ACUSON Sequoia 3.5 (VB30) General Imaging Major Modes Presentation

SIEMENS Healthineers SIEMENS Healthineers .. ACUSON Sequoia Ultrasound System Major Modes Release 3.5 (VB30) 1 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes • Review Doppler controls • Describe Doppler optimization features 2 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Review B-mode and M-mode controls Describe B-mode and M-mode optimization features Explain display modes Review Doppler controls Describe Doppler optimization features Notes No. 2 SIEMENS Healthineers Mode imaging parameters SIEMENS. Healthineers ... System Configuration > System Settings · Workflow Enhancement Image Parameter Dbpby Preview Imaging Settings [ Patient Information Sthear Wave Parameter Institution Naste General D Last Name, First Name Capture Settings D Last Name D Date of Birth Thermal Index . Bone (TIB) Imaging Mode D Patient ID Thermal Index - Cranium (TIC) hermal Index - Soft Tissue (TIS) Image Parameter Display D Date & Time Mechanical Index Qui) D Operator ANL (Wireless only) . Measurement & Report Transducer Frame Rate Transmit Power · Annotations Exam 20 Thermal Index - Bone (TU) Frequency . Features Thermal Index - Cranium (TIC) Gain Dynamic Range Transducer Thermal Index - Soft Tissue (TIS] Speed of Sound Une Density Selection Mechanical Index (MI) . Connectivity & Network ANL (Wireless only) Image Screen · Peripheral Devices 23 Frame Rate Screen Transmit Power System Management 20 Display Frequency Gain/Dynamic Range Speed of Sound Line Density UltraArt Map/Tint 1 Persistence Clarity Level Compounding 30MD D Ciales Dynamic Range Volume Swtop Quality Volume Sweep Angle Restore Default 3 Unrestricted © Siemens Healthineers 2023 Speaker Notes: For each Mode, the user can select the imaging parameters that are displayed on the Image screen. This will apply for all transducers and presets. To configure, select the System Configuration icon on the Touch Screen (System Configuration > Imaging Settings > Image Parameter Display) and select the parameters you wish to display. The image on the right provides a preview of what will be visualized on the Image screen. Notes No. 3 SIEMENS Healthineers B-mode controls SIEMENS . Healthineers ... Control Panel Touch Screen . Abdomen Workflow Patient Imaging Al Abdomen L/R Flip UID Flip Timer Review Report Panoramic Full FOV End Exam Auto TEQ Live Dual Clarity Harmonics Compounding Wide FOV Frequency H Mid InFocus Line Density 5 de Soft Keys O O O 4 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The B-mode image may be optimized using the: • The 2D rotary control on the Control Panel • Soft keys • Touch Screen Notes No. 4 SIEMENS Healthineers Control panel SIEMENS. Healthineers ... Soft key rotary controls O) Power Major Modes Advanced Applications Imaging Control User-defined s Controls Pointer/Delete Freeze Home Base 5 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Power control powers on or powers off the ultrasound system. Orange lighting indicates the ultrasound system is powered on, and a blinking orange light indicates the ultrasound system is plugged in but not powered on. No lighting indicates the ultrasound system is powered off and not plugged in. Advanced applications include the Contrast Enhanced Ultrasound (CEUS control) to enter contrast exams, and Virtual touch (VT control) to enter Elastography and Ultrasound Derived Fat Fraction. The User defined keys, U1 and U2, can be customized to the user's preference. (System Configuration > System settings > Display) The Pointer control is used to highlight or select options from the imaging screen. Delete control: • During the measurement function, this key deletes the measurement in progress in reverse sequence • During the annotation function, this key deletes the annotation in progress in reverse chronological sequence • During review, this key deletes the selected image Home base: The trackball and trackball keys size and position an object on the image screen, for example, the region of interest, Doppler cursor, and measurement markers. Major modes: Major mode controls activate the operating mode and adjust the gain. Press the operating mode control on the Control Panel to activate the operating mode. Rotate the operating mode control to adjust the gain for the operating mode. Freeze control: • Freezes or unfreezes the acquisition of an image, sweep, or spectrum • Enables or disables CINE playback • During a clip capture, ends the capture Notes No. 5 SIEMENS Healthineers B-mode controls on the Control Panel SIEMENS. Healthineers ... DGC 2D Update Zoom Dual Depth 6 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The primary B-mode imaging controls on the Control Panel are: • The DGC slide pots manually adjust brightness and gain at depth. Move to right to increase and to the left to decrease. The recommended placement is in the center. This is adjustable on a live or frozen image • 2D activates or returns to B-mode imaging. Rotate 2D to change the overall B-mode gain/brightness • Depth changes the depth of the field of view (FOV) and is adjustable by rotating to decrease and increase depth. The FOV is adjustable from 0-55 cm depending on the selected transducer • Dual displays two different images side-by-side. Seamless Dual and Full Screen Dual are programmed in the System Configuration Menu > Image Settings > General. This will apply across all transducers and presets • Zoom activates either Zoom or HD Zoom Notes No. 6 SIEMENS Healthineers B-mode controls on the Touch Screen SIEMENS . Healthineers ... ₱ Abdomen 15 Workflow Abdomen 9C2 15L4 15 Workflow Patient 2D Patient maging l Abdomen LUR Flip UID Flip Biopsy Review Timer Imaging Review Report Panoramic Full FOV Report mage Size End Exam End Exam Capture By Seconds Auto TEO Live Dual Clarity Capire Type Clip Length Prospective 3 sec Harmonics ompounding Wide FOV Transfer Data 3 Channel Mode Frequency OK InFocus Une Density H Mid 5 dB Transmit Power Clarity Persist Maps 95 % Page One Page Two 7 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the two pages for the B-mode Touch Screen controls. To access the second page, select the page arrow key or swipe across the Touch Screen. Active selections are highlighted in orange. Available selections are gray if a control is dithered out and not available for the mode, transducer, or preset. We will discuss the optimization later in the presentation. Notes No. 7 SIEMENS Healthineers B-mode controls on the soft keys SIEMENS . Healthineers ... ₱ Abdomen 1816 15L4 902 Workflow 9C2 1514 15L Workflow Patient 20 Patient Imaging U Abdome UR Flip UID Flip Biopsy Imaging Review Timer Review Report Panoramic Full FOV Report mage Size End Exam End Exam Capture By Seconds Auto TEQ Live Dual Clarity Capture Type Prospective Clip Length Harmonics Compounding Wide FOV ransfer Data 3 Channel Mode DR Line Densis Transmit Power Clarity Mapa Tint O O O O O O O 8 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The B-mode soft key rotary controls are located on the Control Panel and lie beneath and correspond to the controls listed on the bottom of the Touch Screen. The active control text is backlit in white. Press to activate the control, then rotate the soft key to adjust. If the image is frozen, the controls available in freeze will display their text in white on the Touch Screen. Controls that are not available will have text that is dithered out. Please review the slide later in the presentation which lists the post-processing features available in B-mode and M-mode. Soft key controls are not customizable but change as you move from live to frozen. Only the items available as post-processing will display their text backlit in white when frozen. Notes No. 8 SIEMENS Healthineers Workflow control SIEMENS . Healthineers ... ₱ Abdomen 1816 15L4 9C2 Workflow Patient Workflow Imaging l Abdomen LUR Flip UID Flip Biopsy Timer Review Fusion Protocols Report Panoramic Full FOV End Exam Modality Compare Physio Auto TEQ Live Dual Clarity Harmonics Compounding Wide FOV Stress Echo Frequency OR InFocus Line Density H Mid O 9 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Workflow Control is available on the Touch Screen. It provides access to some of the advanced applications and options. As a reminder, the Virtual Touch Elastography, 3D/4D and Contrast options are accessed from the Control Panel. Panoramic is now available in B Mode first page selection. Workflow options include: • Protocols • Modality Compare • Physio module • Stress Echo • Fusion Options will display their text backlit in white if available and be dithered out if not available for a specific transducer, mode or if the option does not have an active license on the system. To access, select Workflow, then the specific application required. Notes No. 9 SIEMENS Healthineers M-mode controls SIEMENS .... Healthineers ... M OB TIS:1.27 MI:1.38 86fps 95% 2D 9C2 1514 Workflow H High 9dB/DR55 LD 2 Patient 2D M Mode UA 3 MapE/T9 Imaging P3 M Review 0dB/DR60 Report MapD/T9 E 2 End Exam 8.4cm HD Z Harmonics Clinical Data 10 Unrestricted © Siemens Healthineers 2023 Speaker Notes: M-mode (or motion mode) displays a B-mode reference image and an M-mode sweep. M- mode allows a graphic display of motion, such as tracing a fetal heart rate or a lung ultrasound to evaluate for pneumothorax. The cursor or M-line indicates the path used to obtain the M- mode tracing. Anatomy that remains stationary displays as a straight line, while curved or peaked lines mirror the moving anatomy. To activate M-mode: • Press M on the Control Panel to access the B-mode image/M-mode sweep on the imaging screen and the M-mode menu on the Touch Screen • Roll the trackball to position the M cursor • If desired, change the display format from, 1/2 2D - 1/2 trace; 1/3 2D - 2/3 trace or full screen by selecting the icon on the Touch Screen • Rotate M to change the overall M-mode gain • To select an area of interest to sample, roll the trackball down and place in an area of interest and magnify the trace. This is especially useful in early OB’s or to enlarge an area of interest • To exit, press the M or 2D control on the Control Panel Notes No. 10 SIEMENS Healthineers M-mode Touch Screen controls SIEMENS . Healthineers ... 0 0 0 8 Abdomen DAX 1514 10V4 Workflow Abdomen DAX 1514 1004 Workflow Patient M Mode Patient 2D M Mode Imaging Imaging Review Review Report 5 Report End Exam End Exam 3 Harmonics 2 4 1 × 40 Sweep Speed Edge Maps Tint 60 mm/'s 60 dB H Mid 11 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When scanning in M-mode the Touch Screen provides additional optimization features. 