ACUSON Maple fourSight 4D Presentation

SIEMENS Healthineers ACUSON Maple Ultrasound System Advanced fourSight Technology 1.0 Software Release 1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The purpose of this presentation is to provide an overview of the ACUSON Maple ultrasound system using volume imaging in 3D and 4D. Page No. 1 Objectives SIEMENS . Healthineers .. • Outline activation and volume acquisition • Tools for volume manipulation • Define volume store and editing • Review helpful guidelines and tips 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here are the objectives that will be covered in this training. To start, we will review the activation and volume acquisition for 3D/4D. Page No. 2 Transducers for 3D/4D SIEMENS . Healthineers .. Mechanical 3D/4D Wobbler Transducers Freehand 3D Transducers 9VC2 9VE4 10MC3 3 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The 3D/4D transducers available are the mechanical wobblers 9VC2 and 9VE4. The non mechanical transducers available are the 10MC3 and only can perform a free hand 3D volume acquisition. We will review the terminology and technology for 3D and 4D. During a 3D acquisition, a single freehand or mechanical (automated ) sweep is performed and produces three orthogonal dimensions, or planes, as well as a volume rendering. During a 4D acquisition, the transducer continuously acquires and displays the volume information. This method is also known as a real-time 3D ultrasound. The time is considered the fourth dimension. The controls for both transducers are the same, with the exception of the scanning technique that will be covered later in this presentation. Page No. 3 ROI and VOI SIEMENS Healthineers' ... Region of Interest (ROI) The green solid graphic outline represents the entire area that will be acquired for the volume Volume of Interest (VOI) The corner icons form a rectangular box that represents the boundaries of the rendered volume The dotted line represents the rendered view and direction GA 32w 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once entering 3D/4D acquisition, the ROI (Region of Interest) and the VOI (Volume of Interest) graphic box is adjustable in combination only. The ROI size of the box represents the entire area of interest. The VOI rectangular box defines the content of the volume. Once a volume is performed via the update key, the VOI rectangle box can be re-sized and optimized. The VOI plane can be curved and will be discussed later in the presentation. Please note: When performing a 4D scan, it is possible to re-adjust the VOI during live scanning or in freeze. Please note: When a 3D Auto Sweep is acquired, it is possible to re-adjust the VOI Size in the frozen 3D volume only. Notice: In 3D or 4D mode, when positioning and adjusting the ROI/VOI, the 2D image quality is unchanged. Page No. 4 Volume and multiplanar reconstruction SIEMENS Healthineers ... Nomenclature Transducer 9VE3 GYN Phantom A plane B plane Sagittal view Transverse view C plane Quadrant D Coronal view Rendered volume Volume reference orientation icon 5 5 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: This is the display of an acquired volume with a format 4:1. MPR is the abbreviation of Multiplanar Reconstruction, also known as Multiplanar Reformatting. The quadrants are referred to as A, B, C, and D with quadrants A, B, and C containing the MPR's of the volume and D containing the volume. • A is the acquisition plane • B is the elevation plane • C is the coronal plane • Quadrant D contains the surface rendered volume The reference orientation indicator in the volume quadrant uses color to indicate the relative location of the data acquired. The first data set is displayed in (blue) and the last data acquired (red). The top (apex) of the pyramid represents the transducer. The base of the pyramid represents the data at the greatest depth. Page No. 5 3D/4D reference point SIEMENS Healthineers ... • The reference marker or point is the pivotal point to navigate through the volume • It represents the point where the A, B, and C plane intersect • Placing the point on a specific target displays the anatomy in all three planes Reference point 6 6 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The reference marker is the intersection point between all three orthogonal planes. Volume manipulation is facilitated by placing the reference point within the volume. This subsequently becomes the pivotal point around which the volume may be rotated along any of the three axes, without losing its position, as it remains displayed in all three orthogonal planes. This image using a GYN phantom is provided as an example. The uterus was acquired to demonstrate an implanted embryo using 3D AutoSweep. Rotations are done via X, Y, Z. The embryo remains clearly displayed at all times and in all perpendicular planes as the primary designated structure. If the endometrium becomes the primary point of interest, then the reference marker may be moved from the embryo to the endometrium for navigation within the volume, with the endometrium as a pivotal point. Page No. 6 Activate 3D/4D SIEMENS . Healthineers .. 2D CW 30/40 Angle $ Depth / Focus Esc Dual System Configuration Exam General 1 General 2 Exam Abd Display Freeze Behavior Cine Physio Management 3 Lead ECG Custom Keys Seamless Dual On Aux ECG Soft Keys Dual Behavior on Freeze Left Dual Image Live Lead Type I Lead Type II Aux Signal ED-ES Split Respiration Measurement Indicate R-Wave Text Annotation eSielmage On on Body Marker 20/M & 2D/Doppler Display Format 1/2 20 - 1/2 Trace DI4D Default Selection O 3D 4D Stress Echo 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To acquire a volume: • Press the 3D/4D key on the control panel • Press the Update key to start the 3D/4D acquisition • The default Setting for either 3D AutoSweep or 4D live can be customized for each exam in System Configuration > Exam Type > 3D/4D Default Selection Page No. 7 Home base SIEMENS . Healthineers .. Update key Starts acquisition Axis of rotation X, Y, Z Set key Size and position the ROI/VOI Green ROI becomes a dotted outline during resizing 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Update key starts the volume acquisition using either 3D or 4D, depending on what the user has selected. Before entering a volume acquisition: • Select the Set key to adjust the ROI • Toggle between ROI size and ROI position (panning) using the Set key while using the trackball to adjust/move the ROI • VOI resizing can be done on a frozen volume or during live 4D • The ROI outline will change from a solid line to a dotted line during ROI resizing The Update key allows the user to toggle through the volume rotations X, Y and Z on the selected quadrant. Page No. 8 Getting started with 3D imaging SIEMENS. Healthineers ... Activated 3D VOI Touch Screen 3D tab display 9VC2 a / 9VE4 OB C5-2 Add Exam Workflow Tx Power 98 MI 0.92 TIS 0.3 ? 2D 3D Contrast Elasticity Siescape eSieScan TIB 0.3 ASC 2 Pyn 8 70 004 51 fps Clear Screen VOI Hide Patient Image Fetal Phantom Param SubPreset > 3D End Exam Angle 90 . Quality 5 Volume pre-acquisition controls 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Activating 3D imaging: In addition, the selected angle size will be displayed in the right upper corner. When in a 3D acquisition, the system updates the incremental data set or slice (acquired image). The incremental slice is the mid-plane perpendicular to the 2D scan plane. On the Touch Screen, the 3D method is blue when activated. On the Touch Screen, the major pre-acquisition parameters are: • Quality • Angle Details about quality and angle settings will be discussed later in this presentation. On the entry page, the volume SubPreset is also accessible. Details regarding SubPresets will be discussed later in this presentation. Please note: 3D AutoSweep has a higher volume quality and detail resolution compared to a 4D acquisition. Page No. 9 Getting started with 4D imaging SIEMENS. Healthineers ... Activated 4D VOI Touch Screen 3D tab display 9VC2 C5-2 a 9VE4 Add Exam Workflow OB Tx Power 98% MI 0.92 TIS 0.3 Contrast ASC 2 ? 