the image when the transducer is idle to help manage lens temperature & prevent overheating. Notes No. 24 SIEMENS Healthineers Temperature controls and safeguards SIEMENS. Healthineers ... Z6T: 42.5ºC Cool down state activated OVERRIDE Cardise 3.8vps Cool Down • For lens surface temperature ≥ 42.5°C, system displays warning message on image screen & 4D Mid 20dB/DR60 automatically activates Cool Down State Ò Res V 75" Th 15 • To indicate the system is in Cool Down State Op70 S5 Bro while imaging: Con50 MPR: MapD/T5 Vot • Lens temperature will be displayed in orange MapG/T8 font • Frame / volume rate will be highlighted Cool Down State Activated • Imaging parameter display area will read OVERRIDE below temperature display & Cool Transducer temperature is approaching 43"C. Cool Down state has Down below the Frame Rate / Volume Rate been enabled. Cool Down can be turned off manually if a higher frame rate is needed. Display OK 25 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Cool Down State: when lens surface temperature exceeds 42.5˚C, the system automatically activates Cool Down State & reduces the temperature, allowing for uninterrupted imaging. The system will display the following message: Transducer temperature is approaching 43°C. Transducer Cool Down State has been enabled. Cool Down can be turned off manually if higher frame rate is needed. The user can: 1. Wait for the transducer to cool to below 41˚C to resume imaging. 2. Select OK, to dismiss message & resume live imaging. • To indicate the system is in Cool Down State while imaging, the lens temperature will be displayed in orange font & frame rate / volume rate will be highlighted. It will also read OVERRIDE below the lens temperature reading & Cool Down under the Frame Rate / Volume Rate in the imaging display parameters. • To manually disable system activated Cool Down State, select Cool Down button on page 2 of the 2D & 4D tabs on the touch screen. • While in Cool Down State, 2D frame rates & 4D volume rates, both with & without color Doppler are reduced by 50% to lower the lens temperature. Frame rates / volume rates will remain at 50% until the system is out of Cool Down State. • Reduction in frame rate does not affect M-mode & spectral Doppler modes. To reduce acoustic output & lower lens temperature while imaging with these modes, manually reduce Transmit Power using the 1st rotary control on page 2 Notes No. 25 SIEMENS Healthineers of the 2D touch screen. Notes No. 25 SIEMENS Healthineers Temperature controls and safeguards SIEMENS. Healthineers ... Transducer cooled ZST: < 37'C 4,8vps • System will automatically deactivate Cool Down State & display a message on the image screen to indicate when lens surface temperature has cooled to <41.0°C • Transducer temperature will again be displayed in white font • Cool Down / OVERRIDE will be removed from imaging parameters TEE Cooled • Frame / volume rates will no longer be highlighted & return to original value Transducer has cooled. Click Proceed to continue imaging. Proceed 26 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The system will automatically deactivate Cool Down State & display a message on the image screen to indicate when lens surface temperature has cooled to <41.0°C. • Select, Proceed, to dismiss message & resume imaging. • Transducer temperature will again be displayed in white font. • Cool Down & OVERRIDE will be removed from the imaging parameters display area. • Frame / volume rates will return to their original value & no longer be highlighted. Notes No. 26 SIEMENS Healthineers Temperature controls and safeguards SIEMENS. Healthineers ... Maximum thermal limit Inactive:43.0'C OVERRIDE Cardiac TIS:0.42 MI:0.94 7.7vps 95% • When lens surface temperature reaches 43.0°C, D system displays warning message on image id 20dB/DR60 Q Res screen, suspends imaging & limits available ¥75 Th 15 system controls Op70 S5 Bro Con50 • To resume imaging, transducer must be MPR: MapD/T5 disconnected from the system Vol MapG/TB • Transducer may be reconnected after cooling, or replaced with a different transducer to continue imaging Maximum Thermal Limit ................... .................. The system will remain inoperable until Transducer temperature is 43"C. Imaging has been suspended. Disconnect the transducer. Reconnect the transducer after the A overheated transducer has been transducer has cooled. Or, use a different transducer. disconnected, or power has been cycled to OK ............... the system 27 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Maximum Thermal Limit: when lens surface temperature reaches 43.0˚C, the system stops imaging & limits available controls, rendering the system inoperable. The following message will be displayed: Transducer temperature is 43°C. Imaging has been suspended. Disconnect the transducer. Reconnect the transducer after the transducer has cooled. Or, use a different transducer. • To resume imaging, the user is required to disconnect the transducer from the system. • After temperature has cooled, the transducer can be reconnected, or a different transducer can be used to resume imaging. • Note: The system will remain inoperable until the overheated TEE transducer has been disconnected, or power has been cycled to the system. • If the system's hardware detects the lens surface temperature has exceeded the acceptable limit, the system stops imaging and displays the following message: The transducer temperature is above the acceptable limit. Disconnect the transducer. Remove the transducer from the patient. Contact your Siemens service representative. • Observe the on-screen message; disconnect the