ACUSON Sequoia 3.5 (VB30) LVO Contrast Presentation

SIEMENS Healthineers SIEMENS Healthineers ACUSON Sequoia Ultrasound System Left Ventricular Opacification (LVO) 3.5 (VB30) 1 Unrestricted © Siemens Healthineers 2024 Unrestricted Speaker Notes The purpose of this presentation is to provide an overview of the Contrast-enhanced Ultrasound (CEUS) technology offered for Left Ventricular Opacification (LVO) on the ACUSON Sequoia ultrasound system. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS Healthineers .. • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) Sequoia • Touch screen layout and workflow Sequoia • Image parameters and optimization 2 Unrestricted © Siemens Healthineers 2024 Speaker Notes We will begin by defining the difference between contrast pulse sequencing (CPS) and contrast harmonic imaging (CHI). Notes No. 2 SIEMENS Healthineers Contrast imaging technologies SIEMENS Healthineers .. Contrast Pulse Sequencing (CPS) is a three-pulse Contrast Harmonic Imaging (CHI) is a two-pulse sequence in fundamental imaging mode sequence in harmonic imaging mode Advantages: Advantages: • High degree of motion flash • High resolution suppression • Increased bubble longevity* • Superior penetration • High frame rates* • Excellent tissue suppression 3 *When compared with Contrast Pulse Sequencing (CPS) Unrestricted © Siemens Healthineers 2024 Speaker Notes Ultrasound systems manufactured by Siemens Healthineers currently use two different imaging technologies for contrast imaging – Contrast Pulse Sequencing (CPS), and Contrast Harmonic Imaging (CHI). Both technologies have different advantages and preferred clinical applications related to imaging needs, penetration, frame rates, bubble longevity, and tissue suppression. Knowing which technology to use for an exam requires a greater understanding of what makes up each technology signal, how they are generated, and what their strengths and weaknesses are. This will help us better understand why the ACUSON Sequoia ultrasound system employs the different methods for cardiac contrast imaging. We will begin by discussing Contrast Harmonic Imaging (CHI) in greater detail. Notes No. 3 SIEMENS Healthineers Contrast Harmonic Imaging (CHI) SIEMENS Healthineers .. Contrast Harmonic Imaging: Second harmonic imaging mode Scaling & Transmit Receive from Receive from Overall image • Pulse # Tissue Microbubble • Two transmit pulses Signal make up Linear Non-Linear (components) • Pulse [phase] inversion only Advantages: High frame rates* • 1 Longer bubble lifespan* • +1 Scaling Tissue signal sum = 0 • High resolution + + 2 Bubble signal -1 Scaling sum = + = = (Sum) (Sum) 4 *When compared with Contrast Pulse Sequencing (CPS) Unrestricted © Siemens Healthineers 2024 Speaker Notes Contrast Harmonic Imaging (CHI) is a low MI contrast imaging technique that uses only pulse inversion in the 2nd harmonic to exploit the non-linear behavior of microbubbles. This technology uses two pulses of the same amplitude with opposing values (positive and negative) to emit and send into the tissue from the transducer. The received (tissue) linear and (bubble) non-linear signals are summed (respectively) with the pulse inversion technique. The linear echoes are cancelled out while the non-linear echoes remain to form the image. It should be noted that any tissue signal remaining within the image is a result of those tissue signals not being cancelled out entirely. This “artifact” is due to the fact that tissue can sometimes generate a very small portion of non-linear echoes which, like a non-linear bubble echo, are not cancelled out during the summation process. A good quality contrast image has little to no tissue signal present in general imaging. CHI has many advantages that make it the “go to” choice for cardiac imaging exams. One big advantage of CHI is frame rates. Since CHI uses only two pulses, the image takes less time to generate than if there were more than two. Quick image generation means high frame rates. The two pulse sequence is also thought to maintain bubble integrity longer as there are less sound waves to interact with. CHI also has a resolution advantage as it uses the 2nd harmonic rather