ACUSON Maple 1.0 Arterial Health Package Presentation

SIEMENS Healthineers SIEMENS Healthineers .. Acuson Maple Ultrasound System syngoⓇ Arterial Health Package (AHP) 1.0 Software Release Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this presentation we will discuss the syngo® Arterial Health Package (AHP) on the ACUSON Maple ultrasound system. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Define the syngo Arterial Health Package • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discusssyngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 2 2 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here are the objectives for this presentation. We will start with defining the syngo AHP. Notes No. 2 SIEMENS Healthineers syngo AHP The syngo AHP software provides the clinician with the capability to measure the Intima Media Thickness (IMT) of a patient. The results can then be referenced to normative tables that have been validated and published in peer- reviewed studies. The information is intended to provide the clinician with an easily understood tool for communication with patients regarding the state of their cardiovascularsystem. 3 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The syngo AHP allows the clinician with the capability to measure the Intima Media Thickness (IMT) of a patient. The results can then be referenced to normative tables that have been validated and published in peer-reviewed studies. The information is intended to provide the clinician with an easily understood tool for communication with patients regarding the state of their cardiovascular system. This software should only be utilized according the American Society of Echocardiography Consensus Statement for assessing cardiovascular disease (CVD) risk. Notes No. 3 SIEMENS Healthineers American Society of Echocardiography (ASE) Consensus Statement The syngo Arterial Health Package application should be ASE CONSENSUS STATEMENT Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular utilized according to the American Society of Disease Risk: A Consensus Statement from the American Society of Echocardiogramhy Carotid Intima-Media Thickness Task Force Echocardiography Consensus Statement, “Use of Carotid Endorsed by the Society for Vascular Medicine James H. Stein, MD, FASE, Claudia E. Korcarz, DVM, RDCS, FASE, R. Todd Hurst, MD, Ultrasound to Identify Subclinical Vascular Disease and Eva Lonn MD, MSe, FASE, Christopher B. Kendall, BS, RDCS, Emile R. Mohler, MD, Samer S. Najjar, MD, Christopher M. Rembold, MD, and Wendy S. Post, MD, MS, Madison, Wisconsin; Scottsdale, Arizona; Hamilton, Ontario, Canada; Philadelphia, Pennsylvania; Baltimore, Maryland; and Charlottesville, Virginia Evaluate Cardiovascular Disease Risk: A Consensus Continuing Medical Education Course for "Use of Carotid Ultrasound to identify Bubclinical Vascular Disease and Evaluate Cardiovas- cular Disease Risk: A Consensus Statement for the American Society of Echocardiogramotid intima-Media Thickness Task Force" Accreditation Statement: The American Society of Echocardiogramhy Is accredited by the Accreditation Council for Continuing Medical Education to provide con- tinuing medical education for physicians. The American Society of Echocardiogramhy designates this educational activity for a maximum of 1 AMA PRA Category | Creditste Statement from the American Association of Physicians should only claim credit commensurate with the extent of their participation in the activity. ARDMS and CCI recognize ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers, The American Society of Echocardiogramhy Is committed to resolving all conflict of Interest issues, and its mandate is to retain only those speakers with financial interests that can be reconolied with the goals and educational integrity of the educational program. Dis- closure of tacuity and commercial support sponsor relationships, If any, have been indicated. Target Audience: Echocardiography Carotid Intima-Media Thickness Task 1. Physicians, physicians' assistants, and nurses with an interest in cardiac and vascular imaging, preventive cardiology, and cardiovas- cular disease risk assessment. 2. Ultrasonographers with interest in vascular imaging and cardiovascular disease risk assessment. objectives: Upon completing this activity, participants will be able to: 1. Describe the rationale for using carotid ultrasound to Identity subcinical vascular disease and to evaluate cardiovascular disease risk. 2. Explain the application of carotid ultrasound to cardiovascular disease risk assessment. 3. Describe the scanning technique for identifying subemnical vascular disease using carotid ultrasound, 4, Explain Ine Force, Endorsed by the Society for Vascular Medicine.” key components of interpreting carotid uitrasound studies for cardiovascular disease risk assessment. Authors Disclosures James H. Stoin, MD, FASE: Research grants: Siemens Medical Solutions, Sonosite intellectual property; listed as the inventor of Patent #US 6,730,0235 "Ultrasonic Apparatus and Method for Providing Quantitative indi- Cation of Risk of Coronary Heart Disease." It has been assigned to the Wisconsin Alumni Research Foundation. Emlie R. Mohier III, MD: Speakers bureau for Morck, HMS-Sanofi and AstraZeneca; Research grant support from HMS-Sanofi, Patzer and GBK. Christopher M. Rembold, MD; Advisory Board for Bonostte. Estrnated Time to Complete This Activity: 1 hour Keywords: Atherosclerosis, Cardiovascular disease, Carotid arteries, Carotid intima-media thickness, Risk factors, Ultrasound diagnosis, Ultrasound http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A copy of the American Society of Echocardiography ASE Consensus Statement, “Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: A Consensus Statement from the American Association of Echocardiography Carotid Intima-Media Thickness Task Force, Endorsed by the Society for Vascular Medicine” is easily downloaded for reference at www.asecho.org. This ASE Consensus Statement should be referred to when training customers and installing the syngo AHP at any institution, as the software should be utilized according to the recommendations put forth in the journal article. Notes No. 4 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 5 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the Framingham risk score. Notes No. 5 SIEMENS Healthineers Cardiovascular disease Cardiovascular diseases (CVDs) are the number one cause of death globally, accounting for 31% of deaths worldwide. Coronary heart disease (CHD) accounts for the majority of CVD deaths, followed by stroke and heart failure. Cardiovascular diseases produce immense health and economic burdens in the United States and globally – the cost is expected to reach $1044 billion by 2030 (worldwide). Prevention and early detection are key features in managing the global burden of cardiovascular diseases. One way to help reduce the impact of CVDs is to identify patients at high risk who may benefit from early intervention. Statistics courtesy of American Heart Association. Heart Disease and Stroke Statistics 2017 at a glance. https://healthmetrics.heart.org/wp-content/uploads/2017/06/Heart-Disease-and-Stroke-Statistics-2017-ucm_491265.pdf 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: What is cardiovascular disease and why is it so important? Cardiovascular diseases are the number one cause of death globally, accounting for 31% of deaths worldwide. Coronary heart disease, known as CHD, accounts for the majority of cardiovascular disease related deaths followed by stroke and heart failure. Economically, cardiovascular diseases puts a big strain on healthcare dollars on a worldwide stage, with the costs of CVD expected to reach into the billions by the year 2030. Prevention and early detection are key features in managing the global burden of cardiovascular disease. The ability to identify patients at high risk who may benefit from early intervention is a key factor to help reduce this global impact. Notes No. 6 SIEMENS Healthineers Framingham Risk Score (FRS) In 1948 the National Heart Institute embarked on a project to identify the common factors or characteristics that contribute to CVD. The study, knowns as the Framingham Heart Study, was conducted in the town of Framingham, Massachusetts on 5,029 men and women between the ages of 30 and 62. The results of the study produced the Framingham Risk Score – a gender specific algorithm used to estimate the 10 year cardiovascular risk of an individual. Today, the Framingham Risk Score exists for men and women aged 20 years or older who do not have heart disease. Factorsinvolved in the calculation include total cholesterol, HDL cholesterol, systolic blood pressure, hypertension, diabetes, body mass index, and smoking. https://www.framinghamheartstudy.org/ 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: One of the ways that these candidates can be identified is by using the Framingham Global Risk Assessment model. In 1948 the National Heart Institute embarked on project to identify the common factors or characteristics that contributed to cardiovascular disease. Little was known about the general causes of heart disease and stroke but the death rates from cardiovascular disease were steadily increasing. The study was conducted in the town of Framingham, Massachusetts on 5,029 men and women between the ages of 30 and 62 and was intended to last only 20 years. The study, however, is still going on today and is in it’s third generation of participants. The results of the original study produced the Framingham Risk Score – a gender specific algorithm used to estimate the 10 year cardiovascular risk of an individual. The components used to calculate the risk have been updated over the years to include or exclude different factors. Today the Framingham Risk Score is used for men and women over the age of 20 years that do not have heart disease and include such factors such as: • Total cholesterol • HDL cholesterol • Systolic blood pressure • Hypertension • Diabetes • Body mass index (BMI) • Smoking Values are assigned for the presence or absence of the factors and a risk is calculated placing patients into a low, medium, or high-risk category. There are limitations to the Framingham Risk Score: • The Framingham algorithm is influenced strongly by chronological age • Patients of the same age with similar risk profiles can differ substantially if you take into consideration their existing atherosclerotic burden • The Framingham CHD risk result could over or underestimate the risk in different ethnic groups, as well as populations outside of the USA Notes No. 7 SIEMENS Healthineers Carotid Intima-Media Thickness(CIMT) As a screening test, imaging should be safe, sensitive, affordable and contribute to improved patient condition. Measuring carotid intima-media thickness with B-mode ultrasound is: • Sensitive • Non-invasive • Reproducible • Cost-effective Increased CIMT has been directly associated with an increased risk for cardiovascular events (i.e. myocardial infarction and stroke) in adults without a history of CVD. CIMT values may help improve risk prediction and / or the value of implementing preventative therapies. http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When faced with limitations the best course of action is to expand the assessment scope to include other factors that may narrow that limitation. To combat the issue of existing atherosclerotic burden with the Framingham Risk Score, one of the modifications proposed was to measure the carotid intima-media thickness. As a screening test, imaging should be: • Safe • Sensitive • Affordable • Produce results that contribute to a patient’s outcome Imaging of the carotid intima-media thickness with B-mode ultrasound is a sensitive, non- invasive, and highly reproducible imaging test for quantifying atherosclerotic burden. Increased CIMT has been directly associated with an increased risk for cardiovascular events (i.e. myocardial infarction and stroke) in adults without a history of cardiovascular disease. Notes No. 8 SIEMENS Healthineers CIMT versus carotid duplex SIEMENS. Healthineers Carotid duplex exams: • Use ultrasound and Doppler to identify sclerotic plaque L10-5v Carotid within the vessel lumen causing alteration of blood flow Tx Power 98% MI 0.88 TIS 0.2 TIB 1.0 • Areas of plaque large enough to disrupt / alter blood flow can 4.0 MHZ 5580 Hz Gate 1.0 mm equate to an extensive atherosclerotic burden -3 dB 32 fps Carotid intimal thickness studies: 4.40 mming • Examine the artery wall rather than the lumen • The [CIMT] measurement is the combined thickness of the tunica intima and media layers of the blood vessel http://www.asecho.org 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: How does CIMT differ from a carotid duplex ultrasound exam? A carotid duplex exam uses Doppler to identify atherosclerotic plaque within the vessel lumen causing alteration of blood flow. Blood flow in areas of concern are easily assessed with Doppler to determine the amount of flow disruption caused by the plaque. Blood velocity will increase when exiting the area of narrowing. If plaques are large enough to disrupt or alter blood flow, this can equate to an extensive atherosclerotic burden for the patient. CIMT examines the artery wall rather than the lumen and blood flow velocity. The CIMT measurement is the combined thickness of the tunica intima and media layers of the blood vessel. Notes No. 9 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the ASC recommendations for use. Notes No. 10 SIEMENS Healthineers ASE recommendationsfor use The ASE Consensus statement indicates measuring CIMT and identifying carotid plaque by ultrasound is most useful for refining CVD risk assessment in patients at intermediate CVD risk. Intermediate risk is considered to be a Framingham Risk Score of 6%-20%. Patients with the following clinical circumstances also might benefit from CIMT measurement and carotid plaque detection: • Family history of premature cardiovascular disease (CVD) in a first degree relative (men < 55 years old, women < 65 years old) • Individuals younger than 60 years old with severe abnormalities in a single risk factor (i.e. genetic dislipidemia) whom otherwise would not be candidates for pharmacotherapy • Women younger than 60 years old with at least two CVD risk factors http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The ASE Consensus statement indicates measuring CIMT and identifying carotid plaque by ultrasound is most useful for refining CVD risk assessment in patient at intermediate CVD risk. Intermediate risk is considered to be a Framingham Risk Score of 6%-20% without established coronary heart disease (CHD), peripheral arterial disease, cerebrovascular disease, diabetes, or abdominal aortic aneurysm. Patients with the following clinical circumstances also might benefit from CIMT measurement and carotid plaque detection: • Family history of premature cardiovascular disease (CVD) in a first degree relative (men < 55 years old, women < 65 years old) • Individuals younger than 60 years old with severe abnormalities in a single risk factor (i.e. genetic dyslipidemia), whom otherwise would not be candidates for pharmacotherapy • Women younger than 60 years old with at least