ACUSON Sequoia 3.5 (VB30) Contrast Enhanced Imaging Knobology Presentation

SIEMENS Healthineers SIEMENS Healthineers .. ACUSON Sequoia Ultrasound System Contrast-enhanced Ultrasound Knobology General Imaging Applications Release 3.5 (VB30) 1 Unrestricted © Siemens Healthineers 2024 Unrestricted Speaker Notes: No speaker notes. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Identify software activation and brief overview of the user interface • Discuss the contents of the Control Panel and Touch Screen • Review System Configuration 2 Unrestricted © Siemens Healthineers 2024 Speaker Notes: This presentation will take the user through the knobology for the advanced application contrast software on the ACUSON Sequoia ultrasound system. We will begin with a brief overview of the Touch Screen, Control Panel, and imaging screen relating to contrast imaging before discussing the features in more detail. Image: HOOD05162003330011 Notes No. 2 SIEMENS Healthineers Touch Screen overview – Contrast tab – Page one SIEMENS. Healthineers ... 5C1 Abdomen 10V4 Workflow Agent type Agent selection Patient 2D Contrast destruction maging Agent Type Biopsy options and Review Low MI Off configuration Report Configure Flash Onscreen Sequence Peak Hold image display End Exam 2D + Contrast Capture type Contrast 2D Only Flash Sequence Capture By options Seconds options UltraArt Off Auto TEQ Timer Live Dual Burst Clip Length 30 sec options Auto TEQ MI Limit Frequency DR InFocus Line Density Frame Rate on/off 0.1 Mid 70 dB Off fps 3 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The contrast tab populates the Touch Screen adjacent to the 2D tab, which remains on screen and accessible while in the contrast mode. The layout of the Touch Screen is designed to position the more commonly used contrast controls lower down and closer to the user, while the controls that are used less frequently are positioned higher on the screen. There are two pages of Touch Screen contrast controls – page two is accessed by selecting the arrow key on the bottom right side of the screen or swiping the screen from right to left. Beginning on the left side of the Touch Screen on page one, the user can find the agent type selection and image viewing modes including the UltraArtTM instant optimization key. Agent destruction options and configuration are found on the right side of Touch Screen along with the Auto TEQTM option and Capture by - an option to change the clip capture type for a single exam. (continued next page) Notes No. 3 SIEMENS Healthineers Control Panel – Software activation SIEMENS . Healthineers ... CEUS Update 4 Unrestricted © Siemens Healthineers 2024 Speaker Notes: To activate the advanced application software for contrast imaging, press the Contrast Enhanced Ultrasound (CEUS) key on the left side of the Control Panel. Once activated, the CEUS key will illuminate in orange. The contrast controls will populate the Touch Screen and the imaging screen will display the chosen contrast imaging format. If the application is not supported, the contrast key will not be backlit on the Control Panel. Notes No. 4 SIEMENS Healthineers Touch Screen overview – Contrast tab – Page one SIEMENS. Healthineers ... 5C1 Abdomen 10V4 Workflow Biopsy Patient 2D Contrast Imaging Agent Type Biopsy Review Low MI Off Timer Report Configure Flash Sequence Peak Hold Live Dual End Exam 2D Only Contrast Flash Sequence Capture By Con Fast Only Seconds OTT Auto TEO Timer Live Dual Clip capture Burst Clip Length 30 sec length options Imaging × parameter settings MI Limit Frequency DR InFocus Line Density Frame Rate Change frame 0.1 Mid 70 dB rate option 5 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The user can easily change the clip capture length during an exam, perhaps prior to a bubble destruction sequence, as the key is located close to this feature. The soft keys at the bottom of the screen contain options to alter the image parameters for frequency, dynamic range (DR), frame rate, and MI Limit. The timer feature is a frequently used command during contrast imaging and is centrally located for ease of use. The option for the biopsy guide, however, is near the top of the screen, as this command is less frequently used in conjunction with contrast imaging. Notes No. 5 SIEMENS Healthineers Touch Screen overview – Contrast tab – Page two SIEMENS . Healthineers ... 5C1 Abdomen 7VC2 / 9VE4 Workflow Patient 2D Contrast Imaging Review Report Image End Exam appearance settings Capture Type Prospective Persist Maps Tint 6 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Other options that are less frequently used or are already preset in the selected exam, are located on page two. These include the image appearance settings such as persistence, maps, and tint. To return to page one, select the arrow key in the bottom right corner of the Touch Screen or swipe the Touch Screen from left to right. Notes No. 6 SIEMENS Healthineers Imaging screen overview SIEMENS .... Healthineers ... 