transducer and remove the transducer from the patient. • Failure to disconnect & remove a TEE transducer that has exceeded the maximum thermal limit can burn the patients’ esophagus. • Contact your Siemens Healthineers service representative. Notes No. 27 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Define and review the benefits, indications and contraindications of transesophageal echocardiography (TEE) • Review technical specifications, configuration, and imaging features of the Z6T transducer • Evaluate clinical images obtained with the ACUSON Origin ultrasound system and Z6T transducer • Identify care and cleaning procedures for the Z6T transducer 28 Unrestricted © Siemens Healthineers, 2025 Notes No. 28 SIEMENS Healthineers SIEMENS. Healthineers ... Z6T Transesophageal echo transducer Clinical images 29 Unrestricted © Siemens Healthineers, 2025 Notes No. 29 SIEMENS Healthineers Z6T clinical images SIEMENS.: Healthineers .. ZGT :39.7ºC Z6T: 38.8ºC Cardiac Cardiac TIS:0.68 TIS:0.68 MI:0.37 124 MI:0.37 66fps 51fps 95% 95% 2D 2D Mid 3dB/DR60 -4dB/DR56 LD 3 UA 2 MapD/T5 16cm 59bpm Lead Il 60bpm 2D four-chamber image 2D imaging of transcatheter mitral edge-to-edge repair 30 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Regardless of the modality, the Z6T transducer & ACUSON Origin ultrasound system deliver superb image quality in every scan with DICOM gray scale matching to ensure the same crisp images presented on both the system & the PACS. • The cardiac chambers in this 2D four-chamber image are clean & black with a delineated blood pool-tissue border interface and with minimal visualization of the blood pool. The valve leaflets are crisp in appearance without extraneous thickening. • Here a transcatheter mitral valve edge-to-edge repair device is clearly seen without acoustic shadowing obscuring visualization of the valve leaflets during intraprocedural guidance. Notes No. 30 SIEMENS Healthineers Z6T clinical images SIEMENS.: Healthineers ... ZGT : 38.6ºC 26T :39,2ºC Cardiac TIS:0.79 Cardiac ME:1.26 151 MI:1.18 19fps 28fps 95% 95% 2D 2D Mid Mid -4dB/DR56 1dB/DR60 LD 3 LD 3 UA 2 UA 2 MapD/T5 MapD/T5 C C Low 192 Low OdB -5.5dB General General PRF 5556 PRF 5952 .1an HD Z 60bpm 62bpmn Lead !! Color Doppler imaging of interatrial shunt flow Color Doppler imaging of prolapsed mitral valve 31 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The color Doppler flow imaging on the Z6T transducer is sensitive enough to identify & define relevant hemodynamic information without bleeding of the color flow into cardiac tissue. • This interatrial shunt flow demonstrates exceptional color Doppler sensitivity, without bleeding color into the surrounding tissue. • In the image of the prolapsed mitral valve, the PISA flow convergence is well visualized & defined by the color Doppler, optimizing quantification. Notes No. 31 SIEMENS Healthineers Z6T clinical images SIEMENS. Healthineers ... ZGT: 40.8ºC ZGT: 39.0ºC Cardiac Cardiac TIS:0.75 30. 20º TIS:0.68 MI:0.50 MI:0.47 26fps 30fps 95% 95% ZD 2D Res Mid -8dB -2dB DR52 DR60 LD 3 LD 3 UA 2 UA 2 MapD/T5 MapD/T5 P1 12 cm 59bpm Lead 11 68bpm Lead 11 2D BiPlane+ imaging of interatrial septum for transseptal puncture 2D BiPlane+ imaging of the left atrial appendage to evaluate for thrombus 32 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • BiPlane+ imaging improves workflow efficiency for the imager. • It offers the ability to image a structure of interest in two different planes simultaneously in both 2D & 2D with color Doppler. • This provides imagers with more information to diagnose and enable treatment for patients even faster. • It also minimizes manipulation of the transducer, making imaging more streamlined. Notes No. 32 SIEMENS Healthineers Z6T clinical images SIEMENS. Healthineers ... 267:39-1"C ZGT :39.2ºC Cardiac Cardiac TIS:0.33 TIS:0.30 35.0vps ME:1.13 51.7vps 4D 95% DR51 4D Mid 0dB/DR51 52 MapDITS VOL: 60bpm Live 4D zoom imaging of the left atrial appendage at 35 vps Live 4D full volume imaging of a catheter tip at 51 vps 33 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D imaging on the ACUSON Origin ultrasound system with the Z6T TEE transducer demonstrates clinically relevant volume rates in live 4D volume imaging which is critical for real-time intraprocedural guidance. Notes No. 33 SIEMENS Healthineers Z6T clinical images SIEMENS. Healthineers' ... ZGT: 40.5ºC ZGT: 39.0ºC Cardiac Cardiac TIS:0.77 TIS:0.71 ML:1.34 MI:1.37 14.1vps 95% 95% 4D 4D Mid Mid 13dB/DR60 MPR: -9dB/DR60 TS S2 Vol: Bro TB Con50 MPR MapD/T5 Low Vol: OdB MapA/T8 General C PRF 5102 Low Th15/Op70 OdB P1/LD2 RF 4808 Pr2 MPR MapD/F3 2D + Color Vol: MapA 2D + Color 4D Z 60bpm Lead 11 Live 4D zoom color Doppler imaging of prosthetic mitral valve Live 4D zoom color Doppler imaging of the aortic valve 17 vps paravalvular leak at 14 vps 34 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Real-time 4D volume color Doppler with a superior volume rate provides the clinician with valuable information about the leak for diagnosis and / or intervention. Clinically relevant volume rates in live 4D color Doppler imaging provide clinically relevant & physiologically accurate detail. • The ACUSON Origin ultrasound system and Z6T TEE transducer have integrated legacy imaging & cropping tools incorporated with workflow enhancements, in addition to new imaging & workflow tools. • Please refer to the 4D Imaging Fundamentals presentation for more on 4D imaging workflow. Notes No. 34 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Define and review the benefits, indications and contraindications of transesophageal echocardiography (TEE) • Review