than a fundamental frequency which tends to have less detail resolution than harmonic frequency. The ACUSON Sequoia ultrasound system supports both imaging technologies, depending on the chosen transmit frequency, for all cardiac transducers. Notes No. 4 SIEMENS Healthineers Contrast Pulse Sequencing (CPS) SIEMENS Healthineers .. Contrast Pulse Sequencing: Fundamental imaging mode Scaling & Transmit Receive from Receive from Overall image • Pulse # Signal Tissue Microbubble make up • Three transmit pulses Linear Non-Linear • Pulse [phase] inversion and / or (components) phase modulation Advantages: 1 Tissue signal • High specificity and sensitivity +1 Scaling Tissue penetration + • + sum = 0 • Tissue suppression 2 -2 Scaling + + 3 Bubble signal +1 Scaling sum = + 181 = = (Sum) (Sum) 5 Unrestricted © Siemens Healthineers 2024 Speaker Notes Another signal separation technique, Contrast Pulse Sequencing (CPS), is a low MI contrast imaging technique that uses pulse inversion as well as amplitude modulation to exploit the non- linear behavior of microbubbles in the fundamental imaging mode. CPS uses three pulses during imaging as opposed to the two pulses that CHI employs. Two of the three transmitted pulses are of the same amplitude while one pulse has an altered (scaled) amplitude. The tissue and bubble signal echo summation still occur in the same mathematical manner as CHI, however three signals are involved in the process instead of two. CPS also has advantages that make it the preferred choice for a clinician or exam type. Since CPS uses three pulses and images at the fundamental frequency, it has a high signal-to-noise ratio that makes small amounts of contrast easily visible (high sensitivity). CPS also has a high microbubble to tissue background ratio, thus contrast is easily distinguished within the imaging field (high specificity). Additional advantages of CPS when compared to CHI is slightly increased penetration, motion flash suppression, and background noise suppression. Notes No. 5 SIEMENS Healthineers Summary comparison of CPS and CHI SIEMENS Healthineers ... Property Contrast Pulse Sequencing Contrast Harmonic Imaging (CPS) (CHI) Penetration ++++ +++ Resolution +++ ++++ Motion Flash Suppression +++ ++ Specificity +++ ++ Sensitivity +++ ++ Contrast Agent Lifespan +++ ++++ Frame Rate ++ ++++ 6 Unrestricted © Siemens Healthineers 2024 Speaker Notes When both technologies are compared side by side, this chart highlights comparative strengths and weakness of each. For cardiac exams, which require a high frame rate, CHI is the preferred technology and set as the default application. CHI technology not only offers superior frame rate that’s highly desired in cardiac imaging, but it also has higher resolution and lower bubble destruction rates through the duration of the exam as well. However, there are times when CPS is used in cardiac contrast imaging due to the need for greater penetration. Notes No. 6 SIEMENS Healthineers Contrast technologies per transducer frequency SIEMENS Healthineers .. Transducer Low Mid High Pen 5Z1 CHI CHI -- -- 5V1 CPS CPS CHI CPS 8V3 CPS CHI CHI -- 10V4 CPS CPS CHI -- 7 Unrestricted © Siemens Healthineers 2024 Speaker Notes LVO Contrast, which takes advantage of CPS and CHI technology, is available on the above transducers and frequencies. As a general rule of thumb, the lower frequencies will have CPS for needed penetration. Higher frequencies will utilize CHI for resolution and frame rates. Notes No. 7 SIEMENS Healthineers Objectives SIEMENS Healthineers .. • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) Sequoia • Review touch screen layout and workflow Sequoia • Image parameters and optimization 8 Unrestricted © Siemens Healthineers 2024 Speaker Notes We will now review the touch screen layout and workflow for LVO. Notes No. 8 SIEMENS Healthineers Control panel – software activation SIEMENS Healthineers .. (O CEUS Update Contrast Note: Naming of the control (CEUS vs Contrast) may vary depending on region. 