ACUSON Maple 1.0 Cardiac Major Modes Presentation

SIEMENS Healthineers SIEMENS Healthineers .. ACUSON Maple Ultrasound System Cardiac Major Modes 1.0 SW Release 1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this presentation we will discuss the ACUSON Maple ultrasound system cardiac major modes. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac transducers • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes ACUSON Maple • Review Doppler controls • Describe Doppler optimization features SIEMENS 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here are the objectives we will discuss. We will start with reviewing the cardiac transducers. Notes No. 2 SIEMENS Healthineers P4-2 adult cardiac transducer SIEMENS . Healthineers ... • Phased array • 64 elements • Bandwidth: 1.45 – 4.3 MHz • Plunkability • Inter-costal access with ergonomic nosepiece design • Flat array design helps prevent rib shadowing • Ergonomic handle design for comfortable scanning experience P4-2 3 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The 5P1 is a phased array transducer with a single crystal design. Single crystal design provides a broader bandwidth, resulting in deeper penetration and improved sensitivity and resolution. It also decreases the signal-to-noise ratio and decreases side lobe artifact producing greater image uniformity and overall quality. The transducer’s ergonomic and compact design provides good inter-costal access, helps prevent rib shadowing and gives the user a comfortable scanning experience. Notes No. 3 SIEMENS Healthineers Transducer specifications SIEMENS Healthineers ... P4-2 Form factor Phased Acoustic ceramic material PZT * 1Center Frequency @ -20 dB (Bandwidth) 2.91 MHz (1.45 MHz – 4.36 MHz) Selectable 2D Frequencies 2.7 MHz, 3.1 MHz, 3.6 MHz, 4.0 MHz for Adult Echo 3.0 MHz, 3.6 MHz, 4.0 MHz for Abd 2.7 MHz, 3.1 MHz for TCD * 2Selectable THI Frequencies 5.7 MHz, 6.6 MHz, 7.3 MHz Selectable Color Doppler Frequencies 2.2 MHz, 2.5 MHz, 3.3 MHz for Adult Echo and Abd 2.0 MHz, 2.2 MHz, 2.5 MHz for TCD Selectable Doppler Tissue Velocity(DTV) Frequencies 2.2 MHz in Adult Echo Selectable Pulsed Wave Doppler(PWD) Frequencies 2.2 MHz, 2.5 MHz, 3.3 MHz for Adult Echo and Abd 2.0 MHz, 2.2 MHz, 2.5 MHz for TCD Selectable Pulsed Wave Doppler Tissue Image(PW DTI) Frequencies 2.2 MHz in Adult Echo Selectable Continuous Wave Doppler(CWD) Frequencies 1.8 MHz in Adult Echo Field of view (@ Full FOV) 90 ° Number of Elements 64 Maximum image depth 300 mm Transducer ID 10136143 Exam List Adult Echo, Abd, TCD Imaging Features eSieImage, DTCE, HPRF, Clarify VE * 1 This value is from system-dependent test, therefore it would be different according to sample deviation. * 2 Display frequency 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here are the specifications for the P4-2 transducer. 4 SIEMENS Healthineers 8V4 pediatric cardiac transducer SIEMENS . Healthineers ... • Vector array • 64 elements • Bandwidth: 2.7 – 8.0 MHz 5 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The 8V4 is a lightweight, wide bandwidth vector array transducer that provides user-selectable MultiHertz imaging. Notes No. 5 SIEMENS Healthineers Transducer specifications SIEMENS 8V4 Healthineers ... Form factor Vector Acoustic ceramic material PZT * 1Center Frequency @ -20 dB (Bandwidth) 5.34 MHz (2.67 MHz – 8.01 MHz) Selectable 2D Frequencies 4.2 MHz, 5.7 MHz, 6.7 MHz * 2Selectable THI Frequencies 5.4 MHz, 6.2 MHz, 7.2 MHz Selectable Color Doppler Frequencies 3.6 MHz, 4.4 MHz Selectable Color Doppler Tissue Image(DTI) Frequencies 4.2 MHz, 5.7 MHz, 6.7 MHz Selectable Pulsed Wave Doppler(PWD) Frequencies 3.6 MHz, 4.4 MHz Selectable Pulsed Wave Doppler Tissue Image(PW DTI) 4.2 MHz, 5.7 MHz, 6.7 MHz Frequencies Selectable Continuous Wave Doppler(CWD) Frequencies N/A Field of view (Trapezoid angle in case of linear XDCR) 90 ° Number of Elements 64 Maximum image depth 150 mm Transducer ID 11284847 Exam List Ped Echo, Ped Abd, Neo Echo, Neo Head Imaging Features eSieImage, DTCE, Doppler TEQ, Zoom/HD Zoom, Clarify VE, HPRF * 1 This value is from system-dependent test, therefore it would be different according to sample deviation. * 2 Display frequency 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here are the 8V4 transducer specifications. 6 SIEMENS Healthineers 8V4 Pediatric Echo SIEMENS .. ; Healthineers' ... 8V4 BV4 Ped Echo Ped Echo Tx Power 100% Tx Power 100% MI 0.75 MI 0.64 TIS 0.6 TI5 0.5 TIB 0.6 TIB 0.5 3.6 MHZ DTCE Low 7669 Hz Dyn R 65 dB Flow Med THI 6.2 MHZ 0 dB 0 dB 25 fps 56 bom 0 bpm 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The 8V4 phased array pediatric cardiac transducer has improved B-mode image quality delivering better sharpness and penetration. We can appreciate the improved contrast, resolution and uniformity in the image on the right. Notes No. 7 SIEMENS Healthineers 8V4 Pediatric Echo SIEMENS.: Healthineers ... 