technical specifications, configuration, and imaging features of the Z6T transducer • Evaluate clinical images obtained with the ACUSON Origin ultrasound system and Z6T transducer • Identify care and cleaning procedures for the Z6T transducer 35 Unrestricted © Siemens Healthineers, 2025 Notes No. 35 SIEMENS Healthineers SIEMENS . Healthineers ... Z6T Transesophageal echo transducer Care and cleaning Click to add footnote 36 second line Unrestricted © Siemens Healthineers, 2025 Notes No. 36 SIEMENS Healthineers Transporting, storing and handling the Z6T transducer SIEMENS. Healthineers ... Transporting the transducer • The protective suitcase Z6T transducer is delivered with provides a secure shipping container & allows for safe delivery of the transducer between facilities • Always reprocess / disinfect the transducer after transporting transducer within the case • Do not store reprocessed, disinfected transducers within this case • A dedicated transportation tray delivers a safe method for transporting the TEE transducer between departments & examinations • Transportation container should provide a clear indication of transducer status: Clean / Dirty Protective suitcase Use of dedicated transportation cases has shown to reduce damage to the TEE transducer Transportation tray* *This example of a CIVCO transportation tray can be ordered through the CIVCO 37 Medical Solutions. Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Z6T transesophageal transducer is delivered in a sturdy hard cover case with foam insulation to protect the transducer during long distance transportation and shipping. • Use the case for shipping or for moving the disinfected transducer from one site to another. • Ensure the distal tip is straight & the cable is free of kinks when carefully placing the transducer in the foam padding. • Use an approved disposable tip protector on the distal tip during storage. • Before closing the lid, ensure nothing protrudes from the case. • Do not store the transducer in this case. • Always reprocess (disinfectant clean) the transducer prior to patient use after transporting within this case. • A transportation tray delivers a safe method for transporting the TEE transducer between departments & examinations. • It is recommended to use a dedicated transportation container within the facility for both clean and soiled TEE transducers. This container should have clear indications as to the status of the transducer (clean or dirty). • Dedicated transport containers have an advantage over pillowcases, or reusable plastic boxes. These containers provide: • Dedicated molding of container to keep connector and delicate guide tube and element array away from each other. • Clear indication as to status of transducer (clean or dirty). • Molded areas to reduce liquid intrusion within handle and connector • Disadvantages for use of a transparent plastic container to transport a TEE transducer between departments include: • The connector pod to rub against the guide tube or transducer imaging element array. Notes No. 37 SIEMENS Healthineers • Not having dedicated sections to separate & protect against fluid intrusion into fluid sensitive areas i.e. the control housing or connector pod. Notes No. 37 SIEMENS Healthineers Transporting, storing and handling the Z6T transducer SIEMENS. Healthineers ... The TEE transducer is a mechanically sensitive Take extreme care when handling and storing device. the transducer. H. • ALWAYS use a clean, • Never attempt to move After disinfecting / store approved tip protector the articulating segment the transducer in a as the distal tip is very / distal tip of the clean, dry & protected sensitive to pressure transducer manually environment • Do NOT reuse • Never bend or loop the • Do NOT store in protector after flexible shaft of the transducer holders on reprocessing transducer tighter than a 30.5cm (12in) the system transducer • circumference Do NOT store a wet or • Ensure friction brakes damp transducer in a are OFF, distal tip is container 230.5cm (12in) • straight, and cables & Do NOT store in flexible shaft are free of circumference extreme temperatures kinks when storing or direct sunlight transducer 38 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The transesophageal transducer is a mechanically sensitive device. Take extreme care when handling and storing the transducer. • The distal tip is especially sensitive to pressure. • Always use an approved disposable tip protector on the distal tip of the transducer during storage. • Do not reuse the tip protector after reprocessing the transducer. • Never attempt to move the articulating segment / distal tip of the transducer manually. • Always use the flex controls. • It is important to never bend or loop the flexible shaft of the transducer tighter than a 30.5cm (12in) circumference when handling the transducer. • Excessive bending of the flexible shaft can cause breakage of internal wires. • Damaged wires can cause image artifacts or disable the transducer completely. • Ensure the friction brakes are off, the distal tip is straight, and the cables & flexible shaft are free of kinks when storing the transducer. • The TEE transducer should be stored in a clean transportation case only after it has been properly disinfected & reprocessed. • Store the transducer in a clean, dry, protected environment. • Never store a wet or damp transducer in any container. • Transducer should NOT be stored in the transducer holders on the ultrasound system. • Do not store the transducer in extreme temperatures or direct sunlight. • Refer to the user manual for additional information. Notes No. 38 SIEMENS