ACUSON Juniper™ Ultrasound System Major Modes - VB10 | 1.5 Software

Continue Continue HOOD05162003162313 | Effective Date xx-xxx-xxxx ACUSON Juniper™ Ultrasound System Major Modes Training – VB10 | 1.5 Software This online training will examine the control and optimization of the two-dimensional or 2D-mode and Doppler Modes available on the ACUSON Juniper system. Listed below are the two course objectives. There is no audio accompanying this online training. Please choose the next icon on the lower right corner to continue. Describe the 2D-mode and Doppler controls 1 Examine controls used to optimize 2D and Doppler 2 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 ? Welcome ? Overview The content that follows in this training is a high-level review of the controls and optimization of the two-dimensional (2D-mode), M-mode, Doppler and Spectral Doppler modes. Doppler modes consists of Color Doppler Velocity (CDV), Color Doppler Energy (CDE), Doppler Tissue Imaging (DTI), and Doppler Tissue Energy (DTE). The Spectral Doppler modes are Pulsed Wave (PW) and Continuous Wave (CW) Doppler. Please completely review every page, link, and marker within this course to complete this online training of the two-dimensional Major Modes available on the ACUSON Juniper system. Check with your local Siemens Healthineers sales representative for additional information regarding ACUSON Juniper system VB10 | Software 1.5 upgrade. Select Next to proceed. ? Overview Two-Dimensional 2D-mode We will begin with the 2D push rotary control located on the Control Panel. Rotate to increase or decrease the overall 2D gain or brightness. You can also press down on the 2D push rotary control to exit from other modes. In this segment you will read about the 2D-mode controls found on the ACUSON Juniper system. Select the numbered steps below to learn more about 2D-modes. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 4 4 4 ? ? 2D-mode Trapezoid FOV 8 The Trapezoid mode is available on the Touch Screen and is shown here framed in orange. Trapezoid is available on linear transducers and angles the outer edges of the 2D-mode FOV extending the far field outward. Select the marker below for more information on Full and Wide FOV. Full and Wide FOV Full FOV and Wide FOV are available on the 9MC3 transducer. The Full FOV is at 176 degrees and the Wide FOV is at 220 degrees. Tap or touch the image below to zoom and increase the image size. Tap or touch a second time to close the window. There are three methods to you can use to change the angle of the M-mode cursor after activating M-mode: Rotate the Angle control on the Control Panel to the desired angle. Press Angle AMM on the Touch Screen and rotate the Angle control. Select Marker AMM on the Touch Screen and a free caliper will appear. Lock the caliper with the Set Key and draw the M-mode cursor at the desired angle with the Trackball and press the Set key once more. Anatomical M-mode (AMM) 7 Select the number eight to learn about the Trapezoid display. M-mode is a graphic display of motion over time. Anatomical M-mode (AMM) allows the user to change the angle of the M-mode cursor to correct for off-axis cardiac views. Access the M-mode cursor and tracing by pressing down on the M control located on the Control Panel. Next, select the M-mode framed in orange to learn about AMM methods. M-mode 7 Zoom | Magnification and High Definition Zoom The Zoom push rotary control activates Zoom magnification (Z) and High Definition Zoom (HD Z). Rotate the Zoom key on the Control Panel (highlighted in orange) to adjust the magnification. Press either Set key to Pan and use the Trackball to move the magnification within the Image Area. Pressing down on Zoom will activate the HD Z region of interest (ROI). Adjust the size of the HD Z ROI or Pan the HD Z ROI using the Set Key and Trackball. Select each of the markers for more information about Z and HD Z. 6 High Definition Zoom (HD Z) HDZ rewrites within the region of interest increasing the detail resolution and frame rate. This feature is only available during real-time imaging. An image created using HD Zoom has a HD Z in the lower right next to the depth marker. Tap or touch the image shown here to zoom and increase the image size. Tap or touch the image second time to close the window. Zoom (Z) Zoom magnification is also called read zoom. Zoom magnifies or enlarges a ROI of the 2D image. Tap or touch the image shown here to zoom and increase the image size. Tap or touch the image second time to close the window. Trackball and Set Display In Zoom, the Set Key Display toggles between changing the