5C1 Abdomen TIB:0.00 TIC:0.01 TIS:0.00 Contrast 2D parameter MI:0.09 8fps map 0.5% display 2D Mid 0dB/DR60 Contrast Low 0dB/DR70 P2 Contrast 2D map parameter display InFocus icon Timer(s) Depth 16cm display indicator 02:51 02:57 7 7 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The image can be displayed on the screen in either a dual or full screen format. The factory default tint for contrast is a sepia color, however that can be altered by the user and a preset saved. Imaging parameters are displayed on the right side of the screen with the live or frozen timer placed in the lower right corner. Note that the live timer is a larger font (22 point) than the frozen timer (18 point) for better visualization. Contrast and 2D maps, the InFocus icon, and depth indicator are found on the left side of the screen. Notes No. 7 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Identify software activation and brief overview of the user interface • Discuss the contents of the Control Panel and Touch Screen • Review System Configuration 8 Unrestricted © Siemens Healthineers 2024 Speaker Notes: We will now discuss each feature contained on the Touch Screen, Control Panel, and imaging screen in greater detail and how they are used during contrast imaging. Image: HOOD05162003330011 Notes No. 8 SIEMENS Healthineers Agent type SIEMENS . Healthineers ... Two mechanical index (MI) selections for agent type: Contrast agent(s) Low MI Sonovue TM / Lumason , Definity , Optison® TM TM Mid MI Mid MI Sonazoid TM Low MI Select Agent Type key on Touch Screen to change Agent Type Low MI 9 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Two selections are available for agent type - a Low Mechanical Index (MI) and a Mid MI. The Low MI category would include agents such as Lumason TM and Definity , while the Mid MI TM would be more suited to Sonazoid TM users. Select the Agent Type key on the Touch Screen to display the Low and Mid MI options. Notes No. 9 SIEMENS Healthineers Contrast enabled transducers and exams SIEMENS . Healthineers ... Curved and phased array Transducer Supported exam type 5C1 Abdomen, Abd-Difficult Gyn 4V1 Abdomen, Gyn 5Z1 Cardiac 7VC2 Abdomen 9C2 Abdomen 9C3 Abdomen, Gyn DAX Abdomen, Abd-Difficult, Gyn 11M3 11M2 Abdomen, Neo 5V1 Cardiac, TCI 8V3 Abdomen, Cardiac 10V4 Abdomen, Cardiac 10 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Contrast is supported on all general imaging transducers and all exams except OB, Fetal Echo, and Early OB. Note: Within the United States, Contrast Enhanced Ultrasound is only supported on Abdomen, and Cardiac presets. Notes No. 10 SIEMENS Healthineers Contrast enabled transducers and exams SIEMENS . Healthineers ... Linear and specialty Transducer Supported exam type 7L2 Abdomen, Carotid, Arterial, Venous 10L4 Abdomen, Carotid, Thyroid, Breast, Arterial, Venous, MSK, Testis 14L5 Carotid, Thyroid, Breast, Venous, MSK, Testis 15L4 Carotid, Thyroid, Breast, Venous, Arterial, MSK, Testis 18L6 Thyroid, Breast, MSK, Testis 18H6 MSK 9EC4 Gyn, Prostate 9EV4 Gyn 10EV3 Gyn 11 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Contrast is supported on all general imaging transducers and all exams except OB, Fetal Echo, and Early OB. Note: Within the United States, Contrast Enhanced Ultrasound is only supported on Abdomen, and Cardiac presets. Notes No. 11 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 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 exams CHI is excellent for cardiac exams and very useful for general imaging in specific conditions *As compared to CPS 12 Unrestricted © Siemens Healthineers 2024 Speaker Notes: There are two different imaging technologies that are used for contrast imaging on the ACUSON Sequoia ultrasound system – Contrast Pulse Sequencing (CPS) and Contrast Harmonic Imaging (CHI). The technologies differ in number of pulse sequences (two versus three) and imaging mode (fundamental and harmonic) which give rise to different imaging capabilities. When considering which technology to use for contrast imaging, the exam type and requirements must be considered, as CPS and CHI have different advantages and preferred clinical applications related to imaging needs, penetration, frame rates, bubble longevity, and tissue suppression. For a more in-depth explanation of CPS and CHI, please refer to the ACUSON Sequoia Ultrasound System Introduction to Contrast-enhanced Ultrasound (CEUS) educational presentation. Notes No. 12 SIEMENS Healthineers Contrast technologies per transducer frequency SIEMENS . Healthineers ... Transducer Low Mid High Pen 5C1 CPS CPS CHI -- 4V1 CPS CPS CHI CPS 7VC2 CPS CHI -- -- 9C2 CPS CPS CHI -- 9C3 CPS CPS CHI -- DAX CPS CHI CPS -- 11M3 CPS CHI -- -- 11M2 CPS CHI 5V1 CPS CPS 5Z1 CPS CHI CHI CPS 8V3 CPS CHI CHI CPS 10V4 CPS CPS CHI CPS 13 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Each transducer has at least two contrast enabled frequencies that use either CPS or CHI as their imaging technology. This matrix displays each transducer and all available frequencies with their associated imaging technology. 