Healthineers Cleaning and disinfecting the Z6T transducer SIEMENS . Healthineers ... Warnings and cautions Never use steam heat or ethylene oxide for disinfecting the transducer. These disinfection methods may WARNING: damage the jacketing material, transducer array, or articulation controls, making the device unsafe for patient use. Never use steam heat or ethylene oxide for disinfecting the transducer. These disinfection methods may WARNING: damage the jacketing material, transducer array, or articulation controls, making the device unsafe for patient use. WARNING: Never use iodine or solutions containing iodine for cleaning or disinfecting the transducer. Iodine will cause degradation of the shaft material & distal tip resulting in a dangerous electrical hazard. Caution: Never clean the transducer with bleach. Cleaning with bleach will damage the flexible shaft jacketing material, which will invalidate the manufacturer's warranty and could increase leakage current. Caution: Do not clean the transducer with ethanol or methanol. Ethanol and methanol can damage the transducer. Caution: Never immerse the entire transesophageal transducer in any solution. Immersion of the transducer handle could introduce fluid into the housing & cause damage to the controls or steering cables. Caution: Do not immerse the transducer above 100 cm from the distal tip; doing so may damage the controls. 39 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are several key items to be aware of prior to cleaning or disinfecting the transducer. Notes No. 39 SIEMENS Healthineers Cleaning and disinfecting the Z6T transducer SIEMENS. Healthineers ... Pre-cleaning the transducer at point of use Disconnect and remove transducer Moisten a clean gauze pad or soft, Carefully wipe the surface of the from ultrasound system lint-free cloth with water or an transducer in contact with the • Remove & dispose of any approved cleaner, or use an patient protective cover / transducer approved cleaning wipe, or • Avoid contact with the sheath, if applied sponge* electrical components on the connector ........... Pre-cleaning the transducer at the point of use immediately following each use prevents contaminants from drying on the surface of the transducer ............. 40 *For a list of approved cleaners & disinfectants, click HERE Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The transducer must always be properly cleaned & disinfected before the first use & following each subsequent use of the transducer. • There are four stages in preparing the transducer for the next clinical use following an exam: • The immediate, point of use pre-cleaning, deep cleaning, disinfection & electrical leakage testing. • Pre-cleaning a transducer immediately after each use at the point of care removes mucus & bioburdens & prevents contaminants from drying on the surface of the transducer facilitating subsequent cleaning. • Disconnect & remove the transducer from the ultrasound system. • Always freeze the image before removing any transducer from the system. • If used during the exam, remove & dispose of any protective cover or transducer sheath accordingly. • Moisten a clean gauze pad or soft, lint-free cloth with water or an approved cleaner, or using an approved cleaning wipe or sponge. • Using unapproved cleaning products can cause discoloration, material degradation or solution build-up. • Carefully wipe the surface of the transducer in contact with the patient. Avoid contact with the electrical components on the connector. • Carefully inspect the transducer for any visible signs of damage or deterioration. • Always document any irregularities identified with the transducer. • If damage or breaks within the flexible shaft is seen, clean the transducer, set aside & contact a Siemens Healthineers Service representative. • Upon completion of the pre-cleaning, a deep cleaning can be performed according to procedure. Note: Refer to the user manual for additional information. Notes No. 40 ✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓ Acrylan *For a list of approved cleaners & disinfectants, click HERE Cleaning and disinfecting the Z6T transducer Pre-cleaning immediately at point of use ANIOSYME DD1 Speaker Notes: • • Asepti-Zyme Azo Detergent Wipes (Azodet) The use of any cleaners other than those specified here may damage the transducer and, as a result, may create electrical hazards for patients and / or Visit the Siemens Healthineers Ultrasound Transducer and System website to users. review the most up-to-date approved cleaners & disinfectants. Azo Universal Cleaning and Disinfectant Wipes AZOMAX wipes & spray CaviCide CaviWipes CIDEZYME Enzymatic Detergent Solution CIDEZYME XTRA CLEANISEPT WIPES CLEANISEPT WIPES forte Clinell Universal Wipes & Spray EmPower Endozime ENZOL ESCULASE First Step Bedside Kit gigasept AF Healthineers HospiCare Multi-Surface 60R Instru-Zyme Gel INTERCEPT Detergent Approved cleaners* SIEMENS Lapcholyzime Liquizime Medi-Fect Wipes Medipal Disinfectant Wipes Medizyme MetriZyme mikrozid sensitive wipes & liquid neodisher MediClean forte NUZyme Ultrasound Probe Enzymatic Sponge Orthozime Penta Wipes (Case Solutions) Prepzyme Prolystica 2X Concentrate Enzymatic Presoak & Cleaner Protex Disinfectant Spray and Wipes Protex ULTRA Disinfectant Wipes Protozyme Reynard Premier Detergent & Disinfectant Wipes RTU Enzymatic Wipe Sani-Cloth Active Wipes Unrestricted © Siemens Healthineers, 2025 Sani-Cloth AF Universal Wipes Sekulyse Septiwipes Simple2 Enzymatic Detergent SURFA'SAFE Premium Healthineers ... TEEZyme Trionic D Wipes SIEMENS. trophon companion cleaning wipes Notes No. 41 Tuffie 5 Universal sanitising wipes Virusolve+ Disinfectant Wipes 41 WIP'ANIOS Excel SIEMENS Healthineers Cleaning and disinfecting the Z6T transducer SIEMENS. Healthineers ... Cleaning the transducer Prerequisites: ✓ Transducer is disconnected & removed from the ultrasound system ✓ Transducer sheath is removed from the transducer (if used) Select an approved cleaner.