Zoom size and positioning or Panning the Zoom ROI within the 2D-mode FOV. Additionally, you can rotate the zoom control to enlarge the image. The Depth Gain Compensation or DGC is shown here framed in orange. Moving the slide pot to the right or left will increase or decrease brightness at that level. The DGC control is only adjustable during 2D-mode real-time imaging. Select the marker next to the DGC for more information on the DGC potentiometer controls. Depth Gain Compensation 5 DGC Pots These slide keys are called ‘pots’ which is shortened from potentiometer. The slide pots act as a variable resistor or rheostat. Depth | Focus - Multifunctional Control The multifunctional Depth Focus is located on the Control Panel and shown here framed in orange. This multifunctional key controls the FOV Depth and Focus. Depth or Focus is adjusted by toggling or rotating, depending on the configuration. To increase or decrease the number of focal zones, press the multifunctional key down. Select each marker to read more about the configuration and functionality of the Depth and Focus multifunctional control. 4 Depth and Focus Configuration The functionality of this multifunction key is customizable in the system Configuration menu under Custom Keys. Tap or touch the image below to zoom and increase the image size. Tap or touch the image a second time to close the window. Depth and Focus The imaging depth can be adjusted from zero to 30 centimeters, depending on the selected transducer. The distance between focal zones is controlled by rotating the Soft Key that corresponds to ‘Focus Width’. 3 Touch Screen There are two pages of controls available on the Touch Screen. Use the arrow located at the bottom right of the Touch Screen shown here framed in orange. Or use your finger to swipe across the Touch Screen from right to left or left to right to navigate between each page. Active controls are highlighted in blue, available controls are in grey, and unavailable controls for the transducer or exam type are dithered out and unavailable. Soft Keys – Push Rotary Controls 2 There are multiple Soft Key functions assigned to each push rotary control. On the Touch Screen, the Soft Key controls are listed above each of the push rotary controls. Pressing down alternates the activation of parameters between the first and second row. Once the desired parameter is activated, rotate either clockwise or counterclockwise to adjust the parameter. Soft Key Configuration There are two pages of Soft Key parameters that can be customized. Proceed to the System Configuration page and then choose the Soft Keys. From this location each of the Soft Key parameters can be selected from the drop down menu. Additionally, the location of each parameter can be established or moved between the Soft Keys pages. The default 2D-mode Field of View (FOV) is transducer and exam dependent. To change the size of the FOV, press either Set Key and then roll the Trackball to the desired FOV size. Select either Set key again to lock the resized FOV. Select either Set key once more to ‘Position’ the FOV within the Image Area. Review the marker below for additional information about this functionality. 2D Field of View (FOV) – Size and Position 1 2D Soft Key Controls Next, please choose the Soft Key push rotary controls that are framed in orange on the Control Panel below to explore some the 2D-mode optimization features on the ACUSON Juniper system. ? ? 2D Soft Key Controls Transmit Power The acoustic power or transmit power (Tx) is the acoustic energy delivered to the patient. The Tx soft key, shown here framed in orange, can be adjusted as clinically indicated. Settings are .20 – 100%. Different presets or scanning modes will have different Tx levels. Utilize the ALARA (as low as reasonable achievable) principle. > Proceed < Return to the Soft Keys Choose the Proceed button on the lower left to complete this review of the 2D-mode Soft Keys. To increase or decrease the number of focal zones, press down on the multifunction key. Rotate to increase or decrease the distance between the multiple focus zone carats. There are two focal zone carats are shown here framed in orange. < Return to the Soft Keys Depth | Focus Edge Distinguish the contours of a soft tissue structure during 2D-mode real-time imaging using Edge enhancement. Settings range from zero to three. Increasing Edge will enhance or sharpen contours. Decrease the Edge control to smooth contours. < Return to the Soft Keys Dynamic TCE™ Tissue Contrast Enhancement Technology Dynamic TCE technology is a Siemens proprietary advanced method for speckle