ACUSON Sequoia™ 3.5 VB30 VT 2D SWE Liver Quick Card

Quick Card Virtual Touch 2D SWE in the Liver ACUSON Sequoia Ultrasound System 3.5 (VB30) siemens-healthineers.com/ultrasound Using 2D shear wave elastography (SWE) to measure shear velocity (Vs) in meters per second (m/s) and elasticity (E) in kilopascal (kPa) in the liver Step 1 5C1 Step 3 Abdomen SWE • Select a compatible transducer1 • Select the SWE tab on the touch and the Abdomen exam preset screen • If required, roll the trackball to reposition the 2D SWE region of Step 2 interest (ROI) • Press the VT (Virtual Touch) rotary VT • If required, press the Set key and key located on the control panel roll the trackball to resize the ROI 1 2D SWE imaging is compatible with transducers 5C1, 9C2, DAX for Abdomen; 10L4 for Thyroid, Breast, MSK; 15L4, 18L6 for Thyroid, Breast. SIEMENS Healthineers . Step 4 Update • Press Update on the control panel to begin the acquisition Note: During freeze, a cooling timer indicates the remaining seconds until the transducer is available for image acquisition. During a short cooling time (e.g., 1–2 seconds), the timer appears and then disappears very quickly. Step 5 • When the acquisition is complete, the system automatically freezes, emits one audible “beep”, and activates the Velocity or Elasticity display mode • Alter the Min and/or Max Velocity or Elasticity setting(s) to adjust the range of measurements displayed in the ROI Increase the range if the measured value - exceeds the range by displaying “High” Min Velocity Max Velocity Min Elasticity Max Elasticity 0.5 4 50 or Decrease the range if better visualization - of the velocity of stiffness differences is needed Velocity Elasticity Quality Displacement Displacement 2D Only • Customize the left and right sides of the m/s kPa 2 dual display for the map type(s) by selecting the desired option(s) from the touch screen Quality Velocity m/s • If required, the units (m/s and kPa) may be altered by selecting the unit from the touch Velocity Elasticity screen display options m/s kPa • Rotate the VT rotary dial on the control panel to change the transparency of 2D SWE VT (if required) • Select Live Dual to display the 2D SWE image in full-screen format (if required) Live Dual Step 6 • Press Caliper Site Liver Segment Mass • Select the same measurement label each Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 time/per site Site 7 Site 8 Site 9 Site 10 2 siemens-healthineers.com/ultrasound Step 7 • Roll the trackball to position the measurement ROI • If needed, rotate the ROI Diameter to resize the measurement ROI ROI Diameter • Shear wave measurements, measurement ROI depth, and diameter are displayed next 1 Vs Median=1.44 m/s E Median=6.3 kPa to the image Depth=4.72 cm Diam=1.00 cm Step 8 To enter the measurement into the report: Clip • Press Image to store the image Image or • Press the right or left Set key Step 9 • Unfreeze; repeat steps 4–9 to make additional measurements Freeze Step 10 Report • Select Report Liver Site 1 Median Mean Max Median Mean Depth Diam View, delete, store, print, or transfer shear (m/s) (m/s) (m/s) (kPa) (kPa) (cm) (cm) • wave measurements 1.81 1.98 9.8 11.7 4.59 1.00 1.33 1.35 1.79 5.3 5.5 9.6 4.54 1.00 1.35 1.38 1.79 5.5 5.7 9.6 4.59 1.00 Note: To edit the report values, select the 1.29 1.29 1.74 5.0 5.0 9.1 4.38 1.00 1.40 1.43 1.79 5.8 6.1 9.6 4.75 1.00 Edit Report option from the imaging or touch 1.28 1.31 1.76 4.9 5.2 9.3 4.39 1.00 1.28 1.27 1.48 4.9 6.6 4.33 1.00 screen. Once selected, an “X” will appear 1.38 1.42 1.79 5.8 6.1 9.6 4.72 1.00 1.42 1.46 1.92 6.1 6.4 11.0 4.68 1.00 1.32 1.34 1.79 5.2 5.4 9.6 4.51 1.00 81000 VOUIAWN- beside each measurement in the report. Mean 1.40 1.78 9.6 Click on the “X” to remove a listed value Std Dev 0.16 0.15 0.13 1.5 1.4 1.3 Median 1.34 1.37 1.79 5.4 5.6 9.6 from the report. IQR 0.11 0.12 0.03 0.8 0.3 IQR/Median 0.08 0.07 0.1 0.2 0.0 Overall Statistics Mean 1.39 m/s Std Dev 1.5 kPa Median 1.34 m/s QR/Median 0.08 Mean 5.8 kPa Median 5.4 kPa IQR 0.11 m/s IQR 0.8 kPa QR/Median 0.1 Note: Shear Wave Speed and Elasticity values may vary among manufacturers! siemens-healthineers.com/ultrasound 3 Virtual Touch 2D SWE Liver Application Best Practice Techniques1 Fasting for at least 4 hours In the non-fasting state, the