ACUSON Maple 1.0 LVO Contrast Imaging Presentation

SIEMENS Healthineers SIEMENS Healthineers ACUSON Maple Ultrasound System Left Ventricular Opacification (LVO) Contrast and Contrast-enhanced Ultrasound (CEUS) for Cardiac Imaging 1.0 Software Release 1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this presentation we will discuss the cardiac imaging, contrast-enhanced ultrasound for Left ventricular opacification (LVO). Notes No. 1 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) • Touch Screen layout and workflow • Stress Echo with LVO Contrast • Image parameters and optimization 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here are the objectives for this presentation. We will begin by defining CPS and CHI contrast imaging technologies, the two types of contrast imaging technologies. Notes No. 2 SIEMENS Healthineers Contrast imaging technologies SIEMENS Healthineers ... Contrast Pulse Sequencing (CPS) is a three-pulse Contrast Harmonic Imaging (CHI) is a two-pulse sequence sequence in the fundamental imaging mode. in harmonic imaging mode. Advantages: Advantages: • High degree of motion flash suppression • High resolution • Superior penetration • Increased bubble longevity* • Excellent tissue suppression • High frame rates* CPS is excellent for general imaging applications. CHI is excellent for cardiac exams and very useful for general imaging in specific conditions. 3 * As compared to CPS Unrestricted © Siemens Healthineers 2023 Speaker Notes: Ultrasound systems manufactured by Siemens Healthineers currently use two different imaging technologies for contrast imaging: Contrast Pulse Sequencing (CPS) and Contrast Harmonic Imaging (CHI). For cardiac contrast imaging, CHI is the preferred method. Both technologies have different advantages and preferred clinical applications depending on imaging needs, penetration, frame rates, bubble longevity and tissue suppression. Knowing which technology to use for an exam requires a greater understanding of what makes up each technology signal, how the signals are generated and what their strengths and weaknesses are. This will help to better understand why the ACUSON Maple™ ultrasound system uses the CHI method for cardiac contrast imaging. We will begin by discussing Contrast Harmonic Imaging in greater detail. Notes No. 3 SIEMENS Healthineers Contrast Harmonic Imaging (CHI) SIEMENS Healthineers ... Contrast Harmonic Imaging: Scaling & Transmit Receive from Receive from Overall image • Second harmonic imaging Pulse # Signal Tissue Microbubble make up mode Linear Non-Linear (components) • Two transmit pulses • Pulse [phase] inversion only Tissue Advantages: 1+1 High frame rates* Scaling signal sum = • 0 Longer bubble lifespan* • + + • High resolution A Bubble 2-1 signal sum = Scaling = Ar = + *When compared with Contrast Pulse (Sum) (Sum) Sequencing (CPS) 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Contrast Harmonic Imaging, is a low Mechanical Index (MI) contrast imaging technique that uses only pulse inversion in the 2nd harmonic to exploit the non-linear behavior of microbubbles. This technology uses two pulses of the same amplitude with opposing values (positive and negative) to emit and send into the tissue from the transducer. The received (tissue) linear and (bubble) non-linear signals are summed (respectively) with the pulse inversion technique. The linear echoes are cancelled out while the non-linear echoes remain to form the image. It should be noted that any tissue signal remaining within the image is a result of those tissue signals not being cancelled out entirely. This “artifact” is due to the fact that tissue can sometimes generate a very small portion of non-linear echoes which, like a non-linear bubble echo, are not cancelled out during the summation process. A good quality contrast image has little to no tissue signal present in general imaging. CHI has many advantages that make it the “go to” choice for cardiac imaging exams. One big advantage of CHI is frame rates. Since CHI uses only two pulses, the image takes less time to generate than if there were more than two. Quick image generation means higher frame rates. The two pulse sequence is also thought to maintain bubble integrity longer as there are less sound waves to interact with. CHI also has a resolution advantage as it uses the 2nd harmonic rather than a fundamental frequency which tends to have less detail resolution [than harmonic frequency]. The ACUSON Maple ultrasound system supports CHI imaging technology in the Adult Echo exam for the 5P1 transducer. Notes No. 4 SIEMENS Healthineers Contrast Pulse Sequencing (CPS) SIEMENS Healthineers ... Contrast Pulse Sequencing: Fundamental imaging Scaling & Transmit Receive from Receive from Overall image • Pulse # Signal Tissue Microbubble mode make up Linear Non-Linear (components) • Three transmit pulses • Pulse [phase] inversion and / or phase modulation 1+1 Tissue + Advantages: Scaling + signal sum = • High specificity and 0 sensitivity 2-2 Scaling • Tissue penetration + + • Tissue suppression Bubble 3+1 signal sum = 151 Scaling = An = + (Sum) (Sum) 3 1 71 5 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Another signal separation technique, Contrast Pulse Sequencing, is a low MI contrast imaging technique that uses pulse inversion as well as amplitude modulation to exploit the non-linear behavior of microbubbles in the fundamental imaging mode. CPS uses three pulses during imaging as opposed to the two pulses that CHI employs. Two of the three transmitted