* Action 1 Always follow manufacturer's instructions for concentration & temperature of the solution & contact time when cleaning the surface of the transducer. Clean distal tip & flexible shaft of transducer using one (1) of the following cleaning methods: Action 2 Immersion: Submerge distal tip & flexible shaft up to the 100-cm mark. Do not allow handle, controls, cable, or connector to become wet. Wiping: Carefully wipe distal tip & flexible shaft. Spraying: Spray distal tip & flexible shaft away from the ultrasound system. Never spray the transducer connector. Clean the handle, controls, cable & connector of the transducer. Keep electrical components on the connector dry. .---- Action 3 Moisten a clean gauze pad or soft, lint-free cloth with an approved cleaner, or use an approved cleaning wipe.* Carefully wipe the handle, controls, cable, and connector. Rinse the distal tip & flexible shaft up to the 100-cm mark according to the cleaner manufacturer's instructions. Action 4 Do not rinse handle, controls, cable, or connector. Always keep the electrical components on the connector dry. Note: If rinsing instructions not provided by the cleaner manufacturer, thoroughly rinse distal tip & flexible shaft up to the 100-cm mark with deionized water at room temperature. 42 *For a list of approved cleaners & disinfectants, click HERE Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Cleaning the transducer removes soil, bioburdens & contaminants from the surface of the transducer & prepares the transducer for disinfection. • To deep clean the TEE transducer, the transducer must first be disconnected & removed from the ultrasound system & any probe cover / protective sheath must also be removed if not already done so during the initial pre-cleaning. • The distal tip is very sensitive to pressure. Take care not to damage the tip while cleaning the distal tip. • Follow actions 1 – 4. • Do not soak the transducer in the cleaning solution longer than the manufacturer’s guidelines. • Once deep cleaning is complete, the transducer is ready for disinfection or reprocessing. Note: Always follow department protocols for proper cleaning & disinfection of the transducer. Notes No. 42 *For a list of approved cleaners & disinfectants, click HERE Cleaning the transducer Cleaning and disinfecting the Z6T transducer ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Acrylan Speaker Notes: • • ANIOSYME DD1 The use of any cleaners or disinfectants other than those specified here may Visit the Siemens Healthineers Ultrasound Transducer and System website to and / or users. damage the transducer and, as a result, may create electrical hazards for patients review the most up-to-date approved cleaners & disinfectants. Azo Universal Cleaning and Disinfectant Wipes AZOMAX wipes & spray CaviCide CaviWipes CLEANISEPT WIPES CLEANISEPT WIPES forte Clinell Universal Wipes & Spray Descosept Spezial Approved intermediate and low-level disinfectants* Ecolab Quaternary Disinfectant Wipes gigasept AF HospiCare Multi-Surface 60R Healthineers Medi-Fect Wipes Medipal Disinfectant Wipes SIEMENS Mikrobac Tissues mikrozid sensitive wipes & liquid Protex Disinfectant Spray and Wipes Protex ULTRA Disinfectant Wipes Reynard Premier Detergent & Disinfectant Wipes Sani-Cloth Active Wipes Sani-Cloth AF Universal Wipes Sani-Cloth AF3 Germicidal Disposable Wipe Sani-Cloth HB Germicidal Disposable Wipe Sekulyse Septiwipes SONO Ultrasound Wipes SURFA'SAFE Premium Unrestricted © Siemens Healthineers, 2025 Trionic D Wipes Tristel Solo for Ultrasound trophon companion cleaning wipes Healthineers ... Tuffie 5 Universal sanitising wipes SIEMENS. Virex II 256 Virusolve+ Disinfectant Wipes Notes No. 43 WIP'ANIOS Excel 43 SIEMENS Healthineers Cleaning and disinfecting the Z6T transducer SIEMENS. Healthineers ... Disinfecting the transducer Prerequisites: ✓ Transducer has been cleaned. Select an approved disinfectant for high-level disinfection.* Action 1 Follow the disinfectant manufacturer's instructions for concentration & temperature of the solution & contact time when high-level disinfecting the surface of the transducer. Disinfect distal tip & flexible shaft of transducer using one (1) of the following cleaning methods: Immersion: Submerge distal tip & flexible shaft up to the 100-cm mark. Do not allow handle, controls, cable, or connector to become wet. Action 2 Wiping: Carefully wipe distal tip & flexible shaft. Spraying: Spray distal tip & flexible shaft away from the ultrasound system. Never spray the transducer connector. Reprocessing: Use a device compliant with ISO 15883 & follow the reprocessing device manufacturer's instructions. Disinfect the handle, controls, cable & connector of the transducer. Keep electrical components on the connector dry. Action 3 Moisten a clean gauze pad or soft, lint-free cloth with an approved high-level disinfectant, or use an approved disinfectant wipe.* Carefully wipe the handle, controls, cable, and connector. Rinse the distal tip & flexible shaft up to the 100-cm mark according to the cleaner manufacturer's instructions. 