2D 4D Elasticity SieScape eSieScan TIB 0.3 DTCE High Dyn R 70 dB THI F 5.7 MHZ 1-7 dB "51 fps Screen VOI Hide Patient Param Fetal Phantom SubPreset > 3D 4D End Exam Angle 80 . Quality 2 Volume pre-acquisition controls 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Activating 4D imaging: On the Touch Screen, the 4D function is blue when activated. On the soft key control area, the major pre-acquisition parameters are: • Quality • Angle Details about quality and angle settings will be discussed later in this presentation. On the entry page, the volume SubPreset is also accessible. Page No. 10 Volume monitor layout SIEMENS Healthineers ... Patient banner Fetal Phantom OBIG Dr. Babyface 007 ACUSON Juniper Today 12:00 9VC2 OB Tx Power 98% MI 0.92 TIS 0.3 Volume Imaging parameters TIB 0.3 ASC 2 DTCE High Dyn R 70 dB THI F 5.7 MHZ -7 dB 51 fps Volume display field Volume orientation icon Cine buffer 11 11 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The patient banner display at the top of the screen is customizable in the system configuration > General 2 > Hide Patient Banner. Depending on the user or site preferences, it can display the patient data as well as information, such as, hospital name, time and date of the exam. Volume acquisition imaging parameters, such as opacity, dynamic range, brightness, et cetera, are displayed in the upper left corner of the image. The image screen area contains the acquired volumes • The format of 4:1 is predefined • The surface rendered volume on the left and the related view plane in each orthogonal MPR is displayed on the right A blue and red volume orientation icon is located next to the image display field in the lower left corner to aid the user during manipulation. The Cine buffer indicator is located at the bottom of the screen. Page No. 11 3D AutoSweep acquisition SIEMENS Healthineers' ... • Place VOI just above desired anatomy • Press update to start the acquisition • The transducer will mechanically sweep • The volume will be displayed when completed | UD Keyboard Author | Department 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To acquire a 3D AutoSweep volume, press the 3D/4D control to display the VOI and place it for the desired anatomy. Adjust the VOI size by pressing the Set control and then press Set again to confirm the size. Press the Update control to start the acquisition. The transducer will perform a mechanical sweep of the selected area and, when completed, will display the volume in the image in a 4:1 format. Page No. 12 3D free-hand acquisition SIEMENS Healthineers .... Scan Scan 10MC3 Linear Rocked GYN Tx Power 98% 90 /12 sec MI 0.47 TIS 0.5 • Move the transducer in a slow steady sweep TIB 0.5 ASC 2 DTCE Med Dyn R 60 dB • Press update to start an acquisition 0 dB 45 fps • To shorten the acquisition, press freeze and press image • Default degree is 90 5 cm Author | Department 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To perform a free-hand acquisition with the 10MC3, first select if the scan will be a linear or rocked acquisition. For endovaginal acquisitions select the Rocked option. Move the transducer in a slow, steady sweep and obtain the desired anatomy. The sweep should start from the patient’s right to the patient’s left, or inferior to superior. The position of the transducer should be as consistent as possible to avoid registration lines in the image. The timer will be displayed indicating how much time is left to acquire the anatomy. The user has the option to stop the acquisition during the scan by pressing the Update key and returning to the acquisition mode, although the volume will not be saved. To shorten and save the acquisition, the user will need to press the Freeze key and then press the Image key. The default is 90 degrees and may be changed using the quality and angle options. Page No. 13 3D/4D default selection SIEMENS . Healthineers .. System Configuration Exam General 1 General 2 Exam 09 Display Freeze Behavior Cine Physio Management 3 Lead ECG Custom Keys Seamless Dual On AUX ECG Soft Keys Dual Behavior on Freeze Left Dual Image Live O Lead Type ! Lead Type la Exam ED-ES Split Respiration Measurement Indicate R-Wave Text Annotation eStelmage On Body Marker 2DIM & 2DIDoppler Display Format 1/2 2D - 1/2 Trace 3014D Default Selection O 3D 4D Stress Echo &SieScan Doppler Update Style 2D-Frz / D-Lv Doppler Auto Stat On Clip Store Doppler Trace Orientation Above Baseline Printer Barcode Auto invert of Color White Steering Auto Auto invert of Color and Spectrum O On Archive 2D Steer with Cursor on Service Auto 2D FOV with Color Activation On Restore Defaults Close 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Since both 3D and 4D are available on the ACUSON Maple™ system, the user can select either 3D or 4D as the default imaging type when the volume imaging function is activated. Configuration of the default imaging type is found on the system under System Configuration > Exam. After selecting the exam type from the drop-down menu (OB, GYN, Early OB) with the Pointer, select either 3D or 4D to be the default volume method. In general: • OB exams typically prefer a 4D live imaging mode • GYN exams typically prefer a 3D AutoSweep imaging mode • Early OB exams typically prefer a 3D AutoSweep imaging mode Page No. 14 Objectives SIEMENS . Healthineers .. • Outline activation and volume acquisition • Tools for volume manipulation • Define volume store and editing • Review helpful guidelines and tips 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss the tools available for volume manipulation. Page No. 15 Control panel SIEMENS . Healthineers Y Z D C X O 0000 IHHHI Angle M 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The control panel of the system contains rotary dial keys that allow the user to manipulate the X, Y and Z axis of the acquired volume. • The X axis is controlled by Angle knob • The Y axis is controlled by PW Doppler knob • The Z axis is controlled by color Doppler knob • The MPR Slicing function is controlled by the M-Mode knob Please note: Update key can be used to toggle between X, Y and Z axis while in 3D/4D imaging. Page No. 16 3D/4D volume rotation icons SIEMENS. Healthineers .. Three MPR’s – Multiplanar reconstruction Three MPR's - Multiplanar Rendered volume Panning reconstruction X axis A X axis MPR's Y axis Y axis Volume Z axis Z axis Resize VOI 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The system displays the rotation icons on the selected MPR and volume. When a MPR is selected, the system displays a line and an arrow indicating the axis of rotation on the two corresponding MPR’s. • X axis rotation is similar to the motion of a “rotisserie” • Y axis rotation is similar the motion of a “drill” • Z axis rotation is similar to a back and forth “rocking” motion Icons for panning and resizing are also displayed. Page No. 17 Volume Touch Screen SIEMENS. Healthineers .. 9VE4 9VC2 4 Add Exam Advanced fourSight™ MultiSlice TSI Curved MPR technology 4D Volume plane display A B 90º C D 270º 180º Clear 4D Cine >> Lighting > VOI Curved Volume adjustment area Hide Patien Editing Reset >> CutPlane RenderDir Render Up/Down Surface Translucent Image Param SubPreset > Animation> Wireframe 3D 4D End Exam Volume optimization and Steering Angle Angle 550 Quality 6 Map D Dyn R 60 Tx Power 100% Smooth 50 Contrast 64 Opacity 60 Tint 2 LowTh 68 Brightness 50 soft keys 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once the 3D/4D key is selected, the Touch Screen displays the available functions for manipulating the acquired volume. The Touch Screen layout is grouped for ease of use and contains: • Advanced fourSight™ technology options, Multislice, Thick Slice Imaging (TSI), and MPR’s are located in the upper right corner • Onscreen layout options and plane display choices are displayed next • Volume adjustment options are displayed next • Volume optimization soft keys such as tint, brightness or opacity at the bottom of the Touch Screen associated with the rotary controls on the keyboard Touch Screen selections are highlighted blue when on and gray or dithered when off. Keys that are dithered out are not available in the current active mode but may be available in other modes. Some folders contain additional options or sub-settings which are indicated to the user by an arrow (>) or three gray lines on the Touch Screen key. Press the Touch Screen key to open the options or sub-settings and select the new option or setting. Page No. 18 Advanced fourSight technology SIEMENS. Healthineers 9VE4 9VC2 GYN Add Exam ? 