8V3 has additional option of Res CHI frequency available. Notes No. 13 SIEMENS Healthineers Contrast technologies per transducer frequency SIEMENS . Healthineers ... Transducer Low Mid High Pen 7L2 CPS CHI CHI CPS 10L4 CPS CPS CHI -- 14L5 CPS CPS -- -- 15L4 CPS CPS CHI -- 18L6 CPS CPS -- -- 18H6 CPS CPS -- -- 9EC4 CPS CPS CHI -- 9EV4 CPS CPS CHI -- 10EV3 CPS CPS CHI -- 14 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Each transducer has at least two contrast enabled frequencies that use either CPS or CHI as their imaging technology. This matrix displays each transducer and all available frequencies with their associated imaging technology. Notes No. 14 SIEMENS Healthineers Contrast display modes SIEMENS. Healthineers ... Three different display modes available: Contrast Only • Contrast only • Most commonly used 2D + Contrast Contrast 2D Only Only 2D Only • Reference for poorly visualized or small lesions 2D + Contrast plus 2D overlay Contrast 2D Only Contrast 2D + Contrast • Only • Use with feeder vessels or areas with abnormal flow patterns 2D + Contrast Default display setting is Contrast Only from factory Contrast 2D Only Only 15 Unrestricted © Siemens Healthineers 2024 Speaker Notes: There are three different display modes available for contrast imaging. These options are selectable from the Touch Screen menu. The most popular option, a Contrast Only display mode, displays only the contrast image onscreen without the accompanying 2D overlay. This is the default setting from factory. Should the user wish to have a default setting other than Contrast Only, a customized preset can be saved with either of the other two display options selected. The next option is a 2D Only mode – this option displays just the 2D image without the accompanying contrast image. Users can find this view helpful as a reference for poorly visualized or small lesions. The final display mode is a combination of the other two – the contrast image with a 2D overlay of the tissue signal, formerly known as “mix”. This combination mode of 2D + Contrast is commonly used to visualize feeder vessels or abnormal flow patterns in a region of interest. Users new to contrast imaging may find this combination more likeable due to the presence of the 2D overlay. Notes No. 15 SIEMENS Healthineers Imaging screen layout SIEMENS. Healthineers ... • Default image layout is Live Dual format - contrast image on the left and 2D image on 5C1 the right Abdomen TIB:0.00 TIC:0.01 TIS:0.00 MI:0.10 • Image position is not customizable 10fps 0.5% 2D Mid Customized presets can be saved if a full DdB/DR60 • Contrast screen layout is desired 4 GB DR50 • Contrast imaging parameters are displayed on the right side of the imaging screen 16 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The display format most commonly used during contrast imaging is Live Dual, unless a lesion proves to be too large to be fully displayed on a split/dual screen. Due to its popularity, Live Dual is the default layout for contrast imaging. The contrast image is located on the left side of the screen and the 2D image on the right. The location of the contrast versus 2D image is not configurable, however if the user wishes to have a full (single) screen display, a customized exam preset can be saved with that modification. Steps to define and save customized user- defined exam presets is covered in the ACUSON Sequoia Getting Started presentation. Imaging parameters are separated into 2D and Contrast sections and displayed on the right side of the imaging screen. The display area contents are customizable and can be altered in System Configuration > Imaging Settings > Image Parameter Display. Customization of this display will be covered later in this presentation. Notes No. 16 SIEMENS Healthineers Gain control SIEMENS .. Healthineers ... • Contrast and 2D gain are located on separate keys Control Panel keys 5C1 Abdomen TIB:0.00 TIC:0.00 CEUS 20 TIS:0.00 MI:0.08 7fps 0.5% 2D • Auto TEQ is available Mid OdB/DR60 Contrast Low dB/DR50 Auto TEQ P2 • Map and gain parameters are displayed separately 17 Unrestricted © Siemens Healthineers 2024 Speaker Notes: 2D and contrast gain controls are separated on the ACUSON Sequoia ultrasound system and are found on the Control Panel. Rotate the dial(s) clockwise or counterclockwise to adjust the gain for each image. Auto TEQ is available when the contrast application is active and alters the gain on the contrast image only. If the user wishes to change the Auto TEQ setting for the 2D image, it must be done by selecting the 2D tab on the Touch Screen and altering the Auto TEQ setting on the 2D page. The image screen displays the gain level for both the 2D and contrast image separately on the right side of the screen. Note that the maps pertaining to 2D and contrast are displayed on the left side of the screen. Notes No. 17 SIEMENS Healthineers Live Dual options SIEMENS. Healthineers ... Two options to activate Live Dual: 5C1 Abdomen • Touch Screen key TIB:0.00 TIC:0.01 TIS:0.00 MI:0.12 10fps Live Dual 0.5% 2D Mid OdB/DR60 Contrast Low • Control Panel key dB/DR50 P2 Dual 18 Unrestricted © Siemens Healthineers 2024 Speaker Notes: As discussed in an earlier slide, Live Dual is the most common image layout during contrast imaging. If the Live Dual display format is not already active, the user can select the either the Live Dual key on the Touch Screen or the tactile Dual key on the right side of the Control Panel when in contrast imaging. To exit the Live Dual display and return to a full (single) screen display, re- select either the Live Dual key on the Touch Screen or Control Panel Dual key option. Notes No. 18 SIEMENS Healthineers UltraArt universal image processing SIEMENS. Healthineers ... • UltraArt universal image processing