1. Edge sharpens the contours of a structure in the M-mode sweep. Select on the Touch Screen to modify. Increase for more sharpness and decrease for less sharpness. Choices are 1-4 2. DR (Dynamic Range) increases the number of gray shades displayed in the M-mode Sweep. Choices are 10-80 dB 3. Sweep Speed adjusts the scrolling speed of the M-mode trace. Decrease to display more heart cycles and increase to display fewer cycles (settings range from 8-200 mm/sec (8,12,16, 25, 33, 50, 60, 67, 100, 150, 200) 4. Frequency adjusts B-mode frequency the enhances the M-mode trace. Choices are transducer and exam dependent 5. Display modes (1/2 B-mode - 1/2 trace; 1/3 B-mode - 2/3 trace; Side by Side; 2/3 B-mode - 1/3 trace; Full Screen) Notes No. 11 SIEMENS Healthineers Anatomic and color M-mode SIEMENS .... Healthineers ... 5V1 5V1 *Cardiac- Cardiac TIB:0.72 TIC:3.50 TIS:0.72 MI:0.94 52fps 2D 95% H Mid 2D -6dB/DR61 H High c -10dB/DR60 Mid Angle -2dB/ General 7dB/DR60 PRF 3968 M Reset 2dB/DR60 19cm 12 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Color M-mode provides color to the M-mode trace when using a cardiac transducer. When in M-mode, press Color on the Control Panel to activate. Color M-mode works on cardiac transducers and presets. This is an example of a color M-mode showing the width of the regurgitant jet in Aortic insufficiency. Anatomical M-mode allows the user to modify the angle of the cursor based on patient anatomy and is independent of the transducer orientation. It is available only in the Cardiac exam preset and accessed through the Angle control when in M-mode. To perform an anatomic M-mode: • Rotate Angle on the soft keys and the system activates anatomic M-mode. The anatomic M- mode cursor displays as a dashed line with an arrow pointing in the direction of the deeper part of the image. • To reposition the anatomic M-mode cursor, roll the trackball. • To reset anatomic M-mode, press Reset. • To exit anatomic M-mode, press 2D. These features will be discussed in greater detail in the Cardiac Major Modes presentation. Notes No. 12 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes • Review Doppler controls • Describe Doppler optimization features 13 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Image: HOOD05162003330011 Notes No. 13 SIEMENS Healthineers Auto TEQ image optimization SIEMENS .... Healthineers' ... 5C1 Abdomen Auto TEQ TIB:0.38 TIC:1.55 TIS:0.38 ME:1.38 31fps 95% 20 H High 18L6 15L4 > 1 902 Workflow 1d8/DR65 Patient MapDITS Imaging Al Abdomen UR Flip UD Flip Biopsy Timer Review Off Report Panorami Full FOV End Exam Auto TEQ Live Dual Clarify Harmonics Compounding Wide FOV Frequency InFocus Line Density H.Mid 65 de 14 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto TEQ TM (Tissue Equalization technology) optimizes the overall field of view (FOV) image brightness uniformity by changing the depth gain compensation and overall gain. Auto TEQ continuously applies the TEQ technology to a B-mode image (as displayed in this image of the gallbladder and inferior vena cava). To activate Auto TEQ, select Auto TEQ from the Touch Screen. The default is off. When active, the Auto TEQ control on the Control Panel is backlit in orange and a white icon display appears on the image screen. Press to activate or deactivate. Notes No. 14 SIEMENS Healthineers Harmonic imaging SIEMENS .... Healthineers ... 4V1 Harmonics Abdomen TIB:0.48 TIC:1.67 TIS:0.48 MI:0.81 47fps 2D H High 0dB/DR66 14cm Fundamental Harmonics 15 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Harmonic imaging improves contrast and spatial resolution by reducing noise and clutter within cysts and vessels and is especially helpful in reducing noise in large, difficult to image patients. Tissue harmonics are generated within the tissue beyond the window that causes beam distortion and scattering; therefore, the artifacts caused by the acoustic window are generally reduced. The harmonic frequency received is twice the fundamental frequency (e.g., if a 2 MHz fundamental signal is sent into the body, the ultrasound system uses the 4 MHz harmonic signal that returns from the body to form the image). Harmonics can be used to decrease artifacts such as haze, noise and clutter in vessels or from large, difficult to image patients. Harmonics can help reduce grating lobes and side lobe artifacts (low-intensity weak echoes outside of the main ultrasound beam) typically seen near the diaphragm or near large cystic structures. It can also reduce reverberation artifacts (linear equally spaced echoes) on the anterior portion of cystic structures such as the urinary bladder or gallbladder. This dual image, of the right kidney using the 4V1 transducer, demonstrates the excellent image quality in both fundamental and harmonics. To activate/deactivate harmonics, select Harmonics on the Touch Screen. Notes No. 15 SIEMENS Healthineers Frequency imaging SIEMENS ... Healthineers' ... Frequency DR InFocus Line Density H Mid 65 dB 14cm 16 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Frequency imaging enables the user to adjust the range of frequencies of the transducer in order to improve resolution (higher frequency setting) or increase depth of penetration (lower frequency setting) and clearly visualize the entire FOV from the near field to the far field in B-mode imaging. The image on the left demonstrates excellent uniformity of the liver/kidney using harmonics Low (H Low) on the 9C3 transducer on a small adult. The middle image demonstrates the layers of the bowel using the 18L6 transducer with harmonics High (H High). The image on the right demonstrates excellent uniformity in this liver using the 9C2 transducer and utilizing harmonics Low (H Low). Frequency imaging allows the user to independently select B-mode fundamental or harmonic, color Doppler, M-mode and spectral Doppler frequencies (e.g., the Doppler frequency can be adjusted without changing the B-mode frequency). Each imaging mode has its own range of frequency settings to achieve the highest resolution, penetration and sensitivity for the structure being imaged. The fundamental images choices are Res (Resolution), High, Mid, Low, Pen (Penetration) The harmonic image choices are H High , H Mid, and H Low The settings are adjusted using the corresponding soft key rotary control. The settings are transducer and exam specific. Notes No. 16 SIEMENS Healthineers Compounding SIEMENS .... Healthineers ... Abdome 18L6 Tests TIS-0,80 TIB.0.35 TIC.0.94 5.0,35 Compounding Line Density 11cm Off On 3cm 17 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To access Compounding, select Compounding on the Touch Screen. It will be displayed in orange when activated. The default is on. Compounding is not available on the 4V1, P51, 8V3 or Aux CW transducers. Compounding combines multiple images acquired at different steering angles (multiple lines of sight) to produce a compounded image with less noise, increased contrast resolution and improved border delineation. When Compounding is on, the user adjusts the Line Density to increase level of compounding. In this dual image of the liver/pancreas the image with compounding off clearly delineates the fatty infiltrate in the liver. This is a great example using Dual to demonstrate the difference in the images with and without applying Compounding. Notes No. 17 SIEMENS Healthineers Line Density SIEMENS ... Healthineers ... Frequency DR InFocus Line Density H Mid 65 dB 2 DAX Abdomen TIB:0 37 TIC:2.12 TIS:0.37 ML1.01 19fps 96% 2D H Pen -14B/DR65 LD 3 LA 3 MapC/T4 P3 18 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When Compounding is off, Line Density adjusts the balance between the image line density (resolution) and the frame rate (speed). Settings are one (low resolution/high frame rate) to three (high resolution/low frame rate). Line Density is not available when using Clarify. The image on the left is using the DAX transducer on a technically difficult abdomen. Note how line density of three was applied to increase overall resolution in this lower frequency range. The middle image is using the 10L4 transducer demonstrating a detailed anterior and posterior intima. The line density is set at two which is a good balance between resolution and frame rate. The image on the right is utilizing the 18L6 transducer using a line density of two on the testicle. Note the excellent detail and uniformity. Notes No. 18 SIEMENS Healthineers Clarify vascular enhancement (VE) technology SIEMENS .... Healthineers ... 9C3H Abdomen TIB:0.35 TIC:0.95 TIS:0.35 MI:0.80 15fps 95% • Uses Power Doppler 2D H Mid 2D amplitude information to 1dB/DR65 Clarify 3 enhance B-mode imaging • Reduces artifacts in vessels and improves vessel wall Power definition . 10cm Clarify 19 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Play Clip Clarify vascular enhancement (VE) technology is a real-time, adaptive, pixel-by-pixel analysis which provides exceptional contrast resolution for clear delineation of vessels. It reduces noise and artifacts, improves visualization of micro and macro-vasculature, and increases contrast resolution within tissue and between tissues. It is a patented technology that uniquely utilizes power Doppler amplitude information to enhance B-mode imaging. Use Clarify VE to reduce noise and artifacts within macro-vascular structures (larger vessels) such as the carotid artery, aorta and femoral vein as well as in micro-vascular structures such as the small vessels found in the thyroid, testicle and kidney. It can be used on vessels to help delineate surrounding structures such as on the pancreas to help delineate the splenic vein and portal confluence, or in this example delineating the renal artery and vein. Clarify VE does not change the B-mode image in nonvascular structures such as clearing out artifact within the gallbladder or urinary bladder. To activate/deactivate, select Clarify on page two of the Touch Screen. Rotate the Clarify soft key to adjust Clarify sensitivity levels: (menu opens with selections 1 – 5) • Select a higher level to increase sensitivity • Select a lower level to decrease sensitivity Notes No. 19 SIEMENS Healthineers Clarify VE technology SIEMENS .... Healthineers ... VIS.1.10 .100m 20 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The image on the left is an excellent use of Clarify VE to help delineate the vessels surrounding the pancreas. The image in the middle is using Clarify VE for greatest improved sensitivity to enhance and display the hepatic and splenic artery of the celiac axis. The image on the right is a sagittal view of the aorta using the 5C1 transducer. Note how well the celiac axis and superior mesenteric artery are clearly seen when using Clarify VE. Notes No. 20 SIEMENS Healthineers UltraArt universal image processing SIEMENS .... Healthineers ... Speckle Optimization Edge and Ridge Enhancement Contrast Enhancement Gain and Dynamic Range 21 Unrestricted © Siemens Healthineers 2023 