4D MultiSlice TSI Curved MPR A B 90º C D 270º 180º 4D Cine > Lighting > VOI Curved Screen Hide CutPlane RenderDir Render Patient Editing > Reset > Up/Down Surface Translucent Image Param SubPreset > Animation > Wireframe 3D 4D End Exam Steering Angle Angle 55º Quality 6 Map D Dyn 60 Tx Power 100% Smooth 50 Contrast 64 Opacity 60 Tint 12 LowTh 68 Brightness 50 19 Unrestricted © Siemens Healthineers 2023 Speaker Notes: 3D/4D Advanced fourSight technology contains MultiSlice, thick-slice imaging (TSI) and Curved MPR options. Press the tab for access to the MultiSlice, TSI or Curved MPR feature and the corresponding imaging folder will open for further adjustments. Page No. 19 3D/4D MultiSlice SIEMENS . Healthineers .. MultiSlice Selects MPR plane Chooses layout display Changes amount of slices displayed at once A Plane B Plane 2×2 3x3 C Plane 4x4 6x6 Horizontal Vertical Selects line direction 20 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To initiate MultiSlice, select MultiSlice on the Touch Screen. MultiSlice allows viewing multiple slices of the same plane at the same time. Imagine moving through a volume and displaying each individual slice that you obtained when moving through the volume and spreading them out on a table. This is essentially what MultiSlice does. It is often referred to as CT or MRI-like image presentation. MultiSlice allows selecting: • Which plane should be displayed - A plane, B plane or C plane • Preferred format 3:1, 4:1, 2:1 or full screen display • Number of slices displayed at one time • MultiSlice orientation display with horizontal or vertical lines Please note: Once entering MultiSlice, the surface rendered volume is disabled. Page No. 20 3D/4D MultiSlice SIEMENS . Healthineers .. MultiSlice Moves range incrementally Prev Page Next Page Moves through slices within the selected range Prev Image Next Image Soft keys: Optimization tools Distance between slices Map Tint Dyn R Slice Spacing D 2 45 1.0mm 21 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Once a selection is made, tabs for various page selections appear on the Touch Screen: • Prev Page indicates moving through the entire range incrementally • Prev Image allows moving through the slices within the selected range An advantage selecting via the Touch Screen and target will be that an MPR image stays fixed in the center and the slices will move. Another option is to use the selected plane (A, B or C) to move the MPR via trackball into the MultiSlice. In this case, the slice graphics stay fixed on the MPR. Page No. 21 3D/4D MultiSlice layout SIEMENS Healthineers ... Format 4:1 and layout 2x2 Format 3:1 and layout 3x3 Horizontal lines on A plane Vertical lines on A plane 9VE3 Early OB 4 GB A B Early OB B 4 GB Opacity Dyn R. 50 Dyn R 50 Contrast 44 Contrast 44 Brightness 20 Brightness 20 Map L Map L Tint 2 Tint 2 A C C GYN Phantom GYN Phantom 22 22 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Let’s review the two image examples: • The left image demonstrates a selection of format 4:1 with a layout of 2x2 and chosen vertical lines on A plane • The right image demonstrates a selection of format 3:1 with a layout of 3x3 and chosen horizontal lines on A plane • Highlighting the slice in yellow correlates the selected slice within the display and its position within the slice graphics The ability to rotate the slices in X, Y and Z axis while in one of the three MPR’s using the mode rotary controls on the control panel. Page No. 22 3D/4D MultiSlice full screen format 1:1 SIEMENS Healthineers ... Slice spacing 3.5mm steps 59.5 mm 17/4163.0 mm 18/41- 66.5 mm 41 Total number of slices Current slice 70,0 mm 20/41| 73 21/41 77.0 mm 22|4 Center slice number 80.5 mm 23/4184.0 mm 24/41 87.5 mm 25/41 23 23 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select the 1:1 format using the Select knob or click the Pointer and Set key on the D quadrant on the Touch Screen. In the full screen mode, the slice spacing, slice number and total number of slices is shown. Slice spacing displayed in the image in the left lower corner in mm. In this image example, 3.5 mm slice spacing was pre-defined. The current slice number is displayed together with the total number of slices in the right lower corner. A green marked asterisk indicates the center slice of the total number of slices acquired. Please note: The green asterisk is already present in combination with the three MPR’s layout. The user has the ability to rotate the slices in X, Y and Z axis while in the full screen display using the mode rotary controls on the control panel. To exit the MultiSlice function, press Exit on the Touch Screen. Page No. 23 3D/4D Thick-slice imaging (TSI) SIEMENS . Healthineers .. TSI Slice thickness option Option of planar display A/A A/C Slice Thickness 20mm Access to other Render render modes Surface Soft keys: Optimization tools Smooth Contrast Opacity Tint LowTh Brightness 40 56 65 30 58 24 Unrestricted © Siemens Healthineers 2023 Speaker Notes: TSI allows the user to define a view plane (cut plane) and create a certain thick slice in the region of interest. A benefit using TSI is to have access to a predefined thickness of the volume of interest at the acquired region of interest. The result will display in the render mode in a desired slice thickness (2 mm to 40 mm). This results in increased detail and contrast resolution in the selected rendered volume. To initialize: • Select TSI located on the Touch Screen • Select the desired planar display; the default is A/C which is the most used combination for the clinical application • Abbreviation A/C: Display of the A plane (MPR) with the coronal volume view (D) • Or select the planar option A/A; abbreviation A/A: Display of the A plane (MPR) with the A plane view synchronized to the volume (D) • Option to choose a slice thickness If necessary, select another render mode. The surface mode is selected in this example. Volume optimization parameters are accessible. Use the rotary control to adjust the values. Page No. 24 3D/4D TSI display with A/C plane SIEMENS Healthineers ... A/C Position line Illustration how TSI works: Center of thickness Example with 20mm 10 mm 10 mm GYN Phantom Icon: TSI 25 25 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The default is the A/C planar display and with a pre-defined 20 mm slice thickness. Please note that a new icon appears, marked in a yellow rectangle and inside the A plane MPR slice, as the reference orientation. • The MPR A plane is displayed on the left; Aligned with the reference point, a dotted line appears in advance, named as position line or reference line and this line represents the intersection of the volume rendering (VR) • The VR is displayed in association with the C plane and contains the 20 mm thickness To edit the TSI view: • Before entering TSI function, the user should have adjusted the reference point to the primary designated anatomic structure, and it does not matter if VOI was on or off or which render mode was utilized • If necessary, adjust the Slice Thickness setting and observe the effect on the volume: • A higher thickness setting will create a thicker slice • A lower value will create a thinner slice • Activate A plane by using Pointer and Set key • Move the A plane up or down by using the trackball and Please note the effect on the rendered volume Page No. 25 3D/4D TSI display with A/C plane (cont.) SIEMENS Healthineers ... Move the A Plane via trackball up To rotate the line, press the Update key and use or down to reaches the estimated anatomical area trackball Access to Z axis rotation use Pointer and Set key on C plane TSI 26 26 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The result image is displayed above, continue the editing process: • Image on the left: The reference is fixed, the A plane image was moved up via the trackball until the expected anatomical structure is visible and in this image example with the GYN phantom, the focus was to view the embryo • Image on the right: As long the A plane quadrant is still