9 Unrestricted © Siemens Healthineers 2024 Speaker Notes To activate contrast imaging, select CEUS or Contrast on the control panel. To de-activate, press Contrast again or press 2D on the control panel. Once activated, the contrast key will illuminate orange and the contrast controls will populate on the touch screen. If the application is not supported, the contrast key will not be lit on the control panel. Notes No. 9 SIEMENS Healthineers LVO Contrast – touch screen and workflow SIEMENS Healthineers ... Page one of the touch screen includes the following: Cardiac 521 Workflow 1. Agent Type – Low MI and Mid MI options Patient 2D Contrast Physio Imaging 2. Onscreen image display – Contrast Only Timer Review most used for LVO Report 2 3. Auto TEQ – automatic Gain and DGC End Exam optimization 20 + Contrast 2D Only Contrast Only 4. Capture Type – change for Prospective or Auto TEQ 3 Off Retrospective clip capture 1 Agent Type Low MI Flash 4 Capture Type Prospective Frequency InFocus DR MI Limit Line Density Clip Capture Low 65 dB 0.2 10 Unrestricted © Siemens Healthineers 2024 Speaker Notes The layout of the touch screen is designed to position the more commonly used contrast controls lower and closer to the user’s reach, 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. Some commonly used functions for LVO include: 1. Agent Type – Includes Low MI and Mid MI options, with Low MI being the default; the default MI for both Low and Mid MI is 0.12 for LVO imaging (they are different in general imaging) 2. Onscreen image display options – Contrast Only is default and is most commonly used; 2D + Contrast displays a 2D image overlay; 2D Only displays only the 2D image. 3. Auto TEQ – automatic Gain and DGC optimization; default is Off – press to turn on 4. Capture Type – Configures the length of the clip capture in beats or seconds Additional options that are less commonly used for LVO include: • Timer – Press to turn on/off on-screen timer display Notes No. 10 SIEMENS Healthineers Bubble destruction SIEMENS Healthineers .. Flash – an option to temporarily destroy bubbles • Often used to evaluate myocardial perfusion • Can also be used to destroy bubbles when an excess Off Auto TEQ amount of contrast is injected • Delivers a high mechanical index “burst” only, default at 1.4 Agent Type MI Low MI Flash • Not pre-programmed - user turns feature on manually, but can adjust Flash settings 11 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 mechanical index (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. Flash delivers a high MI “burst.” The user turns the high MI application on 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. Notes No. 11 SIEMENS Healthineers LVO Contrast – touch screen and workflow SIEMENS Healthineers ... • Clip Capture on Flash – captures an image 10V4 5V1 8V3 Workflow when the user selects Flash Patient 2D Contrast Physio • Flash MI – adjusts the flash MI Imaging Review • Flash Period – number of frames flash lasts (1-5 frames) Report End Exam • Flash Delay – configures a delay of the Flash for the clip capture (Off or 1-5 beats) Clip Capture on Note: Flash settings changed configured from the Flash MI lash Perio 4 Frames Flash Delay Persist Maps Tint 1.4 Off touch screen are not retained. The settings will return to default settings after End Exam. These settings are not configurable in System Configuration currently. 12 Unrestricted © Siemens Healthineers 2024 Speaker Notes Page two of the LVO touch screen includes the Clip Capture on Flash option. When activated, the system will acquire a clip for the configured number of time / beats when the user selects Flash on page one of the touch screen. • Flash MI- adjusts the MI of the flash • Flash Period – adjusts the number of frames that the flash lasts (1-5 frames) • Flash Delay becomes an available option from the soft keys when Clip Capture on Flash is turned on, and allows the user to configure a delay of the Flash during the clip capture (Off or 1- 5 beats) Notes No. 12 SIEMENS Healthineers Objectives SIEMENS Healthineers .. • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) Sequoia • Touch screen layout and workflow Sequoia • Image parameters and optimization 13 Unrestricted © Siemens Healthineers 2024 Speaker Notes Finally, we will discuss imaging parameters and optimization. Notes No. 13 SIEMENS Healthineers System Configuration