Speaker Notes: A unique capability available on the system is UltraArt universal image processing. Image post processing parameters can be selected from the Touch Screen with a single touch to instantly optimize images for different patient types. This allows quick and easy matching of the systems acoustic DNA parameters to individual patients in the specific scanning window. The effect of numerous parameter changes can be seen before they are applied. By unifying multiple parameters into optimal settings for each individual patient, the effect of UltraArt patient specific image processing improves contrast resolution of different organs and visualization of small or isoechoic lesions. In the end, UltraArt improves exam quality and consistency across different users by avoiding combinations of individual post processing parameters that do not provide the result the user needs. Reading physicians can look forward to better exam quality standardization. Some of the parameters that are optimized include Speckle, Edge, Contrast, Gain and Dynamic Range. UltraArt can be applied to a live or frozen image. Note: The images displayed on the Touch Screen do not represent the actual image quality but are representative images to choose. The Touch Screen is designed for graphics and text display. The image screen is a high-resolution monitor designed for viewing images. The image shown above was captured from the Touch Screen. The image selected should be chosen from the image displayed on the monitor. Notes No. 21 SIEMENS Healthineers UltraArt universal image processing SIEMENS .... Healthineers ... UA Off UA UA 2 UA 3 UA 4 UA 5 22 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To change the UltraArt setting: • Select the UltraArt icon on the Touch Screen • Selections are 0ff-5 Off represents the natural image • As each gets number gets progressively higher the amount of speckle reduction increases and higher range of Edge enhancement. • Not all Transducers will have 6 selections, the 18L6 will have optimized 4 selections. Once you activate UltraArt, the 6 selections are displayed on the Touch Screen. The image above of the Liver displays the four actual images that were captured from the Touch Screen and the image from the monitor. The UltraArt presets defaults will vary according to transducer. Although the changes are subtle in the frozen image, once displayed on the high-resolution monitor, the changes are more apparent. Notes No. 22 SIEMENS Healthineers InFocus coherent image formation SIEMENS .... Healthineers ... 14L5 Carotid TIS:0.21 TIB-0.70 MIO.73 TIC 3.85 58fps TIS 0.70 2D H Md 0dB/DR65 c=1540 LO 1 OB/DRES Compound UA 2 MapD/T5 P2 Son 23 Unrestricted © Siemens Healthineers 2023 Speaker Notes: InFocus is a patented technology, known in academia as retrospective dynamic transmit. With the power of the image beamformer, the system is able to transmit broader beams than a conventional system, using massive parallel image formation to collect many different angles simultaneously. The beams are then corrected, creating a more tightly focused image from the near field to the far field. There is no longer a need to transmit at multiple depths to maintain image uniformity or have a transmit focus control. InFocus technology is always in use and is activated when the InFocus Icon is seen at the top left of the image. There will be no focal zones seen on the image screen. Here are a few example images that were captured utilizing InFocus technology. The first image of the liver and right kidney is utilizing the 5C1 transducer. Note the image clarity, uniformity and contrast resolution in the overall image. The middle image is the common carotid artery demonstrating intimal thickening utilizing the 14L5 transducer. Notice the detailed anterior and posterior intimal walls and how the vessel lumens are black and artifact free. The last image is comparing the liver and right kidney utilizing the 5C1 transducer in an adult patient. Notes No. 23 SIEMENS Healthineers InFocus coherent image formation – Selectable focus SIEMENS .... Healthineers ... 5C1 Abdomen TIB:0.20 TIC:0.90 TIS:0.20 MI:1.39 25fps 98% 2D H High 1dB/DR60 LD 2 UA 2 MapB/T9 InFocus = 9cm 24 Unrestricted © Siemens Healthineers 2023 Speaker Notes: In some cases, users may want to further enhance a specific area of interest, so a selectable focus can be applied. To activate the selectable focus, select InFocus from the Touch Screen or press the soft key and choose the selectable focus Icon. The image screen displays an icon on the depth scale to indicate the location of the focal zone. Rotate the InFocus soft key to position the focal zone at the desired area of interest. This example demonstrates where the selectable focus was used to further enhance the area of the pancreatic duct. Notes No. 24 SIEMENS Healthineers Transmit Power SIEMENS .... Healthineers ... Abdomen TIC 2:52 TIS 2 23 TIS.0.62 98% 2D H High 0dB/DR66 UA 3 Clinical Data 7cm * 8cm Transmit Power Persist Maps Tint 95 % D 25 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Transmit power can be adjusted by the user and is displayed as Mechanical (MI) and Thermal Indices (TI). The settings display the percentage of power where 100% is the FDA (USA - Food and Drug Administration) and IEC (International Electrotechnical Commission) agencies regulated maximum in each imaging condition/mode/sub-mode. Setting choices are .2% to 100% . The default is 95%. Rotate the Transmit Power soft key to adjust. Changes to Transmit Power apply across all major modes. Turning the power down will show the changes in the TI and MI display and other regulated factors. The MI and TI display values should be interpreted as relative information and only used to assist the operators to implement the ALARA (As Low As Reasonably Achievable) principle for patient examinations; the acoustic output should be the lowest level required to satisfactorily perform the examination. Indices displayed in the abbreviated form represent: MI: Mechanical Index MIF: Maximum of the Mechanical Indices measured at the active focal zones (displayed during CCAI (contrast exams only) TIB: Bone Thermal Index (fetal application) TIS: Soft Tissue Thermal Index TIC: Cranial Thermal Index Notes No. 25 SIEMENS Healthineers Dynamic Range SIEMENS .... Healthineers ... Tests TIB 0 27 TIC.0.81 TIS:0.27 MI.0.63 35fps 95% 4.5cm Frequency DR InFocus Line Density H Mid 65 dB 2 26 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dynamic Range affects the number of shades of gray that are displayed (settings range from 10 80 dB) . Increase the Dynamic Range to produce a “softer” B-mode image; decrease the – Dynamic Range to produce an image with more contrast. Dynamic Range is available on a live or frozen image. Dynamic Range is adjusted by rotating the soft keys and is available on Page one of the 2D Touch Screen. The average Dynamic range on the presets is 60 – 65 dB. Note the excellent contrast resolution displayed in the various images. The blacks are maintained while displaying the subtle gray scale changes. Notes No. 26 SIEMENS Healthineers Maps SIEMENS .... Healthineers' ... SC1 DAX OB TIB 0.68 Abdomen TIC:3 24 TIB:0.80 Compass Post Maps TIS 0 88 TIC.3.29 ML1.10 TIS.0.80 25fps 95% 20 200 H Hgh 7dB/DR55 LD 2 UA 3 MapD/19 PS Clinical Data 100 Input 200 250 Transmit Power Clarify Persist Maps Tint 95 % Off On C 5 27 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Play Clip Maps may be adjusted on a live or frozen image. A gray map determines how dark or light to show each level of gray is displayed based upon the strength of the ultrasound signal. Settings range from A-G. Maps A-F display low to high contrast and Map G is a linear map (primarily used in research) . They are also gain balanced with the exception of Map G. • The image on the left demonstrates a uniform image of a 30 Week fetus utilizing the 5C1 transducer and a map of D to increase the contrast. Notice the contrast resolution of the Liver/Lung/Kidney interface and the thymus gland. • The middle image is utilizing the DAX transducer on a small abdomen. This image shows the penetration and uniformity of the image. Note the detail in the spine. Map B was selected as a softer gray scale for this lower frequency imaging. • The graphic displays the different Maps available. • Maps are available on Page two of the 2D Touch Screen and are also adjustable by rotating the soft key. Notes No. 27 SIEMENS Healthineers Speed of Sound SIEMENS .... Healthineers ... 18L6 Breast TIB:0.13 TIC:0.25 TIS:0.13 MI:0.72 65fps 95% off 2D Mid 2dB/DR65 +C=1446 1540 1480 1460 1446 Speed of Sound c=1446 Trapezoid Live Dual Speed of Sound Correction 3cm 18L6 - Breast Tissue 28 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Speed of Sound key indicates the assumed propagation speed of the acoustic wave when performing exams on different anatomy. In most exams the assumed speed of sound of 1540 m/s is used to produce the ultrasound image. Adjusting the assumed speed in some exam types improves focusing, which results in better spatial and contrast resolution. For example, the speed of sound in the MSK preset is 1446 m/s. The Breast preset allows the user to select the speed of sound based on the composition of the breast tissue being imaged. A lower setting (1446 m/s) is optimal for fatty tissue and a higher setting (1540 m/s) is preferred for less fatty or denser tissue. Notes No. 28 SIEMENS Healthineers Tints SIEMENS ... Healthineers ... 14L5B Vercus TIB:0.14 TIC:0.33 5.0.14 ME0 91 55fps 95% 2D 2.5cm Inverted Rainbow Sepia Gold 29 Unrestricted © Siemens Healthineers 2023 Speaker Notes: (Run Clips) Tint individually colorizes the grayscale image to aid in visualization of subtle tissue differences. There are 10 tints. Six with different shades of gray, as well as blue, inverted rainbow, sepia, and gold. Tint 1 is a true gray and Tints 2-6 are additional gray shades. Tints 7-10 are the color options. They are also gain balanced. Clinical uses may include nerve imaging, to enhance low level echoes in blood and contrast resolution, borders of organs and fetal echocardiography. Tint can be adjusted on a live or frozen image. The image on the left is a clip (move cursor into image to play clip) using Tint 8 (Inverted Rainbow). The colors range from a dark purple to white and purple tint is enhancing the blood flow. The image in the middle is using the Sepia tint. This enhances the borders of the right kidney. The image on the right is also a clip and demonstrates the low-level blood echo using the gold tint in the saphenous vein. Note the detail of the valves and contrast resolution displayed. Notes No. 29 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes • Review Doppler controls • Describe Doppler optimization features 30 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Image: HOOD05162003330011 Notes No. 30 SIEMENS Healthineers Trapezoid SIEMENS .... Healthineers ... Trapezoid - Transverse Testicles Trapezoid 31 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Trapezoid angles the outer edges of the image on linear transducers to extend the far-field display. The angles are increased on each side as follows: • 18L6 transducer - 20 degrees • 14L5 transducer - 20 degrees • 10L4 transducer - 30 degrees Some common areas where trapezoid imaging is clinically used include: • Thyroid imaging to show large nodule or full size of thyroid (as displayed in this transverse view of the Thyroid) • Testicular imaging for pathology (e.g. hydrocele) • Abdominal anatomy, wall or bowel with a linear transducer (as displayed on the GB/IVC image in a small adult) • Pediatric imaging or small adult when higher frequency is needed • Early OB imaging • Vascular imaging • Appendix To activate/deactivate Trapezoid imaging, select Trapezoid on the Touch Screen. Notes No. 31 SIEMENS Healthineers Wide Field of View SIEMENS ... Healthineers ... 