8V4 Ped Echo Tx Power 100% MI 0.05 TIS 0.5 TIB 1.6 4.0 MHZ 14.2 KHz 0 dB 25 fps 0 bpm 29 mm 100 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The 8V4 continuous wave spectral Doppler has improved sensitivity and gain optimization providing a cleaner CW Doppler signal. Notes No. 8 SIEMENS Healthineers Non-imaging continuous wave (CW) transducers SIEMENS . Healthineers ... • CW2 • CW5 • Frequency – 2 MHz • Frequency – 5 MHz and 8 MHz • Application – cardiac • Application – vascular 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The ACUSON Maple system provides three non-imaging continuous wave “pencil” transducers that is displayed here. Notes No. 9 SIEMENS Healthineers 5VT transesophageal transducer SIEMENS . Healthineers ... • Similar to V5Ms in lens and rotary handle construction and function • Has improved articulation sleeve material for durability • Uses Twin Cam – Zero Insertion Force connector (does not require adapter) Please Note: For additional information, refer to ACUSON Maple ultrasound system 5VT Transesophageal Transducer presentation. 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The ACUSON Maple ultrasound system now provides transesophageal echocardiography with the 5VT transducer. The 5VT transducer is very similar to the V5Ms transducer in lens and rotary handle construction and function. The 5VT transducer has improved articulation sleeve material providing enhanced durability and it uses the same Twin Cam – Zero Insertion Force (TC-ZIF) connection as the rest of the ACUSON Maple transducers. This means that the 5VT transducer connects seamlessly to the ACUSON Maple ultrasound system and does not require an adapter. Please Note: For additional information, please refer to the ACUSON Maple ultrasound system 5VT Transesophageal Transducer presentation. Notes No. 10 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac transducers • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes ACUSON Maple • Review Doppler controls • Describe Doppler optimization features SIEMENS 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will review the B-mode and M-mode controls. Notes No. 11 SIEMENS Healthineers B-mode controls SIEMENS. Healthineers ... Add Exam Workflow ? 20 Contrast Elasticity Siescape eSiescan Clarify VE Persist Full Screen Extensive View Clarify VE Ley Edge UR Flip UID Flip Touch Clear THI Screen Patient Physio Settings > Split Depth / Fe Fmage Clip Settings Full FOV 00.00 DICE Med RIS MultiHertz 5.0 MHz Adv . SieClear Tint TEQ Gain 1 Dyn R 68 dB Map nage Size Tx Power 100% Print Stores Soft keys Control Panel 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The B-mode image may be optimized using three different methods: 1. Control Panel 2. Soft keys 3. Touch Screen Notes No. 12 SIEMENS Healthineers B-mode controls on the Control Panel SIEMENS . Healthineers ... 2D 2D D /40 Steer Angle Depth / Focus C O 00.00 UD 1 Est Dual UD 2 lody Marke Caliper Cup Store $ Depth / Focus C Select UD 3 Pointer Print Store 2 Zoom 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The primary B-mode imaging controls on the Control Panel are: • 2D activates or returns to B-mode imaging. Rotate 2D to change the overall B-mode gain / brightness • eSieImage™ multiparametric optimization automatically optimizes gain, DGC (depth gain compensation) and suppresses noise in B-mode imaging • Depth changes the depth of the field of view (FOV) and is adjustable using the multi- function Depth / Focus toggle control (customizable functionality under System Configuration > Custom Keys > Depth / Focus • Focus repositions the focal zone(s) and changes the number of focal zones displayed. It is adjustable using the multi-function Depth / Focus toggle control and its functionality is customizable under System Configuration > Custom Keys > Depth / Focus • Zoom activates either Zoom (read) when rotating or HD Zoom (write) when pressing the Zoom knob Notes No. 13 SIEMENS Healthineers B-mode controls on the soft keys SIEMENS . Healthineers ... 7C2 Add Exam MultiHertz Workflow System Configuration Soft Keys yn R ? 2D Contrast Elasticity SieScape eSieScan General 2 Edge Display Map Clarify VE Persist Full Screen Extensive View Tint Soft Keys Clarify VE Levels Persist Edge UR Flip Exam Tx Power Measurement Split Biopty Se Text Annotation R/S Screen TH Biopsy Line Biopsy Body Marker Physio Settings Trapezoid TEQ Gain Stress Echo DTCE Patient Physio Settings > 48 Split To Setting leedle Visual. DTI Adv. SieClear Image Param Full FOV Che Store Clip Settings High Density OTCE Tint Image Size Clarify VE Levels Multibierta - Forum Width FOV Size TEQ Gain DICE Cear Page Clear All Pages Adv. SieClear Image Size High Density DICE Med RIS Tint TEQ Ga Clarify VE Leveis High Density POV Size MultiHertz 5.0 MHz Adv. SieClear Dyn R 68 dB Map C Image Size Ty k wer 100% Image Size Full FOV High Density Security U/D Flip Service WD Flip LR Flip L/R Flip Focus Width Blank Focus Width Blank 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The B-mode soft key rotary controls are located on the Control Panel and lie beneath and correspond to the controls listed on the bottom two rows of the Touch Screen. These controls are customizable for live imaging and when frozen in System Configuration > Soft Keys. The available control options are displayed on the slide. Alternatively, all B-mode soft key optimization controls, except for MultiHertz and Focus Width, can be configured to the Touch Screen. The active control is highlighted in white. To alternate activation between the first and second row controls, push the corresponding rotary control or touch the desired control. Once activated, turn the rotary control clockwise / counterclockwise to adjust. If the system is frozen, only those controls available in freeze will be available. Controls that are not available will appear dithered. Soft key controls do not change when navigating pages. Notes No. 14 SIEMENS Healthineers B-mode controls on the Touch Screen SIEMENS. Healthineers ... Add Exam Workflow Soft Kitys Dyn R Full FOV A Contrast Elasticity SieScape 20 Ly 20 frs Edge Split ? 