100 cm Action 4 Do not rinse handle, controls, cable, or connector. Always keep the electrical components on the connector dry. Note:. If rinsing instructions not provided by the manufacturer, thoroughly rinse distal tip & flexible shaft up to the 100-cm mark with deionized water at room temperature Action 5 Follow the disinfectant manufacturer's instructions for drying the transducer. Do not use heated air. Note: If the disinfectant manufacturer does not provide drying instructions, dry the transducer with a clean, soft, lint-free cloth. Action 6** Store the transducer in a clean, dry, protected environment. Apply an approved disposable tip protector to the distal tip before storage. Transducer is fragile; do not be store in the transducer holders on system. *For a list of approved cleaners & disinfectants, click HERE 44 **If electrical leakage test has not yet been performed; perform testing prior to storage Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Depending on the facility, disinfection or performing the electrical leakage testing of the transducer is be performed after deep cleaning. • Disinfection destroys pathogens and other microorganisms & prepares the transducer for storage or the next clinical use. • The distal tip is very sensitive to pressure. Take care not to damage the tip while disinfecting the distal tip. • Follow Actions 1 – 6 to disinfect the transducer. • Follow the disinfectant manufacturer's instructions for concentration & temperature of the solution & contact time when disinfecting the surface of the transducer. • Refer to the disinfectant manufacturer's instructions for guidance on proper rinsing of the disinfectant from the transesophageal transducer. If rinsing instructions are not provided by the manufacturer, thoroughly rinse distal tip & flexible shaft up to the 100-cm mark with deionized water at room temperature. • Any disinfectant remaining on the transesophageal transducer can burn the patient's mouth or esophagus. • Always follow departmental protocols for disinfection, electrical leakage testing & proper storage of the transducer. Note: Refer to the user manual for additional information Notes No. 44 SIEMENS Healthineers Cleaning and disinfecting the Z6T transducer SIEMENS. Healthineers ... Disinfecting the transducer Approved high-level disinfectants* DSD EDGE Dual Basin AER with Rapicide PA Disinfector with TD-8 DSD EDGE Dual Basin AER with Rapicide PA UV Smart D60 System with Rapicide PA System with Rapicide PA ADVANTAGE PLUS Endoscope Reprocessing Antigermix E1 ASTRA TEE with CIDEX OPA ASTRA TEE with MetriCide OPA Plus ADVANTAGE PLUS Endoscope Reprocessing Antigermix E1 ASTRA TEE with CIDEX OPA ASTRA TEE with MetriCide OPA Plus TD100 Automated TEE Probe Disinfector with TD-5 TD100 Automated TEE Probe Disinfector with TD-8 TEEClean Automated TEE probe Cleaner ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 45 *For a list of approved cleaners & disinfectants, click HERE Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The use of any cleaners or disinfectants other than those specified here may damage the transducer and, as a result, may create electrical hazards for patients and / or users. • Visit the Siemens Healthineers Ultrasound Transducer and System website to review the most up-to-date approved cleaners & disinfectants. Notes No. 45 SIEMENS Healthineers Additional resources SIEMENS. Healthineers ... .... Diagnostic Ultrasound Navigate to the Siemens Healthineers Transducer Cleaners ultrasound transducer and system and Disinfectants website for current approved cleaners: https://www.siemens-healthineers.com/en- us/ultrasound/ultrasound-transducer-catalog Ask your local Siemens Healthineers Call the local Customer Care Center representative for an approved list HO 46 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • For specific instructions on the care & cleaning of the transducer, in addition to the user manual: • Ask your local Siemens Healthineers representative for an approved list. • Navigate to the Siemens Healthineers Ultrasound Transducer and System website to review the current approved cleaners. • Or, call the local Customer Care Center. Notes No. 46 SIEMENS Healthineers Z6T electrical safety SIEMENS. Healthineers ... Leakage current testing WARNING: The leakage current test for WARNING: To prevent electric shock and possible injury to transesophageal transducers must be performed prior anyone near the leakage current tester, avoid touching the to each use in order to reduce the likelihood of harm conductivity probe when the tester is on. Refer to the to the patient. Unsafe leakage current could result in manufacturer's operating instructions for the leakage electrical burns to the patient during use, including current tester. during defibrillation. Refer to the manufacturer's operating instructions for the leakage current tester. WARNING: To avoid damage to the transducer, Leakage current testing must be observe the immersion levels. Do not allow the transducer handle, controls, strain relief, cable, and performed prior to each use of the Z6T system connector to become wet. Keep the handle, transducer. Passing criteria assures the flex controls, strain relief, cable, and connector dry to prevent introducing fluid into the housing and leakage current is within acceptable limits damage to the controls or steering cables. at the time of the test. 47 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Electrical leakage current testing measures the leakage current of a transesophageal transducer independent of an ultrasound system. • Due to the proximity of the TEE transducer to the heart during a normal procedure, abnormally elevated electrical leakage currents can be hazardous to the patient. • Excessive electrical leakage could result in burn to the patient or even induce micro-shock, resulting in cardiac fibrillation. • This test ensures the electrical leakage current is within acceptable limits & is required for the TEE transducer prior to each use. Notes No. 47 SIEMENS Healthineers Electrical leakage current testing SIEMENS. Healthineers ... Equipment AmpSat Z6T Transducer Conductivity Probe MASIN PRO Conductive Liquid Leakage ZGT Connector Current Adapter Tester Refer to the list of approved disinfectants or the Siemens Healthineers ultrasound transducer and system website for a list of approved disinfectants. 