5C1 Abdomen Abdome 1514 Workflow TIB:0.51 TIC:3.21 TIS:0.51 Patient MI:1.38 22fps Imaging 95% Al Abdomen LIR Flip WID Flip Biopsy Review Off HLOW dB/DR65 Report Panoramic Full FOV LD 2 End Exam Compound UA 3 MapD/T5 P2 Auto TEQ Live Dual Clarify Harmonies Compounding Wide FOV × 6 Frequency Line Density H Mid OR ImFocus 10cm 32 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Wide field of view is available on the 5C1 transducer in B-mode imaging. Wide FOV increases the viewing area from 70 degrees to 100 degrees for a 43% increase in the imaging field of view. Notes No. 32 SIEMENS Healthineers Dual SIEMENS .... Healthineers ... 9C3 9C2 Abdomen Abdomen TIB:0.39 1 Rt Kidney Length=9.98 cm 2 Rt Kidney AP=4.79 cm TIB:0.36 Dual TIC:0.77 TIC:1.26 TIS:0.39 Rt Kidney Width=4.86 cm MI:0.55 Rt Kidney Vol :1 21 65 am TIS:0.36 MI:0.93 12fps 48fps 95% 95% 20 2D B DR65 H Low 2dB/DR65 c=1540 14cm 13cm 33 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dual displays two separately acquired images side-by-side. In dual, the user can annotate, measure (as shown in the image on the right of a conventional dual display of the sagittal and transverse view of the right kidney and add color (as displayed on the liver and Hepatic vein/IVC image) and place Body Markers on each adjacent image. Press Dual on the Control Panel to activate the Dual feature. Press Update to activate and toggle between images. Press 2D to exit Dual. The “a” ACUSON icon is displayed orange and denotes the active side. One useful feature is available after freezing an image. Users can press Dual, and the frozen image is placed on the left side of the dual image and the right side is live to take additional images. The system can be configured for conventional dual or seamless dual (System Configuration > Image Settings > General). Conventional dual allows measurements on either the right or left image. Seamless Dual allows for measurement across the central line. The system can be configured for Full Screen Dual in System Configuration > Image Settings > General. When Enable Full Screen Dual is selected, dual mode will automatically enlarge into a full screen. When returning to a single screen from Dual, the system will deactivate full screen. To configure hide/display image settings in Dual, select the System Configuration Icon > Image Settings > General and check or uncheck. Notes No. 33 SIEMENS Healthineers Live Dual SIEMENS .... Healthineers' ... 9C3= 501 H Abdomen Abdomen TIB:0.39 TIB:0.87 TIC:0,88 TIC:2.17 TIS:0.39 TIS:0.87 MI:0.86 MI:1.30 19fps 20fps 95% 2D H Mid 5dB/DR60 B Kidney -821 P14 20 + colle 20 + Color Live Dual 34 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Play Clips on both images Live Dual displays the same image side-by-side. Comparisons may include: B-mode, B-mode with Clarify B-mode and B-mode with color/power Doppler, (as displayed here in the Portal vein and IVC and Aortic/Iliac bifurcation). Live Dual is often used to compare the B-mode image next to the color Doppler image in order to evaluate both the hemodynamics and the underlying B-mode image. On a live image, select Live Dual on the Touch Screen to activate or deactivate. Notes No. 34 SIEMENS Healthineers Left/Right and Up/Down Flip SIEMENS ... Healthineers ... 4V1 Abdomen TIB:0.30 TIC:1.18 TIS:0.30 MI:0.76 43fps L/R Flip 20 AdBIDPAY HM U/D Flip 35 Unrestricted © Siemens Healthineers 2023 Speaker Notes: On the Touch Screen, the image can be L/R flipped or U/D flipped. This may be useful in endovaginal gynecology, prostate, cardiac, pediatric, Fusion imaging and biopsy procedures. When available, it will be highlighted in orange on the Touch Screen. Select the desired orientation on the Touch Screen to change the orientation. In this example, we are highlighting the InFocus imaging to demonstrate the uniformity of the image from near to far field. Notes No. 35 SIEMENS Healthineers Panoramic imaging SIEMENS .... Healthineers ... Abdomen HBVDR60 MapA/F3 20% Color 2 02-10.78 cm Power Doppler - Panoramic Mode D3- 36 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Panoramic imaging offers an image with a larger field of view (FOV) to visualize and measure structures in their entirety or to better visualize and understand spatial relationships between anatomy/pathology. A panoramic image is acquired by sliding the transducer along the patient's anatomy and then the system blends the multiple images together to form one larger image with an extremely wide field of view. It compares consecutive images, rotating and stitching them together to form the final image. Panoramic Cine can be used to recall single frames for review. Panoramic imaging allows acquisition and display of grayscale and Power Doppler images up to 60 cm in length and up to 360° when the depth is less than the radius of the target area being scanned. It is available on curved and linear transducers. All color data is preserved during image acquisition and the peak of the signal is saved for the color panoramic image. Clinical applications for use may include: • Thyroid (nodules, goiters) • Breast (masses, areas of inflammation, reference anatomy) • Musculoskeletal (Baker’s cysts) • Vascular (anastomoses, varicose veins, saphenous vein mapping, vessel orientation) • OB/GYN (fetal lie, placenta) and acquiring a volume of an organ Notes No. 36 SIEMENS Healthineers Panoramic imaging – B-mode SIEMENS .... Healthineers' ... Venous TIB:0.14 TIC:0.33 TIS:0.14 MIO.91 H Mind 2GB/DR60 0 ? 0 5 5C1 1014 1816 10V4 Workflow Patient 2D anoramic Imaging Flex Ruler Restore Redisplay Exit Review Report Best Fit End Exam 37 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To activate, select Panoramic tab (appears on the Touch Screen when a linear or curved array transducer is active, and the system is unfrozen). • Press the Update key to start the acquisition • Move the transducer in the long axis of the desired anatomy to display • Press Freeze or one of the Set keys to end acquisition • Unfreeze to reactivate acquisition if desired • Use Panoramic Review controls after completing the acquisition to resize, restore, rotate, pan, zoom or measure the Panoramic image • Use the Panoramic Cine function to recall single frames for review • To scale the image to fit the image area, select Best Fit • Select Exit on the Touch Screen to exit Panoramic Review This is an example of the saphenous vein using the 14L5 transducer. Notes No. 37 SIEMENS Healthineers Panoramic imaging – Power Doppler SIEMENS .... Healthineers ... DAX 15L4 Workflow 10L4 Patient 2D Color Panoramic MI:1.08 95% Imaging 2D Flex Ruler Restore Redisplay Exit H High Review 1dB/DR60 #1540 LD 1 Report All Power Color Capture Best Fit Compound UA 3 End Exam MapD/T5 Flow Acquisition P2 Fraction C Mid OdR General P4/LD1 PRF 1131 S4/Pr4 MapA/F3 2D Color 38 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Panoramic imaging is also available in Power Doppler. All color data is preserved during image acquisition and the peak of the signal is saved for the color panoramic image. To activate, select Power Doppler from the Color tab on the Touch Screen. • Select Workflow > Panoramic tab (appears on the Touch Screen when a linear or curved array transducer is active and the system is unfrozen) • Place the transducer on the required location and do not move the transducer, the select Color Capture • After the color data is captured, you can begin moving the transducer • To display or remove color data in the image, select Flow • To adjust the selection of the color region of interest • To maximize the selection area and display 100% of the region of interest, select Acquisition Fraction • To minimize the selection area and display 30% of the region of interest, select Acquisition Fraction again • Unfreeze to reactivate acquisition if desired • Select Exit to exit Panoramic imaging Notes No. 38 SIEMENS Healthineers Zoom and HD Z SIEMENS .... Healthineers ... 10L4 4V1 Carotid Abdomen TIB:0.62 TIB:0.51 (zoom TIC:1.34 TIC:1.61 TIS:0.62 TIS:0.51 MI:1.15 GB MI:1.14 84fps 95% 2D 2D H High H High BdB/DR60 -3dB/DR66 c=1540 C Pen -3dB General PRF 2315 Mid GS 1.5 RF 3788 F BO 8.7cm HDZ Zoom HD Z 39 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Zoom control activates either Zoom or HD (high-definition) Zoom. • Zoom magnifies the image on a live or frozen image. A “Z” is displayed on the image screen (as displayed here in the image of a Carotid on the left). • Rotate Zoom to increase/decrease magnification of the image. Roll the trackball to pan the image. • Zoom is available in B-mode, Color and in Split mode, the B-mode/Color Doppler image can also be Zoomed. • Zoom is not available in Anatomic M-mode. • HD Zoom (HD Z) acquires a high-definition image indicated within the zoom ROI (region of interest) box at a higher frame rate and updates the depth value on the image screen to indicate the distance from the skin line to the top of the zoom box. • Available on a live image only and at an image depth greater than 2cm. • When selected, “HD Z” displays on the image screen, shown here in the image of the liver and gallbladder. Notice how well the GB wall and liver fatty sparing is seen. • To activate: • Press Zoom once to display the zoom box (region of interest) • Adjust the size or position of the zoom box and press a trackball key, if necessary. • Position indicates the trackball is assigned to repositioning the zoom box. A solid line outlines the zoom box. • Size indicates the trackball is assigned to resizing the field of view. A dotted line outlines the zoom box. • Roll the trackball to adjust the size or position • Press Zoom a second time to activate. • Press Zoom a third time to deactivate. • HD Z is not available in Doppler, M-mode, Anatomic M-mode, and Virtual Touch Imaging Notes No. 39 SIEMENS Healthineers Image Size SIEMENS ... Healthineers ... Image Size Image Size Image Size 1 5 40 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Image Size changes the size of the image. Settings range from 1-5 and the default Image Size is 4. Increase or decrease Image Size for personal display preference. Pixels may appear tighter when using a smaller Image Size (as displayed in the image on the left of the Carotid bifurcation). The field of view (FOV) width is not affected when the image size is changed. This is an example of the carotid bifurcation using the inverted Rainbow tint. Notes No. 40 SIEMENS Healthineers Sector Size SIEMENS ... Healthineers' ... 