20 eSieScan Map 4B Persist Tint U/D Flip Clarify VE Full Screen Extensive View Persist L/R Flip THI Sepy Sering Clarify VE Levels Edge UR Flip Tx Power Trapezoid R/S Biopsy CEP Settings Screen THI Biopsy Line Biopsy TEQ Gain Biopsy Settings Off Mich Dernity DICE THI Blopay Settings Clip Settings Chip Settings Hide Adv. Sietker Physio Settings > 4B Split Physio Settings> DTCE Physio Settings > Adv. SieClear Needle Visual. Clip Settings Full FOV Clarify VE Timer Clarify VE Levels Blank . . FOV Size High Density DTCE Med RIS Tint TEQ Gain Image Size MultiHertz 5.0 MHz Adv. SieClear Dyn R 68 dB Map c Image Size 2 Tx Powe 100% DTI CTI High Density 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The B-mode imaging Touch Screen controls are customizable for live imaging and when frozen in System Configuration > Soft Keys. The available control options are displayed on the slide. A control is highlighted in blue when it is active, white when it is available and will be dithered out if unavailable. Touch the control to activate / deactivate or open a menu selection. If the system is frozen, only those controls available in freeze will be available. Select the arrowhead in the lower right corner to view the second page or swipe the Touch Screen from right to left. Notes No. 15 SIEMENS Healthineers M-mode controls SIEMENS .. : Healthineers ... M Add Exam Workflow ? 2D Contrast eSieLaH Stress Echo eSieScan Full Screen 13 cm Extensive View Clear Patient Physio Settings> Full M M Mode mage Clip Settings Angle AMM Marker AMM MultiHertz 3.6 MHZ| Edge Dyn R 65 d8 Map 4 Tx Power 100% 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: M-mode (or motion mode) displays a B-mode reference image and an M-mode sweep. M- mode allows a graphic display of motion, such as a valve or, in the example shown, the right and left ventricles. The cursor or M-line indicates the path used to obtain the M-mode tracing. Anatomy that remains stationary displays as a straight line while curved or peaked lines mirror the moving anatomy. To activate M-mode: • Press M on the Control Panel to access the B-mode image / M-mode sweep on the imaging screen and the M-mode menu on the Touch Screen • Roll the trackball to position the M cursor • If desired, select Full M on the Touch Screen to enter / exit full screen sweep • Rotate M to change the overall M-mode gain • To exit, press the M or 2D control on the Control Panel The M-mode soft key and Touch Screen controls are customizable for live imaging and when the image is frozen in System Configuration > Soft Keys. The 2D / M-mode imaging format (1/2 2D, 1/2 trace; 1/3 2D, 2/3 trace; 2/3 2D, 1/3 trace; Side-by-Side) is configurable under System Configuration > Exam > 2D / M & 2D / Doppler Display Format. For M-mode functionality, the user has the option to bypass the cursor. This is selected in System Configuration > Display > Doppler / M-mode > Bypass Cursor Mode. Uncheck to display the full screen B-mode display with the M cursor after pressing M. Check to bypass the initial full screen B-mode display with the M cursor and immediately activate in the B-mode / M-mode sweep format. Notes No. 16 SIEMENS Healthineers Anatomic M-mode SIEMENS .. ; Healthineers' ... X M Angl Adult Eche Add Exam Workflow ? 2D Contrast eSieLit Stress Echo eSieScan 13 cm Full Screen Extensive View Clear Patient Physio Settings> Full M M Mod mage Clip Settings Angle AMM Marker AMM MultiHertz 3.6 MHZ Edge Dyn R 65 de Map 4 Tx Power 100% 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Anatomic M-mode allows the user to change the angle of the M-mode cursor. This can be especially helpful in off-axis cardiac windows / views. • To activate anatomic M-mode, press M on the Control Panel and the M-mode cursor will appear as normal • There are three methods to changing the angle of the cursor: 1. Rotate the Angle control on the Control Panel after activating the M-mode cursor and press M a second time to obtain an M-mode sweep 2. Select Angle AMM on the Touch Screen and rotate the Angle control on the Control Panel; Press M a second time to obtain an M-mode sweep 3. Select Marker AMM on the Touch Screen and a caliper will appear; Use the left or right set keys and trackball to draw the M-mode cursor at the desired angle and once the cursor is drawn, press either of the set keys again (similar to making a measurement), and the M-mode sweep will begin Notes No. 17 SIEMENS Healthineers Full M SIEMENS .. ; Healthineers ... M A P4-2 Add Exam Workflow Contrast eStellt| Stress Echo eSieScan Full Screen Extensive View Cheer Patient Physio Settings > Full M Clip Settings F MultiHertz 3.6 MHZ Edge Dyn R 65 dB Map C Sweep Tx Power 100% 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Full M activates a full screen display of an M-mode tracing. The 2D image with cursor is no longer displayed, as is seen here in this M-mode sweep of the mitral valve. Notes No. 18 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac transducers • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes ACUSON Maple • Review Doppler controls • Describe Doppler optimization features SIEMENS 19 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the optimization features for B-mode and M-mode. Notes No. 19 SIEMENS Healthineers eSieImage