ACUSON Sequoia™ Ultrasound System Virtual Touch pSWE | VA30 Software Release

ACUSON Sequoia Ultrasound System VA30 SW release Virtual Touch pSWE ..... Quick Reference Card siemens-healthineers.com/ultrasound Using point shear wave elastography (pSWE) 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 Abdomen PSWE • Select compatible transducer1 and • Select pSWE, if needed Abdomen exam preset • Site 1 is default measurement label • If desired, select an alternate label Step 2 Note: If No Label is selected, measurements will appear next to the image but will not • Press VT (Virtual Touch) located on VT be sent to the report or added to the overall control panel statistics. 1 pSWE imaging is compatible with 5C1, DAX,4V1: General, Abdomen; 10L4: Abdomen. SIEMENS Healthineers . Step 4 O Step 8 • Roll trackball to position ROI • Unfreeze; repeat steps 5–8 to make (region-of-interest) at least additional measurements if required Freeze 1.5–2 cm below the liver capsule Note: During freeze, a cooling timer indicates • Ensure the “+” marker on the sample remaining seconds until transducer is available line is parallel with the liver capsule for image acquisition. During a short cooling time (e.g., 2 seconds depending on ROI depth), the timer appears and then disappears very quickly. Step 5 Update • Instruct the patient to suspend respiration then press the Update Step 9 Report key on the control panel to begin • Select Report on left side of touch acquisition screen • View, delete, store, print or transfer shear wave measurements Step 6 1 Liver Site 1 Vs=1.34 m/s E=5.4 kPa Liver Site 1 When acquisition is complete, Vs F Depth • Depth=6.01 cm m/s kPa cm the system automatically freezes, emits one audible “beep” and 1.30 5.0 4.7 1.26 4.8 4.7 displays shear wave measurement 1.52 6.9 4.7 1.36 5.6 4.7 and ROI depth next to image 1.28 4.9 4.7 1.37 5.7 4.7 1.34 5.3 4.7 1.37 5.6 4.7 1.24 4.6 4.7 1.81 9.9 4.7 8000 VULAWN- Step 7 Mean 1.39 5.8 Std Dev 0.17 1.6 To enter measurement into report: Median 1.35 5.4 IQR 0.09 0.8 Press Image to store image IQR/Median 0.07 0.1 • Overall Statistics or Image Mean 1.39 m/s Std Dev 0.17 m/s Median 1.35 m/s IQR 0.09 m/s IQR/Median 0.07 • Press right or left Set key Mean 5.8 kPa Std Dev 1.6 kPa Median 5.4 kPa IQR 0.8 kPa IQR/Median 0.1 Note: Shear Wave Speed and Elasticity values may vary among manufacturers! 2 siemens-healthineers.com/ultrasound 501 Vivor Sito 1 Abdomen Vs=1.37 m/s TIB 1.10 TIC 2.94 TIS.1.10 ME:1.39 25fps 98% 2D H Mid OdB/DR60 Virtual Touch pSWE c=1540 PSWE Liver Application Best Practice Techniques1 . 9cm Cooling 1 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°) left Optimal positioning to improve intercostal access and clearly visualize lateral decubitus position with right arm an artifact free area of the liver. raised above head 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. 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. Take measurements in right lobe of liver Placing the ROI in an artifact free area devoid of vessels, large ducts, using intercostal scanning approach and/or fluid filled structures such as cysts, is recommended to obtain reproducible results. Place the sample ROI at least 1.5–2 cm Avoid increased subcapsular reverberation by placing ROI perpendicular below the liver capsule while aligning to and at least 1.5–2 cm below the liver capsule. This can be achieved the “+” marker on the line parallel with by placing the 2 cm cursor depth marker on the liver capsule. Non- the liver capsule (Fig. 1) parallel alignment of the “+” sample marker can result in inaccurate measurements – tilt or rock transducer to achieve proper alignment. 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”; resume normal breathing. Valsalva or deep inspiration can cause an undesired increase in central venous pressure which can falsely elevate shear wave measurements. Obtain 10 measurements at same site Multiple measurements to ensure the median value is reliable. Fewer than 10 measurements can be made (at least 5); however, the IQR/ Median ratio should be within the recommended range. Maintain an Interquartile Range (IQR)/ Indicates variability of measurements lie within reasonable variability Median ratio of ≤ 0.3 for values in range. It is the recommended quality control measure for adequate kilopascals and ≤ 0.15 for values in technical quality. The IQR/Median ratio for elasticity in units of kPa will meters per second 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, 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. · HOOD05162003217791 · 11085 0921 online · ©Siemens Medical Solutions USA, Inc., 2021