ACUSON Sequoia™ Ultrasound System 2.5 (VA50) SW Release Auto Point Shear Wave (Auto pSWE)

Quick Reference Card Virtual Touch™ Auto Point Shear Wave (Auto pSWE) ACUSON Sequoia™ Ultrasound System (VA50) siemens-healthineers.com/ultrasound Using Virtual Touch Auto point shear wave (Auto pSWE) to obtain up to 15 individual shear wave velocity (Vs) measurements in meters per second (m/s) and elasticity (E) measurements in kilopascals (kPa) in the liver Step 1 DAX Step 3 Abdomen PSWE • Select compatible transducer1 • Select pSWE, if needed and the Abdomen or General exam preset • Select the Auto pSWE key from Auto pSWE the touch screen – the pSWE ROI (region-of-interest) will enlarge once activated Step 2 • Liver Site 1 is active as the default VT • Press VT (Virtual Touch) located measurement label on control panel • If desired, select an alternate label Note: If No Label is selected, measurements will appear next to the image but will not be sent to the report or added to the overall statistics. Note: If selected from the touch screen, the Ultrasound Derived Fat Fraction (UDFF) technology can be used simultaneously with Auto pSWE. Measurement values for both technologies will be displayed on screen. 1 Auto pSWE is compatible with the Deep Abdominal Transducer (DAX) and 9C2 transducer on the Abdomen and General exam presets. SIEMENS Healthineers Step 4 Step 7 • Roll trackball to position ROI at least To enter measurement into report: 1.5–2 cm below the liver capsule • Press Image to store image • Ensure the “+” marker on the sample or Image line is parallel with the liver capsule • Press right or left Set key Step 5 Update Step 8 • Instruct the patient to suspend • Unfreeze; repeat steps 5–8 to acquire respiration then press the additional measurements if required * Freeze Update key on the control panel to begin acquisition Step 6 Liver Site 1 Step 9 Vs Median=1.05 m/s Report • When acquisition is complete, E Median=3.3 kPa Depth=5.5 cm • Select Report on left side of touch system automatically freezes, screen emits one audible “beep” and Liver Site 1 Measurements Vs(m/s) E(kPa) D(cm) • displays the Vs Median and View, delete, store, print or transfer 1 0.92 2.5 5.5 1.12 3.8 5.5 E Median values for up to 15 shear wave measurements 0.79 1.9 5.5 individually measured sub-ROIs 0.84 2.1 5.5 1.09 3.5 5.5 in the measurement display 0.98 2.9 5.5 Liver Site 1 Liver Site 2 Liver Site 3 Liver Site 4 1.05 3.3 5.5 VS E Depth Vs E Depth Vs E Depth Vs E Depth mis kPa cm mis kPa Cm mis kPa cm mis kPa cm area (MDA) 0.79 1.9 5.5 0.93 2.6 5.5 0.80 1.9 0.95 2.7 0.94 2.6 1.40 5.9 5.5 0.76 1.7 1.11 3.7 0.85 2.2 Individual values for each 1.18 4.2 5.5 0.93 2.6 1.00 3.0 1.23 4.5 0.63 1.2 1.00 3.0 1.15 4.0 • 1.20 4.3 5.5 0.91 2.5 1.20 4.4 1.36 5.5 sub-ROI and associated 1.22 4.5 5.5 0.89 2.4 1.04 1.01 3.1 0.94 2.7 E'E 0.92 2.6 0.90 2.5 1.04 3.2 5.5 0.86 2.2 1.47 6.5 1.58 7.4 statistics will be displayed on 1.22 4.5 5.5 1.07 3.4 1.40 5.9 1.42 6.0 Y Statistics 1.26 4.7 1.32 15.2 0.99 3.0 0.96 2.8 0.90 2.4 1.39 5.8 the imaging screen left panel Vstmis) E(kPa) 1.16 4.0 1.36 5.5 1.29 5.0 Mean 1.05 3.4 1.20 4.3 1.34 5.4 1.89 10.7 0.84 2.1 1.91 10.9 2.46 18.2 once the image is stored or Std Dev 0.18 1.1 1.09 3.6 1.65 8.2 Median 1.05 3.3 IQR 0.28 1.8 Mean 0.96 2.8 1.24 4.9 the Set key has been pressed Std Dev 0.17 1.0 0.29 2.4 4.3 IQR/Median 0.27 0.5 Median 0.93 2.6 1.20 4.4 0.25 1.5 0.40 2.9 0.48 Note: If Auto pSWE is being used in Overall Statistics : Liver IQR/Median 0.33 0.6 0.33 0.7 0. 39 Statistics Vs(m/s) E(kPa) conjunction with UDFF, the UDFF value Mean 1.05 3.4 will not be displayed in the left panel. Std Dev 0.18 1.1 Median 1.05 3.3 The UDFF value will only be displayed IQR 0.28 1.8 IQR/Median 0.27 0.5 next to the image and in the patient report. 2 siemens-healthineers.com/ultrasound DAX Liver Site 1 Abdomen Vs Median=0.87 m/s TIB:0.86 E Median=2.3 kPa TIC:2.46 Depth=5.6 cm TIS:0.86 MI:1.38 20fps Auto pSWE 95% 2D H Low 0dB/DR60 c=1540 in the liver PSWE Best Practice Techniques 16cm Cooling 6 Fig. 1: Optimal technique Fasting for at least 4 hours In the non-fasting state, the liver can have falsely elevated values. Position patient supine or slight (30°) Optimal positioning to improve intercostal access and clearly left lateral decubitus position with right visualize an artifact free area of the liver. arm raised above head Ensure the transducer is perpendicular Inaccurate or invalid measurements can result if the transducer is to skin surface and use ample gel not perpendicular to the skin line and/or there is a loss of contact between the transducer and the skin. Optimize the B-mode image and avoid Optimize the B-mode image to maximize the uniformity and rib shadows (Fig. 1) brightness of the parenchyma. Rib shadows on either side of the ROI result in poor generation and propagation of the shear wave from the Acoustic Radiation Force Impulse (ARFI) push pulse. Take measurements in the right lobe of Placing the ROI in an artifact free area devoid of vessels, large ducts, the liver, at least 1.5–2 cm below the and/or fluid filled structures such as cysts, is recommended to liver capsule (Fig. 1) using an intercostal obtain reproducible results. scanning approach Align “+” marker on the sample line Non-parallel alignment can result in inaccurate measurements – parallel to the liver capsule (Fig. 1) tilt or rock transducer to achieve proper alignment. Perform acquisition during suspended Instruct patient to breathe normally and then to momentarily stop respiration; patient may resume normal breathing during acquisition. When acquisition is complete, the breathing after audible “beep” is heard system freezes and emits one audible “beep” and the patient can resume normal breathing. Maintain an Interquartile Range (IQR) / Indicates variability of measurements lie within reasonable Median ratio of ≤ 0.3 for values in variability range. It is the recommended quality control measure kilopascals and ≤ 0.15 for values in for adequate technical quality. The IQR/Median ratio for elasticity meters per second in units of kPa will be twice the IQR/Median ratio for shear wave velocity in units of m/s as the conversion of m/s to kPa is nonlinear. 1 Barr, RG, et al. (2020), “Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement.” Radiology, 00:1-12. doi.org/10.1148/radiol.2020192437. https://pubs.rsna.org/doi/10.1148/radiol.2020192437 siemens-healthineers.com/ultrasound 3 For the proper use of the software or hardware, please always use At Siemens Healthineers, we pioneer breakthroughs in healthcare. the Operator Manual or Instructions for Use (hereinafter collectively For everyone. Everywhere. By constantly bringing breakthrough “Operator Manual”) issued by Siemens Healthineers. This material is innovations to market, we enable healthcare professionals to deliver to be used as training material only and shall by no means substitute high-quality care, leading to the best possible outcome for patients. the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest Our portfolio, spanning from in-vitro and in-vivo diagnostics to version of the software and hardware available at the time of the image-guided therapy and innovative cancer care, is crucial for training. The Operator Manual shall be used as your main reference, clinical decision-making and treatment pathways. With our strengths in particular for relevant safety information like warnings and in patient twinning, precision therapy, as well as digital, data, and cautions. artificial intelligence (AI), we are well positioned to take on the biggest challenges in healthcare. We will continue to build on Note: Some functions shown in this material are optional and might these strengths to help fight the world’s most threatening diseases, not be part of your system. improving the quality of outcomes, and enabling access to care. Certain products, product related claims or functionalities described We are a team of 66,000 highly dedicated employees across more in the material (hereinafter collectively “Functionality”) may not than 70 countries passionately pushing the boundaries of what’s (yet) be commercially available in your country. Due to regulatory possible in healthcare to help improve people’s lives around the requirements, the future availability of said functionalities in world. 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. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. ACUSON Sequoia and Virtual Touch are trademarks of Siemens Medical Solutions USA, Inc. Siemens Healthineers Ultrasound owns the rights to all images. Siemens Healthineers Headquarters Manufacturer Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 Ultrasound 91052 Erlangen, Germany 22010 S.E. 51st Street Phone: +49 9131 84-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-healthineers.com/ultrasound Published by Siemens Medical Solutions USA, Inc. · HOOD0516200346320 · 13494 0423 online · Effective date 10-Apr-2023 ©Siemens Medical Solutions USA, Inc., 2023