multiparametric optimization SIEMENS .: Healthineers ... P4-2 Adult Echo Tx Power 98% MI 1.05 TIS 0.7 TIB 0.7 DICE High Dyn R 65 dB THI 4.0 MHZ -8 dB 49 fps System Configuration Exam General 1 General 2 Exam Adult Echo Display Freeze Behavior Cine Custom Keys Seamless Dual On Soft Keys Dual Behavior on Freeze Left Dual Image Live Exam ED-ES Split Measurement 18 cm Text Annotation eSielmage O on Off 20 Unrestricted © Siemens Healthineers 2023 Speaker Notes: eSieImage optimization automatically and intelligently optimizes key imaging parameters in real-time B-mode imaging, reducing scanning time and operator effort. This allows the user to smoothly navigate from one scan window to another with little to no adjustment while maintaining image quality, uniformity and contrast resolution throughout the entire field of view (as displayed in this image of an apical 4 chamber window). eSieImage optimization continuously adjusts overall gain and depth gain compensation (DGC) and performs continuous noise analysis and correction. It automatically tracks tissue on a frame-by-frame basis, identifying tissue versus noise, ensuring that B-mode image quality, uniformity and contrast resolution are optimally maintained across different tissue types. When active, the eSieImage optimization control on the Control Panel is backlit in blue and a gold icon display appears on the image screen. Press once to activate or press twice to deactivate. Automatic activation with exam selection is customizable under System Configuration > Exam > eSieImage > On / Off. Notes No. 20 SIEMENS Healthineers Tissue harmonic imaging (THI) SIEMENS .: Healthineers ... THI Without THI With THI 21 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Tissue harmonic imaging (THI) improves contrast and spatial resolution by reducing noise and clutter within cardiac chambers and is especially helpful in reducing noise in large, difficult to image patients. Tissue harmonics are generated within the tissue beyond the window that causes beam distortion and scattering; therefore, the undesirable effects of the acoustic window are generally reduced. The harmonic frequency received is twice the fundamental frequency (e.g., if a 2 MHz fundamental signal is sent into the body, the ultrasound system uses the 4 MHz THI signal that returns from the body to form the image). THI can be used to decrease artifacts such as haze, noise and clutter in chambers and vessels (as displayed here in the cardiac chambers) or from large, difficult to image patients. THI can help reduce grating lobes and side lobe artifacts (low-intensity weak echoes outside of the main ultrasound beam). It can also reduce reverberation artifacts (linear equally spaced echoes). To activate / deactivate THI, select THI on the Touch Screen. Notes No. 21 SIEMENS Healthineers MultiHertz multiple frequency imaging SIEMENS. Healthineers ... High Density DICE Med R/S 13 Tint 11 Image Size 12 Tx Power 100% MultiHertz 4.0 MHZ Adv. SieClear Off Dyn R 60 dB Map D Focus Width TEQ Gain P4-2 Adult Echo Tx Power 98% MI 1.05 TIS 0.7 TIB 0.7 DTCE High THI 4.0 MHZ 49 fps 18 cm 22 Unrestricted © Siemens Healthineers 2023 Speaker Notes: MultiHertz multiple frequency imaging enables the user to adjust the center frequency of the transducer in order to improve resolution (higher MultiHertz setting) or increase depth of penetration (lower MultiHertz setting) and clearly visualize the entire FOV from near field to far field in B-mode imaging (as displayed in this PLAX view). MultiHertz imaging allows the user to independently select B-mode fundamental or THI, color Doppler and spectral Doppler center frequencies (e.g., the Doppler frequency can be adjusted without changing the B-mode frequency). Each imaging mode has its own frequency setting to achieve the highest resolution, penetration and sensitivity for the structure being imaged in each mode. Multiple fundamental and harmonic frequencies are available on each transducer via the corresponding soft key rotary control. Notes No. 22 SIEMENS Healthineers Dynamic TCE tissue contrast enhancement technology SIEMENS. Healthineers ... High Density O DTCE Med R/S 3 Tint 12 Image Size 2 Tx Power 100% MultiHertz 3.6 MHZ Adv. SieClear Dyn R 53 dB Map C Focus Width TEQ Gain 0 Without DTCE With DTCE (Med) 23 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dynamic TCE™ tissue contrast enhancement technology (Dynamic TCE) reduces image speckle (as displayed in this PSAX image) while maintaining detail resolution for improved tissue contrast. Dynamic TCE technology is a Siemens proprietary, advanced method for speckle reduction. Speckle is displayed as a granular pattern formed from interferences of backscattered ultrasound waves which substantially lowers contrast and obscures image details. Its suppression must be balanced, as it can contain diagnostic information. Select one of four levels of DTCE (Off, Low, Med and High) to apply to the image. Notes No. 23 SIEMENS Healthineers High Density SIEMENS. Healthineers ... High Density 1 DTCE High R/S Tint 11 Image Size Tx Power 100% MultiHertz 4.0 MHz Adv. SieClear Off Dyn R 0 dB Map D Focus Width TEQ Gain O High Density 0 High Density 1 24 Unrestricted © Siemens Healthineers 2023 Speaker Notes: High Density increases / decreases line density (higher levels = higher resolution) when HD Zoom is activated. An increase in the High Density setting will cause a decrease in the frame rate. Notes No. 24 SIEMENS Healthineers Additional optimization features SIEMENS . Healthineers ... A 8 P4-2 Adult Echo Add Exam Workflow C5-2v Add Exam Workflow ? 