ACUSON Juniper™ Virtual Touch Point Shearwave Quantification (pSWE) - VB10 | 1.5 Software

ACUSON Juniper ultrasound system VB10 SW Release Virtual Touch pSWE (Virtual Touch Quantification)1 ealthineers ACUSON Juniper Quick Reference Card siemens-healthineers.com/juniper Using point shear wave elastography (pSWE) to measure shear velocity (Vs) in meters per second (m/s) or elasticity (E) in kilopascal (kPa) in the Liver Application Step 1 5C1 Step 4 Abd • Select 5C1 transducer and • Select desired measurement label Abdomen exam Note: If No Label is selected, measurements will appear next to image but will not be sent to report or added to overall statistics. Step 2 Site 1 Site 2 Site 3 Site 4 Lesion 1 Lesion 2 Elasticity Lesion 3 Lesion 4 Liver Segment 1 Liver Segment 2 Liver Segment 3 |Liver Segment 4A • Select Elasticity tab on touch iver Segment 4B |Liver Segment 5 |Liver Segment 6 |Liver Segment 7 |Liver Segment 8 No Label screen Note: kPa is defaulted On to display measurement units in both velocity (m/s) kPa Step 3 Measurement and elasticity (kPa) next to the image Site 1 (does not affect units displayed in report). • Select Measurement to open measurement label list Tip: kPa (kilopascal) activation is available before or after acquisition. 1 Note: This Quick Reference Card uses the term “Virtual Touch pSWE” to refer to “Virtual Touch quantification” displayed under the “Elasticity” tab on the ultrasound system. SIEMENS HOOD05162003117185 - August 11, 2020 Healthineers Step 5 Step 9 • Roll trackball to position ROI ** • Unfreeze, repeat steps 6–8 to (region of interest) make additional measurements in the same location in the liver Step 6 Step 10 • Press Update on control panel to • Press Report on control panel begin acquisition Report Step 7 Site 3 Step 11 VTQ Measurement Vs 1.47 m/s When acquisition is complete, E 6.51 kPa • • View, delete, store, Site 1 system automatically freezes and Depth 5.6 cm print, or export shear Vs(m/s) Depth(cm) displays shear wave measurement 1 1.07 4.70 wave measurements 2 1.06 4.70 and ROI depth next to image 3 1.14 4.70 4 1.05 4.70 5 1.16 4.70 6 1.18 4.70 Step 8 7 1.27 4.70 8 1.14 4.70 • Measurement is entered into Print Store 1 9 1.46 4.70 Report by: 10 0.99 4.70 Storing image or, Median - 1.14 m/s Pressing right or left Set key Mean 1.15m/s - StdDev 0.13m/s IQR 0.11m/s IQR/Median 0.10 Tip: Either velocity (m/s) or elasticity (kPa) can be displayed on the report – customize before or after report generation under > System Configuration > Measurement > General > Shearwave Measurement Units 2 siemens-healthineers.com/juniper - HOOD05162003117185 - August 11, 2020 MI 1.47 TIS 0.7 TIB 1.6 ASC 1 DTCE Med ES 0.99 m/s Dyn R 63 dB 2.94 kPa THI 5.0 MHZ Depth 4.8 cm 5 dB 24 fps Virtual Touch pSWE Liver Application Best Practice Techniques1 12 cm Fr118 Fig. 1: Optimal technique Fasting for at least 4 hours In the non-fasting state, the liver can have falsely increased values. Position patient supine or slight (30°) left Optimal positioning to improve intercostal access. lateral decubitus position with right arm raised above head Transducer perpendicular (90°) to skin A transducer angle < 50° to the skin surface, or use of inadequate surface using ample gel amount of gel, can result in artificially low shear wave measure- ments due to loss of transducer contact. Take measurements in right lobe of liver, Optimal ROI placement to obtain reproducible results and avoid in either segment 8 or 5 (Fig. 1), using cardiac motion. intercostal scanning approach Position ROI between 3–6 cm deep The transducer-specific lens focus is typically about 4–5 cm below (whenever possible, position the ROI about the transducer, thus the best measurements are in this region. 4–5 cm deep for optimal results) and at Avoid increased subcapsular reverberation by placing ROI least 1.5–2 cm below the liver capsule perpendicular to and at least 1.5–2 cm below liver capsule. (Fig. 1) Scanning parallel to ribs and in an inter- Rib shadows on either side of the ROI result in poor generation and costal space to avoid rib shadow artifacts, propagation of the shear wave from the Acoustic Radiation Force optimize B-mode image (Fig. 1) so liver Impulse (ARFI) push pulse. parenchyma is bright and large vessels, bile ducts and rib shadows are avoided Take measurements during suspended Valsalva or deep inspiration can cause an undesired increase in respiration central venous pressure which can falsely elevate shear wave measurements. Instruct patient to breath normally and then to momentarily stop breathing during acquisition. 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 Median ratio of m/s, of ≤ 0.3 for values variability range. The recommended quality control measure for in kilopascals and ≤ 0.15 for values in adequate technical quality. The IQR/Median ratio for elasticity in meters per second 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/juniper - HOOD05162003117185 - August 11, 2020 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 Juniper and Virtual Touch are trademarks of Siemens Medical Solutions USA, Inc. Siemens Healthineers Ultrasound owns the rights to all images. Siemens Healthineers Headquarters Legal Manufacturer & Published by 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 siemens-healthineers.com USA Phone: 1-888-826-9702 siemens-healthineers.com/ultrasound Published by Siemens Medical Solutions USA, Inc. · 9195 0720 · ©Siemens Medical Solutions USA, Inc., 2020 - HOOD05162003117185 - August 11,2020