4V1 4V1 Abdomen Abdomen TIB:0.30 TIB:0.30 TIC:1.16 TIC:1.13 TIS:0.30 TIS:0.30 MI:0.87 MI:0.83 44fps 67fps 95% 95% 2D 2D H Mid H Mid 0dB/DR65 0dB/DR65 11cm 11cm 41 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Additional B-mode display modes include: • Full FOV maximizes the field of view when the sector size has been decreased. • FOV Size increases/decreases the sector angle for transducers displaying a curved array or sector format. • To increase or decrease the field of view use the set keys in B-mode imaging. Notes No. 41 SIEMENS Healthineers B-mode post-processing features SIEMENS .... Healthineers ... 902 General TIB:1.02 TIC:3.42 TIS:1.02 • DR • Gain MI:1.29 45fps 95% 2D H Mid • Map • M-mode Gain 0dB/DR65 c=1540 LD 1 UA 2 apD/T3 • Tint UltraArt P2 • • Image Size • L/R Flip • DGC • U/D Flip Transverse Pancreas 42 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When the image is frozen, the available post-processing features will be displayed on the Touch Screen or soft keys and will be backlit in white. The following optimization controls may be adjusted after the image is frozen: • DR • Gain • M-mode gain • L/R Flip • U/D Flip • Image Size • UltraArt • Map • Tint • DGC Notes No. 42 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes • Review Doppler controls • Describe Doppler optimization features 43 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Image: HOOD05162003330011 Notes No. 43 SIEMENS Healthineers Doppler controls SIEMENS . Healthineers ... Control Panel Touch Screen O O 18L6 A 15L4 Workflow Patient Color Imaging LUR Flip UID Flip Biopsy Review Report Panoramic End Exam 20 . Color 2D Only Color Only Slow Kidney Aorta Live Dual Dir Power Low General Color Power Filte Scale Line Density Soft keys O O O 44 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler image may be optimized by the: • Control Panel • Soft keys • Touch Screen Notes No. 44 SIEMENS Healthineers Doppler controls on the Control Panel SIEMENS. Healthineers ... O) CW Dual 45 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The primary Doppler controls on the Control Panel are: • Press C to enter/exit color Doppler. Rotate C to change overall color Doppler gain. • Press PW/CW to enter pulsed-wave. In pulsed wave, the cursor will appear on the image screen. • Press PW again, or Update, to begin the PW (pulsed wave) Doppler • Rotate PW to adjust overall spectral Doppler gain • Press PW or 2D to exit • Press Update (located above the trackball) to cycle between the image and Doppler spectrum • Press PW/CW (continuous wave) to activate SCW (steerable continuous wave Doppler) for phased array transducers or for the auxiliary CW pencil transducers. Note: Dual, Zoom and HD Zoom are available in color Doppler. Zoom is available for the B-mode reference image in spectral Doppler. Functions in Doppler are displayed at the bottom of the monitor identified by a diagram of the home base area. To perform the below functions, roll the trackball and press the right or left Set key (located adjacent to the trackball) Functions: • Position the color Doppler ROI • Size the color Doppler ROI • Position the spectral Doppler cursor • Cine the Doppler image or spectral Doppler waveform in freeze • Position the Pointer Notes No. 45 SIEMENS Healthineers Doppler modes SIEMENS .... Healthineers' ... 3.5cm 46 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The systems support Color, Power, Spectral (PW), and both imaging and non-imaging CW Doppler. The left image is an example of the 9C3 transducer with color in the IVC and hepatic veins on a small adult. The color displays excellent spatial resolution and hemodynamics. Note how the 2D image maintains image uniformity when in color. The middle image demonstrates the Full Screen spectral display. The right image shows the Power Doppler capability using a blue map. The image of the carotid is displayed in the dual format. Note how the color stays within the vessel. Notes No. 46 SIEMENS Healthineers Color controls on the Touch Screen SIEMENS . Healthineers ... Abdomen 9 902 15L4 Workflow ? @ Abdomen @ 9C2 15L4 Workflow Patient Color Patient 2D maging Imaging Review L/R Flip UID Flip Biopsy Review Report Report End Exam End Exam 20 + Colo 2D Only Color Only invert Kidney Aorta Live Dual LOW General High × 4 Color Power Filte Frequency Auto Baseline Scale Line Density Smooth Persist Maps Priority Page One Page Two 47 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the Touch Screen controls for Color Doppler. There are two pages. To access the second page, select the page arrow key or swipe across the Touch Screen. We will discuss the optimization later in the presentation. Notes No. 47 SIEMENS Healthineers Color Doppler controls on the soft keys SIEMENS ... Healthineers ... 501 903 Abdomen Abdomen TIB:1.15 TIB:0.67 TIC.3.14 TIC:1.04 TIS:1.15 TIS:0.67 MI1.12 MI:0.89 13fps 21fps 98% 95% 20 2D H High H High 18B/DR65 0dB/DR65 LD 2 LD 2 UA 2 UA 3 MapD/T4 MapD/T4 P3 P3 C High -2dB/ Aorta 2dB/Kidney P2/LD2 P3/LD3 PRF 5000 PRF 625 MapF/F4 S2/Pr4 MapFIF3 20 + Color 20 + Color 10.1cm HD 2 Filter Frequency Baseline Line Density Smooth Persist Maps Priority Auto Scale 48 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler soft key rotary controls are located on the Control Panel and lie beneath and correspond to the controls listed on the bottom row of the Touch Screen. The active control is backlit with white text. To activate, push the corresponding soft key or touch the desired control. Once activated, rotate the control to adjust. If the system is frozen, only those controls available in freeze will be available and they will be backlit with white text. Controls that are not available will appear dithered out. Soft key controls do not change when navigating pages. Notes No. 48 SIEMENS Healthineers PW controls on the Touch Screen SIEMENS . Healthineers ... Abdomen 1816 1514 9C2 Workflow Abdomen 1846 A 1514 Workflow Patient 20 Color Patient Color Imaging Imaging 10 Review Review Report uto Trace Report End Exam End Exam on Freece Invert Auto TEQ LiverLive Frequency Filter Gate Size Baseline Edge Maps Tint 2 mm 60 mmis Page One Page Two 49 Unrestricted © Siemens Healthineers 2023 Speaker Notes: These are the Touch Screen controls for Spectral (PW) Doppler. There are two pages. To access the second page, select the page arrow key or swipe across the Touch Screen. We will discuss the optimization later in the presentation. Notes No. 49 SIEMENS Healthineers PW Doppler controls on the soft keys SIEMENS . Healthineers ... 902 CHA The 3.12 5C1 1 PS=69.09 cm/s Abdomen 16 2 Vel=23.4 cm/s TIB 3.28 TIC 4.17 TIS 2.14 MEO.48 9tps 20 H High Mid -3.5dB odB/General General PRE 1250 PRF 1420 D D PW PW Mid Low GS 2.0 GS 2.0 PRF 2392 PRF 3289 F 120 F 200 20 ................................................................................................ .......................................... 24.2 sec Gate Size Sweep Speed Scale Angle Correct DR Edge Maps Tint 2 mm 60 mm/s Baseline 60 dB 50 Unrestricted © Siemens Healthineers 2022 Speaker Notes: The Doppler soft key rotary controls are located on the Control Panel and lie beneath and correspond to the controls listed on the bottom row of the Touch Screen. The active control is backlit in white. To activate, push the corresponding soft key or touch the desired control. Once activated, rotate the control to adjust. If the system is frozen, only those controls available in freeze will be available and they will be backlit in white. Controls that are not available will appear dithered out. Soft key controls do not change when navigating pages. The left image shows the common hepatic artery spectral Doppler. The image on the right demonstrates color in the hepatic veins. Note the spatial resolution of the color Doppler. To display additional parameters on the imaging screen, select the System Configuration icon on the Touch Screen (System Configuration > Image Settings > Image Display Parameters) and check the desired display settings. Notes No. 50 SIEMENS Healthineers Velocity variance map SIEMENS. Healthineers ... Velocity variance map provides a variance in color flow 10L4 H Carotid TIB:0.72 display for differentiating complex flow patterns TIC:1.38 TIS:0.72 MI:1.14 25fps 95% 2D • Available in Color Doppler velocity mode H Mid 0dB/DR60 C=1540 LD 1 MapC/T5 • Map H – General & Vascular 1.5dB • Map J – Cardiology General P2/LD2 PRF 2941 MapH/F3 S3/Pr4 2D + Color • Available on all transducers and presets 3.5cm 51 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Velocity variance map provides a variance in color flow display for differentiating complex flow patterns. It has been demonstrated that turbulent flow in stenotic areas can be better visualized with velocity variance colorization. These areas could include a cardiac valve stenosis or a stenosis in an arterial vessel. This map provides additional shades of green in the color bar for displaying and differentiating complex flow patterns. It is available on all transducers and presets while using color Doppler velocity mode. Color Map H is the variance map for General imaging and vascular and Map J is the variance map for Cardiology. This new map was previously seen on the legacy ACUSON Sequoia ultrasound system. Notes No. 51 SIEMENS Healthineers Objectives SIEMENS. Healthineers ... • Review B-mode and M-mode controls • Describe B-mode and M-mode optimization features • Explain display modes • Review Doppler controls • Describe Doppler optimization features 52 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Image: HOOD05162003330011 Notes No. 52 SIEMENS Healthineers Auto flash artifact suppression SIEMENS . Healthineers ... Auto flash artifact suppression applies flash 5C1- Abdomen suppression relative to user motion TIB:1.38 TIC:4.04 TIS:1.38 MI:1.13 11fps 95% 2D H High -2dB/DR70 Mid -5dB/ General PRF 1250 18cm 53 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto flash suppression is a patented technology in color Doppler. In color Doppler, auto flash artifact suppression: • Reduces motion artifacts • Enhances color sensitivity • Allows high quality scanning at a fast pace In the video, notice how the color Doppler displays excellent color sensitivity without motion artifacts. 