reduction. Select one of four levels of Dynamic TCE technology to apply to the image. Dynamic TCE technology can be used with advanced SieClear spatial compounding to enhance visualization of the tissue texture, subtle tissue contrast differences, border definition, and pathology. Dynamic TCE technology software can be accessed from the Soft Keys or the Touch Screen. < Return to the Soft Keys Advanced SieClear™ Spatial Compounding Advanced SieClear™ spatial compounding combines multiple images acquired at different steering angles. This compounding produces an image with less noise, increased contrast resolution, and improved border delineation. Settings include off, one, two, or three. A higher compounding level will increase the number of steering angles for a smoother or softer appearing image. < Return to the Soft Keys MultiHertz™ Multiple Frequency Imaging < Return to the Soft Keys MultiHertz™ multiple frequency imaging enables the user to adjust the 2D-mode frequency of the transducer independently while using other modes. Use a higher setting to improve 2D resolution. To improve the depth of penetration, use a lower frequency setting. MultiHertz imaging helps to achieve the highest resolution, penetration, and sensitivity for every imaging mode. Tissue Equalization Gain (TEQ) TEQ or Tissue Equalization Gain is a user definable threshold that accommodates different user preferences for gain settings and various room lighting conditions. Settings range from negative five to five (-5 to 5). TEQ gain especially useful when imaging in rooms with bright ambient lighting. < Return to the Soft Keys Tints < Return to the Soft Keys Tint colorizes the grey scale to aid in subtle tissue differences. Settings are from zero to 15. The 2D-mode Tint can be changed during real-time imaging or from a frozen image. Maps Maps enhances aesthetics by adjusting grey scale assignments to modify the image contrast. Settings are A-G with low to high contrast. The 2D-mode Map can be changed during real-time imaging or from a frozen image. < Return to the Soft Keys Breast display using Map A Liver display using Map C Dynamic Range The Dynamic Range (Dyn R) setting impacts the number of gray shades that are displayed and the units are shown in decibels (dB). Settings are 10-90 dB. Increase the Dyamic Range to produce a softer 2D-mode image. Decreasing the Dyamic Range will produce a 2D-mode image that is more black and white. < Return to the Soft Keys Sagittal view of the Carotid artery. Apical four-chamber view of the heart. Persistence creates a visible smoothing effect by maintaining lines of image data for each frame of image data. The settings are from zero to five. A setting at zero will yield low persistence and a setting of five is the maximum level of persistence. Utilize a low persistence to demonstrate motion. A higher level of persistence is useful in slow blood flow states and soft tissues that have little or no motion. A higher persistence level was use here in this example of slow blood flow in the calf veins. Persistence < Return to the Soft Keys Resolution - Speed These Soft Key controls adjust the balance between the image line density or resolution and speed or frame rate. The settings are from zero to five. A setting of zero will have the lowest 2D-mode resolution and the highest frame rate. A setting of five has the highest 2D-mode resolution and the lowest frame rate. A lower R / S setting may be helpful in exams that have a higher heart rate as in this fetal heart example. < Return to the Soft Keys Image Display Size Increase or decrease the Image Display Size based upon personal preferences. The settings are from zero to four and the default size is two. Review each of the orange markers below for more information about the image display sizes that were used for each of these parasternal long axis views of the heart. Image Size 4 Image Size 0 < Return to the Soft Keys 2D-Mode Soft Key Adjustments Select each of the 2D Soft Keys one through twelve that are highlighted in orange below to learn more about some of the 2D-mode Soft Key adjustments available on the ACUSON Juniper System. 1. Image Size 2. R / S 7. MultiHertz 8. Adv SieClear 9. DTCE 5. Map 3. Persistence 12. Tx Power 4. Dyn Range 6. Tint 10. Edge 11. Focus Width Additional 2D Features Choose from each of the orange arrows to read about some additional 2D-mode imaging features available on the ACUSON Juniper system. eSieImage™ Multiparametric Optimization Tissue Harmonic Imaging Clarify™ Vascular Enhancement (VE) Technology Custom Tissue Imaging ? ? 