pulses are of the same amplitude while one pulse has an altered (scaled) amplitude. The tissue and bubble signal echo summation still occur in the same mathematical manner as CHI, however three signals are involved in the process instead of two. CPS also has advantages that make it the preferred choice for a clinician or exam type. Since CPS uses three pulses and images at the fundamental frequency, it has a high signal-to-noise ratio that makes small amounts of contrast easily visible (high sensitivity). CPS also has a high microbubble to tissue background ratio, thus contrast is easily distinguished within the imaging field (high specificity). Additional advantages of CPS when compared to CHI is slightly increased penetration, motion flash suppression and background noise suppression. Notes No. 5 SIEMENS Healthineers Summary comparison of CPS and CHI SIEMENS Healthineers ... Property Contrast Pulse Sequencing Contrast Harmonic Imaging (CPS) (CHI) Penetration ++++ +++ Resolution +++ ++++ Motion Flash Suppression +++ ++ Specificity +++ ++ Sensitivity +++ ++ Contrast Agent Lifespan +++ ++++ Frame Rate ++ ++++ 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When both technologies are compared side by side, this chart highlights each technology’s comparative strengths and weakness. For cardiac exams, which require a high frame rate, CHI is the preferred technology and set as the default application. CHI technology not only offers superior frame rate, which is highly desired in cardiac imaging, it also has a higher resolution and lower bubble destruction rates through the duration of the exam. Notes No. 6 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) • Touch Screen layout and workflow • Stress Echo with LVO Contrast • Image parameters and optimization 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the Touch Screen layout and workflow. Notes No. 7 SIEMENS Healthineers LVO Contrast – Touch Screen and workflow SIEMENS Healthineers ... • LVO Contrast is available on the 5P1 P4-2 dult Echo Add Exam Workflow transducer for the Adult Echo exam 20 eSieScan preset • To activate, select LVO Contrast on the Touch Screen LVO Contrast • To de-activate, press LVO Contrast again or press 2D on the Control Panel THI Split Physio Settings >> Trapezoid 4B CTI Clip Settings DTI DTCE Med RIS Tint 11 Image Size 2 Tx Power 3.20% 3.7 MHZ Dyn R 60 dB Map E 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: LVO Contrast, which uses CHI technology, is available on the 5P1 transducer for the Adult Echo exam preset. The image shows the default layout. To activate contrast imaging, select LVO Contrast on the Touch Screen. To de-activate, press LVO Contrast again or press 2D on the Control Panel. Notes No. 8 SIEMENS Healthineers LVO Contrast – Touch Screen and workflow SIEMENS .... Healthineers ... • Focus – To extend the bubble duration, lower the Focus (below structure of interest) P4-2 Adult Echo Tx Power 98% MI 1.05 TIS 0.7 • Mechanical index (MI) level is automatically TIB 0.7 DTCE High changed to a low level when software is activated Dyn R 65 dB THI 4.0 MHZ -8 dB 49 fps • Default 2.9 MHz (range: 1.45-4.3 MHz) 18 cm 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once you’re in the LVO Contrast imaging mode, it is suggested to lower the Focus (below the structure of interest) to reduce the bubble destruction increasing the bubble lifespan. The default is set to a low MI state, but you can increase or decrease the Transmit Power to achieve the desired result. Please note: Increasing the MI accelerates the bubble destruction rate, while improving penetration. The default frequency is set at 2.9 MHz, but a frequency ranging from 1.45-4.3 MHz is available. A higher frequency would improve resolution, while penetration is reduced, and vice versa. Notes No. 9 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) • Touch Screen layout and workflow • Stress Echo with LVO Contrast • Image parameters and optimization 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss stress echo with LVO contrast. Notes No. 10 SIEMENS Healthineers LVO Contrast – Stress Echo activation SIEMENS Healthineers ... There are two ways to activate LVO Contrast P4-2 Adult Echo Add Exam Workflow for Stress Echo. 2D Stress Echo 2 Stress Echo eSieScan First method: 1. Select LVO Contrast on the 2D tab 1 VO Contrast 2. Press Stress Echo to select and begin a stress protocol THI Split Physio Settings > Trapezoid Clip Settings DTI o DTCE Med RIS Tint 11 Image Size 2 Tx Power 3.20% 3.7 MHZ Dyn R 60 dB Map E TEQ Gain 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are two ways to activate LVO Contrast for Stress Echo. First method: 1. Select LVO Contrast from the 2D tab 2. Then press Stress Echo, on the upper right-hand corner, to select and begin a Stress Echo protocol For more information on how to use the Stress Echo application, please refer to the ACUSON Maple Stress Echo presentation. Notes No. 11 SIEMENS Healthineers LVO Contrast – Stress Echo activation SIEMENS Healthineers ... Second method: PA-2 Adult Echo Add Exam Workflow 1. Press Stress Echo to select and 2 2D 4 Stress Echo 1 Stress Echo eSieScan begin a stress protocol 2. Select 2D tab 3 VO Contrast 3. Select LVO Contrast 4. Select Stress Echo tab to resume THI Split the stress protocol Physio Settings > Trapezoid Clip Settings DTI DTCE Med RIS Tint 11 Image Size Tx Power 100% 3.7 MHZ Dyn R 60 dB Map D Focus Width TEQ Gain O 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In the event a Stress Echo protocol has