active, the user can access the A plane rotation • Press the Update key and the trackball will be combined with the rotation line function and a new rotation icon will appear • Move the trackball to adjust the angle and to see the effect on the C volume plane with TSI. Please note: be aware that the rotate line does not allow the functions as X, Y, Z • To access the Z axis, rotate the anatomical assessment into a portrait view: • Activate the C plane TSI by using Pointer and Set key • A gray outline will be displayed, and the Z axis rotation is activated for use via the C mode knob on the control panel • Rotation for X axis and Y axis are disabled when in TSI function Page No. 26 3D/4D TSI display with A/A plane SIEMENS Healthineers ... A/A A/A plane with chosen slice thickness of 2mm GYN Phantom Entering A/A plane, the TSI icon changes into reference line disappears, A plane view the reference dot is displayed 27 27 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select the A/A folder to initiate the A plane with the synchronized A view. Please note that the reference line has disappeared. The reference dot is still present and promotes the thick slice center. The TSI icon, marked in yellow, changes into the reference orientation based on the A plane view. To exit TSI function, Select Exit on the Touch Screen. Page No. 27 3D/4D curved MPR SIEMENS . Healthineers .. Curved MPR Choose a draw method tab line, spline or trace on Touch Screen Line Spline Trace Soft keys: Optimization tools Map Tint B 1 Dyn R 60 28 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The function Curved MPR transports the MPR reformatting image into any linear or curved plane. Curved MPR allows the user to set points along a curved object to straighten it. The placement of the points tells the software where to put the center of the image. The process is called warping, and the effect is straightening. • Selection Line: Defines a curved-line structure with two marker positions • Selection Trace: Defines a free-form drawn outline • Selection Spline: Defines a curved-line structure with three or more marker positions Page No. 28 3D/4D curved MPR Spline method SIEMENS . Healthineers .. GYN Phantom Spline Generates a MPR image into a curved plane. Sets points along a curved object in order to straighten it. Rotate curved MPR line: Use Pointer, hold Set key and track to the end of line. A circle appears to allow rotating. GYN Phantom 29 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To activate Spline, press Spline on the Touch Screen and a cursor appears. To draw the line: • Position the crosshair at the top of the endometrium (shown in this example) and press the Set key. Please note: The place you begin the trace affects the orientation of the straightened image • Use the trackball in combination with Update key to Set the spline method points • Once you have finished drawing the line, press the Set key and the straightened image will be displayed to the right • Reposition the line, if necessary: • Position the Pointer over the red dot in the middle of the line and a hand icon appears • Press and hold the Set key and move the trackball to pan the curved MPR line • Please note: If you only press the Set key instead of pressing and holding the Set key, the traced line will disappear, and the trace will need to be repeated The image on the right has been straightened. The Z axis rotation brings the image in the desired anatomical view. To rotate the line: • Position the Pointer over either end of the line and a circle rotation icon will appear • Press and hold the Set key and move the trackball to rotate the curved MRP line • Please note: If you only press the Set key instead of pressing and holding the Set key, the traced line will disappear, and the trace will need to be repeated • To exit the TSI function, select Exit on the Touch Screen Page No. 29 Display format SIEMENS Healthineers ... Quadrant selection Display format Volume orientation Active quadrant will be highlighted Changes the display format for the Rotates in 90° increments, with a green outline volume and MPR's Green dot indicates orientation A B 90º C D in 270º 180º 90. O 270* 180º 30 30 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To select a quadrant: • Select the desired quadrant from the options located on the left side of the Touch Screen or position the Pointer on the required quadrant on the Image Screen and press the Set key To select a display format: • Select the desired format for 2:1, 4:1, 3:1 or 1:1 from the options in the center of the Touch Screen • 1:1 displays the selected quadrant only • Please note: To display the rendered volume, the quadrant D must be highlighted To select the volume orientation: • Select the desired angle on the right side of the Touch Screen to align the rendered volume to the selected angle • The small green dot on the side of the volume indicates the displayed degrees of angulation – choices are 0°, 90°, 180° or 270° Page No. 30 3D/4D select volume full size SIEMENS Healthineers ... Control panel • Push the Select key • Fastest access for a 1:1 display format of the rendered volume Fetal Phantom Select knob Format 1x1 00 Selon Select 31 31 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Select knob allows quick access into the 1:1 format for the volume display only. The quadrant activated is the one highlighted in green. Press Select again to return to the previous format display. Please note: This is the fastest access into the 1:1 volume display for workflow. Page No. 31 VOI size and curve SIEMENS Healthineers ... VOI Size MPI Position Position Size Size Curved Curved 32 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The VOI can be resized, repositioned and curved after acquisition. The VOI will be backlit in blue when active. To position or size the VOI, select the Set keys to toggle between each mode. Position allows the user to pan the image to the desired location. Size allows resizing of the VOI. Select Curved from the touch panel or from the editing tab to access the VOI Curve. The two home base configuration options are displayed here. Page No. 32 3D/4D Curved VOI SIEMENS. Healthineers .. To access the Curved Render view: A 90º D DE 270" 80% • Select Curved A yellow cross appears in the center of the 4D Cine> Lighting > VOI Curved • icon Editing > Reset >> CutPlan RenderDir Render Up/Down Translucent • Roll the trackball to desired location Surface • Select Curved again to exit SubPreset > Animation > 3D 4D Icon: curved x+ 33 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Curved VOI allows the user to curve the rendering view line of the VOI box and exclude extraneous information. To access the curved render view, select Curved on the touch panel or from the editing tab and move the trackball to the desired curve. A yellow cross appears in the center of the icon at the top of the image. To exit, select Curved again. Page No. 33 3D/4D functions with VOI Off SIEMENS Healthineers ... VOI Off enables the CutPlane method VOI • Volume data not displayed beyond a plane • Press VOI and choose A or B plane CutPlane Off • Slice through the volume via M-mode key • Wireframe graphic will appear Wireframe Off A B Off A B CutPlane A M CutPlane B 34 34 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Wireframe and CutPlane folders are dithered out while the VOI is On. CutPlane enables or disables the cut plane for the volume data. The acquired volume displays the data based on the ROI region size. When enabled, the volume does not display any volume data beyond the cut plane. When the cut plane for A or B is active, the reference “cut plane” slice appears as a solid green rectangle. Use the M-mode key on the control panel to slice through the volume. Each MPR is synchronized when the selected quadrant is highlighted. Typically, the C plane is aligned. The adjustment Sync is under the folder Reset which will be explained later in this presentation. Tip: Working with VOI Off is often used when performing a fetal head rendering, especially in the corpus callosum area. In gynecology applications it is useful to slice through the uterus, endometrium and/or ovaries. Page No. 34 Touch Screen controls SIEMENS. Healthineers .. MultiSlice