two CVD risk factors Notes No. 11 SIEMENS Healthineers ASE recommendationsfor use • [CIMT] imaging should not be performed in patients with ASE CONSENSUS STATEMENT established atherosclerotic vascular disease or if the results Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular would not be expected to alter therapy Disease Risk: A Consensus Statement from the American Society of Echocardiogramhy Carotid Intima-Media Thickness Task Force • Serial studies of CIMT to address progression or Endorsed by the Society for Vascular Medicine James H. Stein, MD, FASE, Claudia E. Korcarz, DVM, RDCS, FASE, R. Todd Hurst, MD, regression are not recommended for use in clinical Eva Lonn MD, MSe, FASE, Christopher B. Kendall, BS, RDCS, Emile R. Mohler, MD, Samer S. Najjar, MD, Christopher M. Rembold, MD, and Wendy S. Post, MD, MS, Madison, Wisconsin; Scottsdale, Arizona; Hamilton, Ontario, Canada; Philadelphia, Pennsylvania; Baltimore, practice Maryland; and Charlottesville, Virginia Continuing Medical Education Course for "Use of Carotid Ultrasound to identify Bubclinical Vascular Disease and Evaluate Cardiovas- cular Disease Risk: A Consensus Statement for the American Society of Echocardiogramotid intima-Media Thickness Task Force" Accreditation Statement: The American Society of Echocardiogramhy Is accredited by the Accreditation Council for Continuing Medical Education to provide con- tinuing medical education for physicians. The American Society of Echocardiogramhy designates this educational activity for a maximum of 1 AMA PRA Category | Creditste Physicians should only claim credit commensurate with the extent of their participation in the activity. ARDMS and CCI recognize ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers, The American Society of Echocardiogramhy Is committed to resolving all conflict of Interest issues, and its mandate is to retain only those speakers with financial interests that can be reconolied with the goals and educational integrity of the educational program. Dis- closure of tacuity and commercial support sponsor relationships, If any, have been indicated. Target Audience: 1. Physicians, physicians' assistants, and nurses with an interest in cardiac and vascular imaging, preventive cardiology, and cardiovas- cular disease risk assessment. 2. Ultrasonographers with interest in vascular imaging and cardiovascular disease risk assessment. Upon completing this activity, participants will be able to: 1. Describe the rationale for using carotid ultrasound to Identity subcinical objectives: vascular disease and to evaluate cardiovascular disease risk. 2. Explain the application of carotid ultrasound to cardiovascular disease risk assessment. 3. Describe the scanning technique for identifying subemnical vascular disease using carotid ultrasound, 4, Explain Ine key components of interpreting carotid uitrasound studies for cardiovascular disease risk assessment. Authors Disclosures James H. Stoin, MD, FASE: Research grants: Siemens Medical Solutions, Sonosite intellectual property; listed as the inventor of Patent #US 6,730,0235 "Ultrasonic Apparatus and Method for Providing Quantitative indi- Cation of Risk of Coronary Heart Disease." It has been assigned to the Wisconsin Alumni Research Foundation. Emlie R. Mohier III, MD: Speakers bureau for Morck, HMS-Sanofi and AstraZeneca; Research grant support from HMS-Sanofi, Patzer and GBK. Christopher M. Rembold, MD; Advisory Board for Bonostte. Estrnated Time to Complete This Activity: 1 hour Keywords: Atherosclerosis, Cardiovascular disease, Carotid arteries, Carotid intima-media thickness, Risk factors, Ultrasound diagnosis, Ultrasound http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The ASE Consensus Statement goes on to state that carotid intima-medial thickness imaging should not be performed in patients with established atherosclerotic vascular disease or if the results would not be expected to alter therapy. In addition, serial studies of CIMT to address progression or regression of disease is not recommended for use in clinical practice. Notes No. 12 SIEMENS Healthineers ASE recommended result percentile guidelines CIMT values of: ASE CONSENSUS STATEMENT Use of Carotid Ultrasound to Identify Subclinical • Vascular Disease and Evaluate Cardiovascular Greater than or equal to the 75th percentile is considered Disease Risk: A Consensus Statement from the high and indicative of increased CVD risk American Society of Echocardiogramhy Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular Medicine • Values between the 25th and 75th percentile are considered James H. Stein, MD, FASE, Claudia E. Korcarz, DVM, RDCS, FASE, R. Todd Hurst, MD, Eva Lonn MD, MSe, FASE, Christopher B. Kendall, BS, RDCS, Emile R. Mohler, MD, average and are indicative of an unchanged original risk Samer S. Najjar, MD, Christopher M. Rembold, MD, and Wendy S. Post, MD, MS, Madison, Wisconsin; Scottsdale, Arizona; Hamilton, Ontario, Canada; Philadelphia, Pennsylvania; Baltimore, Maryland; and Charlottesville, Virginia classification Continuing Medical Education Course for "Use of Carotid Ultrasound to identify Bubclinical Vascular Disease and Evaluate Cardiovas- cular Disease Risk: A Consensus Statement for the American Society of Echocardiogramotid intima-Media Thickness Task Force" Accreditation Statement: The American Society of Echocardiogramhy Is accredited by the Accreditation Council for Continuing Medical Education to provide con- tinuing medical education for physicians. • Valuesless than or equal to the 25th percentile The American Society of Echocardiogramhy designates this educational activity for a maximum of 1 AMA PRA Category | Creditste Physicians should only claim credit commensurate with the extent of their participation in the activity. ARDMS and CCI recognize ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers, The American Society of Echocardiogramhy Is committed to resolving all conflict of Interest issues, and its mandate is to retain only are considered a lower [than original] risk level those speakers with financial interests that can be reconolied with the goals and educational integrity of the educational program. Dis- closure of tacuity and commercial support sponsor relationships, If any, have been indicated. Target Audience: 1. Physicians, physicians' assistants, and nurses with an interest in cardiac and vascular imaging, preventive cardiology, and cardiovas- cular disease risk assessment. 2. Ultrasonographers with interest in vascular imaging and cardiovascular disease risk assessment. objectives: Upon completing this activity, participants will be able to: 1. Describe the rationale for using carotid ultrasound to Identity subcinical vascular disease and to evaluate cardiovascular disease risk. 2. Explain the application of carotid ultrasound to cardiovascular disease risk assessment. 