ACUSON Sequoia™ Ultrasound System VA30 SW Release Auto Intima Media Thickness (Auto IMT)

Job Aid Auto Intima Media Thickness (Auto IMT) with electrocardiogram (ECG) ACUSON Sequoia™ Ultrasound System VA30 SW Release Step 1 10L4 Select compatible transducer and Carotid exam preset.* Carotid * Auto IMT is compatible with all linear transducers and carotid exam preset. Optional Electrocardiographic Trace (ECG Trace): See Appendix 1. Step 2 Obtain a 2D-mode image of the Common Carotid Artery (CCA) at the desired location with or without ECG Trace. Press Freeze and scroll the trackball to the desired frame and save the image if desired. Step 3 Press Caliper to open the measurement options. Step 4 Select the Right or Left side from the touch screen. Right Left Step 5 Choose an IMT label from the touch screen list to activate theAuto IMT tool. Dist CCA IMT Step 6 LOL4 Preview mode Trackball the blue dashed lines that create the region of interest (ROI) to the location that aligns with the chosen IMT label. For the Distal CCA IMT, place the ROI within 5 mm of the distal CCA termination. Press the Update key to enter the Preview mode and review the Rt Dist ICA IMT Meen measurement and IMT contour lines. To exit Preview mode, roll the trackball away from the ROI. If the contours do not track proceed to Step 8, Edit Mode. RI DISTICA INT Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2022 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 24 Feb 2022 | HOOD05162003254350 Healthineers Auto IMT with ECG | ACUSON Sequoia System VA30 Effective Date: 24Feb 2022 | HOOD05162003254350 Step 7 If the contours track correctly, press the Update key to enter the measurement into the Patient Report. Step 8 Edit Mode – Edit contour(s) that are not tracking. From the Preview Mode, press one of the Set keys located on either side of the trackball. The system displays two lines: blue and orange. RE DISE ICA INT Step 9 Place the blue, linear, edit cursor (circled in orange) near the line for O editing. In this example, the tunica intima. The ROI has been enlarged in Steps 9 – 11. Step 10 Place the edit cursor on the area for modification. Step 11 Press the Set key to adjust the line tracing. Step 12 Edit mode – Orange Line (tunica media interface) In the Edit mode, move the trackball to the orange contour and the line changes to blue. Move the edit cursor to the desired location on the (formerly orange line) and press one of the Set keys to adjust the contour. Step 13 Press Update to enter the measurement into the Patient Report. Customize your measurement in the System Configuration in the Per Label Configuration section of the Measurement & Report page. RL DiEL ICA IMT Max-0.76 mm SIEMENS Healthineers Auto IMT with ECG | ACUSON Sequoia System VA30 Effective Date: 24Feb 2022 | HOOD05162003254350 Appendix 1 Optional Edit Report Edit Report Select Report from the left side of the touch screen. - Intima Media Thickness (IMI) Mean Max Method Lt Dist ICA IMT 0.61 mm 0.71 mm Last Select Edit Report. 0.61 0.71 Last 0.62 0.71 0.63 0.71 Min Position over the Method menu, choose the desired display then click 0.61 Max 0.71 one of the Set keys and OK. 0.61 0.71 To remove IMT measurement, place the pointer over the X, press one of the Set keys and then OK. Fig. 1 - Edit Report Method. Optional Electrocardiographic (ECG) gating One standardized IMT method integrates ECG gating to target the 2D-mode frame at a specific point within the cardiac cycle. Enable the three-lead ECG trace prior to image collection. Three-Lead ECG Affix the conductor patches and ECG leads to the patient based on the ECG cable design, either the American Heart Association (AHA) as shown in Fig. 2 or the International Electrotechnical Commission (IEC) as shown in Fig. 3. O O O O O O Fig. 2 - Three-lead AHA and standardized lead placement Fig. 3 - Three-lead IEC and standardized lead diagram. placement diagram. Choose Workflow at the top right of the touch 000 carotid Workflow screen, Physio, and then Enable ECG Trace. Patient Physio DVR Imaging ECG Trace Sweep Speed, Size, and Position are also ECG AUX Review editable from the touch screen shown in Fig. 4. Report ECG Trace End Exa Swtop Speed Size Position Fig. 4 - Touch screen with ECG Trace enabled. SIEMENS Healthineers Auto IMT with ECG | ACUSON Sequoia System VA30 Effective Date: 24Feb 2022 | HOOD05162003254350 Auto IMT Caros Techniques, Terminology, and Best Practices Rt Dist CCA IMT 1 Mean=0.64 mm Max=0.75 mm C10=0.71 mm Fig. 5 - Auto IMT with ECG and measurement results. The Measurement Display Area (MDA) shows up to 10 values. Position patient supine with a head rotation of Optimal positioning moves the mandible away from 45-degrees toward the contralateral side the imaging area increasing access. Ensure a perpendicular transducer orientation Inaccurate or invalid measurements can result with an oblique angle of incidence and/or there is a loss of contact between the transducer and skin. Adjust the overall gain and TGC levels Appropriate gain adjustments allow for visualization of the vessel wall layers. Place the ROI within 5 mm of the distal CCA Consistently placing the ROI in the same location allows reproducible results. 1, 2 Optimize the 2D-mode image to reduce Reverberation artifacts obstruct the vessel layers reverberation artifacts possibly reducing measurement accuracy. Obtain multiple measurements at the same site Using an average ensures calculation of the correct median value. IMT C10 value The Japanese Society of Ultrasound and Medicine proposed that the IMT-C10 is a single point 10 mm from the distal CCA.3 Fig. 5 demonstrates the C10 value within the MDA. References 1. Touboul, P.J., Hennerici, M.G., Meairs, S., Adams, H., Amarenco, P., Bornstein, N., Csiba, L., Desvarieux, M., Ebrahim, S., Hernandez Hernandez, R., Jaff M., Kownator, S., Naqvi, T., Prati, P., Rundek, T., Sitzer, M., Schminke, U., Tardif, J.C., Taylor, A., Vicaut, E., Woo, K.S. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290-6. doi: 10.1159/000343145. Epub 2012 Nov 1. PMID: 23128470; PMCID: PMC3760791. 2. Polak, J.F., Szklo, M., & O'Leary, D.H. Carotid Intima-Media Thickness Score, Positive Coronary Artery Calcium Score, and Incident Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2017 Jan 21;6(1):e004612. doi: 10.1161/JAHA.116.004612. PMID: 28110311; PMCID: PMC5523639. 3. Terminology and Diagnostic Criteria Committee, Japan Society of Ultrasonics in Medicine. Standard method for ultrasound evaluation of carotid artery lesions. J Med Ultrason (2001). 2009 Dec;36(4):219-26. doi: 10.1007/s10396-009-0238-y. PMID: 27277444. SIEMENS Healthineers Auto IMT with ECG | ACUSON Sequoia System VA30 Effective Date: 02July 2021 | HOOD05162003201420 Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. ACUSON Sequoia is a trademark of Siemens Medical Solutions USA, Inc. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2022 SIEMENS Healthineers