SIEMENS Healthineers .. The following capture settings can be System Configuration configured for contrast imaging: System Settings Workflow Enhancement Imaging Settings Exam Present Carosac General • Clip Capture – Prospective or Capture Settings Imaging Mode Default Capture Settings Contrast Capture Settings 4D Capture Settings Retrospective Image Parameter Display Dip Ciphaw Clip Cephin Cip Capture > Measurement & Report Prospective Prospective Prospective • Clip Length – time or beats; R-wave Annotations: · Features Oip Length Cip Lengily offset Transducer Time Custom (1-300) Time histam (1-10) Secoit's • Compression – compresses the images Connectivity & Network Peripheral Devices Beats Custom (lisboa) Boats Custom (1-100) Boats Custom (1-1 2 3 captured System Management First I-wove Offset Last R-wave Ofbel First R-wave Offset Last R-wave Ofhet First &-wave Offset Last H-wirve Offvet 0 Fines D figines Enable Compression 11 Enable Compression El Enable Compression Compression Lavel Compression Level Compression Level Medium Medium Mediam Capture Definition Capture Onfinition Umit Clip Capture Rate to 30Hz 1]timit Olp Capture Rate to 30Hz Restore Detauns: Cardiac 14 Unrestricted © Siemens Healthineers 2024 Speaker Notes Contrast Capture Settings can be accessed in System Configuration under Image Settings > Capture Settings. Select Cardiac from the Exam Presets drop-down menu. The middle column is designated for default Contrast Capture Settings. • Clip Capture – select Prospective or Retrospective for clip capture type. • Clip Length – select Time and number of seconds, or Beats and number of beats for default clip capture length. R-wave offset can also be set as a default to allow capture of additional frames beyond the R-wave on the ECG. • Compression settings – select Enable Compression to compress file size of clips. Options include Low, Medium and High. Notes No. 14 SIEMENS Healthineers InFocus (soft key) SIEMENS Healthineers .. • InFocus technology is always active during contrast scanning • Onscreen focal icon is depth adjustable InFocus to provide the most flexibility to the user • In LVO imaging, the focal point is usually placed just below the region of interest 16cm 15 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. In LVO imaging, the focal point is usually placed just below the region of interest. The InFocus technology is discussed in detail in the ACUSON Sequoia Major Modes 2D and M- mode presentation. Notes No. 15 SIEMENS Healthineers LVO Contrast – imaging screen SIEMENS .... Healthineers ... 5Z1 • • Focus - to extend the Cardiac Mechanical index (MI) TTO.U.QU MI:0.18 bubble duration, lower level is automatically 491Ps 2D Focus (below structure changed to a low level 0dB/DR60 UA Off of interest) MapG/T5 when software is Contrast activated OdB/DR57 P2 24cm 80bpm Lead Il 16 Unrestricted © Siemens Healthineers 2024 Speaker Notes Once you’re in the LVO Contrast imaging mode, it’s suggested to lower the Focus below the structure of interest to reduce the bubble destruction and increase the bubble lifespan. Transmit Power can be increased or decreased to achieve the desired result, if needed. It’s important to note that increasing the MI would accelerate the bubble destruction rate, while improving penetration. Notes No. 16 SIEMENS Healthineers UltraArt universal image processing SIEMENS Healthineers .. • UltraArt universal image processing is available in contrast imaging Off 2 W • 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 17 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. 