is available in contrast imaging Off 2 3 • Options are Off, 1, 2, or 3 – no live visual display of image options on Touch Screen Off Timer Live Dual • Default setting for the contrast application is Off 19 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The instant optimization feature, UltraArt universal image processing, is available while utilizing the contrast software during live scanning or after the image is frozen. A more in-depth explanation of the UltraArt technology can be found in the ACUSON Sequoia Major Modes presentation. The UltraArt key is located on the left side of the Touch Screen and identified by three overlapping circles on the key face. Unlike during general imaging, the available UltraArt image options will not be displayed as four live images on the Touch Screen for the user to choose from; instead, the options - Off, 1, 2, or 3 – will be displayed on the Touch Screen when the UltraArt key is pressed. Off is the default setting for the contrast application. Notes No. 19 SIEMENS Healthineers Clip capture/length SIEMENS. Healthineers ... To activate clip capture: Clip capture length options: • Select the Clip key located on the right side of the trackball Time 15 sec 30 sec 45 sec 60 sec 90 sec Update Timer Burst Clip Length 15 sec ABC Beats* XX Clip will automatically store when 1 beat 2 beats 3 beats 5 beats 8 beats • completed Timer Clip Length 1 beat *If physio module is connected 20 Unrestricted © Siemens Healthineers 2024 Speaker Notes: To use the clip capture feature to image a contrast exam, press the Clip key located on the right side of the trackball at home base. Clip capture length can be defined by either time (seconds) or beats if the physio module is connected. The default setting is in time and set to a 30 second duration. Alternate clip capture length options are available during an exam by pressing the Clip Length key on Page one of the Touch Screen to display the drop-down selections. If the physio module is connected, the user has the option to clip capture in beats. To change the clip type during an exam from time to beats or vice versa, select the Capture By key found on Page two of the Touch Screen. The Capture By key allows the user to alter the type for a single exam. If the user wishes to change the length or type of the clip capture permanently, that must be changed in the system configuration. The default option for clip capture type and length is selected in System Configuration > Imaging Settings > Capture Settings and will be covered later in this presentation. Notes No. 20 SIEMENS Healthineers Contrast soft key options SIEMENS . Healthineers ... Page One MI Limit Frequency DR InFocus Line Density Frame Rate 0.1 Mid 70 dB KO Off fps Page Two Persist Maps Tint 2 21 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Each page of the Touch Screen contains contrast related soft keys and associated Control Panel dials at the bottom of the screen. To adjust the controls, rotate the dial on the Control Panel clockwise/counterclockwise pertaining to the parameter you wish to alter until the appropriate setting is obtained. This section of the presentation focuses on these soft key controls. Notes No. 21 SIEMENS Healthineers Soft keys SIEMENS . Healthineers ... Transmit Power and Frequency Mechanical Index Limit: Higher frequencies result in: • Adjust to manage Mechanical Index 0.05 – 1.4 • Decreased tissue penetration available • MI Limit Higher resolution Frequency 0.3 Low Impact of high MI Limit/Transmit Power: Lower frequencies result in: • More penetration • Increased tissue penetration • More bubble destruction • Decreased resolution • Higher bubble destruction 22 Unrestricted © Siemens Healthineers 2024 Speaker Notes The mechanical index can be controlled by using the MI Limit soft key. Available settings are 0.05 to 1.4. Increasing the MI accelerates the bubble destruction rate, while improving penetration. Transmit Power is kept very low in contrast imaging to help maintain bubble integrity, and it is important to remember the impact of power prior to any adjustments. Frequency also affects the bubble life and tissue penetration. Lower frequencies give better tissue penetration but at the expense of the bubble integrity. Higher frequencies result in a decreased penetration of the tissue but higher resolution. Contrast imaging is always a balance between achieving a good image quality while maintaining bubble integrity. Notes No. 22 SIEMENS Healthineers Soft keys SIEMENS. Healthineers ... Frame Rate control Low frame rate: Higher frame rate: • Can limit visualization of fill characteristics of • Improves characterization and detection of lesions lesions • Maintains bubble integrity longer • Improves visualization of lesions with rapid wash-in • Smaller clip files for PACS transfer and storage • More readily destroys contrast agent Frame Rate Off fps Frame Rate Frame Rate 1 fps 10 fps 23 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Frame rate is user adjustable and is found on page one of the Touch Screen in the soft key menu. Adjusting the frame rate will affect both the contrast and 2D image (they are not independent). Higher frame rates will improve characterization and detection of lesions however higher frame rates contribute to more