3. Describe the scanning technique for identifying subemnical vascular disease using carotid ultrasound, 4, Explain Ine key components of interpreting carotid uitrasound studies for cardiovascular disease risk assessment. Authors Disclosures James H. Stoin, MD, FASE: Research grants: Siemens Medical Solutions, Sonosite intellectual property; listed as the inventor of Patent #US 6,730,0235 "Ultrasonic Apparatus and Method for Providing Quantitative indi- Cation of Risk of Coronary Heart Disease." It has been assigned to the Wisconsin Alumni Research Foundation. Emlie R. Mohier III, MD: Speakers bureau for Morck, HMS-Sanofi and AstraZeneca; Research grant support from HMS-Sanofi, Patzer and GBK. Christopher M. Rembold, MD; Advisory Board for Bonostte. Estrnated Time to Complete This Activity: 1 hour Keywords: Atherosclerosis, Cardiovascular disease, Carotid arteries, Carotid intima-media thickness, Risk factors, Ultrasound diagnosis, Ultrasound http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The ASE has recommended result guidelines for reporting in percentiles. The percentile will be included on the CIMT report at the completion of the exam. According to the ASE, CIMT values of: • Greater than or equal to the 75th percentile is considered high and indicative of increased CVD risk • 25th to 75th percentile is considered average and is indicative of an unchanged original risk classification • Values less than or equal to the 25th percentile are considered a lower [than original] risk level Notes No. 13 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will describe the vessel anatomy and the ASC scanning technique. Notes No. 14 SIEMENS Healthineers Anatomy of the vessel wall SIEMENS . Healthineers Vessel walls are made up of three layers: Normal arterial wall cross section 1. Adventitia • The outermost layer • Made up of loose connective tissue Adventitia 2. Media • The middle layer Media • Consists of smooth muscle and an External elastic membrane external elastic membrane Smooth muscle • Gives vessel stiffness, elasticity, and strength 3. Intima • Innermost layer • Consists of the endothelium and an internal elastic membrane Intima Internal elastic membrane Endothelium 15 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Before we can talk about the recommended CIMT scanning technique, we must first discuss the arterial vessel anatomy to ensure the user is familiar with the make up of the vessel they will be examining. Vessel walls are made up of three layers: • The adventitia, which is the outermost layer and made up of loose connective tissue. • The media, which is the middle layer and consists of smooth muscle and an external elastic membrane. This layer gives the vessel stiffness, elasticity, and strength. • Lastly, the innermost layer, the intima, which consists of the endothelium and an internal elastic membrane. Notes No. 15 SIEMENS Healthineers Ultrasound appearance of vessel anatomy SIEMENS. Healthineers .. In a true longitudinal plane using a linear transducer: Intima • The intima and adventitia display as parallel echogenic lines (“double line” sign) • The anechoic void between the two lines represents the media Media Adventitia 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: With B-mode ultrasound these layers appear as a “double line” sign with the intima and the adventitia being displayed as parallel echogenic lines and the media represented by the anechoic space between them. Now that we understand what the appearance of the vessel anatomy looks like with ultrasound, we must now dive into the imaging technique required to perform a CIMT measurement. Notes No. 16 SIEMENS Healthineers Recommended CIMT assessment technique SIEMENS . Healthineers American Society of Echocardiography Consensus Statement* • Position patient and sonographer comfortably; adjust throughout 180 exam as necessary to obtain optimal images in the anterior, lateral, and posterior windows 225 135 • Using a linear transducer of at least 7 MHz and a transverse imaging plane, utilize B-mode to obtain an overview of the vessel orientation / anatomy. Scan from proximal CCA to mid ICA at a 270 90 standard depth of 4 cm (adjust depth if required for larger necks) 45 • Screen for plaque in transverse and sagittal scan planes wedge • Interrogate the ICA and ECA with Doppler in the proximal 1 cm of *Recommended carotid ultrasound scanning technique, ASE consensus statement Recommended patient setup - a Meijer arc each branch and obtaining pre and post velocities in areas or similar device can help standardize suspicious for stenosis transducer angle by displaying exterior visual landmarks http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: According to the American Society of Echocardiography Consensus Statement, there is a recommended protocol / technique for obtaining the CIMT assessment images. The recommendations are: • The patient and sonographer must be positioned comfortably to allow for proper access to the scanning area – a 45 degree wedge is suggested to stabilize the head and lateral rotation • Adjust the patient throughout exam as necessary to obtain optimal images in an anterior, lateral, and posterior windows • Using a linear transducer of at least 7 MHz and a transverse imaging plane, utilize the B- mode to obtain an overview of the vessel orientation and anatomy • Scan from proximal CCA to mid ICA. A standard depth of 4 cm is suggested as it covers the majority of patients, however the depth can be adjusted for larger necks or deeper vessels • Perform a circumferential screen for plaque in both transverse and longitudinal scanning planes • Interrogate the ICA and ECA vessels with Doppler in the proximal 1 cm of each branch and obtain pre and post velocities in any areas suspicious for stenosis Notes No. 17 SIEMENS Healthineers Recommended CIMT assessment technique SIEMENS . Healthineers American Society of Echocardiography Consensus Statement* Anterior • For CIMT, obtain longitudinal clips from the 3 imaging planes (see diagram) in the distal 1 cm of each common carotid artery. CIMT measurements will be calculated on the far wall only of each Lateral vessel • Ensure the double lines of the near and far walls of the vessel are displayed to indicate perpendicularity for each clip / image taken Posterior • Enabling zoom during image acquisition is not recommended *Recommended carotid ultrasound scanning technique, ASE consensus statement Scanning plane positions • ECG is recommended with a 3-5 beat cine-loop length from at least 3 different angles in each segment http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement-on-Clinical-App-of-Ultrasonic-Contrast-Agents-in-Echo.pdf 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: (continued from previous slide) • For CIMT, obtain longitudinal clips from the 3 imaging planes (see diagram) in the distal 1 cm of each common carotid artery CIMT measurements will be calculated on the far wall only of each vessel • Ensure that each image of the common carotid artery that is obtained displays the double lines of the near and far wall of the vessel to indicate perpendicularity • The use of zoom during image acquisition is not recommended • An ECG trace is recommended for CIMT assessment with a 3-5 beat cine-loop at each of the three imaging planes with the measurements performed at the peak of the “R” wave, however CIMT measurements can be performed without an ECG. • It is also highly recommended that each image is well-labeled with scanning position and laterality to make the assessment performed later in review much easier. Notes No. 18 SIEMENS Healthineers syngo AHP terminology Term Definition AHP syngo AHP software program CIMT Carotid intima-media thickness ARIC Atherosclerosis Risk in Communities study IMB Intima-media boundary IMT Intima-media thickness LI or LIB Lumen-intima or Lumen-intima boundary MA or MAB Media-adventitia or Media-adventitia boundary CHD Coronary heart disease CCA Common carotid artery BULB Carotid bulb ICA Internal carotid artery 19 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To use the syngo AHP, the user must be familiar with this list of terminology, mostly consisting of abbreviations of vessel anatomy. I would like to draw your attention to the “ARIC” abbreviation in this list, as the term directly relates to the type of protocol the user will be selecting when performing the CIMT measurement using the software. ARIC is the abbreviation for the Atherosclerosis Risk in Communities study. This study was sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and was conducted in 4 US communities. ARIC was designed to investigate the causes of atherosclerosis and its clinical outcomes taking into consideration the variation in cardiovascular risk factors, medical care, and disease by race, gender, location, and time. To date, ARIC has published over 2,000 articles in peer-reviewed journals (https://www2.cscc.unc.edu/aric/desc_pub). Notes No. 19 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 20 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the syngo AHP terminology, navigation tools and how to configure the software. Notes No. 20 SIEMENS Healthineers syngo AHP navigation controls Report Set up – configuration access options CIMT border - returns to the Exit software CIMT screen X .......... + Starts playback of clip, displays previous or next Pan to position the current frame clip or frame in the display Magnify or area minimize clip or frame 21 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Navigation controls for using the syngo AHP are situated in the upper right corner of the screen when the software is active. These controls allow the user to: • Access the report • Determine the set up for the region of interest (ROI) Play image clips • Move around the image (“Pan”) Zoom the image • Exit the software back to the imaging screen • Use the Pointer and Set key to select any of the desired parameters Notes No. 21 SIEMENS Healthineers syngo AHP navigation controls Adjust brightness Adjust contrast Delete the outline of Edit semi-auto trace the CIMT ROI media-adventitia × Edit semi-auto trace Exclude frame lumen-intima from analysis Manual trace lumen-intima Manual trace Magnify ROI media-adventitia Undo 22 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are also navigation controls for editing the image contrast and brightness to enable the user to visualize the vessel anatomy easier. Use the slider bar to adjust the necessary parameters. If the CIMT outline has been drawn on the image by the auto trace, the user has the ability to edit the outline or delete the outline entirely and use the manual trace option. A zoom feature is available for editing, as well as an undo feature should the user be unhappy with any changes. The user also has the option to exclude any frames from the analysis - note that excluded frames are not deleted from the image clip just removed from the analysis sequence. Notes No. 22 SIEMENS Healthineers syngo AHP navigation controls SIEMENS. Healthineers Exam PATIENT NAME PATIENT_NUMBER options CCA ARIC White Female Right Distal CCA PATIENT NAME Anterior 1 + PATIENT NUMBER ACUSON 13/12/2017:3 Thumbnails Region of Interest (ROI) X CIMT Frame: 0 Measured values, Cine loop Max (mm): 0.815 frame position, and save function frames Mean (mm): 0.550 Std Dev: 0.255 Save CIMT Frame marker CIMT Saved report 23 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once the software is activated, the monitor will display the image that has been selected for analysis along with the available thumbnails on the right side of the screen. The frame marker is indicated by a white line on the Cine loop line as well as the exact frame number is displayed in the CIMT results box. The region of interest box (ROI) is displayed in red and moved around the screen using the trackball, however prior to placement of the ROI the exam options must be chosen from the drop-down menus located at the top of the image. Notes No. 23 SIEMENS Healthineers Configuration bordersettings SIEMENS . Healthineers ... Border Report | Units | Define Protocol Filter Protocols Border lines Border lines Border Settings: Solid shading (Mean CIMT) Solid shading (Max CIMT) Display of CIMT area: Thickness shading Border lines Skip Excluded Frames on Playback Show Search Region Detect All Frames Search Length (cm): 1.00 Zoom to ROI on Detection Far Wall Search Depth (cm): 0.50 Enable Maximum CIMT Threshold Maximum CIMT Threshold (mm): 1.50 Save Page Restore Page Defaults 24 24 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The syngo AHP has a number of configurable options in order to tailor the software to a specific user or imaging site. Select the Set-Up icon from the navigation controls in the upper right corner to open the configuration menu. The configuration menu is divided into selectable tabs, the first being the Border tab that contains the different border types available, as well as ROI size, and automatic zoom. The different border options are found in the drop-down menu located under Display of CIMT area. The default setting is Border lines which consist of a pink and yellow outline for the intima and the media-adventitia interface contained in the ROI. Another option is Solid shading that fills the area between the intima and media-adventitia interface and displays a color scale on the left side of the image. Both options are shown in the above image examples. Notes No. 24 SIEMENS Healthineers Configuration Zoom SIEMENS. Healthineers Zoomed ROI on Border Report Units Define Protocol Filter Protocols Detection not Border Settings : selected -Display of CIMT area: Border lines Skip Excluded Frames on Playback Show Search Region Detect All Frames Search Length (cm): 1.00 Zoomed ROI on Zoom to ROI on Detection Far Wall Search Depth (cm): |0.50 Detection selected Enable Maximum CIMT Threshold Maximum CIMT Threshold (mm): 1.50 Save Page Restore Page Defaults 25 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Another option found on the border tab is the option to automatically zoom the ROI after the vessel walls are detected. To select this feature, use the Pointer to check off the option Zoom to ROI on Detection and select Save Page at the bottom of the page. Should the user not like the automatic zoom or any other modifications, the Restore Page Defaults option can be selected at the bottom of the page. Unchecking an option and saving the page also accomplishes turning the feature off. Notes No. 25 SIEMENS Healthineers Configuration Report Border Report Units Define Protocol Filter Protocols Institution: Reporting Physician New Remove Recommendations Title: Description: New Remove Save Page Restore Page Defaults 26 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The next tab found in the configuration is for customization of Reports. Reports can be configured to display the institution name, reporting physician, and any recommendations determined by the diagnosing physician. Recommendations can be pre-programmed options or manually entered using the keyboard. Any modifications made to the reports must be saved by selecting the Save Page option at the bottom of the screen. Notes No. 26 SIEMENS Healthineers Configuration Units Border Report Units Define Protocol Filter Protocols Default selections for: Cholesterol Units mg/dL .................................... mg/dL mM/L Default Cholesterol Units: mg/dl Height Units in Default Height Units: in in m Default Weight Units: |Ib Weight Units Ib ka Save Page Restore Page Defaults 2727 27 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Units tab allows the user to select which units are used for entering values for cholesterol, height, and weight. All options are displayed in the drop-down menus and must be saved by selecting the Save Page icon at the bottom of the page if an alteration is made from the default selections. Notes No. 27 SIEMENS Healthineers Configuration Define Protocol Atherosclerosis Risk in Communities study (ARIC) Border Report Units |Define Protocol Filter Protocols options Protocol: CCA ARIC White Female Protocol