2D Features Custom Tissue Imaging (CTI) Custom tissue imaging, labeled CTI on the Touch Screen, adjusts the speed of sound increasing lateral resolution and boundary definition. This feature corrects for differences in the speed of sound between different structures. Settings are –1, 1, 0, 1, and 2. CTI can be used in breast exams as in this image showing a cyst within fatty breast tissue. For MSK matching the speed of sound to the soft tissue densities reduces or eliminates many artifactual errors. Clarify™ Vascular Enhancement (VE) Technology Clarify VE technology is a real time adaptive pixel by pixel analysis, which provides exceptional contrast resolution for clear delineation of vessels. This patented technology uniquely utilizes power Doppler flow information. The result is a reduction in noise and artifacts within microvascular structures such as the thyroid or testicle and in larger vessels such as the carotid artery, femoral vein, and aorta. Clarify VE is On Clarify VE is Off Tissue Harmonic Imaging (THI) improves contrast and spatial resolution by reducing haze, noise and clutter within cystic structures, heart chambers, and vessels. THI is especially helpful in reducing noise in large, difficult to image patients. THI can help reduce grating lobes and side lobe artifacts typically seen near the diaphragm or large structures. When active, THI will appear blue on the Touch Screen and is displayed in the data field. Tissue Harmonic Imaging eSieImage™ Multiparametric Optimization eSieImage optimization continuously optimizes image brightness by changing the overall gain and DGC. This 2D imaging tool performs continuous noise analysis and correction to improve image quality, uniformity and contrast resolution across different tissue types. Activate and deactivate eSieImage multiparametric image optimization from the Control Panel. When active, the eSieImage control on the control panel is backlit and blue and gold icon display appears on the image screen. Display Features Dual Seamless Dual Split 4B ? Select each of the orange arrows to learn more about some of the display features available on the ACUSON Juniper system. ? 2D Display Features 4B 4B displays four separately acquired images in a quadrant format to display and measure each quadrant on one image. To activate, select 4B from the Touch Screen and then choose one image from the thumbnails and 4B again to assign an image to each of the remaining quadrants. Split Select Split during live imaging to compare two real-time images. A golden icon will indicate the active side and the active side is shown here framed in orange. This display feature is useful as a real-time comparison of 2D-mode to other modes. In this Split image, the 2D-mode is next to Clarify™ Vascular Enhancement (VE) technology over the abdominal aorta at the bifurcation. The golden icon indicates that Clarify VE technology is on the active side and is shown here framed in orange. Seamless Dual Seamless Dual provides an uninterrupted image allowing for measurement of the structure. Enable or disable this feature within System Configuration by selecting Soft Keys and then Exam. From here you can turn the seamless feature on or off. Dual Dual (outlined in orange) is located on the Control Panel. The Dual function displays two separately acquired images side by side. Select Dual and the gold letter indicates is the active side (shown here framed in orange). Pressing dual again activates the other side. Press the 2D control to exit Dual. Color Doppler Controls The ACUSON Juniper system offers excellent image quality, color, sensitivity and penetration. Select the numbered steps below to learn more about CDV. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 ? ? Color Doppler Controls eSieImage™ Multiparametric Optimization 7 eSieImage optimization continuously adjusts the CDV gain, scale, and if enabled will also automatically invert the CDV display. Activate and deactivate eSieImage multiparametric image optimization from the Control Panel. When active, the eSieImage control on the control panel is backlit and blue and gold icon display appears on the image screen. Doppler Tissue Imaging (DTI) 6 Color DTI is a way to visually assess myocardial motion. To activate color DTI, first initiate CDV and then select the DTI control from the Touch Screen. Select the marker below for more information. Doppler Tissue Energy (DTE) and Color Doppler Energy (CDE) When phased array transducers and echocardiography applications are engaged, DTE and CDE Power Doppler modes are available. Directional CDE is also available. Color Doppler Energy (CDE) 5 Color is applied to the received signals based