bubble destruction. Lower frame rates will maintain the integrity of the bubble for a longer period but there is risk of limiting visualization especially in lesions with a fast wash in or out. For safety reasons, the frame rate control feature will be disabled when the biopsy guide feature is activated. Note that the maximum frame rate is 15 frames per second, however the system will only operate up to the acoustic maximum, even if the programmed value for frame rate is higher. Notes No. 23 SIEMENS Healthineers Soft keys SIEMENS . Healthineers ... InFocus • InFocus technology is active during contrast scanning • Onscreen focal icon is depth adjustable to provide the most flexibility to the user InFocus • InFocus technology is discussed in detail in the ACUSON Sequoia Major Modes presentation 16cm 24 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The InFocus technology is active (on) during contrast imaging, however the focal zone icon representing InFocus can be depth adjusted during contrast imaging. The adjustability gives the user the most flexibility during contrast imaging for maintaining such parameters as bubble life, while still providing the coherent processing benefits of InFocus technology. The InFocus technology is discussed in detail in the ACUSON Sequoia Major Modes presentation. Notes No. 24 SIEMENS Healthineers Soft keys SIEMENS . Healthineers ... Dynamic Range (DR), Persistence, Maps, and Tint Persistence (Persist) • Optimized for contrast agent to keep temporal Persist Maps variance of noise low 2 Maps • Pertains only to contrast image • Default is Map F Tint • Colorization of contrast image • Default is Tint 1 (sepia) Dynamic Range (DR) DR Tint 70 dB • Independent of B mode • Single increment adjustment 25 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Persistence (Persist) • Optimized for contrast agent to keep temporal variance of noise low • Default setting is 2 • Options range from 1 through 4 Maps • Pertains only to the contrast image • Default setting is Map F • Available options are A through F Tint • Colorization for contrast image only • Default setting is 1 • 12 tint options available • Sepia (tint 1) is most common Dynamic Range (DR) • Applies to contrast – independent of B mode • Default setting is 70dB • Range of 10 – 80dB • Adjusts in single increments Notes No. 25 SIEMENS Healthineers Peak Hold persistence SIEMENS . Healthineers ... • Layers (“persists”) contrast agent on one image for a user-controlled amount of time Configure Flash Good for lesions with low blood flow or Sequence Peak Hold • determining the fill pattern of a lesion • Select Peak Hold to start persistence-hold Peak Hold Flash Sequence Capture By Seconds process, press again to exit hold Clip Length • Also known as maximum intensity projection Burst 30 sec imaging (MIP) 26 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Peak Hold is a feature used to enhance areas of low contrast agent concentration. The Peak Hold layers or “persists” the contrast agent in the image over several frames. The time of the persistence is user controlled. The user selects the Peak Hold key to begin the hold and presses the Peak Hold key again to exit/end the hold. Peak Hold is also known as maximum intensity projection (MIP) imaging in the clinical environment. Notes No. 26 SIEMENS Healthineers Bubble destruction options SIEMENS. Healthineers ... Two options to destroy bubbles: Burst • Delivers a high mechanical index “burst” only Macro of pre- programmed steps Configure Flash • Not pre-programmed - user turns feature on Sequence Peak Hold and off manually Flash Sequence L Flash Sequence Capture By Seconds • A macro of pre-programmed steps • Sequence delivers a burst, followed by a Burst Clip Length defined imaging state and an end sequence 30 sec command such as freeze Temporary high mechanical index “burst” 27 Unrestricted © Siemens Healthineers 2024 Speaker Notes: When contrast bubbles need to be destroyed, the user has two options with which to disrupt the bubble integrity. Both options increase the transmit power of the ultrasound system and result in a temporarily applied high mechanical index state during the scan. The high MI causes the bubbles to increase their expansion and contraction (oscillation) states to a level that is beyond the limits of the bubble’s fragile gas containment shell; this results in bubble rupture. What follows the high MI state and resulting bubble destruction is how the two options differ. The first option, Burst, delivers a high MI burst stage only. The user turns the high MI application on and off manually – it is not pre-programmed. Once the manually applied burst is completed, the image returns to the normal low MI contrast imaging state it was in prior to the burst application. If there are contrast bubbles still circulating in the blood stream, they will begin to re-accumulate within the lesion. A burst can also be used to destroy most of the leftover circulating contrast prior to a second injection. Before the addition of a specific key to deliver this high MI burst in contrast imaging, the burst was achieved by turning color Doppler imaging on and off, as color Doppler operates at a higher mechanical index. Users generally referred to this early process as “flashing” and