ACUSON Juniper™ Virtual Touch Strain Imaging (eSie Touch Elasticity Imaging)1 - VB10 | 1.5 Software

ACUSON Juniper ultrasound system VB10 SW Release Virtual Touch Strain === Imaging (eSie Touch Elasticity Imaging)1 ealthineers ACUSON Juniper Quick Reference Card siemens-healthineers.com/juniper Using Strain imaging to qualitatively assess relative tissue stiffness Step 1 Elasticity • Position patient to obtain perpendicular plane to skin surface for optimal axial 12L3 Breast motion Tx Power 100% MI 0.94 TIS 0.2 • Position compatible transducer2 over area of interest and optimize B-mode image DTCE High Dyn R 68 dB THI 10.0 MHZ Select Elasticity tab on touch screen 1 dB • 12 fps HD QF 90 • Roll trackball to position region of interest (ROI) • Press Set key and roll trackball to resize ROI Note: The B-mode image and elastogram display in live, dual format (Fig. 1). The elasticity imaging bar (located above the grayscale bar) represents the range of gray or color shades available for depicting tissue stiffness from Fig. 1: Left: B-mode image with ROI. Right: B-mode image with corresponding SF (soft) to HD (hard). ROI displaying elastogram. 1 Note: This Quick Reference Card uses the term “Strain imaging” to refer to “eSie Touch elasticity imaging” displayed as “eSie Touch” under the “Elasticity” tab on the ultrasound system. 2 Strain imaging is compatible with 16L4, 13L4, 12L3, 11L4: Breast, Thyroid; 18H5: Thyroid. SIEMENS Healthineers Step 2 12L3 Breast MI 1.17 TIS 0.2 • Use minimal compression; avoid lateral or TIB 0.2 SC 2 rocking motion DTCE High Dyn R 68 dB THI 8.4 MHZ -2 dB Tip: Patient respirations or cardiac motion may 11 fps QF O be sufficient. • Adjust axial motion or cease lateral movement if gray overlay box appears on elastogram (Fig. 2) • Maintain QF > 50 Note: The system displays a real-time quality factor (QF) 4 cm score. A QF value > 60 (Fig. 1) indicates minimal global motion artifact. A QF value < 50 (Fig. 2) indicates a less than optimal result; perform another acquisition. Fr1166 Fig. 2: A gray overlay box on the elastogram indicates insufficient or excessive axial motion or lateral movement. Step 3 5C1 16L4 1213 Breast Add Exam 2D • Optimize elastogram and then press Freeze; Elasticity eSieScan review cine to obtain desired frames eSie Touch > • Rotate Zoom on the control panel to magnify the image Clear L/R Flip El Color If desired, select EI Color to select a color Screen Split • Hide Patient UID Flip map El Map Index Image If desired, select EI Map Index: Param Exit • 0: Standard default map - 1: Normalized map (compensates for - non-uniform stress applied with transducer) 2: Inverted map - • Select Exit to exit elasticity imaging 2 siemens-healthineers.com/juniper Measurements Shadow Shadow Duplicates and displays a measurement on the adjacent image for a comparison of lesion size and/or location. Tip: Shadow may be used with the strain ratio or EI/B ratio. • On a live or frozen image, press Caliper • Select Shadow • Measure the right or left image • Select Caliper to exit measurements Strain Ratio Compares the relative stiffness of tissue within two ROIs Strain Ratio (e.g., compares average strain of a lesion and average strain of the surrounding tissue). Strain ratio = 1: stiffness of tissue in both ROIs is equal. • On a frozen image, press Caliper Strain ratio > 1: Select Strain Ratio lesion is harder than surrounding tissue. • Place ROI 1 (ellipse) in surrounding tissue and press Set key Strain ratio < 1: • lesion is softer than surrounding tissue. • Place ROI 2 (ellipse) in lesion (same size and at same depth) Note: Results reflect placement of ROI 1 in and press Set key surrounding tissue; results will differ if ROI 1 Note: ROI size may be adjusted by rotating Select rotary control located on is placed in lesion. the control panel. Strain ratio and average strain (%) for both ROIs are displayed in the measured results. Note: Strain Ratio is not available when using EI Color. Distance Ratio or Area Ratio Elasticity imaging/B-mode (EI/B) ratio May be used as an indication of the likelihood of malignancy in breast lesions. When the ratio is > 1, the probability of malignancy is high.1 More % • On a frozen image, press Caliper % Select More Dist Ratio Area Ratio • Select Dist Ratio or Area Ratio 1 A • 0.31 cm2 B 0.11 cm2 • Measure lesion on elastogram and press Set key A/B 2.81 BIA 0.36 Measure lesion on B-mode image (A-B)/A 0.64 • • The EI/B ratio is represented by the A/B ratio in the measurement display area 1 Barr, R. G., De Silvestri, A., Scotti, V., Manzoni, F., Rebuffi, C., Capittini, C. and Tinelli, C. (2019), Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis. J Ultrasound Med, 38: 1397-1404. doi:10.1002/jum.14849. siemens-healthineers.com/juniper 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. Any material used in this training will not be healthcare. updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the An estimated 5 million patients globally everyday benefit from our training. The Operator Manual shall be used as your main reference, innovative technologies and services in the areas of diagnostic and in particular for relevant safety information like warnings and therapeutic imaging, laboratory diagnostics and molecular medicine, cautions. as well as digital health and enterprise services. Note: Some functions shown in this material are optional and might We are a leading medical technology company with over 170 years not be part of your system. of experience and 18,000 patents globally. With more than 48,000 dedicated colleagues in 75 countries, we will continue to innovate Certain products, product related claims or functionalities described and shape the future of healthcare. in the material (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. 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 Juniper, eSie Touch, 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 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. · 9196 0620 · ©Siemens Medical Solutions USA, Inc., 2020