53 SIEMENS Healthineers Color Doppler SIEMENS .... Healthineers' ... 5C1 1816 15L4 9C2 Workflow 5C1 Abdomen Abdomen TIB:0.56 TIC:1.88 Patient 2D Color TIS:0.56 MI:1.34 10fps Imaging LIR Flip UID Flip 2D Review H Mid -3dB/DR60 LD 2 Report Panoramic UA 3 MapF/T5 P3 End Exam C 2D + Color 2D Only Color Only Invert Res -3dB/Kidney P4/LD3 PRF 772 Kidney Aorta Live Dual MapA/F3 S1/Pr4 X 2D + Color Low General High Color Power Filter Frequency Auto Baseline Scale Line Density 54 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Color Doppler velocity applies colors to vascular structures based on velocity and direction of flow (as displayed here in the aortic/iliac bifurcation). Color Doppler controls include: • Color Display: activates/deactivates the color display (ROI remains on the image) without unfreezing the image. Choices are 2D + Color, 2D Only and Color Only • Flow States: optimize multiple parameters for specific flow states. Choices are Low, General, High and in some presets, Aorta, Renal, and Ovary • Invert: reverses the colors depicting flow towards or away from the transducer in the color ROI and the color bar located on the left side of the image • Color or Power: activates color Doppler velocity or Power Doppler • Live Dual: displays the same image side-by-side with and without color when in Color mode Notes No. 54 SIEMENS Healthineers Display modes SIEMENS. Healthineers ... 9C2 Abdomen 2D + Color 2D Only Color Only TIB:1.37 TIC:2.81 TIS:1.37 MI:0.96 10fps 95% 2D H Low 3dB/DR65 c=1540 Slow Kidney Aorta PRESS Low General High 55 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are multiple display modes for color Doppler that can be changed while live and when frozen. Display modes: • 2D + Color – Displays both the grayscale image and the color Doppler information • 2D Only – Removes the color Doppler information and the ROI • Color Only – Removes the grayscale image within the ROI Make the selection from the Touch Screen when the image is live or frozen. Notes No. 55 SIEMENS Healthineers Flow states SIEMENS . Healthineers ... 5C1 Abdomen 2D + Color 2D Only Color Only TIB:0.79 TIC:3.32 TIS:0.79 MI:1.24 12fps 95% 2D H H Mid 4dB/DR54 LD 2 Slow Kidney Aorta UI 3 MapC/T4 E3/P3 CDV Mid -5dB/ High P3/LD1 PRF 1984 MapF/F3 Low General High 83/ Pr4 C Display 2D+C 14cm 56 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Flow states optimize multiple parameters for specific flow states. They are displayed on the Color Touch Screen. Select the choice based on clinical need. In this example of the right kidney, the setting was changed to High to demonstrate the main renal vessels verses the parenchymal vessels. • Low provides maximum sensitivity to low velocity flows by incorporating the lowest possible filter settings and lower pulse repetition frequency. You may experience increased flash (motion artifacts) • General produces an optimal balance between flash suppression and maximum sensitivity by using an adaptive wall filter • High optimizes the system for the high arterial flow common to pulsatile vessels and stenotic conditions • Additional flow state settings are available based on anatomy and transducer, such as Kidney, Aorta or Slow Flow Notes No. 56 SIEMENS Healthineers Flow state examples SIEMENS . Healthineers ... 14L5 Carotid TIB:0.43 TIS 151 TIC:0.91 TIS:0.43 MI:1.11 24fps 95% PUB/DRES 2D H High 0dB/DR65 PRESHOW -1dB/General 11cm 57 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Clinical uses include: • Low (e.g., renal perfusion, pancreas, testicular, thyroid, breast, calf veins, fetal head, placenta) • Medium (e.g., liver, splenic vein, portal vein, hepatic veins, peripheral vascular in extremities, OB cord) • High (e.g., fetal heart, aorta, cardiac) • Kidney (specifically designed for the kidney- similar to the Low setting) • Aorta (specifically designed for the high flow state of the aorta - similar to the High setting) Notes No. 57 SIEMENS Healthineers Dynamic MultiHertz Technology SIEMENS .... Healthineers ... 5C1 Abdomen TIB:0.56 TIC:1.88 Auto Manual TIS:0.56 MI:1.34 10fps 98% 2D H Mid -3dB/DR60 LD 2 Frequency Line Density UA 3 MapF/T5 P3 Auto = C Res -3dB/Kidney P4/LD3 PRF 772 MapA/F3 2D + Color 58 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Dynamic MultiHertz is a workflow enhancement technology that automatically adjusts the color Doppler frequency when the region of interest depth increases or decreases. Select the workflow control under the frequency soft key and then select Auto to activate or select Manual to deactivate. Dynamic MultiHertz is available on the 5C1 transducer in the Abdomen & Abd-Difficult presets and on the 10L4 Venous & Arterial presets. Notes No. 58 SIEMENS Healthineers SIEMENS .... Auto Doppler Healthineers ... • Available on Touch Screen when Color or PW Doppler activated A 0 0 0 4 1014 Carotid 14L5 5V1 Workflow Patient 2D Color Automated placement of Color ROI 24 Imaging • UR Flip UID Flip Biopsy Review Off Report • Automated placement of the sample gate and 60 ° angle correct for Pulsed-wave End Exam 20+ Color 2D Only Color Only Invert Doppler Live Dual Auto Doppler • Available on 10L4 Transducer in the carotid Low General High Color Power and arterial preset 24. cmis requency Baseline ine Density Steer Pen icale 20 0 20 • Icon located above color bar 59 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The use of color and pulsed-wave Doppler is common in most every ultrasound department. Unlike existing methods, the Auto Doppler feature is a workflow automation tool that may reduce the cognitive load and repetitive keystrokes for the user. Auto Doppler utilizes an algorithm that automatically places and steers the color box and Doppler sample-gate within a vessel. In addition, it keeps the angle correct parameter at 60°, all without user interaction. There may be instances where manual adjustment is necessary, such as patients with severe disease or if a vessel dives deeply and is parallel to the beam. • This technology is available on the Touch Screen for the 10L4 transducer when color or Color/PW are active and when using the carotid or arterial presets • There is an icon located above the color bar when the technology is activated • If the technology is active, the icon is blue. If the technology is paused, the icon is gray • Manually moving the trackball, adjusting color steer, or changing the Doppler angle will cause the technology to pause. Select Auto Doppler to reactivate Notes No. 59 SIEMENS Healthineers Power Doppler SIEMENS . Healthineers ... 5C1 1816 5C1 Abdome 15L4 Workflow Abdomen TIB:0.37 TIC:1,86 TIS:0.37 Patient 2D Color MI:1,39 16fps 98% Imaging 2D L/R Flip UID Flip Biopsy H High 4dB/DR60 Review c- 1540 Report Panoramic -11.5d8 PRE COM End Exam 2D + Col 2D Only Color Only Slow Kidney Aorta Live Dual Dir Power Low General High Color ower Filter Frequency Auto Scale Line Density 60 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Power Doppler applies colors to vascular structures based on flow amplitude versus velocity information. Power demonstrates less angle dependence than Color Doppler and is useful for low volume, low velocity flow states, and to demonstrate presence or absence of flow. Directional Power Doppler applies color based on amplitude and direction of flow, towards or away from the transducer. Notes No. 60 SIEMENS Healthineers Slow Flow SIEMENS Healthineers ... 5C1 5C1 18L 1514 Abdomen 902 Workflow Abdomen TIB:0.58 TIC:2.07 TIS:0.58 Patient 2D Color MI:1.39 16fps 98% Imaging LIR Flip UID Flip Biopsy Review Report Panoramic End Exam 2D + Colo 2D Only Color Only Invert Slow Kidney Aorta Live Dual Dir Power Low General High Color Power X Filter Frequency Auto Scale Line Density 9cm 61 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Conventional Doppler filters work well in Doppler imaging when the image clutter and blood flow signals are well separated. For most vessels of normal caliber and associated blood flow, this is often the case, allowing the user to easily generate high-quality Doppler images. As blood flow becomes weaker or slower within a region of interest, obtaining a clear and diagnostic Doppler image becomes more difficult. Visualization becomes hindered in this type of environment due to the Doppler signal blends into the clutter of the image signal. Slower blood flow in smaller vessels lacks the separation that makes a Doppler signal clean and clear. Slow Flow is a feature that extends the capability of the system to detect and separate these weaker Doppler signals. When engaged, Slow Flow technology extends the capabilities of conventional doppler techniques in the Color Doppler Energy (CDE) mode, also referred to as Power Doppler enabling better detection and improved imaging of slower flowing, smaller blood vessels. The Slow Flow feature accomplishes this improved imaging state by supplementing conventional Doppler techniques and thereby allowing for the detection of a broader range of flow signals. Slow Flow employs sophisticated wall filters, called smart filters, which extract flow out of the clutter by motion filtering, adaptive signal enhancement and flash suppression. These smart filters detect and label slower flow signals that would otherwise be mixed in with the clutter and excluded by conventional Doppler velocity cutoffs. Adaptive filters then take these weak signals and amplify them while simultaneously suppressing any flash or motion artifacts that are not true signal components. These combined processes not only produce a clear true Doppler signal, but also provide better vessel branch visualization in these difficult to image tissues. The overall result is that Slow Flow can generate high quality vascular images with better branch visualization in tissues that feature slower flow or smaller caliber vessels. Notes No. 61 SIEMENS Healthineers Color Doppler – Soft keys SIEMENS . Healthineers ... Abdomen TIB.0.93 Filter Frequency Baseline Scale Line Density TIC.2.26 TIS:0.93 Auto ME-1.34 12fps 98% 2D H Mc 2dB/DR60 Page One PRE 792 Smooth Persist Maps Priority Page Two HO Z 62 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Color Doppler applies colors to vascular structures based on velocity and direction of flow as displayed here in the sagittal view of the right kidney. Color Doppler controls include: • Filter adjusts the color wall filter • Setting are 1-4 (low to high) • Frequency adjusts the range of frequencies for the Color Doppler and are independent of the 2D frequency. Decrease to increase Color Penetration and increase for greater sensitivity • Choices are Pen, Med, High and Res • Line Density adjusts the