Name: CCAARIC White Female Vessel Name orientations (CSV) Right Distal CCA Anterior 1,Anterior 2,Lateral, Optimal,Posterior 1,Posterior 2 ARIC Black Female Left Distal CCA Anterior 1,Anterior 2,Lateral, Optimal,Posterior 1,Posterior 2 ARIC Black Female ARIC Black Male .......... ARIC White Female ARIC White Male CCA ARIC Black Female CCA ARIC Black Male CCA ARIC White Female CCA ARIC White Male Delete Protocol Copy Protocol Save Page Restore Page Defaults 28 28 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Define Protocol tab allows the user to set the default protocol for the exam. The Atherosclerosis Risk in Communities study (ARIC) is the basis for the protocol based on gender and race. All options are contained in a drop-down protocol menu at the top of the page. The most commonly accepted protocol is the single CCA vessel measured bilaterally at the three locations set by the ASE Consensus statement. To display a vascular age on the report a minimum of six measurements must be taken that include all three positions for both the right and left CCA. Options to Delete Protocol or Copy Protocol are also available. The steps to copy or alter a protocol will be covered in a later slide. Any changes to the protocol selection must be saved using the options at the bottom of the page. Notes No. 28 SIEMENS Healthineers Configuration Define Protocol Border |Report |Units |Define Protocol |Filter Protocols Atherosclerosis Risk in Communities study (ARIC) Protocol: ARIC Black Female options Protocol Name: ARIC Black Female Vessel Name Orientations (CSV) Right Distal CCA Angle 90,Angle 120,Angle 150,Angle 180,Anterior, Mid,Posterior Right Bulb Angle 90,Angle 120,Angle 150,Angle 180,Anterior, Mid,Posterior ARIC Black Female Right ICA Angle 90,Angle 120,Angle 150,Angle 180,Anterior,Mid,Posterior ARIC Black Female Left Distal CCA Angle 300,Angle 270,Angle 240,Angle 210,Angle 180,Anterior,Mid,Posterior ARIC Black Male ARIC White Female Left Bulb Angle 300,Angle 270,Angle 240,Angle 210,Angle 180,Anterior, Mid,Posterior ARIC White Male CCA ARIC Black Female Left ICA Angle 300,Angle 270,Angle 240,Angle 210,Angle 180,Anterior,Mid,Posterior ISCR ARI CCA ARIC Black Male CCA ARIC White Female Delete Protocol Copy Protocol CCA ARIC White Male Save Page Restore Page Defaults 29 29 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Another available ARIC protocol features measuring not only the CCA, but the bulb and ICA as well. This protocol has the user measuring all vessels at several different angles in addition to the three recognized positions set by the ASE Consensus statement. This method is the original Atherosclerosis Risk in Communities study protocol and is still available to users. This protocol is generally considered an older method for measuring CIMT. Notes No. 29 SIEMENS Healthineers Configuration Create / Copy new Protocol Border Report Units | Define Protocol Filter Protocols • Select Copy Protocol then rename the copied protocol Protocol: CCA ARIC White Female1 Protocol Name: Maple Protocol 1 • Add or remove orientations Vessel Name Orientations (CSV) contained in protocol Right Distal CCA Anterior 1,Anterior 2,Lateral, Optimal,Posterior 1,Posterior 2 Left Distal CCA Anterior 1,Anterior 2,Lateral,Optimal,Posterior 1,Posterior 2 • Select Save Page Delete Protocol Copy Protocol Maple Protocol 1| ARIC Black Male ARIC White Female ARIC White Male CCA ARIC Black Female CCA ARIC Black Male CCA ARIC White Female Save Page Restore Page Defaults CCA ARIC White Male Maple Protocol 1 30 Unrestricted © Siemens Healthineers 2023 30 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Protocols can be copied and customized for content or name. This example demonstrates the copying of the CCA ARIC White Female protocol and being renamed to Maple Protocol 1. While no changes have been made to the original protocol, the user does have the ability to add or delete the orientations contained in the protocol during this step. Once the protocol alterations are completed the user must select Save Page to complete the changes. Note that the new protocol will now be displayed in the drop-down protocol choices. Notes No. 30 SIEMENS Healthineers Configuration Filter Protocols Define default protocolsetting Border Report Units |Define Protocol Filter Protocols • Select the exam from drop-down menu Show Clinical Protocols • Select Save Page Show Research Protocols Show User Defined Protocols Default Protocol: CCA ARIC White Male ARIC White Male CCA ARIC Black Female CCA ARIC Black Male CCA ARIC White Female CCA ARIC White Male Maple Protocol 1 Save Page Restore Page Defaults 31 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The software set up also gives the option to define the default protocol that the software will automatically select when it is activated. The Filter Protocol tab contains all the available protocols, including customized protocols, in a drop-down menu. The user can filter the type of protocols that are displayed in the drop-down menu while using the software. This feature streamlines workflow, eliminating the need to scroll through the lengthy list to select an alternate protocol. Any changes to the default must be saved using the Save Page at the bottom of the page. Notes No. 31 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 32 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the activation of AHP and the steps to use the software. Notes No. 32 SIEMENS Healthineers Activating the syngo AHP SIEMENS Healthineers Patient Browser Review General Review Selectill Deselect All 1X2 Patient 1x1 2x2 Archived Report 4x4 5x5 Show Selected Slide Show Bx3 Stress Echo Review Exam Clear Teaching File Export PC Printer USB B&W USB Color Printer Printer AHP Review Hide Patient Delete Image Param Report Save Reset Marker End Exam DICOM Print 5/7 Cine Speed Color Cine Frame Cine Start Marker Cine End Ma 120 33 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To perform a CIMT assessment using the syngo AHP, the images must be first obtained using a linear transducer and viewed using the Review function on the ACUSON Maple system. To enter Review select the Review key on the control panel. The touch screen will display the AHP option key. Using the Pointer select and appropriate clip or image then the 1x1 image layout on the touch screen. Select the AHP key on the touch screen to activate the software. To select another clip or image, double-click the desired thumbnail. Notes No. 33 SIEMENS Healthineers syngo AHP patient information SIEMENS . Healthineers Once activated, the software will prompt PATIENT NAME the user to add patient information (if PATIENT_NUMBER CCA ARIC White Male missing) Right Distal CCA Anterior 1 PATIENT NAME PATIENT NUMBER ACUSON 13/12/2017 13:16:49 Carved Age Tz Power 100% • MI 1.19 TIS 0.3 TIB 0 3 • Gender X ASC 1 DTCE Med Dyn R 51 dB THI 8.0 MHZ Required Patient Demographic Info Missing: Select Apply to add the information to the patient Age (years) Gender: CIMT profile 45 - Male Frame: Female Max (mm): Apply Mean (mm): Std Dev: 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once the software is activated, the system displays an edit box for patient age and gender if the patient information is missing from the patient registration. Use the Pointer to select the appropriate fields and enter the missing information. Select Apply to add the information and continue with the evaluation. Notes No. 34 SIEMENS Healthineers syngo AHP patient information SIEMENS. Healthineers Select the patient’s gender and population group PATIENT NAME from the drop-down menu PATIENT NUMBER CCA ARIC White Male Right Distal CCA Anterior 1 KOMP P + PATIENT NAME PATIENT NUMBER CCA ARIC Black Female CCA ARIC Black Male JSON 210 17 13:16:49 CCA ARIC White Female "CCA ARIC White Male Carotid Tx Power 100% MI .1.19 TIS 9.3 Select the correct vessel segment from drop-down X ASC 1 OTCE Med Dyn R. 41 dB menu THI 8 0 MHZ 41 fpi Right Distal CCA Right Distal CCA CIMT- Left Distal CCA Frame: Max (mm): Select scanning plane orientation Mean (mm): • Anterior Anterior 1 Std Dev: • Lateral Anterior 1 BIVE CINIT Optimal Anterior 2 • Lateral • Posterior Optimal Posterior 1 Posterior 2 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The next step is to further customize the parameters according to your patient’s gender and population group. Using the Pointer, select the patient’s gender and population group from the drop-down menu. Note that the “ARIC” refers to the Atherosclerosis Risk in Communities study. Now select the vessel segment you wish to analyze as well as the scanning plane orientation from which the image was obtained (anterior, lateral, or posterior). Notes No. 35 SIEMENS Healthineers syngo AHP ROI placement SIEMENS . Healthineers • Place the region of interest (ROI) on the far wall PATIENT NAME in the distal 1 cm of the vessel PATIENT_NUMBER CCA ARIC White Male Right Distal CCA Anterior 1 KM AA + 22_01_2018_10_07 20 ACUSON 22/01/2018 10:07:57 • Landmark the flow divider point between the Carotid ICA and ECA vessel to determine position Tx Power 300% MI 1.18 TIS0.3 TIB 0.3 X ASC 1 DICE Med Dyn R $1 48 THI 8.0 MHZ 40 fps CIMT Frame: Max (mm): Flow Distal 1 cm Mean (mm): divider of vessel Std Dev: point (approx.) • Select Set to anchor the ROI 36 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A red region of interest box (ROI) will automatically appear on the screen when the software is activated. Use the trackball to place the ROI in the distal 1 cm of the CCA vessel on the far wall. A good landmark for the distal portion of the vessel is the point where the flow divides between the ICA and ECA; the distal vessel segment is approximately 2 cm proximal from that point. Position the ROI and select the Set key to anchor the box. Notes No. 36 SIEMENS Healthineers syngo AHP Auto trace SIEMENS . Healthineers Border outlines or border shading will appear PATIENT NAME automatically once box is anchored PATIENT_NUMBER CCA ARIC White Male Right Distal CCA Anterior 1 22_01_2018_10_07 20 O ACUSON 22/01/2018 10:07:57 112.4 Carotid Tx Power 100% MI 1.19 TIS0.3 TIBO.3 X ASC 1 DTCE Med Dyn R $1 20 THI 8.0 MHa • Yellow outlines the intima + -CIMT Frame: 0 Max (mm): 0.987 Mean (mm): 0.806 Std Dev: 0.101 Save CIMT • Pink outlines the media-adventitia interface 37 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once the box has been anchored, the software will automatically outline the borders of the vessel according to the chosen option for border outline selected in the set-up. This example has yellow outlining the intima and pink outlining the media-adventitia interface. Notes No. 37 SIEMENS Healthineers syngo AHP Zoom for editing SIEMENS . Healthineers • If the zoom option is enabled, the image will PATIENT NAME automatically display only a small portion of PATIENT_NUMBER CCA ARIC White Male the vessel including the ROI Right Distal CCA -Anterior 1 • Option to zoom the image is found in navigation panel if the function is not enabled X • Zoom is excellent for visualization of borders CIMT during editing or for inspection of trace Frame: 0 accuracy Max (mm): 0.866 Mean (mm): 0.725 Std Dev: 0.071 Save CIMT 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: If the Zoom to ROI on Detection is enabled the image that will be seen on screen once the ROI has been activated will be zoomed rather than the full display seen on the previous slide. If this feature is not enabled there is an option to zoom the ROI in the navigation tools on the right side of the screen. The zoom tool is an excellent feature to use when editing the outlined vessel walls, as the user has a better visual of the pathway of the vessel walls and their interface with surrounding structures. Notes No. 38 SIEMENS Healthineers syngo AHP Edit borders SIEMENS . Healthineers • To edit a border, select the editing icon for PATIENT NAME that border from the navigation tools PATIENT_NUMBER CCA ARIC White Male Right Distal CCA Anterior 1 X • Use the Pointer and Set key to alter the pathway of the colored line CIMT Frame: 0 • Double select the Set key to finish the edits Max (mm): 0.866 Mean (mm): 0.528 • Select Undo to undo edits and return to original Std Dev: 0.240 trace (if required) Save CIMT 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To edit a border, select the appropriate editing icon from the navigation tools on the right side of the screen. Use the Pointer and Set key to alter the pathway of the colored line by placing plus (+) signs along the new pathway. Double click the Set key to finish the edits and display the new line. To undo any edits and return to the original trace select the Undo tool from the navigation plane. To delete the outline entirely select the delete tool, “X”, from the navigation pane. To save the result select the Save CIMT key in the results panel. Notes No. 39 SIEMENS Healthineers syngo AHP Save result SIEMENS . Healthineers • Optional Framingham Risk Assessment PATIENT NAME appears when saving first CIMT X PATIENT_NUMBER CCA ARIC White Male - Right Distal CCA PEE Anterior 1 measurement + 22_01_2018_10_07_20 ACUSON 22/01/2018 10:07:58 Carend • To use the assessment, select the check box MI 1.19 TIS 6.3 and fill in the necessary data fields X ASC 1 DICE Med Dyn R $1 4B THI & D MP3 Patient Data 40 fpe Gender Framingham Assessment • To decline the use of the assessment, ensure the Male Perform Framingham Assessment O Female box remains unchecked Blood Pressure: 126 60 mmHg Frame: 18 Age: 45 Years Total Cholesterol: 50 Race: mg/dL Max (mm): 0.809 Heart Rate: 60.0 bpm HDL Cholesterol: 120 • Select Save Height: 72.00 in Smoking Mean (mm): 0.714 Weight: 197.0 Diabetes kg Std Dev: 0.059 Save DEVE CIMT 40 Unrestricted © Siemens Healthineers 2023 40 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Upon saving the first CIMT measurement, a dialogue box will appear on the screen with the option of entering the patient’s information for the Framingham Risk Assessment. This is an optional assessment tool. Should the user wish to use the tool, simply select the Perform Framingham Assessment check box and fill in the necessary data. If the user does not want to use the Framingham Risk Assessment, just ensure the box remains unchecked. Select Save and the dialogue box will close. Notes No. 40 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the AHP report. Notes No. 41 SIEMENS Healthineers Report The report may include the following averages for each segment of the vessel: • Maximum CIMT • Mean CIMT • Mean CIMT for age, sex, and race The report may include the following averages for both the right and left distal CCA segments: • Mean CIMT • Mean CIMT percentile • Vascular age of the segment The report may include the following averages across all segments of the vessel: • Composite mean CIMT • Composite mean CIMT percentile • Average vascular age • Framingham Model CHD Risk (%) based on age, blood pressure, cholesterol, diabetes, and smoking 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: While the report has the ability to display multiple different parameters as listed here, only results for measured parameters will be displayed within the report. If a measurement was not performed the result will not be displayed. If all of the components required to calculate a compound result were not performed, the result will be displayed as “not available” in the report. For example, composite mean percentile and average vascular age requires the measurement of the three angles for each segment (six measurements total, three per side). If all three angles for each segment are not measured, vascular age result will be displayed as “not available” on the report. Notes No. 42 SIEMENS Healthineers Report To enter the report, select the Report icon from the CIMT Summary Report • navigation tools Institution ACUISON Patient Name: PATUINT NAME Patient ID: PATIENT_NUMBER Gender: Female Agei 45 Exam Description: Carund Exams Date: 12/13/2017 1:14:13 PM Referring Physician Vospordend Average CIMI Measurements: Vessel MAX.CIMI Mean CLMT Mein CIMI Pertensie ffer age, ses, and ruce) • Selectable report options: Anterior 1 0.815 mm 0 350 mt 25 - 748 Rada Dutel CCA Lateral 0.815 man 0.676 IRE 2 75d: 1. Show Report Rade Dintal CC.A. Portenor ! 0.815 mm 0 682 112m 2. Show Worksheet SUMMARY 3. Edit Patient Data CIMI Right Distal CCA Mean CIMI (rami: 0.636 Right Distal CCA Mom CIMI Percenelec Not Available 4. Edit Measurements Right Distal CCA Vascular Age (years| Not Available Left Distal CCA Mesa CIMI (rm) Left Distal CCA Meas CIMT Percentiles 5. Edit Summary Left Distal CCA Vascular Age (years) Composite Mean CIMT (numk 0 636 Composte Mean CIMT Percentiles Not Aveldbile 6. Export Average Vascular Age (years] Not Available 7. Print Preview Reperting Physician Date 8. Print Composite Mean CIMT Average CMT Compared to Population Show Report Edit Patient Data Edit Summary Print Preview Show Worksheet Edit Measurements Export Print Speaker Notes: To enter the AHP report, select the Report icon located in the navigation tools. Located below the displayed report are a set of eight of keys that can be selected to display the following: • Show Report – allows the user to view the entire report by using scrollbar on the right side • Show Worksheet – lists all measurements performed for all measured vessel segments • Edit Patient Data – allows the user to make changes to patient information and Framingham Risk factors (if used) • Edit Measurements – allows the user to delete or edit measurements from the calculations and report • Edit Summary – allows user to enter the name of the person who performed the study or recommendations that were created in the set-up menu Choose the Reporting Physician from drop-down menu • Select Recommendations from the drop-down menu • Select Add to place items in the recommendations box or Free text to manually enter data in the summary area • Select Save or Cancel at the bottom of the page once selections / entries are made for the changes to appear in the final report • Export – sends report to USB in PDF format • Print Preview – allows the user to preview the report before final printing • Print – sends report data to an off-line printer Notes No. 43 SIEMENS Healthineers Objectives • Define the syngo Arterial Health Package (AHP) • Discover cardiovascular disease and the Framingham Risk Score • Illustrate the American Society of Echocardiography (ASE) recommendationsfor use • Describe vessel anatomy and ASE scanning technique • Discuss syngo AHP terminology, navigation tools, and configuration of software • Explain activation and steps of use for the software • Outline the syngo AHP report • Identify tips and techniques 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Lastly, we will identify tips and techniques when using AHP. Notes No. 44 SIEMENS Healthineers ASE recommended tips and techniques Lack of “double-line sign”? TIP Place vessel horizontal on the screen, move the transducer perpendicular to the vessel, adjust focus and gain to optimize Image too deep, blurry posterior angles? TIP Increase the distance of the vessel from near field, add more gel, use less pressure until the ideal acoustic impedance is achieved showing clear double lines Image too shallow, slice thickness artifact? TIP Increase the distance of the vessel from near field, add more gel, use less pressure, and scan over the jugular vein (optimal window) 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Lack of “double-line sign”? • Place vessel horizontal on the screen, move the transducer perpendicular to the vessel, adjust focus and gain to optimize Image too deep, blurry posterior angles? • Increase the distance of the vessel from near field, add more gel, use less pressure until the ideal acoustic impedance is achieved showing clear double lines Image too shallow, slice thickness artifact? • Increase the distance of the vessel from near field, add more gel, use less pressure, and scan over the jugular vein (optimal window) Notes No. 45 SIEMENS Healthineers ASE recommended tips and techniques Tortuous vessel? TIP Further extend and slightly rotate neck to elongate the segment, change scan window Under-gained images? TIP Adjust time-gain compensators and overall gain, ensure proper monitor settings Over-gained images (falsely thick appearance)? TIP Adjust time-gain compensators and overall gain, ensure proper monitor settings Translation artifact from pulsatile jugular vein? TIP Ask patient to hold breath at mid inspiration to stabilize image and quickly print-store the image 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Tortuous vessel? • Further extend and slightly rotate neck to elongate the segment, change scan window Under-gained images? • Adjust time-gain compensators and overall gain, ensure proper monitor settings Over-gained images (falsely thick appearance)? • Adjust time-gain compensators and overall gain, ensure proper monitor settings Translation artifact from pulsatile jugular vein? Ask patient to hold breath at mid inspiration to stabilize image and quickly print-store the image Notes No. 46 SIEMENS Healthineers References https://healthmetrics.heart.org/wp-content/uploads/2017/06/Heart-Disease-and-Stroke- Statistics-2017-ucm_491265.pdf http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/02/09/14/58/heart- disease-and-stroke- statistics-2017 http://www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html http://www.who.int/mediacentre/factsheets/fs317/en/ https://www.theheartfoundation.org/heart- disease-facts/heart-disease-statistics/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408160/ http://circ.ahajournals.org/content/97/18/1837.long http://journals.lww.com/critpathcardio/Abstract/2011/12000/Carotid_Intima_media_Thickness Determined_Vascular.4.aspx 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes Notes No. 47 SIEMENS Healthineers References Vascular Age: Integrating Carotid Intima-media Thickness Measurements with Global Coronary Risk Assessment. Clin. Cardiol. Vol 27, July 2004. pp 388-392. Adolphe, Allen B., Huang Xun MS, and Cook, Linda S. Carotid Intima-media Thickness Determined Vascular Age and the Framingham Risk Score. Critical pathwaysin Cardioology: Dec 2011 Vol 10 issue 4. pp 173-179. https://www2.cscc.unc.edu/aric/ http://www.asecho.org/wordpress/wp-content/uploads/2013/05/ASE-Consensus-Statement- on-Clinical-App-of- Ultrasonic-Contrast-Agents-in-Echo.pdf https://www.framinghamheartstudy.org/ 48 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes Notes No. 48 SIEMENS Healthineers SIEMENS . Trademarks and Disclaimers Healthineers ... • ACUSON Maple is a registered trademark of Siemens Medical Solutions USA, Inc. • syngo® Arterial Health Package (AHP) is a registered trademark of Siemens Healthcare GmbH 49 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Notes No. 49 SIEMENS Healthineers SIEMENS . Thank you for your enthusiasm! Healthineers ... Questions? 50 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 50