48 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The following is required to perform the electrical leakage current test: • The Z6T transducer • Compatible leakage current tester, cables & leakage tester manufacturer's instructions for use. • Compatible transducer adapter • Dual conductivity probe • Test basin • Conductive liquid (sterile saline solution or an approved disinfectant) • Refer to the list of approved disinfectants or the Siemens Healthineers Ultrasound Transducer and System website for a list of approved disinfectants. • Do NOT use distilled water. Notes No. 48 SIEMENS Healthineers Electrical leakage current testing SIEMENS . Healthineers ... Compatible leakage testers Compatible transducer adapter BC Biomedical ULT-2020 ultrasound Acertera AmpSafe leakage tester For use with third-party leakage transducer leakage tester • BYOD (PC / tablet / phone) operation using any • tester • Basin and connectivity probe included in kit device with web browser Included with purchase of Z6T • Conductivity probe more convenient for • Basin and conductivity probe included in kit • transducer customers using automated reprocessing • Tablet purchasable though Siemens machines Healthineers • Contains selectable Siemens Z6T Pass / Fail data • Contains selectable Siemens Z6T Pass / Fail in the user interface data in the user interface • Results logging feature is included • Advanced data logging with cloud support through Acertera AULT- 2020 BATH AmpSafe ACERTARA 49 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The required compatible transducer adapter to connect Z6T to the leakage tester is included with the purchase of the Z6T transducer. • There are currently two (2) third-party leakage testers compatible with the transducer adapter for the Z6T: • BC Biomedical ULT-2020 • Acertara AmpSafe • The leakage tester does not come with the transducer & is available for purchase through Siemens Healthineers. • The UL-2020 is more common & preferred by customers using automated reprocessing machines due to the longer conductivity probe option. • AmpSafe is newer to the market & is a bring-your-own-device system. Requires any device with a web browser. Tablets are purchasable through Siemens Healthineers. • If a customer currently has either of these supported models, additional purchase is not required. • Confirm the existing leakage tester is one of two models listed & the firmware is updated & current to work with the adapter. Notes No. 49 SIEMENS Healthineers Electrical leakage current testing SIEMENS . Healthineers ... Preparing for the leakage current test Prerequisite: ✓ A compatible leakage current tester & a compatible transducer adapter. Action 1 Connect the transesophageal transducer to a compatible transducer adapter. Immerse the liquid-tight portion of the transducer into a bath of disinfectant or sterile saline solution up to, Action 2 but not beyond, the 100-cm mark. Keep the handle, flex controls, strain relief, cable, & system connector dry. Action 3 Place the conductivity probe in the disinfectant or sterile saline solution bath to a minimum depth of 25 mm 100 cm (1 inch). Action 4 Connect the transducer adapter and conductivity probe to the leakage current tester as indicated in the manufacturer's operating instructions for the leakage current tester. 50 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Follow Actions 1 – 4 to prepare to conduct the leakage current test. • Refer to user manual & leakage tester manufacturer's instructions for further information. Notes No. 50 SIEMENS Healthineers Electrical leakage current testing SIEMENS. Healthineers ... Preparing for the leakage current test Prerequisite: ✓ Prepare for the leakage current test. Carefully follow the manufacturer's operating instructions for the leakage current tester as you perform all required tests, for example: • Action 1 Enter required test voltage & leakage current test values; or select default test settings for the Z6T transducer. • Test leakage current tester. • Test bath conductivity, if necessary. Note: Compatible leakage current tester may simultaneously test the bath conductivity & the TEE transducer. • Test the transesophageal transducer. Obtain leakage current results for the transducer. Action 2 • PASSING indicates transducer can be prepared for use. • FAILING indicates transducer did not pass the leakage current test. Check all connections & then re-test the transducer. If a failure occurs again, do not use the transducer for a patient study & contact Siemens Healthineers service representative. To prepare the transducer for use, rinse the distal tip & flexible shaft of the transducer up to the 100-cm mark according to the disinfectant manufacturer's instructions. Action 3 Do not rinse the handle, flex controls, strain relief, cable, or connector. Keep the electrical components on the connector dry. Note: If the disinfectant manufacturer does not provide rinsing instructions, thoroughly rinse distal tip & flexible shaft up to the 100-cm mark with deionized water at room temperature. 