balance between the image line density or resolution and the frame rate or speed • Settings are 1 (low resolution/high frame rate) to 3 (high resolution/low frame rate) • Scale adjusts the pulse repetition frequency (PRF) - the color Doppler velocity range or the power Doppler frequency range • Smooth adjusts the level of spatial averaging, both axial and lateral resolution, used to smooth the flow pattern display • Settings are 1-4 (low to high) • Baseline adjusts the position of the range of flow velocities displayed above and below the baseline • Persist (persistence) adjusts the time that the color flow data frame remains in the ROI before being replaced by another color frame • Settings are 1-4 (low to high) • Maps selects a processing curve that assigns the velocity/variance range for Color or flow amplitudes or Power Doppler to a range of colors • Choices are A-G • Priority adjusts the threshold for overlaying color pixel information on the B-mode image • Setting are 1-4 Many settings are available as post-processing options. See a complete list later in the presentation. Notes No. 62 SIEMENS Healthineers Power Doppler – Soft keys SIEMENS . Healthineers ... Abdomen Filter Frequency Scale Line Density TIB:0.40 TIC:0.79 TIS.0.40 3 Auto 2 MI:0.57 16fps 95% H Low Page One -5dB/DR60 LD 2 UA 3 MapE/T4 P3 -6dB/ Aorta P2/LD3 PRF 992 Gate Size Angle Correct MapE/F3 S3/Pr4 2D + Color 2 mm 60 0 60 Page Two 63 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Power Doppler controls include: • Filter adjusts the color wall filter • Setting are 1-4 (low to high) • Frequency adjusts the range of frequencies for the color Doppler and are independent of the 2D frequencies. Decrease to increase Color Penetration and increase for greater sensitivity • Choices are Low, Mid and High • Line Density adjusts the balance between the image line density or resolution and the frame rate or speed • Settings are 1 (low resolution/high frame rate) to 3 (high resolution/low frame rate) • Scale adjusts the pulsed repetition frequency (PRF) - the color velocity range or the power frequency range • Smooth adjusts the level of spatial averaging, both axial and lateral resolution, used to smooth the flow pattern display • Settings are 1-4 (low to high) • Persist (persistence) adjusts the time that the color flow data remains in the ROI before being replaced by another color • Settings are 1-4 (low to high) • Maps selects a processing curve that assigns the velocity/variance range for (for Color) or flow amplitudes (Power) to a range of colors • Priority adjusts the threshold for overlaying color pixel information on the B-mode image • Settings are 1-4 (low to high) Many settings are available as post-processing. See complete list later in the presentation. Notes No. 63 SIEMENS Healthineers Color post-processing SIEMENS Healthineers ... DAX • 2D Gain Abdomen TIB:1.04 TIC:3.27 TIS:1.04 • Baseline MI:1.22 95% 2D • Map H Mid :0dB/DR65 C Mid Priority -7dB/ General • PRF 794 • Invert 14cm 64 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following optimizations controls can be changed on a frozen image: • 2D Gain • Baseline • Map • Priority • Invert Notes No. 64 SIEMENS Healthineers Pulsed wave (PW) Doppler SIEMENS . Healthineers ... Abdomen 1816 15L4 9C2 Workflow Abdomen TI8 3.02 TIC:3.36 Patient 2D Color TIS:1.76 MIO.45 9fps Imaging 10 Review 148/DROO Report Auto Trace End Exam Auto TEQ Invert 14cm Auto TEQ requency Filter Gate Size Sweep Speed Scale Angle Correct 2 mm Baseline 60 mm/s PRF HPRF 60 0 60 65 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Pulsed wave (PW) Doppler measures flow velocity within a gated sample volume as demonstrated in this image of the hepatic vein. To activate PW Doppler: • Press the PW/CW key on the Control Panel • This enters directly into PW Doppler if Enable Cursor Mode is not checked in System Configuration (System Configuration>Imaging Setting>Imaging Mode) • If not, press the Update key on the Control Panel to enter split mode • Press the Update key to toggle back and forth between the 2D/Color image and the trace • Upon freeze, select the Color tab on the Touch Screen and roll the trackball to cine the 2D/Color image if needed PW Doppler controls include: • Physio Settings adjusts the ECG controls when in cardiac imaging • Invert, inverts the Doppler spectrum values display above/below the baseline • Audio setting adjust the spectral Doppler audio volume • Live/Live - triplex mode • Display modes - 1/2 B-mode - 1/2 trace ; 1/3 B-mode - 2/3 trace ; Side by Side ; 2/3 B- mode - 1/3 trace ; Full Screen • Auto Trace - provides real-time automatic measurements of the Doppler trace. Choices are above the baseline, below the baseline, or both above and below the baseline • HPRF - High Pulse Repetition Frequency is a setting to overcome the limitations of PW Notes No. 65 SIEMENS Healthineers Doppler when the velocity is too high to fully display and aliasing occurs. HPRF is defaulted off Notes No. 65 SIEMENS Healthineers Pulsed wave (PW) Doppler – soft keys SIEMENS . Healthineers ... 14L5 PS=82.4 cm/s Carotid ED-5.9 cm/s T18:1.33 RI=0.93 TIC:0.84 TIS 0.48 ME:0.38 16fps 95% 20 H High 5dB/DRES CE/ General Gate Size Sweep Speed Scale Angle Correct PRF 3968 Baseline D 2 mm 60 mm/s PRF HPRF 60 0 60 PW Low GS 1.5 PRF 7813 F 273 Page One 66 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To access the PW optimization controls, select on the Touch Screen or press the soft key on the Control Panel. PW Doppler controls include: • Gate adjusts the sample volume size. It is transducer and exam dependent • Setting choices are 1-20 mm • Sweep Speed adjusts the scrolling speed of the Doppler spectrum. Decrease to display more heart cycles and increase to display fewer cycles • Settings range from 8-200 mm/sec (8,12,16, 25, 33, 50, 60, 67, 100, 150, 200) • Baseline adjusts the position of the range of velocities displayed on either side of the baseline • Scale adjusts the pulse repetition frequency (PRF) - the spectral Doppler frequency range. The PRF is dependent on the transmit frequency and depth of the Doppler gate • Angle Correct depicts the degree of angle correction for the Doppler spectrum. The default angle for the carotid exam, as displayed here, is 60° • Press Angle to quickly adjust the flow angle from 60/0/- 60 degrees or rotate to adjust the flow angle by one-degree increments. When the angle is 61 degrees or greater, the system highlights the value of the angle in white • Steer, steers the color Doppler ROI and the spectral Doppler cursor to the right or left. Steering angles for linear transducers are: • 18H6 = -20 to 20 in one-degree increments • 14L5 = -20 to 20 in one-degree increments • 10L4 = -30 to 30 in two-degree increments Notes No. 66 SIEMENS Healthineers Pulsed wave (PW) Doppler – soft keys SIEMENS . Healthineers ... 18L6 General TIB:1.10 TIC:0.67 TIS:0.47 MI:0.38 31fps 95% 2D H High 24B/DR60 DR Edge Maps Tint MODO/TA 60 dB 2 D 5 18B/High P3/LD3 PRF 7813 MapF/F2 2.8cm HOZ 18mm 60 S2/Pr4 Page Two D PW -BdB/DR70 PIW MapD/T9 GS 1.0 PRF 7813 F 352 67 Unrestricted © Siemens Healthineers 2023 Speaker Notes: To access the PW optimization controls, select on the Touch Screen or press the rotary key on the Control Panel. PW Doppler controls on page two include: • Dynamic Range adjusts the overall contrast resolution of the spectral display in 5 dB increments Lower levels are more black/white, and higher levels show a greater range of gray shades • Settings range from 10 dB to 80 dB • Edge adjust the sharpness of the waveform • Maps selects a processing curve that assigns echo amplitudes to gray shades in the Doppler spectrum • Settings range from A – H • Tints colorizes the Doppler Spectrum • Settings are 1-10 Notes No. 67 SIEMENS Healthineers Tint SIEMENS . Healthineers ... 18L6 4V1 General Abdomen TIB:1,10 TIB:2.82 TIC:0.67 TIC:0.98 TIS:0.47 TIS:0.45 MI:0.38 MI:0.65 31fps 23fps 95% 95% 2D 2D H High H High -2dB/DR60 1dB/DR60 LD 2 UA 3 C MapD/T4 Res P2 -1dB/Low PRF 784 C Mid -11dB/High P3/LD3 PRF 7813 MapF/F2 2.8cm HD Z 18mm 60% S2/Pr4 37mm -150 2D + Color D PW -100 Mid -8dB/DR70 MapD/T10 GS 1.0 PRF 7813 F 352 68 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select Tint to colorize the Doppler spectrum. Selections include 1 – 10. Adding a Tint increases contrast resolution and may assist in measurements and spectral evaluation. Notes No. 68 SIEMENS Healthineers UltraArt SIEMENS . Healthineers ... Off Low Mid High Mid Livellive DAX Abdomen TIB:4.35 -1.20 TIC.2.46 1.20 TIS:1.22 ME.0.68 -1.00 10fps -1.00 95% 2D -0.80 H Low OdB/DR60 -0.60 P3 -0.40 C Pen 14B/Aorta 14B/ Aorta -0.20 P2/LD1 -0.20 P2/LD1 PRF 1488 PRF 1488 MapF/F4 MapF/F4 S2/Pr4 S2/Pr4 2D + Color 2D + Color 0.20 PW Low 6dB/DR70 High GB/DR70 -0.40 MapD/T6 GS 2.0 PRF 3788 69 Unrestricted © Siemens Healthineers 2023 Speaker Notes: UltraArt also works in PW Doppler and helps to quickly adjust the spectral look by adjusting both the edge and contrast enhancement of the spectrum. • UltraArt selections are displayed as Off, Low, Medium and High on the Touch Screen • Off is the fundamental image trace • The spectral edge and contrast enhancement is increased as settings are changed from off to High Notes No. 69 SIEMENS Healthineers Edge in PW Doppler SIEMENS . Healthineers ... 3 Edge -40 -30 .20 -cm/s 70 Unrestricted © Siemens Healthineers 2023 Speaker Notes: UltraArt includes edge enhancement, but the ACUSON Sequoia system provides additional edge control for Spectral Doppler. • To increase the sharpness of the spectral trace, increase the edge. For a softer spectral trace, decrease the edge • Options are 1-4 Notes No. 70 SIEMENS Healthineers Auto Trace Optimization & Sensitivity SIEMENS. Healthineers 5V1 PS=87.93 cm/s TCI SC1 ED=38.08 cm/s TIC:1.16 Workflow TAMx=55.5 cm/s MI:0.57 TAMn=28.8 cm/s 10fps Patient 2D Color RI=0.57 PI=0.95 Mean TCD=54.70 cm/s Mid Imaging 0dB/DR60 10 c=1540 Review LD 2 UA 2 MapC/T5 Report Auto Trace Auto Trace P3 bove Baseline C and Exam Pen Auto TEQ 16cm 54mm On Freez Invert Sensitivity - 1.50 General 8PO P2/LD1 PRF 3289 S2/Pr4 Auto TEQ Live/Live - 1.00 MapF/F2 2D + Color frequency Filter -0,50 PW Pen 0dB/DR60 MapD/T2 Gate Size 2 mm wweep Speed Baseline Angle Correct m/s Scale GS 4.0 PRF 4545 -- 0.50 F 100 71 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto Trace is available on the Touch Screen and will automatically trace the PW waveform. There is a Sensitivity control on the PW Touch Screen for further optimization of the trace. Sensitivity levels range from 0-20. If the user needs more sensitivity, the number will need to be increased. Notes No. 71 SIEMENS Healthineers Auto Trace SIEMENS. Healthineers ... 