17 SIEMENS Healthineers Contrast soft key options SIEMENS Healthineers ... Page 1 Frequency InFocus DR MI Limit Line Density Clip Capture Low 5 dB 0.2 3 Beats Sec Page 2 Flash MI Flash Period Persist Maps Tint 1.4 4 Frames 2 4 18 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. • Frequency – adjusts transmit frequency of current transducer. • InFocus – rotate soft key to adjust transmit focal zone. • Dynamic Range – applies to contrast (independent of B mode); default setting is 70dB and adjusts in single increments. • MI Limit – adjusts the transmit power; lower Transmit Power will give lower MI and cause less bubble destruction, whereas higher Transmit Power will give higher MI and cause increased bubble destruction. • Line Density – increase for more spatial resolution, decrease for higher temporal resolution. • Clip Capture – press to change clip capture to beats / seconds; rotate to increase / decrease clip capture length. • Flash MI – configures the mechanical index when the Flash option is used. • Flash Period – configures the number of frames for the Flash. Higher number of frames will raise the MI for a longer length of time; lower number of frames will raise the MI for a shorter length of time. • Persist (Persistence) – 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. • Tint – colorization for contrast image only; default setting is 1. Notes No. 18 SIEMENS Healthineers Soft keys SIEMENS Healthineers ... Transmit Power and Frequency Transmit Power: Higher frequencies result in: • Adjust to manage Mechanical Index ∼0.05 – • 100% available Decreased tissue penetration • • Varies with transducer 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 19 Unrestricted © Siemens Healthineers 2024 Speaker Notes Transmit Power will vary with the selected transducer and is used to manage the mechanical index (MI) level. Available settings are approximately 0.20 to 100% - again, the default setting will vary with transducer. 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. Higher power equates to more penetration in the image however more bubbles are destroyed when the power is higher. 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. 19 SIEMENS Healthineers LVO Contrast – image parameters and optimization SIEMENS ... Healthineers ... Imaging parameters to further optimize the contrast 5V1 Cardiac image: TIS:0.00 MI:0.14 2D • HD Zoom - increase resolution 0dB/DR60 UA Off MapD/T5 • Depth - reduce unwanted depth Contrast Low 6dB/DR50 P4 • Decrease sector size • Line Density- Lower number increases FR; Spatial/Temporal 24cm 30bpm Lead li 20 Unrestricted © Siemens Healthineers 2024 Speaker Notes Some additional imaging parameters and tools to help further optimize your contrast image are: • HD Zoom (write zoom) feature to increase image size, detail resolution and frame rate in the region of interest (ROI). • Limit the Depth to exclude any unwanted regions in the field of view. • Decrease sector size to rid of unwanted information and to increase frame rate. • Line Density – lower line density will increase frame rates; higher line density will increase spatial resolution. It is also important to always try to find the best acoustic window and optimize the image as much as possible before contrast is injected. Notes No. 20 SIEMENS Healthineers Summary SIEMENS Healthineers .. • Define the two types of contrast imaging technologies: • Contrast Pulse Sequencing (CPS) • Contrast Harmonic Imaging (CHI) Sequoia • Touch screen layout and workflow Sequoia • Image parameters and optimization 21 Unrestricted © Siemens Healthineers 2024 Speaker Notes Finally, we will discuss imaging parameters and optimization. Notes No. 21 SIEMENS Healthineers Trademarks and disclaimers The products/features mentioned in this document may not be commercially available in all countries. Due to regulatory reasons their future availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. ACUSON Sequoia is a trademark of Siemens Medical Solutions USA, Inc. At Siemens Healthineers, our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare. An estimated five million patients worldwide everyday benefit from our innovative technologies and services in the areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine as well as digital health and enterprise services. We’re a leading medical technology company with over 120 years of experience and 18,500 patents globally. With over 50,000 employees in more than 70 countries, we’ll continue to innovate and shape the future of healthcare. 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-heathineers.com/ultrasound 22 Unrestricted © Siemens Healthineers 2024 22 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS Healthineers .. Questions? 23 Unrestricted © Siemens Healthineers 2024 Speaker Notes No speaker notes.