perhaps had an influence on the naming of the second option – Flash Sequence. The Flash Sequence still delivers a high MI state, but what follows that state differs from a simple burst, as it is pre-programmed macro of steps. Following the timed burst, the user has the option to define a specific imaging state and then an end of sequence command. These states or commands can include a peak hold persistence, live imaging, or an automatic image freeze. Programming the Flash Sequence is very easy and will be covered in the next few slides. Notes No. 27 SIEMENS Healthineers Flash Sequence Configuration SIEMENS . Healthineers ... Three (easy) steps Select Configure Flash Sequence key on the Touch Screen to display the configuration page Configure Flash Flash Sequence Configuration Sequence Exit Step 1 Select Exit to close configuration page Burst Step 2 Contrast Imaging Step 3 End of Sequence when completed 1 2 3 Clip Capture on Flash Peak Hold Live Imaging Stay Live Auto Freeze Exit Flash Delay Burst Time Flash MI maging Time Off Fr Sec 1.4 10 Seconds 28 Unrestricted © Siemens Healthineers 2024 Speaker Notes: There are three easy steps to configure a flash sequence. To access the configuration page, select the Configure Flash Sequence on the Touch Screen. To exit the configuration page, select the Exit option to return to the imaging screen. The three steps that require configuration are: 1. Burst 2. Contrast Imaging 3. End of Sequence We will now look at each step in detail in the following slides and discuss the available options. Notes No. 28 SIEMENS Healthineers Step one SIEMENS . Healthineers ... Burst Time • Step one is to define the duration of burst time Step 1 Step 2 Step 3 Contrast Imaging End of Sequence • Select Burst Time to display options Available options are 1–5 seconds Clip Capture on Flash ak Hold Live Imaging Stay Live Auto Freeze • • Cannot configure a custom burst time Flash Delay Burst Time Flash M Imaging Time Off 1.4 10 Seconds 29 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Step one requires the user to define the length of the high mechanical index burst. To define the duration, select the Burst Time option to display the drop-down menu of options. Select the desired increment, in seconds, from the numbers displayed. The options are confined to 1 through 5 seconds. Custom burst time lengths cannot be configured at this time. Notes No. 29 SIEMENS Healthineers Step two SIEMENS . Healthineers ... Contrast Imaging options Follows the high mechanical index burst Follows the high mechanical index burst Option one – Peak Hold Option two – Live Imaging Step 2 Step 2 Contrast Imaging Contrast Imaging Peak Hold Live Imaging Peak Hold Live Imaging Duration options are 1, 5, 10, 20, 30, 60, and Duration options are 1, 5, 10, 20, 30, 60, 90 seconds and 90 seconds Imaging Time Imaging Time 10 Seconds 10 Seconds 30 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Step two involves defining the contrast imaging state that follows the conclusion of the burst. There are two options available – a Peak Hold state or a Live Imaging state. Selecting a Peak Hold state will “hold” or “persist” the contrast on the imaging screen for a time set by the user. This hold allows the contrast to layer within the image over several frames. Professional photographers call this type of imaging “open shutter” photography when they allow the film or digital sensor inside their camera to be exposed to light for an extended exposure time. The result in general photography is the same as in contrast – a layered image gathered over time. In contrast imaging this feature is helpful in areas of low blood flow resulting in low contrast agent concentration, or to see the fill patterns of a lesion to aid in diagnosis. Option two is Live Imaging and is exactly as it sounds – the image returns to live imaging (no hold) after the completion of the burst. The transmit power returns to the low pre-burst level and the sequence advances to Step three at the end of the defined duration. To configure the length of the duration for Step two, rotate the Imaging Time rotary control. The minimum duration is one second while the maximum duration is 90 seconds. Notes No. 30 SIEMENS Healthineers Clip Capture on Flash option SIEMENS . Healthineers ... • Option to capture entire sequence of steps as Flash Sequence a clip Configuration Will begin recording clip when Flash Sequence Flash Sequence Configuration • is selected Exit Burst Step 2 Step 3 End of Sequence • Clip capture will terminate upon the Contrast Imaging conclusion of all sequence steps regardless of the default clip length setting Clip Capture on Peak Hold Live Imaging Stay Live Auto Freeze Flash Delay Burst Time Flash Mi Imaging Tim Off Cor Sec 1.4 10 Seconds 31 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The Flash Sequence configuration also contains an option to record the entire sequence of events as a clip. The bottom corner of the configuration tab for the Flash Sequence contains a command key labeled Flash Sequence Clip Capture. If the key is orange, the feature is active (turned on). If the key is gray, the feature is inactive (turned off). When the feature is active, the clip capture starts when the user initiates the sequence by pressing the Flash Sequence