10L4 Carotid TIB:1.92 TIC:1.19 TIS:0.93 Above Baseline Below Baseline Above and Below MI:0.31 19fps 95% 2D H High 8dB/DR60 Auto Trace Auto Trace c=1540 Above Baseline C Pen -1.5dB General 16mm PRF 2315 D 100 Mid Auto Trace PRF 5682 Auto Trace Above Baseline Lt Mid CCA PS=65.28 cm/s . 1 .. ED=19.49 cm/s 72 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Auto Trace function automatically traces the spectral Doppler waveform and records several measurements in PW Doppler (as displayed here in the vertebral artery). The sensitivity and accuracy of Auto Trace flow statistics can be improved with gain control after the display is frozen. When gain optimization is enabled in the system configuration page, the gain is optimized at the start of Doppler scanning. Clinical scanning has shown this significantly improves user adjustments by instantaneously putting weak signals in a good range. To activate Auto Trace, select Auto Trace on the Touch Screen. Selecting Auto Trace (Above Baseline) control expands to allow you to choose, above and below the baseline or both). Auto Trace enables the display of Doppler statistics including beats per minute (bpm), pulsatility index (PI), resistive index (RI), systolic/diastolic ratio (S/D), peak systole (PS), end diastole (ED) time average max (TAMx),and time average mean (TAMn). Select settings for data above, below or on both sides of the baseline. Auto Trace is available on live and frozen images. Measurements populate to the report once entered into the measurement package. Notes No. 72 SIEMENS Healthineers Auto Trace configuration SIEMENS Healthineers ... 14L5 Syurm Configuration 1 Rt Dist CCA Carotid . Sytters Sesings PS=41.2 cm/s TIB:1.06 ED=10.4 cm/s TIC:0.54 · beaumoment & Boport RI=0.75 MI:0.39 95% 2D Ottors Celcuirfore H High 70 1am 5dB/DR65 O& Tables Volume Tool . Arcalikes 3 Didarces Mid OdB/ General > Connectivity & Network PRF 3968 > Porquecal Dodkces . Syuters Management Doppler Toch D Default Tool PW Low GS 1.5 Volume Flow Toul PRF 3125 Volume 18mm F 109 HowI Cycle TAMX Show cm/s 0.0 Canis Time [ Show ms O Tr Semi Major Axis [] Show cm 1 ............................................................................. ~20 0.00 Vel cm/s 0.0 Velocity Ratio 0.00 Vmax Show cmis 0.0 Vmean [] Show cm/s 0.00 73 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select the System Configuration icon on the Touch Screen to configure the measurement display for Auto Trace under System Configuration > Measurements and Reports > Measurement > Exam Package. Notes No. 73 SIEMENS Healthineers Auto TEQ tissue equalization technology SIEMENS Healthineers ... Doppler optimization Automatic spectral Doppler optimization of: Live X800 02:22 PM 5/16/2018 Abdomen • Gain TIB:1.04 TIC.2.71 TIS:1.04 ML1.33 14fps 98% 2D H High • Scale/Baseline 1dB/DR65 LO 2 LA 2 MapD/T4 P3 C • Dynamic Range GB( Aorta PRE 5000 76mm S2/Pr4 2D + Color MapD/TS Auto TEQ On Freeze Off Auto TEQ 74 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Auto TEQ for Doppler is an instantaneous optimization of the Doppler spectrum when live or frozen. Auto TEQ for Doppler can be enabled manually at any time by selecting the Auto TEQ control on the Touch Screen, or when selecting freeze, which is the default for all exams except the venous preset. To activate Auto TEQ for Doppler, select Auto TEQ on the Touch Screen. When in a live spectral Doppler trace, gain, dynamic range and scale/baseline are the parameters that will be optimized. When freezing a PW image, scale and baseline will be the only parameters that will be optimized. These parameters can be customized in the System Configuration which will be discussed on the next side. Once the trace automatically optimizes after freezing the image, the user can change multiple post-processing parameters including Dynamic range, Scale and Baseline for fine tuning. Notes No. 74 SIEMENS Healthineers Auto TEQ tissue equalization technology SIEMENS Healthineers ... Doppler optimization System Configuration 10L4 Arterial System Settings TIB:2.20 + Workflow Enhancement TIC:1.37 TIS:0.77 Abdomen MI:0.48 20fps Capture Settings 95% Ingjry Moo- Imaging Corser Wantlow Freeze behavior 20 Inloge Farassetet Chplay H Mid Paterssten -3dB/DR60 . Measurement & Report Mode Menu Gan + Amnotions Doppler and M Modo Dmankc Rangs Features -78B/ General 1 Scalefinefre Transducers Puyifrase CINE PRF 2500 . Connectivity & Network Doppler Mode D PW Peripheral Devioin 60 Low System Managerrent GS 1.0 1/2 20, 112 Trace Peopler Ques ITO Target Special fairmity PRF 2353 F 82 273 20, 10 Track 75 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Select the System Configuration icon on the Touch Screen to select optimized parameter(s) under System Configuration > Image Settings > Imaging Mode > Doppler Auto TEQ. Parameters that can be automatically optimized include Gain, Dynamic Range, Scale/Baseline. You can also adjust the Target Spectral Intensity for the PW and CW. This is an example of the posterior tibial artery using the 10L4 transducer. Upon Freeze the system automatically adjusts multiple parameters. Notes No. 75 SIEMENS Healthineers Auto TEQ on Freeze SIEMENS . Healthineers ... Touch Screen Touch Screen PW Mode Button will only appear @ BV3 11M3 SC1 Workflow when Doppler TEQ on freeze is turned on Patient 2D Color Imaging 10 When feature is Review • activated: scale and Report Auto Trace baseline will End Exam Auto TEQ automatically optimize On Freeze Invert on freeze Off Auto TEQ • When the feature is Filter × 00 not activated: scale and baseline is set by Sweep Speed Scale Angle Correct user and remain 60 mm/s Baseline PRE 60" 60 0 60 unchanged after freeze 76 Unrestricted © Siemens Healthineers 2023 Speaker Notes: When the Doppler TEQ on Freeze is turned on, the Scale and Baseline will automatically optimize when frozen. When the feature is not activated, Scale and Baseline is set by the user and remain unchanged after freeze. Users can turn off this feature anytime during an exam and is available for all exams and transducers. The user can pause or turn off Doppler TEQ without re-entering System Configuration. Notes No. 76 SIEMENS Healthineers Doppler Auto TEQ on Freeze SIEMENS. Healthineers ... • There is the option to System Configuration pause Auto TEQ on System Settings Workflow Enhancement Imaging Settings Exiin Preset Freeze General Carotid • System Configuration Capture Settings Imaging Mode Imaging Carsor Workflow Treere Bletsirvior Doppler Auto TEQ > Imaging Settings > Image Parameter Display E3 Enable Cursor Mode Defailt Menu in Touch Screen Parameters Measurement & Report Imaging Mode > Gain Annotations Doppler and M Mude Mode Many Dynamic Range · Features doppler Auto TEQ on E3 Enable Automatic Color Invert Transducers PlayPause CINE Doppler Mode Doppler Auto TEO on Freeon Freeze Connectivity & Network thermal Mitex Display Peripheral Devices O off System Management Display Format On 1/2 20. 1/2 Trate M Mode Display Format 2/3 20, 103 Traces Medien 77 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The Doppler Auto TEQ on Freeze will need to be enabled to be displayed on the Touch Screen. To enable the Doppler Auto TEQ on Freeze feature, go to System Configuration > Imaging Settings > Imaging Mode > Doppler Auto TEQ on Freeze. Notes No. 77 SIEMENS Healthineers Live/Live (triplex) SIEMENS Healthineers ... Abdome 1816 1514 9C2 Workflow Patient 2D Color Imaging 10 Review Report Auto Trace End Exam Auto TEQ On Freeze Invert luto TEQ Live/Live X Frequency Gate Size Sweep Speed Scale Angle Correct 2 mm 60 mm/s Baseline 78 Unrestricted © Siemens Healthineers 2023 Speaker Notes: Live/Live enables or disables the simultaneous live display (i.e., duplex or triplex mode ) of the B-mode, color image and/or Doppler spectrum in real time. Select Live/Live on the Touch Screen to activate/deactivate. In triplex, the frame rate will be lower. A video of the carotid artery utilizing the software DVR in Live/Live (triplex) mode is displayed here. Notes No. 78 SIEMENS Healthineers Display modes SIEMENS Healthineers ... 10L4 Carotid TIB:1.05 TIC:0.51 TIS:0.26 MI:0.32 19fps 95% 2D H High dB/DR60 c=1540 Pen -1.5dB General 15mm 60º PRF 2315 D PW Mid GS 1.5 PRF 3788 F 80 cm/s 79 Unrestricted © Siemens Healthineers 2023 Speaker Notes: There are multiple display modes for Doppler that can be changed when the image is live or frozen. Display modes (1/2 B-mode - 1/2 trace ; 1/3 B-mode - 2/3 trace ; Side by Side ; 2/3 B-mode - 1/3 trace ; Full Screen). Select the choice on the Touch Screen when the image is live or frozen. The default display can be set in the System Configuration > Image Settings > Image Mode. Notes No. 79 SIEMENS Healthineers HPRF – High pulse repetition frequency SIEMENS Healthineers ... Carorio 14L 5V1 5V1 Workflow Cardiac TIB:4.52 TIC:2.93 Patient 20 Color TIS:1.18 MI:0.43 25fps Imaging 95% - 1.00 2D Review H Mid -15dB/DR60 Report C Auto Trace -0.50 Mid OdB/ General End Exam PRF 2976 Invert PW Low GS 3.5 HPRF 6250 Auto TEQ LiverLive F 250 Frequency Filter × @ Low .1.00 Gate Size Sweep Speed Scale Angle Correct Steer 19cm HD Z 160mm ............................................. 1.5 mm Baseline 60 mmis 60 0 60 20" 20 0 20 80 Unrestricted © Siemens Healthineers 2023 Speaker Notes: HPRF is high pulse repetition frequency and is used when the velocity scale is too low for the depth required. A ghost sample gate is added to allow for greater sampling and increase of scale. It is important to not have the ghost gate in the color ROI. HPRF is defaulted off. To activate, press the Scale soft key to alternate between PRF and HPRF. This typically occurs in areas where Doppler sample is placed deep or in areas of high stenosis (e.g. renal artery stenosis). This is an example of HPRF display in an adult heart. To avoid going into HPRF, reduce the frequency when in PW Doppler or if possible, or select a lower frequency transducer. Notes No. 80 SIEMENS Healthineers Doppler post-processing SIEMENS . Healthineers ... • 2D/PW Gain • Ultra Art • Scale • Sweep Speed Baseline JB / DR60 • • Dynamic Range 98B/ Genere • Invert • Maps 4.5cm • Angle Correct • Tints • Edge • Format (1/3-2/3, side-by-side, • Auto Trace 2/3-1/3, 1/2-1/2) 81 Unrestricted © Siemens Healthineers 2023 Speaker Notes: The following Doppler controls can be changed when the image is frozen. • 2D and PW Gain • Scale • Baseline • Invert • Edge • Ultra Art • Angle Correct • Sweep Speed • Dynamic Range • Maps • Tints • Format (1/3-2/3, side-by-side, 2/3-1/3, 1/2-1/2) Notes No. 81 SIEMENS Healthineers Trademarks and disclaimers SIEMENS. Healthineers ... Auto TEQ, Clarify VE, MultiHertz, UltraArt, and ACUSON Sequoia are registered trademarks of Siemens Medical Solutions USA, Inc. 82 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. Notes No. 82 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS. Healthineers ... Questions? 83 Unrestricted © Siemens Healthineers 2023 Speaker Notes: No speaker notes. 83