TSI Curved MPR A B c D 270º 180º Clear Screen Screen AD Cine- Lighting > VOI Curved Hide Patient 1 Editing > 2 Reset > CutPlane 5 RenderDir 6 Render 7 Up/Down LightSource image Param 3 SubPreset > 4 Animation > Wireframe BD AD Map D Dyn R 60 Tx Power 100% Smooth 90 Contrast 60 Opacity 60 Tint 3 LowTh 59 Brightness 60 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Additional 3D/4D tools are available and will be discussed in detail later in this presentation: 1. Editing allows the user the following different tools to edit a volume: • Polygon • Large eraser • Small eraser • Trace • Undo All Edit • Undo Last Edit • VOI on/off • Curved – Curve the VOI from the touchscreen 2. Reset allows the user to reset or change the orientation of the volume with the following tools: • Sync - or (synchronize) aligns the selected plane with the rendered volume (VR) • Flip - reverses the render direction • Reset Ori. - restores the default orientation for all quadrants • Reset All – restores to the default preset options 3. SubPreset – will be discussed later in this presentation 4. Animation – allows the volume to automatically rotate and will be discussed later in this presentation 5. Render Direction 6. Render Mode 7. LightSource Page No. 35 3D/4D volume editing tools SIEMENS Healthineers ... Editing > Removes data from a volume to clarify anatomical structures Polygon Large Eraser Trace Small Eraser 36 36 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To edit and remove unnecessary structures, select Editing on the Touch Screen and choose the preferred cutting method: • The active method will be highlighted in blue • The cursor is active only on the selected quadrant, therefore select your quadrant first (A, B, C or D) • Please note: Rotating the volume assists in determining the type of editing required Editing features include: • Polygon: Defines an irregular area from a drawn outline • Position and anchor the starting point • For each segment of the polygon, roll the trackball to position the ending point and then press the Update key • Press Set to complete the polygon • Position the cursor where data will be removed (inside or outside the polygon) and then press Set • Trace: Defines an area from a free-form drawn outline: • Position and anchor the starting point • Roll the trackball to trace the area of interest • Position and then anchor the ending point • Position the cursor where data will be removed (inside or outside the traced shape) and press Set • Eraser: Small and Large displays a circle-shaped cursor: • Position and anchor the starting point • Roll the trackball to erase data • Press Set to complete the edit • To delete all the edits, select Undo All Edit Page No. 36 3D/4D selection for reset SIEMENS . Healthineers .. Reset > Aligns slice and volume orientation Reverses render direction Sync Flip Reset Ori. Reset All Restores default orientation for all quadrants Restores orientation, format and settings to default 37 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Sync (synchronize) aligns the slice (MPR) and volume orientation (D). • When the selected quadrant is a slice, Sync aligns the orientation of the volume quadrant to that of the slice quadrant • When the selected quadrant is the volume quadrant, Sync aligns the orientation of all slice quadrants to that of the volume quadrant • This is a helpful tool when the VOI is off and using the “Cut plane” (A or B) functions Flip reverses the render direction. It is typically used for fetal spine or fetal facial bones. Reset Orientation restores the default orientation for all quadrants. Reset All restores the default orientation and display format for all quadrants. • Reset All restores the default (or user-defined) settings of other parameters for all quadrants • User-defined settings are those that were in effect when the current volume was first displayed Page No. 37 3D/4D volume SubPreset SIEMENS . Healthineers .. SubPreset > Spine 2nd/3rd Tri Soft List of default SubPresets SubPreset X Define Spine Apply 2nd/3rd Tri Soft New Save current setting as ... Default Fetal Phantom Overwrite [ Set as default Delete Create user-defined SubPresets OK Cancel Rename Move Up Move Down Close 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The system will have predefined SubPresets for each transducer and preset. To enter a SubPreset, select SubPreset on the Touch Screen to enter the SubPreset folder. Define creates an optimized configuration of volume parameters for use during 3D or 4D imaging. Please note: The SubPresets are independent of the 2D image parameters. Use a QuickSet (user-defined Exam Preset) to customize the 2D Settings and use a SubPreset to customize the 3D/4D Settings: • Select Define to display the SubPreset menu and a dialog box appears • Select New • Add a name and select OK To enable the new SubPreset as the default exam type for subsequent patient studies: • Select Set as default • The new SubPreset is displayed next to the SubPreset name • Select OK Page No. 38 3D/4D user-defined SubPreset SIEMENS. Healthineers .. SubPreset > Spine 2nd/3rd Tri Soft Fetal Phantom Face 20w Face 25w Face 30w Uterus 3D SubPreset X Spine Apply 2nd/3rd Tri Overy 3D EarlyOB 3D Early OB 4D Spine 3D Soft Fetal Phantom New Face 20w Face 25w Default CorpCallosum 3D Face 30w Endometrium 3D IUD 3D more 1 Uterus 3D Overwrite Overy 3D EarlyOB 3D Delete Early OB 4D Rename Spine 3D more 2 more 3 more 4 more 5 CorpCallosum 3D Move Up Endometrium 3D IUD 3D Move Down more 1 more 2 Close Example of a SubPreset list Accessible also in frozen volume SubPreset tools 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: This is an example of a user-defined SubPreset list. On the Touch Screen there are 17 user-defined SubPresets. Please note: Any SubPreset can be selected in frozen volume image. Page No. 39 3D/4D exam presets SIEMENS. Healthineers .. An exam type consists of optimized imaging settings and a compatible transducer 9VE4 9VC2 GYN Add Exam ? Early OB GYN Abd Close OB Pelvic Floor Edit OB (Adv) Clear Screen Fetal Echo Hide 40 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The exam type contains the measurements, text annotation, body markers and the default SubPreset. The user can assign a user-defined SubPreset with the exam type. Set as default must be selected while in process to create a SubPreset. Page No. 40 3D/4D volume animation SIEMENS . Healthineers .. 4D Cine > II Play and pause Set Start Marker Set End Marker Cine Speed Reset Markers Sets a margin Selects Cine speed Animation > Play and pause Soft keys: Angle Speed Axis Clip Time Animation setting 60 Slow Axial 4sec 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To activate 4D Cine, select 4D Cine on the Touch Screen: • Review Cine data, reviews the data in a continuous loop • Play, starts Cine playback • Pause, stops Cine playback • The Cine speed can be selected by rotating the soft key To activate the Animation feature that automatically rotates the volume: • Select Animation on the Touch Screen • Adjust the settings for speed, angle, axis and clip time by rotating the soft key • To pause animation, select Pause on the Touch Screen Please note: You can change the automatic rotation settings while the volume is rotating. Page No. 41 3D/4D Render modes SIEMENS . Healthineers .. Render selects a display method for the volume quadrant Render Surface MinIP MeanIP MaxIP Surface Slice MPR Only 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Render key allows the user to select the display render method for the volume: • Press Render and select a mode • The Render method controls how the rendered volume is displayed except for Slice and MPR Only Below are the render options: • Surface Mode: smooths the image contours, creating a soft sculptured appearance for highlighting surface features; uses the mode specific selections for surface percentage and threshold; the main application is for fetal face and in gynecology for uterus and ovaries and most internal structures • MaxIP (Maximum Intensity Projection) limits the display to maximum-value pixels with the highest value along each projection of the volume; used for bone structures like spine, long and short bones or fetal facial bones • MPR Only displays the 3 MPR reconstructed slices without the rendered volume display; It is commonly used to identify internal structures • MinIP (Minimum Intensity Projection) limits the display to minimum-value pixels with the highest value along each projection of the volume; It is a helpful tool when visualizing hypo-echoic lesions and large vascular structures - e.g., fetal aorta, fetal heart and in gynecology for the adnexa area • MeanIP (Mean Intensity Projection) limits the display to average-value pixels by selecting pixels with the arithmetic mean (average) value along each projection of the volume • The Slice mode displays a one-voxel thick slice in its 3D context. The displayed slice (within the volume) corresponds to the most recently selected slice (MPR) quadrant Page No. 42 LightSource SIEMENS Healthineers ... • Acquire a volume LightSource • Select LightSource • Select Light key (update) Roll the trackball to move the position of the light Light • source Position Position Size Size • Select Set to confirm the light direction • To exit, select the Exit key (update) Exit Set Set 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: LightSource is a moveable light source helps increase depth perception, reveal surface details, provides an element of texture and can provide a deeper understanding of relational anatomy. To use LightSource: • Acquire a volume • Select LightSource from the Touch Screen • Select the Light Key from the trackball pad • Roll the trackball to move the position of the light source • Select Set to confirm the light directions • Select Exit to go back to the prior render Page No. 43 LightSource SIEMENS ..... Healthineers ... Using LightSource: 9VC2 Surface 1 • When acquiring a volume, the format will be 4:1 Op 60 Br 52 5 90 LowTh 69 • LightSource will intuitively go to a 1:1 format Map A Tint 8 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When acquiring a volume, the format displayed will be 4:1. When LightSource is activated, the 1:1 format will automatically display. Here is an example of entering the LightSource feature and using the caliper to adjust the light. Page No. 44 LightSource SIEMENS ..... Healthineers' ... 9VE4 9VE4 GYN GYN ? 3D ? 3D Lighting > A B C D Clear Screen clear 4D Cine > Lighting > Screen Hide Patient Hide Image Patient Editing > Reset > Param Exit Param SubPreset > Animation > Light 76% 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When in the LightSource mode, the user will have the option of selecting the Lighting feature. This will allow the user to access 9 separate light directional icons for quick access. Another option is to adjust the brightness of the light levels ranging from 1-100% to change the percentage of light on the volume, rotate the Light rotary control. To Exit, select Exit on the Touch Screen. Page No. 45 LightSource - Lighting SIEMENS ..... Healthineers ... 9VE4 9VC2 A GYN OB Surface 1 LightSource 2 3D Op 60 Dyn R 50 Con 60 Lighting> Br 52 LOWTh 69 Map A Tinto Clear Screen Hide Patient Image Param Exit Light 76% Position 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Here is an example of using the different Lighting directions. Page No. 46 LightSource – Tints and Brightness SIEMENS ..... Healthineers ... Tints Brightness 0% 100% 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: LightSource offers 10 different Tints to choose from. Here is an example of Brightness 0 and 100%. Page No. 47 3D/4D sweep angle SIEMENS Healthineers ... Pre-adjusting tool: Angle Observe the angle width in the C plane and A plane Angle size 10° Angle size 45° Angle size 75° B B B C C C Fetal Phantom etal Phantom etal Phantom 48 48 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The volume angle determines the distance of the volume sweep. A large angle is equivalent to a larger sweep. • Maximum FOV angle with the 9VC2 transducer is 69° • Maximum FOV angle with the 9VE4 transducer is 145° The acquisition angle default setting for 9VC2 transducer with 4D imaging is 55° and works well in most fetal face scanning. The default setting for the 9VC2 transducer with 3D imaging is 65°. The FOV and acquisition angle default setting for the 9VE4 is 90°. Increasing the sweep angle is recommended in later pregnancy and/or if the fetal face is shallow to (nearby) the transducer. • A lower angle setting will result in a higher volume rate per second in 4D imaging • A higher angle setting will reduce the volume rate per second in 4D imaging When scanning the uterus using the 9VE4 transducer, it is highly recommended to use 3D AutoSweep with the largest acquisition angle of 90°. It is important to display the uterine fundus with the endometrium border on the left and right side. Page No. 48 3D/4D Quality setting SIEMENS Healthineers ... Pre-adjusting tool: Quality Controls line density for volume acquisition High line density value at 6 Low line density value at 3 B B C C Fetal Phantom Fetal Phantom 49 49 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A higher quality setting acquires more slices and typically provides a more detailed reconstructed image. Available values are from 1 to 6 ranging from low to high: • High scan line density with the highest setting (Quality 6) enhances the detail resolution of the rendered volume, but decreases the volumes per second • Medium scan line density (Quality 4-5) enhances the volumes per second, which results in a limited loss of volume resolution • Low scan line density (Quality 1-3) has the lowest rendered volume quality, but the highest volumes per second Page No. 49 Optimization tools SIEMENS . Healthineers .. Pre- and post-processing tools Six controls corresponding to the Touch Screen and selections shared in two fields. Select the parameter on the Touch Screen and rotate the dial, or press the control panel dial and then rotate the dial to select a setting Angle 55º Quality 4 Smooth 50 Contrast 56 Opacity 45 Map D Dyn R 60 Tx Power 100% Tint 2 LowTh 50 Brightness 48 50 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The soft key area contains the pre- and post-processing image optimization tools. These parameters improve the display of the MPR planes and the rendered volume. Six controls are located on the control panel with corresponding selections on the Touch Screen. The selections correspond with the location of the rotary keys. On the Touch Screen, select the desired parameter to change or push and rotate the corresponding rotary control clockwise or counterclockwise. Dithered-out (gray) out fields may be available in a mode and are activated by pushing the rotary control and rotating to change a value. Please note: The three MPR’s images and volume have some specific parameters when selected. Make sure you have one of the MPR’s or the rendered volume prioritized (green outline). Page No. 50 Optimization tools SIEMENS . Healthineers .. Low Threshold Opacity • Sets the LowTh high or low for opacity • Adjusts the percentage of opacity in the curve volume to create a more soft or sculptured • Removes small echoes or noise that contain appearance values lower than the selected threshold • Decrease the value for a more transparent Lower setting creates a more saturated look • image • Increase the value for more solid look Available for Surface mode only • Available for Surface mode only • 51 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Low threshold: When changing the threshold, all echoes below that level are enhanced in a green color for a certain interval and is seen on the three MPR images. • Decreasing the value of Low Threshold will fill in the surface rendered volume with more low- level echoes (voxels); soft tissues like vernix, noise or umbilical vessels are enhanced • Increasing the value of Low Threshold will remove low level echoes (voxels); it may help to clean up the face image when noise, artifacts and/or low-level echo structures like vernix are present The quality depends on the scanning quality of amniotic fluid, maternal abdomen and how many structures are in front of the fetal face. Default Setting starts at 50%. Opacity: Adjusts the percentage of opacity level on overall rendered volume density. Default setting starts with 60%. • For fetal face, the values between 60% to 70% are