liver can have falsely elevated values. Position the patient in a supine or slight Optimal positioning improves intercostal access and clearly visualizes (30°) left lateral decubitus position with an artifact-free area of the liver. the right arm raised above the head Optimize the B-mode image and avoid Optimize the B-mode image to maximize the uniformity and brightness rib shadows (Fig. 1) of the parenchyma. Rib shadows on either side of the ROI result in poor generation and propagation of the shear waves from the Acoustic Radiation Force Impulse (ARFI) push pulse. Ensure the transducer is perpendicular Inaccurate or invalid measurements can result if the transducer is not to the skin surface using ample gel perpendicular to the skin line and/or there is a loss of contact between the transducer and the skin. Take measurements in the right lobe Placing the ROI in an artifact-free area devoid of vessels, large ducts, of the liver in an artifact-free area and/or fluid-filled structures, such as cysts, is recommended to obtain reproducible results. 1 Barr, RG, et al. (2020), “Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement.” Radiology, 00:1-12. doi.org/10.1148/radiol.2020192437. https://pubs.rsna.org/doi/10.1148/radiol.2020192437 4 siemens-healthineers.com/ultrasound 5C1 Sequoia 1 Vs Median=0.85 m/s Abdomen E Median=2.2 kPa TIB:0.71 TIC:1.49 6.5 Depth=4.33 cm Diam=1.00 cm TIS:0.71 MI:1.39 26fos 98% 2D H Mid OdB/DR60 c= 1540 SWE Velocity Transp: 60% O 9cm Fig. 1: Optimal technique Position the measurement ROI at least The 2D SWE ROI can be positioned closer to the liver capsule if 1.5–2 cm below liver capsule (Fig. 1) reverberation artifacts are avoided, however, the recommended optional placement of the measurement ROI is 1.5–2 cm below the liver capsule. Perform the acquisition during Instruct the patient to breath normally and then to momentarily stop suspended respiration; the patient may breathing during acquisition. When the acquisition is complete, the resume normal breathing after an system freezes and emits one audible “beep”. The patient can then audible “beep” is heard resume normal breathing. Valsalva or deep inspiration can cause an undesired increase in central venous pressure which can falsely elevate shear wave measurements. Obtain 5 measurements at the same site Multiple measurements should be taken to ensure the median value is reliable. Maintain an Interquartile Range (IQR)/ Indicates the variability of measurements lie within reasonable Median ratio of ≤ 0.3 for values in variability range. It is the recommended quality control measure for kilopascals and ≤ 0.15 for values in adequate technical quality. The IQR/Median ratio for elasticity in units meters per second of kPa will be twice the IQR/Median ratio for shear wave velocity in units of m/s, as the conversion of m/s to kPa is nonlinear. siemens-healthineers.com/ultrasound 5 Please note: At Siemens Healthineers, we pioneer breakthroughs in healthcare. For the proper use of the software or hardware, please always use For everyone. Everywhere. Sustainably. As a leader in medical the Operator Manual or Instructions for Use (hereinafter collectively technology, we want to advance a world in which breakthroughs “Operator Manual”) issued by Siemens Healthineers. This material is in healthcare create new possibilities with a minimal impact on to be used as training material only and shall by no means substitute our planet. By consistently bringing innovations to the market, the Operator Manual. 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All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. ACUSON Sequoia and Virtual Touch are trademarks of Siemens Medical Solutions USA, Inc. Siemens Healthineers Ultrasound owns the rights to all images. 1 Personalization of diagnosis, therapy selection and monitoring, after care and managing health. Siemens Healthineers Headquarters Manufacturer Siemens Healthineers AG Siemens Medical Solutions USA, Inc. Siemensstr. 3 Ultrasound 91301 Forchheim, Germany 22010 S.E. 51st Street Phone: +49 9191 18-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-healthineers.com/ultrasound Published by Siemens Medical Solutions USA, Inc. · QR700011298 · 15693 0924 online · ©Siemens Medical Solutions USA, Inc., 2024