2D Contrast eSiOLH Stress Echo eSiescan 2D Contrast Elasticity Siescape SieScan Clarify VE Persist Full Screen Extensive View Clarify VE Levels Edge L/R Flip Clear Screen THI Screen Hide Patient Physio Settings > 48 Split Image Param Clip Settings Full FOV DTI Param Timer End Exam DTCE Med RIS 3 Tint High Density DICE Med RIS 3 Tint 2 TEQ Gain MultiHertz 3.6 MHZ Dyn R 65 dB Map Image Size 3 Tx Power 100% MultiHertz 4.0 MHz Adv. SieClear Dyn R 65 dB Map G Image Size Tx Power 98% Page 1 Page 2 25 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Additional B-mode and M-mode optimization features include: • R/S (Res / Speed) adjusts the balance between the image line density (resolution) and the frame rate (speed); Settings are 0 (low resolution / high frame rate) to 5 (high resolution / low frame rate) • DynR (Dynamic Range) affects the number of gray shades that are displayed; Increase the Dynamic Range to produce a “softer” B-mode image; decrease the settings (settings range from 10 – 90) to produce an image with more contrast and Dynamic range is available on a live or frozen image • Tint individually colorizes the grayscale image to aid in visualization of subtle tissue differences; Clinical uses may include better wall motion visualization or a more detailed valve visualization Tint can be adjusted on a live or frozen image and tints are numbered 0-15 • Map enhances aesthetics by adjusting greyscale assignments to modify image contrast (only aesthetics change, as maps do not affect data content); Map may be adjusted on a live or frozen image; A gray map determines how dark or light you prefer to show each level of white / gray / black based upon the strength of the ultrasound signal and settings range from A - G • Tx Power (transmit power) allows manual adjustment of the acoustic energy delivered to the patient (settings range from .20 – 100%) • TEQ Gain is a user-definable threshold that accommodates different user preferences for gain settings and various room lighting conditions (settings range from -5 to 5) • Persist (Persistence) controls the number of images the system will average per frame; Increasing the persistence increases the number of images averaged reducing noise and making the image appear smoother; An average persistence setting is 2 or 3 (settings range from 0-4) • Edge (Edge Enhancement) enhances or smooths edges or borders; Increasing edge will enhance / sharpen borders and decreasing edge will smooth borders; settings range from 0-3 Notes No. 25 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac transducers • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes ACUSON Maple • Review Doppler controls • Describe Doppler optimization features SIEMENS 26 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will describe the B-mode and M-mode optimization features. Notes No. 26 SIEMENS Healthineers Zoom and HD Zoom SIEMENS ... Healthineers' ... Zoom 15 cm Z 15 cin HD Z Zoom HD Zoom 27 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Zoom activates either Zoom (read) or HD Zoom (write). • Zoom magnifies the image on a live or frozen image. A “Z” is displayed on the image screen (as displayed here in the image of the mitral and aortic valves). • Rotate Zoom to increase / decrease magnification of the image; Roll the trackball to pan the image • Rotation is customizable under System Configuration > Custom Keys > Increase Zoom > Clockwise / Counter Clockwise • Zoom is also available in color Doppler; In Split, the B-mode / color Doppler image can also be Zoomed • HD Zoom (write) increases image size, detail resolution and frame rate in a region of interest (ROI). Available on live image only. When selected, “HD Z” displays on the image screen (as displayed here in the image of the mitral and aortic valves). • Press Zoom once to display the ROI • Rotate Zoom to resize the ROI • Roll trackball to position the ROI • Press Zoom a second time to activate • Press Zoom a third time to deactivate Notes No. 27 SIEMENS Healthineers Split SIEMENS . Healthineers ... Split LVOT Diam 24.5 mm 13 cm HD Z 28 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Split displays the same image side-by-side. Comparisons may include: B-mode, B-mode and B- mode with color, or image with and without measurements (as displayed in the measurement of the LVOT). Split is often used to compare the B-mode image next to the color Doppler image in order to evaluate both the hemodynamics and the underlying B-mode image. On a live image, select Split to activate / deactivate. Notes No. 28 SIEMENS Healthineers Image Size SIEMENS. Healthineers ... High Density 2 OTCE Med R/S 3 Tint Image Size 2 Tx Power 00% MultiHertz 3.6 MHZ Adv. SieClear Dyn R 63 dB Map C Focus Width TEQ Gain 0 - Adult Echo Ta Power 100% Tx Power 100% TIS 0.4 TID 0.4 TIS 0.4 DTCE High Dyn R E0 0 OTCE High THI3.7 MIT THI 3.J Metz 0 dn 68 bpmn Image Size Image Size 4 O 29 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Image Size changes the size of the image. The default Image Size is 2. Increase or decrease Image Size for personal display preference. Pixels may appear tighter when using a smaller Image Size (as displayed in the image on the left). The FOV width is not affected when the image size is changed (settings range from 0 – 4). Notes No. 29 SIEMENS Healthineers Post-processing features SIEMENS . Healthineers ... Zoom A Adult Echo Add Exam Workflow A haile Echo Add Exam WorkHow Contrast eSioLH Stress Echo eSieScan 2D Contrast ? 