commonly used • To perform 3D for internal structures such as fetal abdomen or fetal head, a higher opacity level is necessary, mainly between 65% - 85% • 3D imaging in GYN application, the opacity setting is default at 65%; Opacity level may be increased up to 85% for cases e.g., myoma, fibroma, endometrium disease or hemorrhagic cysts Page No. 51 Optimization tools SIEMENS . Healthineers .. Brightness Contrast • Adjust the percentage in the rendered • Adjusts the percentage of contrast on volume rendered volume • An increase in brightness increases the • If the fetal face is very smooth, use a higher saturation of voxels that have a higher and contrast value lower voxel value • Available for Surface mode only • Available for Surface mode only 52 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Brightness enhances the voxel saturation however it depends how much the 2D gain was adjusted before entering 3D/4D. Increasing the 2D gain slightly prior to entering 3D or 4D imaging may be necessary to achieve an acceptable surface rendered volume compared to conventional 2D. • Default settings is at 50% To get a good surface rendered volume in early OB to early 2nd trimester, the 2D gain must be • increased slightly prior entering 3D/4D Contrast allows greater visualization of voxels next to each other. A good contrast setting will enhance the depth perception. • Available adjustments from 0% to 100% • Default Settings is at 50% Page No. 52 Optimization tools SIEMENS . Healthineers .. Smooth Map • Adjusts the percentage of smoothing • Selects a processing curve that assigns echo applied in the rendered volume amplitudes to gray levels • Increase for a “fleshy” look • Uses the same maps as 2D Available for Surface mode only • Available for MPR planes • 53 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Smooth adjustment affects the display of the surface rendered volume. For the fetal face, a range between 40% to 60% is preferred. For early OB to mid 2nd trimester, use less smoothing for a more detailed look • For the end of the 2nd to mid 3rd trimester, the skin is still developing fatty tissue; at this stage the • skin of the fetus may have a rough-looking appearance and increasing the value may result in a smoother fetal face Important Please note: To perform 3D data acquisition for internal structures such as fetal abdomen, fetal head, and internal structures in GYN application, typically 0% is used. The maximum adjustment should not be more than 10% - 20%. The effect of a higher smooth value in any internal structures decreases the tissue visualization and will blend the voxels next to each other with an adverse result in image quality. Gray Map selection: • The gray maps affect all three MPR images • Map values are not available for the rendered volume and is dithered out on the soft key menu when the D quadrant is selected Page No. 53 Optimization tools SIEMENS Healthineers ... Dynamic Range • Affects the amount of gray scale information displayed Dyn R 75 • Applies MPR's and rendered volume LowTh 42 separately Default MPR's at 60dB Fetal Phantom - Default render mode with - 45dB • Fetal face utilizes less Dynamic Range than 2D. Dyn R 40 LowTh 42 Fetal Phantom 54 54 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Dynamic Range value can be adjusted separately between the three MPR's (2D) and the surface rendered volume. To adjust: • Using the format 3:1, 2:1 or 4:1, the volume must be activated (green outline) by selecting the quadrant on the Touch Screen or Pointer and Set key on the control panel • Press the soft key field of LowTh and Dyn R to the option of Dyn R • Rotate the soft key to change the Dynamic Range This is important in both pre- and post-processing as it will reduce unnecessary low-level echoes and fatty tissue in front of the fetal face. Dynamic Range enhances the contrast and detail resolution of the fetal face. The default setting for the volume is at 45dB and works for most fetal face imaging. In a technically difficult scan and/or a patient with a lot of vernix, lowering the Dyn R to 35-40dB is recommended. If the fetus appears too transparent, increase the Dynamic Range. Page No. 54 Optimization tools SIEMENS Healthineers ... Tint Tint 14 Tint 11 • Applies the selected Tint to the selected quadrant • Tint can be adjusted separately between three MPR's and the volume • Watch when changing Tint on an optimized volume. Some Tint colors may require image adjustment • Default volume Tint 14 Default three MPR's Tint 2 Tint 10 Tint 15 55 55 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Tint selection applies to either the Volume or the MPR’s. If the selected rendering method is active (D quadrant), it will apply to the volume only. If one of the MPR images is selected, the Tint applies to the A, B and C planes. It is recommended to select the Tint first. Once a volume is optimized, it is not recommended to change the Tint. It may need a re-optimization for Low Threshold, Dynamic Range, brightness and/or contrast. Page No. 55 Measurements SIEMENS Healthineers' ... x ... x Caliper 1 Endo Thick (TA)=0.99 cm 56 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Measurements may be performed on the MPR planes, although it is not available on the volume. Please note: Measurements may not be performed on the freehand MPR planes. Page No. 56 3D/4D measurements SIEMENS Healthineers ... OB fetal biometry* and GYN Obstetrics MPR's 08 Early OB Fetal Echo • OB (Adv) • Rendered volume Right Left None 2 Fetal Head Fetal Abd Fetal Extremities BPD 4 D 72.1 mm 1 2 D 39.3 mm D 58.7 mm D 32.8 mm OFD APAD x ... x Caliper TAD 3 01 Q2 Fetal Phantom Q3 04 Please note: *AutoOB disabled Cerebellum Fetal biometry can be measured manually and added into the Lat Vent Cist Magna report 57 57 Unrestricted © Siemens Healthineers 2023 Unrestricted © Siemens Healthineers 2023 Speaker Notes: All measurements are possible using the 9VC2 and 9VE4 transducers, which are the mechanically- driven curved arrays. Please note: syngo® AutoOB measurements are not possible and will be automatically grayed out when the caliper is pressed. Manually labeled measurements are available. No measurements are available with freehand 3D using the conventional 2D transducer. Page No. 57 3D/4D volume editing tools SIEMENS . Healthineers .. Remove data parallel to the region of interest Available only when VOI is switched off Parallel Cut Niche A wireframe graphic comes into the view 58 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To edit: • Turn off VOI • Additional editing tools are available and will not be grayed out • To access Parallel Cut, quadrant D (volume) must be active To activate Parallel Cut, select Parallel Cut on the Touch Screen • The system displays the wireframe and highlights the first active plane on the left • Parallel Cut selects six planes (layers) within the volume and removes all the voxels outside the selected plane • For each plane to be used in the edit, roll the trackball to position the plane and press Update • Press Set to complete the edit Niche removes data inside a niche (cube shape) • You can perform one niche edit at a time • Rotate the volume until the area that requires editing is in front • Select Niche on the Touch Screen • To simultaneously adjust the size of all planes of the cube, roll the trackball • To resize one plane of the cube, press Update • Press Set to complete the edit Page No. 58 Objectives SIEMENS . Healthineers .. • Outline activation and volume acquisition • Tools for volume manipulation • Define volume store and editing • Review helpful guidelines and tips 59 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Next, we will discuss how to edit and store a volume. Page No. 59 3D/4D volume data store SIEMENS . Healthineers .. • To store a volume, select the Clip store key on the control panel • When in 3D, the volume will be saved • When in 4D, there will be the choice to save a 4D Single Volume or to save a series of volumes which is 4D Cine Save volume X Default @ AD Cine Stores a sequence C 4D Single volume of 4D data sets OK Cancel Save volume X Clip Store 4D Cine . 