51 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Follow Actions 1 – 3 to conduct the electrical leakage current test. • If rinsing instructions are not provided by the manufacturer, thoroughly rinse distal tip & flexible shaft up to the 100-cm mark with deionized water at room temperature. • Any disinfectant remaining on the transesophageal transducer can burn the patient's mouth or esophagus. • If transducer do not pass after two (2) test attempts, do not use the transducer for a patient study & contact Siemens Healthineers service representative. • Always follow departmental protocols for disinfection, electrical leakage testing & proper storage of the transducer. • Refer to user manual & leakage tester manufacturer's instructions for further information. Notes No. 51 SIEMENS Healthineers Z6T transesophageal transducer SIEMENS . Healthineers ... Preventing injury and equipment damage Potential harm to patient / Preventive measure Problem potential damage Place TEE transducer’s flex controls in the neutral alignment position, without applying Improper insertion or withdrawal Esophageal cuts, bruising, bleeding, the friction brakes, when inserting or withdrawing the transducer. ligament damage, perforations Do not force the transducer. Inspect TEE transducer prior to each use to ensure that it is functioning properly & Mechanical damage, electrical Severe trauma, esophageal cuts, bleeding, that it has no cuts, tears, fraying, loose parts, or rough edges. damage, leakage current perforation, electrical burns, serious electrical hazards Use only isolated output electrosurgical units with the TEE transducer. Non-isolated electrosurgical units Electrical burns Disconnect transducer when it is not in use. Adjust the Transmit Voltage (dB or %) as low as clinically useful. Observe the on-screen Improper transducer temperature Esophageal burns temperature warning messages & respond accordingly. and/or acoustic output For maximum safety, disconnect TEE transducer from the system prior to defibrillation Defibrillation Electrical burns rather than relying on the transducer’s built-in safeguards. Maintain a regimen of electrical safety checks. Electrical damage, leakage current Esophageal burns, electrical damage Put the transducer in the neutral position, without either friction brake applied, when Pressure necrosis Permanent damage to esophageal inserting or withdrawing it. Minimize pressure applied to the articulating section & lining distal tip. Do not let the distal tip displace tissue for more than five minutes. Do not use TEE transducer if a patient has esophageal varices or masses or strictures Esophageal varices Excessive bleeding are present. 52 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Following the preventive measures outlined in this table will help ensure patient safety & prevent avoidable equipment damage. Notes No. 52 SIEMENS Healthineers Z6T transesophageal transducer SIEMENS . Healthineers Preventing injury and equipment damage Potential harm to patient / Preventive measure Problem potential damage Do not use the TEE transducer for any procedure requiring hyperextension of the neck. Improper patient position Vocal cord paralysis Be aware that a patient with a loose tooth could lose the tooth during a TEE Improper assessment of dental risk Tooth loss procedure. Use a bite guard. No dental protection Dental damage; electrical damage Follow bite guard manufacturer’s instructions to clean, disinfect & rinse bite guard if Disinfectant residue on the bite Burns in the mouth and esophagus using reusable bite guard. guard and TEE transducer Refer to the disinfectant manufacturer's instructions for guidance on proper rinsing of the disinfectant from the TEE transducer. Never use steam heat or ethylene oxide for disinfecting the TEE transducer. Improper cleaning resulting in Esophageal burns Do not use any disinfectants other than those specified. electrical damage Do not use iodine or solutions containing iodine for cleaning or disinfecting the transducer. Immerse TEE transducer no longer than time required by the manufacturer for high- Improper disinfection, exposing Nosocomial infection, electrical damage level disinfection. electrical workings to liquids affecting image quality, electrical safety, or Never immerse transducer controls or the system connector in liquids. mechanical operation Do not force distal tip articulation. Always use the controls to alter articulation. Forcing the deflection control Stretching or breaking deflection controls Store TEE transducer in a clean, dry, protected environment, for example, suspended Improper storage Damage to array elements, cuts & abrasions from a wall rack. Do not store the transducer in a tight coil. to the flexible shaft 53 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Following the preventive measures outlined in this table will help ensure patient safety & prevent avoidable equipment damage. Notes No. 53 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS. Healthineers ... Questions? 54 Unrestricted © Siemens Healthineers, 2025 Notes No. 54 SIEMENS Healthineers Trademarks and disclaimers The products/features mentioned in this document may not be commercially available in all countries. Due to regulatory reasons their future availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. ACUSON Origin is a trademark 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. Origin 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 Healthineers AG Siemens Medical Solutions USA, Inc. CO Siemensstr. 3 Ultrasound 91301 Forchheim, Germany 22010 S.E. 51st Street Phone: +49 9191 18-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-heathineers.com/ultrasound Unrestricted © Siemens Healthineers, 2025