20 ? esielH Stress Echo eSieScan Clarity VE Persist Full Screen Extensive View Full Screen Extensive View Clarify VE Levels Edge LIR Flip Screen THI Screen Physio Settings > 48 Split Physio Settings > Full M M Mode Frage Clip Settings Full FOV DI Clip Settings Angle AMM Marker AMM DTCE Med RIS 11 Focus Wid MultiHertz 3.6 MHZ Dyn R 65 dB Map D Image Size Tx Power 100% B-mode M-mode 30 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When the image is frozen, the available post-processing features will be displayed on the Touch Screen or soft keys. Available post-processing features on the Control Panel will be backlit. The following optimization controls may be adjusted after the image is frozen: • Zoom • B-mode: DTCE, DynR, Tint, Map, Cine Speed, L/R Flip, U/D Flip • M-mode: DynR, Tint, Map, Sweep, Angle AMM, Marker AMM Notes No. 30 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac transducers • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes ACUSON Maple • Review Doppler controls • Describe Doppler optimization features SIEMENS 31 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the display modes. Notes No. 31 SIEMENS Healthineers Doppler controls on the Control Panel SIEMENS . Healthineers ... 2D CW 30 / 40 PW Steer Angle Depth / Focus C O 0000 IHHHI UD 1 Dual Zoom ABC CW UD 2 lody Mark Caliper Print Store Clip Stor O UD 3 Print Store 2 32 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The primary Doppler controls on the Control Panel are: • C enters / exits color Doppler; Rotate C to change overall color Doppler gain • PW activates the Doppler cursor; Press PW again to enter PW (pulsed wave) Doppler; Rotate PW to adjust overall spectral Doppler gain; Press PW or 2D to exit; Press Update (located above the trackball) to cycle between the image and Doppler spectrum • CW activates continuous wave Doppler. SCW (steerable continuous wave Doppler) is available for phased array transducers or for the auxiliary CW pencil transducers; Rotate PW to adjust over spectral Doppler while in CW Doppler • Steer steers the color Doppler ROI and the spectral Doppler cursor right / left • Angle depicts the degree of angle correction for the Doppler spectrum • eSieImage optimization activates automatic spectral Doppler optimization Please Note: Dual, Zoom and HD Zoom are available in color Doppler. Zoom is available for the B-mode reference image in spectral Doppler. Roll the trackball and press the right or left Set key (located adjacent to the trackball) to perform functions in Doppler such as: • Position the color Doppler ROI • Size the color Doppler ROI • Position the spectral Doppler cursor • CINE the Doppler image or spectral Doppler waveform in freeze • Position the Pointer Notes No. 32 SIEMENS Healthineers Doppler controls on the soft keys SIEMENS . Healthineers ... a-Blend Off Filter RIS Priority smooth x Power 100% MultiHertz 3.3 MHZ Scale 1220 Hz Baselin Map C Flow Med Persist 2 Color Doppler MultiHertz 2.7 MHZ Filter 98 Hz Dyn R 80 dB Tint Tx Power 100% Gate 4.0 mm Scale 2170 Hz Baseline Map C Sweep Volume 10 Spectral Doppler 33 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler soft key rotary controls are located on the Control Panel and lie beneath and correspond to the controls listed on the bottom two rows of the Touch Screen. These controls are customizable for live imaging and when frozen in System Configuration > Soft Keys. All color Doppler soft key optimization controls, except for MultiHertz, Scale, and Baseline can be configured to the Touch Screen. All spectral Doppler soft key optimization controls, except for MultiHertz, Filter, Scale, and Baseline can be configured to the Touch Screen. The active control is highlighted in white. To alternate activation between the first and second row controls, push the corresponding rotary control OR touch the desired control. Once activated, turn the rotary control clockwise / counterclockwise to adjust. If the system is frozen, only those controls available in freeze will be available. Controls that are not available will appear dithered. Soft key controls do not change when navigating pages. Notes No. 33 SIEMENS Healthineers Doppler controls on the Touch Screen SIEMENS . Healthineers ... A Add Exam Workflow A P4-2 Adult Echo Add Exam Workflow ? 2D Contrast eSieLH Stress Echo eSiescan 2D PW Contrast eSieLH Stress Echo eSieScan Full Screen xtensive View Full Screen Extensive View Mute Screen VelTag off ED Frame ES Frame Clear Auto Sta Trace Direction Hide Physio Settings> Set Start Marker Set End Marker Hide Patient Physio Settings > Full D Update Rate Sensitivity Image Invert Color Display Reset Markers Param Clip Settings Invert DTI Mean Trace a-Blend Priority tiHertz 2.5 MHZ| Filter 195 Hz Dyn 65 de Tint Tx Power 100% Baseline Map D| Cine Speed 1 x 3.0 mm Color Doppler Spectral Doppler 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler Touch Screen controls are customizable for live imaging and when frozen in System Configuration > Soft Keys. Alternatively, all color Doppler Touch Screen optimization controls, except for CDE, Color Display, Invert, 4B, and Split can be configured to the soft keys. All spectral Doppler Touch Screen optimization controls, except for DTI, Invert, Full D, Auto Stat, Simultaneous, and Mute can be configured to the soft keys. A control is highlighted in blue when it is active, white when it is available and will be dithered out if unavailable. Touch the control to activate / deactivate or open a menu selection. If the system is frozen, only those controls available in freeze will be available. Notes No. 34 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Review cardiac transducers • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes ACUSON Maple • Review Doppler controls • Describe Doppler optimization features SIEMENS 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will review the Doppler controls. Notes No. 35 SIEMENS Healthineers Dynamic persistence SIEMENS .. ; Healthineers' ... Auto flash artifact suppression • Dynamic persistence adjusts P4-2 persistence relative to user motion Adult Echo Tx Power 98% MI 1.14 • Auto flash artifact suppression applies TIS 0.8 flash suppression relative to user TIB 0.8 2.5 MHZ motion 4325 Hz Flow Med 0 dB 17 fps 15 cm 36 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dynamic persistence and auto flash suppression are two unique technologies for color Doppler. Dynamic persistence technology: • Prevents “ghosting” motion in B-mode and color Doppler imaging • Enhances static color sensitivity • Reduces static B-mode noise In color Doppler, auto flash artifact suppression: • Prevents motion artifacts • Enhances color sensitivity • Allows high quality scanning at a fast pace Notice how the color Doppler, in the video of the heart shown here, displays excellent color sensitivity without motion artifacts. Notes No. 36 SIEMENS Healthineers Flow SIEMENS. Healthineers' ... Filter R/S 4 Priority 14 Smooth Tx Power 100% MultiHertz 6.7 MHZ Scale 781 Hz Baseline Map C Flow Low Persist 3 Flow Low Flow High 37 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Flow opens the flow state optimization preset selections. In this view of an apical 4 chamber, the Low Flow setting displays the greatest amount of color Doppler flow information for the pulmonary veins. Select Flow to quickly optimize the color Doppler flow state without changing multiple controls. • Flow Low (e.g., pulmonary veins, coronary arteries) • Flow Medium (e.g., normal flow throughout the heart) • Flow High (e.g., turbulent flow patterns, such as valvular stenosis) Notes No. 37 SIEMENS Healthineers Split SIEMENS .. ; Healthineers ... Split P4-2 Adult Echo Tx Power 98% MI 1.14 TIS 0.8 TIB 0.8 2.5 MHZ 4325 Hz Flow Med 0 dB 17 fps 66.6 15 cm 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Split displays the same image side-by-side. Split is often used to compare the B-mode image next to the color Doppler image in order to evaluate both the hemodynamics and the underlying B-mode image (as displayed here in the LVOT / aortic valve). On a live image, select Split to activate / deactivate. Notes No. 38 SIEMENS Healthineers Pulsed wave (PW) Doppler SIEMENS . Healthineers ... PW P4-2 Adult Ech Add Exam Workflow ? 2D C PW Contrast eSieLH Stress Echo eSieScan Full Screen Extensive View Mute 17 cm 110 mm Clear Screen Auto Stat Trace Direction Hide Patient Physio Settings > Full D Update Rate Sensitivity Image Param Clip Settings Invert DTI Mean Trace MultiHertz 2.5 MHZ Filter 195 Hz Dyn R 65 de| Tint 11 Tx Power 100% Gate 3.0 mm Scale 6510 Hz Baseline Map D Sweep 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Pulsed wave (PW) Doppler measures flow velocity within a gated sample volume (as displayed here in the mitral inflow). PW Doppler controls include: • Physio Settings adjusts the ECG controls when in cardiac imaging • Invert reverses the Doppler spectrum (values display above / below the baseline) • Mute deactivates the spectral Doppler audio volume • Update Rate adjusts the interval for refreshing the B-mode image; Selections include Off, 1-4 and 8 seconds • MultiHertz adjusts spectral Doppler frequency independent of the B-mode or color frequency, maintaining spectral Doppler flow sensitivity in vessels located in the near, mid or far field • Gate adjusts the sample volume size. Setting choices are 0.5-15.0 mm • Filter rejects signals below the selected frequency setting (e.g., signals generally caused by tissue clutter). Increase the filter to reduce clutter • Scale adjusts the pulsed repetition frequency (PRF) - the spectral Doppler frequency range; The PRF is dependent on the transmit frequency and depth of the Doppler gate • Dynamic Range adjusts the overall contrast resolution (dynamic range) of the spectral display in 5 dB increments; Lower levels are more black / white and higher levels show a greater range of gray shades (settings range from 10 dB to 80 dB) • Baseline adjusts the range of velocities displayed on either side of the baseline • Map selects a processing curve that assigns echo amplitudes to gray shades in the Doppler spectrum (settings range from A – G) • Sweep adjusts the scrolling speed of the Doppler spectrum. Decrease to display more heart cycles and increase to display fewer cycles (settings range from .75 – 12) • Tx Power (transmit power) allows manual adjustment of the acoustic energy delivered to the patient (settings range from .20 – 100%) Notes No. 39 • Volume adjusts the Doppler audio volume SIEMENS Healthineers Doppler auto optimization SIEMENS . Healthineers ... Automatic spectral Doppler optimization of: • Gain • Scale / Baseline • Dynamic Range • Auto Invert Doppler Auto Optimization ¥ Gain V Dynamic Range Scale/Baseline Auto Invert 40 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Press eSieImage on a live spectral Doppler trace to automatically optimize selected parameter(s). Go to the System Configuration menu to select optimized parameter(s) under System Configuration > Display > Doppler / M-mode > Doppler Auto Optimization. Parameters that can be automatically optimized include Gain, Dynamic Range, Scale / Baseline and Auto Invert. Notes No. 40 SIEMENS Healthineers Full D SIEMENS. Healthineers' ... P4-2 Full D TCD 140 Tx Power 98% MI 0.45 120 TIS 1.0 TIB 3.2 100 2.2 MHZ 6510 Hz 80 Gate 5.0 mm -3 dB 60 72 bpm -40 96.23 cm/s 20 PS ED 29.54 cmle ......................................................................... -cmis MD 29.09 cm/s RI 0.69 -20 PI(ED) 1.23 PI(MD) 40 1.24 S/D 3.26 -60 TAmx 54.16 cm/s TAmn 37.60 cm/s 59.3 mm/s 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Full D displays only the Doppler spectrum and hides the B-mode image. This image displays a mitral valve inflow tracing. Notes No. 41 SIEMENS Healthineers Doppler tissue imaging SIEMENS .. ; Healthineers' ... DTI 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Doppler tissue imaging (DTI) is a way to measure myocardial velocities. Color and pulsed waved Doppler tissue imaging are both available. For color DTI, press C and select the DTI control on the touch panel, as is shown in the image on the left. For a spectral DTI pattern, press PW and select the DTI control on the touch panel, as is shown in the image on the right. Notes No. 42 SIEMENS Healthineers Bypass cursor mode SIEMENS . Healthineers ... System Configuration Display General 1 Monitor Doppler 1 M-Mode General 2 Bypass Cursor Mode Display Enable Screen Saver 20 minutes Velocity Custom Keys Screen Saver Delay Dynamic Range Soft Keys Screen Saver Type SIEMENS Doppler Auto Optimization Scale Baseline Auto Invert Exam Measurement Text Annotation Body Marker DGC Stress Echo DGC Invert with Image Invert eSieScan DGC Curve Display Time Out Contrast DGC Contre Current Image Depth Clip Store Printer normal Index Display (Neo Head Exam Only) Barcode O TISITIB TIC Wireless Network Utility Archive Security Service Close 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: For PW functionality, the user has the option to bypass the curser. This is selected in System Configuration > Display > Doppler / M-mode > Bypass Cursor Mode. Uncheck the box to display the full-screen B-mode image with the Doppler cursor after pressing PW. Check the box to bypass the initial full screen B-mode image with the Doppler cursor and immediately activate the B-mode / Doppler split format. Notes No. 43 SIEMENS Healthineers Continuous wave (CW) Doppler SIEMENS .. ; Healthineers' ... P4-2 Adult Echo CCCC Tx Power 98% MI 0.09 CW TIS 0.6 TIB 3.4 O 1.8 MHZ Adult Eche Add Exam Workflow 9191 Hz 17 fps BP O 2D CW Contrast esieLH 2 Stress Ech eSieScan 15 on Full Screen Extensive View Mute 100 Trace Direction -150 Screen Simult Auto Stat Hide Patient Physio Settings > Full D Update Rate Sensitivity Image Param Clip Settings Invert DTI Mean Trace MultiHertz 1.8 MHZ| Filter 195 Hz Dyn 65 dB Tint 11 Tx Power 100% Gate 3.0 mm Scale 6510 Hz Baseline Map D| Sweep 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Continuous wave (CW) Doppler is available on adult and pediatric cardiac transducers, including the Auxiliary (Aux) CW2 pencil probe for adult cardiac and Aux CW5 pencil probe for pediatrics and vascular. CW Doppler is accessed via the left Control Panel controls, but can be assigned to a User Defined key under System Configuration > Custom Keys for easier access. Selecting the AUX CW transducer automatically enables non-imaging CW Doppler. Notes No. 44 SIEMENS Healthineers Post-processing features SIEMENS . Healthineers ... Zoom P4-2 Add Exam Workflow Adult Echo Add Exam Workflow ? 2D Contrast efield!| Stress Echo eSieScan 2D ContrasteSieLH Stress Echo eSiescan ? * Full Screen xtensive View Full Screen Extensive View Mute VelTag Screen Auto Stat Trace Direction Physio Settings> Patient Physio Settings > Full D Update Ra Clip Settings Invert olor Displa Clip Settings Invert Mean Trace a-Blend Filter RIS Priority 1 Smooth 2| Tx Power 100% tiHertz 2.5 MHZ 195 Hz Dyn R 65 de Tint Tx Power MultiHertz 2.5 MHZ Scale 4325 Hz Baseline Map Flow Med Persist 3.0 mm Color Doppler Spectral Doppler 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When the image is frozen, the available post-processing features will be displayed on the Touch Screen or soft keys. Available post-processing features on the Control Panel will be backlit. The following optimization controls may be adjusted after the image is frozen: • Color Doppler: Invert, VelTag, Color Display, ED Frame, ES Frame, Baseline, Priority, Map, Cine Speed, Zoom • Spectral Doppler: Invert, Full D, DynR, Baseline, Tint, Map, Sweep Notes No. 45 SIEMENS Healthineers SIEMENS . Trademarks and Disclaimers Healthineers ... • ACUSON Maple, eSieImage™ multiparametric optimization and Dynamic TCE™ tissue contrast enhancement technology are trademarks of Siemens Medical Solutions USA, Inc. 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Notes No. 46 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS . Healthineers ... Questions? 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Notes No. 47