4D Single volume Stores a 4D single Volume OK Cancel 60 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When acquiring volume cases, the volume should be stored to perform further manipulation in the review state. This will allow the user to re-construct the volume from another perspective and/or perform improved volume optimization. To store the volume: • Press Clip Store on the control panel • When in 3D, the volume will be saved • When in 4D, the system displays a dialog box allowing selection of a specific storage mode • Please note: The default store volume is 4D Cine • Select 4D Cine to store a sequence of 4D volumes consisting of all 4D imaging volumes in the Cine buffer • Select OK to confirm • Select 4D Single volume to store only one volume • Select OK to confirm • The thumbnail panel displays the saved data with the 3D/4D icon for data review • Please note: The maximum length of volume 4D Cine store is 3 seconds Page No. 60 3D/4D Cine store live 4D SIEMENS . Healthineers .. • To store an image of 3D/4D, select print Store 1 or 2 • To store a clip of 4D, select the clip store key (not a volume) Static image of 3D/4D Print Store 1 Clip Store to store or print Cine clip icon Print Store 2 61 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Pressing Clip Store, the 4D live will continuously store the data to the hard drive and display in the thumbnail panel as a clip. The clip length depends how the system was configured. The clip length can be adjusted temporarily on the Touch Screen under the folder Clip Settings. The permanent clip length can be programmed under System configuration > folder Clip Store > Clip length from 1 sec. to 60 sec. (drop-down menu). Additionally, it is possible to configure how a clip should be stored retrospectively or prospectively. Default is prospective. Print Store 1 and Print Store 2 are the controls to store the single image frame on the hard disk and print a single image via the printer. The configuration depends on how the system is set up. Review System configuration > Custom keys > Key function via drop-down menu the various pre-defined settings. Example for a system with a printer solution: • Clip Store: When scanning live, it will save a three second clip. Once the system is in frozen mode, press Clip Store and the volume can be stored in 4D Cine or 4D single. • Print Store 1: Store the single image to the hard drive • Print Store 2: Print the actual image Page No. 61 3D/4D review volume data SIEMENS . Healthineers • To review a stored 3D, 4D or 4D Cine volume, select the Review key on the control panel Review • With the pointer, double-click on the volume you would like to review Pointer • With the pointer, Select the Volume icon at the bottom right side of the image 62 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To review the stored volumes, press the Review key on the Control Panel. • Stored volumes are marked with a cube graphic • With the pointer, double-click on the volume you would like to review • Select the volume icon at the bottom right side of the image to enter volume editing • If a volume 4D Cine was stored, the Cine buffer appears Page No. 62 Objectives SIEMENS . Healthineers .. • Outline activation and volume acquisition • Tools for volume manipulation • Define volume store and editing • Review helpful guidelines and tips 63 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Lastly, we will discuss guideline and tips for volume imaging. Page No. 63 3D/4D guidelines and tips SIEMENS . Healthineers .. To obtain quality 3D/4D volumes • Avoid moving the transducer while in volume acquisition • A lighter pressure with the volume transducer provides a better result in 3D/4D performance • 9VE3 GYN 3D on the uterus, it is essential to set the sweep angle at 90° Positioning the transducer: • Use mid-sagittal view for orientation, not acquisition and fetal position and amniotic fluid location • View from the side produces the best rendered images for fetal face • Create user-defined SubPresets for each trimester for easy workflow - just one “press” on SubPreset folder reduces optimization time 64 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The greatest potential causes for less-than-optimal 4D fetal face quality is pushing too hard with the transducer on the maternal abdomen. Lighter pressure on the transducer will produce a better result when utilizing 3D/4D imaging. The midsagittal view typically does not provide the fetal face view. Use the mid sagittal view for orientation, not acquisition. Imagine taking a portrait photo with a camera. • The Z axis rotation is priority to use based on the A plane • Rotating the X axis and Y axis creates lines • To avoid seeing the lines, rotate the transducer in 4D live first When in GYN and acquiring a 3D uterus, it is essential to have the largest sweep angle which is 90°. It is clinically important to see the both uterus cornua and the uterine fundus in the C plane. These are necessary in case of malformation when performing measurements. Page No. 64 3D/4D guidelines and tips SIEMENS . Healthineers .. To obtain good 3D/4D volumes (cont.) • Choose the region of interest to include occipital region • The target should be in the center. For fetal face imaging use the nose and mouth Conditions for good volumes are: • Maternal abdominal wall • Amniotic fluid consistency • Fetal face skin development and fetal movements • If borders are not well defined, adjust LowTh, DynRange, brightness and contrast in combination 65 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Other potential causes for less-than-optimal 4D fetal face quality is having an ROI that is too small for the selected depth. Adjust the depth of ROI to include the occipital region. The stage of the fetal face skin development as well as the clarity of amniotic fluid is essential for a good 3D/4D acquisition. A lot of vernix in front of the face and in the amniotic fluid provides the clarity in a fetal face image. The amniotic fluid consistency changes throughout the pregnancy, so it is important to be aware of the timing (e.g., a fetus scanned at 28w may have a better result when scanned a week later.) Page No. 65 3D/4D image GA 31w SIEMENS Healthineers' .... 12 0m Sucking time 66 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this gestational age, the fetal skin is well-developed. The difficulty in obtaining a quality 4D fetal face is due to the hand placed in front of the face and the consistency of amniotic fluid demonstrating a lot of vernix. In the volume image, you can see the fetus sucking on the umbilical cord and holding the umbilical cord. Page No. 66 3D/4D image GA 32w - Same fetus SIEMENS Healthineers' .... Facial muscle exercise Comfortable time 67 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A Gestational age between 29w to 34w is very exciting, because it is when the facial muscle development occurs. A lot of fetal face expression can be seen during this time. Examples include: • From an angry looking moment to a happy relaxed time; clearly visible in this presented comparison • Image on the left: Facial muscles demonstrating lip pucker, inner brow raise, cheek raise, nose wrinkle and the eyes are squeezed shut • Image on the right: Approximately five minutes later, the fetus started to play with the umbilical cord, feet and hands. Page No. 67 3D/4D image GA 32w (cont.) - Facial impressions SIEMENS Healthineers ... Thinking Talking Looking Smiling 68 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In this gestational age, fetal face entertainment has begun. These images demonstrate fetal face expressions looking through the 4D cine loop. Based on the upper left image, the following parameters were used: • Reduction of VOI size • Decreased LowTh value to reduce soft tissues • Volume DynRange decreased to 40dB • Increased contrast resolution by decreasing the brightness Page No. 68 SIEMENS . Trademarks and Disclaimers Healthineers .. • ACUSON Maple and ACUSON fourSight technology are registered trademarks of Siemens Medical Solutions USA, Inc. • syngo® Auto OB measurements is a trademark of Siemens Healthcare GmbH 69 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Page No. 69 Thank you for your enthusiasm! SIEMENS . Healthineers .. Questions? 70 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No Speaker Notes. Page No. 70