on the amplitudes that are generated by blood flow from vascular structures. This is often referred to as power Doppler. CDE demonstrates less angle dependency than CDV and is useful for very low flow states to demonstrate presence or absence of flow. During real-time imaging with CDV, activate CDE from the Touch Screen. A directional component can be added to CDE by selecting Directional Power (Dir Power) from the Touch Screen. CDV – Invert 4 Select the Invert control on the Touch Screen to reverse the color hue depicting flow toward or away from the transducer. In these images, flow moving towards the transducer (blue box) displays blue. After Inverting the color (orange box) the same vessel has a color tag of red; however, the flow direction has not changed. CDV – Color Display 3 Color Display on and off…. The Color Display option removes color information from within the color Doppler ROI. To turn off the CDV display, select Color Display on the Touch Screen. The CDV information from the image will be removed, but the color Doppler bar is still displayed. Select Color Display again on the Touch Screen to reactivate CDV in the ROI. CDV – Steer The steer control key, shown here framed in orange is located on the control panel. The steer is available on linear transducers to move the color ROI left, center, and to the right. 2 1 Color Doppler Velocity (CDV) Activate Color Doppler Velocity (CDV) by pressing the C push rotary control on the Control Panel that is shown here framed in orange. The CDV gain, Touch Screen, and Soft Keys function as previously described in 2D-mode. Review the marker over the Trackball for more information on CDV size and position control. Trackball and Set Display The Set Key Trackball Display is visible below the Image Area and will display the active Set Key function. Located on either side of the Trackball, the Set Keys work in tandem. Depending on the active Set Key function, use the trackball to either change the size or position the ROI in within the Image Area. Color Doppler - Continued Next you will continue to review some CDV features available from the Touch Screen and Soft Keys. Select the numbered steps below to learn more about CDV. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 8 8 8 7 7 7 ? Color Doppler Optimization Color Doppler – Priority Adjusting this parameter accentuates either the displayed color information or the 2D information. In situations where you cannot see blood flow in the vessel and color Doppler is not filling, raising the priority for color information may emphasize the CDV display over the 2D. To advance to the final segment of this online course, choose the Proceed button below. > Proceed 5 < Return to the Soft Keys Color Doppler – Persistence Persistence adjusts the time that the CDV data remains in the ROI before being replaced by the next set of CDV data. A higher persistence is sometimes used on slow or low blood flow volume. A lower persistence is used in echocardiography to display the hemodynamics from the heart valves and chambers. 5 < Return to the Soft Keys Color Doppler – Smooth This is a postprocessing feature that adjusts the level of spatial averaging and helps to produce a color Doppler image that has less noise at the blood flow tissue boundary. Adjust smoothing to aid in the definition of the blood flow to wall interfaces of vascular structures. A higher smooth level was used in this image to enhance the color display. 5 < Return to the Soft Keys Color Doppler – Baseline Moving the CDV Baseline alters the amount of the velocity range that is displayed above and/or below the baseline. Raise the baseline to display more color Doppler signals from below the baseline. Lower the color Doppler baseline to display more color Doppler signals from above the baseline. In this Color M-mode example, the CDV Baseline was raised. Also, in this example, the CDV is aliasing. 5 < Return to the Soft Keys Color Doppler – Scale 5 < Return to the Soft Keys Nyquist Limit Within the Doppler instrumentation, CDV is a pulsed Doppler modality that has a velocity limit known as the Nyquist limit. Velocities that are greater than twice the PRF will alias. This velocity range is determined by the pulse repetition frequency or PRF. The Scale adjusts the maximum and minimum velocities or the velocity range that are displayed for CDV and all Doppler modes. The Scale also adjusts the amplitude range of Color Doppler Energy and Color Tissue Energy modes. Review the orange marker next to the CDV color bar for more information on the CDV Scale. MultiHertz™ Multiple Frequency Imaging MultiHertz imaging adjusts the CDV transducer frequency range independent of the 2D-mode frequency. This imaging feature helps to maintain the CDV sensitivity throughout the color Doppler ROI. Increase the frequency range for greater spatial resolution or decrease the frequency range for deeper vessels or when more CDV penetration is needed. 