begun before activating LVO Contrast, please follow the following steps. Second method: 1. Press Stress Echo to select and begin a stress protocol 2. Select the 2D tab to return to the main screen, as LVO Contrast is located here 3. Select LVO Contrast 4. Select Stress Echo tab to resume stress protocol It is recommended to use the first method for Stress Echo that requires contrast imaging, as the second method described here requires more steps in the workflow. For more information on how to use the Stress Echo application, please refer to the ACUSON Maple Stress Echo presentation. Notes No. 12 SIEMENS Healthineers LVO Contrast – Stress Echo and Doppler controls SIEMENS Healthineers ... Doppler controls are disabled when LVO PA-2 Contrast is activated. Adult Echo Add Exam Workflow 2 2D 1 ess Echo eSieScan To access Doppler controls: 1. Select Stress Echo to pause stress protocol 3 VO Contrast 2. Select 2D tab THI Split 3. Select LVO Contrast to Physio Settings > Trapezoid 48 deactivate it Notice that the Doppler controls are now Clip Settings DTI enabled (Color, CW, PW). O DTCE Med RIS Tint 11 Image Size Tx Power 100% 3.7 MHZ Dyn R 60 dB Map D TEQ Gain Please Note: A “play” icon becomes visible once the stress Echo protocol is paused. Press this control to resume. 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Doppler controls are disabled when LVO Contrast is activated. To access Doppler controls: 1. Select Stress Echo to pause the stress protocol, notice the Stress Echo tab is no longer visible when paused 2. Select 2D tab to access LVO Contrast control 3. Select LVO Contrast to deactivate it Now, notice that the Doppler controls are enabled (Color, CW, PW). Please note: A “play” icon becomes visible once the Stress Echo protocol is paused. Press this Stress Echo control to resume the Stress Echo protocol. If LVO Contrast is still needed, be sure to reactivate it on the 2D tab before resuming the stress echo. Notes No. 13 SIEMENS Healthineers Objectives SIEMENS Healthineers ... • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) • Touch Screen layout and workflow • Stress Echo with LVO Contrast • Image parameters and optimization 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Lastly, we will discuss the image parameters and image optimization. Notes No. 14 SIEMENS Healthineers LVO Contrast – Image parameters and optimization SIEMENS Healthineers ... Imaging parameters to further optimize the P4-2 Adult Echo Add Exam Workflow contrast image: 20 eSieScan • Gain serves only to amplify the receive signal; it does not alter the resolution or penetration, but does affect image LVO Contrast quality Clear Screen Split • Maps and Tints – user preference Hide Patient Physio Settings > Trapezoid 4B CTI Image Param Clip Settings DTI ligh Density DTCE Med R/S Tint Image Size 2 Tx Power 3.20% MultiHertz 3.7 MHZ Dyn R 60 dB Map 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: While the default contrast imaging settings are suitable for most imaging needs, there are circumstances where additional imaging adjustments may be needed to improve the image quality. Other than the transmit power, transducer frequency and focus placement that were discussed on the previous slide, there are additional image parameters that should also be considered when attempting to improve the image quality. Gain is used to amplify the receive signal as it does not change the sensitivity or specificity to the contrast agent. However, having the proper gain setting does affect the image quality as is true in regular B-mode imaging. It is important to adjust gain to the appropriate level to visualize the tissue and blood pool borders or the vascularity in tissues and cardiac mass. Having too much gain can lead to added noise, while insufficient gain can cause loss of image details from weaker contrast signals. Next are Map and Tint. The default map is E and tint is 11 for LVO Contrast. While there is an ongoing debate on whether tint enhances the visualization of motion, in general, choose a Map and Tint that offers you the best visualization on the region of interest (ROI). Notes No. 15 SIEMENS Healthineers LVO Contrast – Image parameters and optimization SIEMENS Healthineers ... Imaging parameters to further optimize the contrast image: • HD Zoom – Increase resolution • Depth – Reduce unwanted depth • eSieImage™ multiparametric optimization – Optimizes the gain • Dynamic TCE™ tissue contrast enhancement technology – Reduce speckles and enhance tissue contrast differences 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Some additional imaging parameters and tools to help further optimize your contrast image are: Zoom, Depth, eSieImage™ multiparametric optimization and color Doppler. Use the HD Zoom (write zoom) feature to increase image size, detail resolution and frame rate in the region of interest (ROI). Limit the Depth to exclude any unwanted regions in the field of view. Use eSieImage optimization to automatically optimize the gain and suppress noise. Use Dynamic TCE™ tissue contrast enhancement technology to reduce speckles and enhance the tissue contrast differences. And lastly, always try to find the best acoustic window and optimize the image as much as possible before contrast injection. Notes No. 16 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. 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Notes No. 17 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS Healthineers ... Questions? 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes.