ACUSON Sequoia™ Ultrasound System Virtual Touch 2D SWE-Liver | 2.5 (VA50) Software Release

Quick Reference Card Virtual Touch™ 2D SWE ACUSON Sequoia™ Ultrasound System (VA50) siemens-healthineers.com/ultrasound HOOD05162003358779 | Effective date 20-Jun-2023 Using 2D shear wave elastography (SWE) to measure shear velocity (Vs) in meters per second (m/s) and elasticity (E) in kilopascal (kPa) in the liver Step 1 5C1 Step 3 SWE Abdomen • Select a compatible transducer1 • Select the SWE tab on the touch and Abdomen exam preset screen • If required, roll the trackball to reposition the 2D SWE region of Step 2 interest (ROI) • Press the VT (Virtual Touch) rotary VT • If required, press the Set key and key located on control panel roll the trackball to resize ROI 1 2D SWE imaging is compatible with 5C1, 9C2, DAX: General, Abdomen; 10L4: General, Thyroid, Breast, MSK; 15L4, 18L6: General, Thyroid, Breast. SIEMENS Healthineers . Step 4 Update • Press Update on control panel to begin acquisition Note: During freeze, a cooling timer indicates the remaining seconds until transducer is available for image acquisition. During a short cooling time (e.g., 1–2 seconds), the timer appears and then disappears very quickly. Step 5 • When the acquisition is complete, the system automatically freezes, emits one audible “beep” and activates the Velocity or Elasticity display mode • Alter the Min and/or Max Velocity or Elasticity setting(s) to adjust the range of measurements displayed in ROI Increase range if measured value exceeds - range by displaying “High” Min Velocity Max Velocity Min Elasticity Max Elasticity 0.5 4 50 or Decrease range if better visualization of - the velocity of stiffness differences is needed Customize the left and right sides of the Velocity Hlastkity Quality Dr.placement ho Only • dual display for the map type(s) by selecting the desired option(s) from the touch screen • If required, the units (m/s and kPa) may be altered by selecting the unit from the touch Velocity Elasticity screen display options m/s kPa • Rotate the VT rotary dial on the control panel to change the transparency of 2D SWE VT (if required) • Select Live Dual to display the 2D SWE image in full-screen format (if required) Live Dual Step 6 • Press Caliper Uver Segment Mais • Select the same measurement label each Site 6 time / per site 2 siemens-healthineers.com/ultrasound Step 7 • Roll trackball to position the measurement ROI • If needed, rotate the ROI Diameter to resize measurement ROI ROI Diameter • Shear wave measurements, measurement ROI depth and diameter are displayed next Vs Modian= 1.44 m/s E Medion=6.3 kPa to the image Depth=4.72 cm Diam=1.00 cm Step 8 To enter measurement into the report: • Press Image to store the image or • Press right or left Set key Step 9 • Unfreeze; repeat steps 4–9 to make additional measurements Freeze Step 10 Report • Select Report Median Mean Median Mean Max • View, delete, store, print or transfer shear wave measurements Note: To edit report values select the Edit Report option from the imaging or touch screen. Once 1.40 9.5 4.75 1.2 9.3 4.39 selected, an “X” will appear beside each measurement 1.42 1.48 in the report. Click on the “X” to remove a listed value 1.47 6.1 3898888888 from the report. Mean 1.40 0.1 1.77 LOR inpi/dedian Mean 1.mimk Mean 5.8 kPa Median 5.4 fra IQUMedian 6.1 Notes Shear Wave Speed and Eletricity values may vary among manufacturers! siemens-healthineers.com/ultrasound 3 Virtual Touch 2D SWE Liver Application Best Practice Techniques1 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 visualize left lateral decubitus position with right an artifact free area of the liver. arm raised above head Optimize the B-mode image and avoid Optimize the B-mode image to maximize the uniformity and brightness rib shadows (Fig. 1) 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. Ensure the transducer is perpendicular Inaccurate or invalid measurements can result if the transducer is not to skin surface using ample gel perpendicular to the skin line and/or there is a loss of contact between the transducer and the skin. Take measurements in the right lobe Placing the ROI in an artifact free area devoid of vessels, large ducts, of the liver in an artifact free area and/or fluid filled structures such as cysts, is recommended to obtain reproducible results. 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 4 siemens-healthineers.com/ultrasound 501 Abdomen Va Median O AS mus F Mixdian-2.2 1Pa TIB 0 7 Dupll 4 33 cm TIG:1.49 Dium= 1.00 cm T18 0. 71 MI:1.29 26fps 98% 20 Mid ₾‘1540 SWE Fig. 1: Optimal technique Position the measurement ROI at least The 2D SWE ROI can be positioned closer to the liver capsule if 1.5–2 cm below liver capsule (Fig. 1) reverberation artifacts are avoided, however the recommended optional placement of the measurement ROI is 1.5–2 cm below the liver capsule. Perform acquisition during suspended Instruct patient to breath normally and then to momentarily stop respiration; patient may resume normal breathing during acquisition. When acquisition is complete, the system breathing after audible “beep” is heard freezes and emits one audible “beep”. The patient can then resume normal breathing. Valsalva or deep inspiration can cause an undesired increase in central venous pressure which can falsely elevate shear wave measurements. Obtain 5 measurements at same site Multiple measurements are taken to ensure the median value is reliable. Maintain an Interquartile Range (IQR)/ Indicates the variability of measurements lie within reasonable Median ratio of ≤ 0.3 for values in variability range. It is the recommended quality control measure for kilopascals and ≤ 0.15 for values in adequate technical quality. The IQR/Median ratio for elasticity in units meters per second 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. siemens-healthineers.com/ultrasound 5 For the proper use of the software or hardware, please always use At Siemens Healthineers, our purpose is to enable healthcare the Operator Manual or Instructions for Use (hereinafter collectively providers to increase value by empowering them on their journey “Operator Manual”) issued by Siemens Healthineers. This material is towards expanding precision medicine, transforming care delivery, to be used as training material only and shall by no means substitute and improving patient experience, all enabled by digitalizing the Operator Manual. 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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. · HOOD05162003216838 · Effective date 20-Jun-202313780 0523 online · ©Siemens Medical Solutions USA, Inc., 2023