option on the Touch Screen. The clip capture will contain the first two steps of the sequence (Burst and Contrast Imaging) and will terminate when the sequence completes the third step in the sequence (End of Sequence). The length of the clip capture will be determined by the Burst Time set in step one plus the Imaging Duration time set in step two, and the time it takes to activate the end sequence action (either Stay Live or Auto Freeze). Notes No. 31 SIEMENS Healthineers Shadow calipers SIEMENS .. Healthineers ... • Can be placed on either image – caliper will 9C3 populate the opposing image automatically Abdomen TIB:0.00 Lesion 1=4:52 cm TIC:0.01 TIS:0.00 • Press Caliper to activate the measurement MI:0.11 9fps 2% feature 2D Low 0dB/DR60 Contrast • Select the Shadow key on Touch Screen to turn Low 1dB/DR70 shadow feature off P2 Shadow 14cm 32 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Shadow calipers are available when in contrast mode. Shadow calipers can be added/applied to either side of the image (2D or contrast) when in a dual mode and the “shadow” will appear on the opposite image. Shadow calipers are available on live or frozen images and in review. To activate the shadow calipers, press the Caliper key on the left side of the trackball. Use the trackball to move the caliper into position and one of the Set keys to lock/anchor the caliper. Use the Delete key on the Control Panel to delete the measurement if required. If the shadow feature is not desired by the user, select the Shadow option on the Touch Screen to turn the feature off. For more information on the operation of the ACUSON Sequoia measurement package, please refer to the ACUSON Sequoia Onscreen Measurements and Reports presentation. Notes No. 32 SIEMENS Healthineers Biopsy guide feature SIEMENS. Healthineers ... • Select Biopsy key on Touch Screen to activate 5C1 Abdomen Biopsy TIB:0.00 TIC:0.01 TIS:0.00 MI:0.09 8fps 0.5% 2D Mid • Select Needle Guide Angle 138B DR60 Contrast Low -11dB/DR70 P2 • Minimum needle length option available 16cm Minimum Needle Biopsy: 1 Minimum Needle Length- Length 33 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The biopsy guide feature is available during contrast imaging. To use the biopsy guide feature, select the Biopsy option on the Touch Screen. Select the Needle Guide Angle from the displayed options. The option to determine the minimum needle length required for the biopsy is available. Uses the trackball to move the indicator into the biopsy area to determine the needle length. Notes No. 33 SIEMENS Healthineers Biopsy guide feature SIEMENS .. Healthineers .. • Dual screen and full screen display options available with curved transducers 5C1 Abdomen TIB:0.66 • Full screen only available with linear TIC:3.61 MI:1.38 transducers 10L4, 14L5, 15L4, and 18L6 19fps 2D H Mid 0dB/DR65 • Trapezoid feature is disabled with biopsy c=1540 guide feature Disables frame rate control option • 16cm Biopsy: 1 34 Unrestricted © Siemens Healthineers 2024 Speaker Notes: The biopsy guide feature is available for use in either dual or full screen format when utilizing the curved transducers. If the user selects a linear transducer, the biopsy guide feature is only available in a full screen display format. The trapezoid feature will be unavailable to the user when using a linear transducer in combination with the biopsy guide feature. Note that the use of the biopsy guide feature will disable the option for the user to alter the frame rate during contrast imaging. Notes No. 34 SIEMENS Healthineers Contrast imaging with fusion SIEMENS .... Healthineers ... Transducer 1 5C1 5C1 Abdomen Abdomen Needle TIB:0.00 TIB:0.00 TIC:0.01 Needle TIC:0.01 TIS:0.00 TIS:0.00 MI:0.09 MI:0.09 8fps 8fps 0.5% 20 Mid Mid 0dB/ DR60 0dB/DR60 LD 1 LD 1 UA 3 UA 3 MapD/T5 MapD/T5 P3 Contrast Contrast 0GB/DR70 Low 0dB/DR70 P2 Fi 16cm 16cm Available in Live Dual Available in full screen 35 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Contrast imaging is available for use in with fusion imaging. Contrast imaging can be used in conjunction with fusion to verify blood flow within a lesion. This advanced application is discussed in detail in the ACUSON Sequoia Fusion presentation. Dual and full screen display options are available when both features are active. Notes No. 35 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Identify software activation and brief overview of the user interface • Discuss the contents of the Control Panel and Touch Screen • Review System Configuration 36 Unrestricted © Siemens Healthineers 2024 Speaker Notes: We will now review the system configuration pages that relate to the contrast application. Image: HOOD05162003330011 Notes No. 36 SIEMENS Healthineers Configuration options SIEMENS . Healthineers ... Located under System Configuration > System Configuration System Settings Imaging Settings > Capture Settings > Workflow Enhancement Imaging Settings Abdomen General Capture Settings Customize by exam preset for Imaging Mode Detanim Capture Settings Contrast Capture Settings 40 Capture Settings Image Parameter Display • Clip capture type > Measurement & Report Prospective Prospective > Annotations • Clip capture length Features Is tangu Transducer Custom (1-390) Custom (1-10) • Compression level > Connectivity & Network 300 > Peripheral Devices Custom (1-300) Beats • Clip capture rate System Management Erst & wine Offhet First Nueve Ofhet Enable Compression Enable Compression 23 Enable Compression Chingressios Level Compression Level Compression Level Medium Medium Capture Definition Limit Clp Capture Rate to 30H2 Restore Defaultse Abdomen 37 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Configurable options for contrast are found in System Configuration > Imaging Settings > Capture Settings. Note that clip capture settings for 2D and 4D are also contained on this page but act independently from each other. Customization is by preset for • Clip capture type • Clip capture length • Compression level of stored images • Clip capture rate (limit) Notes No. 37 SIEMENS Healthineers Contrast capture settings SIEMENS . Healthineers ... One custom clip capture length can be added for the selected exam preset Contrast Capture Settings GYN Clip Capture To add a custom clip capture length OB Prospective Select an exam type or All Exams from the Arterial • Clip Length drop-down Venous Cardiac Time Custom (1-300) 30 300 • Select Time or Beats (cardiac) Fetal Echo Seconds Enter the desired clip length in field Custom (1-300) MSK . Beats • Beats provided Prostate Maximum clip length for contrast is 300 Early OB First R-wave Offset Last R-wave Offset • 0 4 Frames Testis seconds All Exams Enable Compression Compression Level Medium Author | Department 38 Unrestricted © Siemens Healthineers 2024 Speaker Notes: One custom clip capture length can be added for the selected exam preset. To add a custom clip capture length: • Select an exam type from the drop-down menu found on the Capture Settings configuration page. If the user wishes the custom clip to be applied to all contrast enabled exams, then select All Exams from the list of available selections • Select the clip capture type – Time or Beats • Enter the desired length in the field provided • Note the maximum custom clip capture length is 300 seconds (five minutes) Notes No. 38 SIEMENS Healthineers Custom clip capture length SIEMENS. Healthineers ... • Custom clip length will appear in drop-down menu in configuration and Touch Screen Contrast Capture Settings Clip Capture Prospective 15 sec 30 sec 45 sec 60 sec 90 sec Clip Length Time Custom (1~300) 30 sec 30 Seconds 300 15 Custom (1-300) • No need to save the entry 30 Beats 45 Offset Last R-wave Offset • Restore Defaults option or delete individually in exam type 60 90 Frames 300 Restore Defaults: GYN LaVIC compression Compression Level Medium 39 Unrestricted © Siemens Healthineers 2024 Speaker Notes: Once the custom value has been entered in the field it is part of the exam options. It will appear in the drop-down menu on both the configuration page and Touch Screen for contrast. To delete the custom value, the user has the option to use the Restore Defaults command for all exams or an individual exam or delete the value out of the field manually for an individual exam. Notes No. 39 SIEMENS Healthineers Image parameter display SIEMENS. Healthineers ... • To change onscreen image parameter age Parameter Display Preview display, go to: Color Map (3D) 30 Threshold/Opacity Priority (3D) Exam IMPR Color Display (3D) Thermal Index - Bone (TIB) • System Configuration [ Volume Color Display (30) Thermal Index - Cranium (TIC) Thermal Index - Soft Tissue (TIS) Submode Mechanical Index (MI) Frame Rate • Image Settings Frequency Transmit Power Gain/Dynamic Range 20 Image Parameter Display Map/Tint • Gate Size GainiDynamic Range Speed of Sound PRF Clarity Level Filter 30/40 Gain/Dynamic Range Check  or uncheck  available Gain/Dynamic Range Volume Sweep Quality • Volume Sweep Angie Threshold options under the contrast heading Eden Enhancement Opacity Smoothing Frequency Brightness Gain/Dynamic Range Contrast Line Density MPR Map MPR Tint UltraArt Volume Tint Map/Tint C Persistence/Peak Hold Frequency Contrast Display Galn Flow State PRE Color 3D Threshold/Opacity Map Index D SWE Submnode Shear Wave Parameter Frequency Transp Gate Size PRF 05WE Filter Restore Defaults 40 Unrestricted © Siemens Healthineers 2024 Speaker Notes: As mentioned in an earlier slide, the contrast application has a separate display for the image parameters. The information that is displayed can be customized by the user in System Configuration > Image Settings > Image Parameter Display > Contrast. Simply check or uncheck the desired parameters under the contrast heading. Note the configuration page provides the user with a representative screen image to show what order and where the data will be displayed during use. Notes No. 40 SIEMENS Healthineers Trademarks and disclaimers SIEMENS . Healthineers ... ACUSON Sequoia, UltraArt, and Auto TEQ are registered trademarks of Siemens Medical Solutions USA, Inc. OPTISON and Sonazoid are trademarks of GE Healthcare. Lumason/SonoVue is a registered trademark of Bracco Diagnostics Inc. DEFINITY is a registered trademark of Lantheus Medical Imaging, Inc. 41 Unrestricted © Siemens Healthineers 2024 Speaker Notes: No speaker notes. Notes No. 41 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS. Healthineers ... Questions? 42 Unrestricted © Siemens Healthineers 2024 Speaker Notes: No speaker notes. Notes No. 42