5 < Return to the Soft Keys Color Doppler – Resolution / Speed Resolution and Speed or R / S adjusts the balance between the image line density of the 2D image and color Doppler frame rate. Choosing level one yields a lower 2D resolution and a higher color Doppler frame rate. Selecting level two will display mid-level 2D and color Doppler frame rate. Increasing the R / S setting to three will produce a higher 2D resolution and lower color Doppler frame rate. 5 < Return to the Soft Keys Color Doppler – Filter The CDV filter reduces color Doppler clutter by adjusting to the level of motion discrimination that can occur during real-time imaging. Increase the filter where there is a lot of flash due to patient breathing or movement. 5 < Return to the Soft Keys 5 Color Doppler Adjustments Select each of the orange buttons below to learn more about some of the CDV Soft Key adjustments that are available on the ACUSON Juniper System. 1. Filter 2. R / S 3. MultiHertz 4. Scale 5. Baseline 6. Smooth 7. Persistence 8. Priority Use this feature to tag a single blood flow velocity or a range of blood flow velocities. Select each of the markers below for more information. Color Doppler – Velocity Tag 4 Single Velocity Tag Enable Velocity Tagging by choosing VelTag from the Touch Screen. To place a velocity tag at a single area of interest, select Sngl from the Touch Screen and roll the trackball vertically to select the area of interest. Click or tap the image to enlarge. Click or tap a second time to close the window. Range (Rng) Velocity Tag To tag a range of velocities, select Rng from the Touch Screen and roll the trackball horizontally to select the amount of velocity range and then vertically to place that range in the desired area. Velocity Tagging can be done on done during real-time imaging or on a frozen image. Click or tap the image to enlarge. Click or tap a second time to close the window. Color Doppler - Split 3 Choose Split from the Touch Screen to display the same image side-by-side with and without CDV. Auto Flash Artifact Suppression 2 Auto Flash Artifact Suppression technology prevents motion artifacts relative to user motion. Auto Flash Artifact Suppression also enhances color sensitivity and allows high quality scanning at a fast pace. Notice how the CDV in the video shown here displays excellent color sensitivity without motion artifacts. Dynamic Persistence Dynamically adjusts the amount of time that the lines of image data remain for each frame of image data. This feature continuously enhances the color sensitivity while reducing 2D noise. 1 Spectral Doppler The ACUSON Juniper has excellent Spectral Doppler sensitivity and clarity. In this section you will review activating and optimizing Pulse Wave (PW) and Continuous Wave (CW) Spectral Doppler. Select the numbered steps below to learn more about Spectral Doppler modes. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 ? ? Spectral Doppler Map Control 7 The Spectral Doppler Map is a post processing curve that assigns grey scale levels to a range of amplitudes that are received from the reflected signals (blood cells). The settings are A-G with low to high contrast. This completes the review of the Spectral Doppler Soft Keys < Return to the Soft Keys > Proceed Sweep Speed 7 The Sweep Speed is the compression of time that is displayed across the horizontal axis. The Sweep Speed can be expanded or further compressed depending on the Spectral Doppler pattern and clinical need. < Return to the Soft Keys Baseline 7 The direction of the blood cells is plotted alongside the Spectral Doppler Baseline. Moving the Baseline alters the amount of the spectral Doppler velocity range that is displayed above and/or below the baseline. Raise the baseline to display more spectral Doppler signals from below the baseline. Lower the color Doppler baseline to display more spectral Doppler signals from above the baseline. < Return to the Soft Keys Scale 7 Adjusts the Scale to optimize the velocity range that is displayed for the spectral Doppler signal. The appropriate Scale for PW or CW should fit the Spectral Doppler display. Increase the Scale to display a higher velocity range or decrease the Scale to display a lower velocity range. Review the marker below for more information. < Return to the Soft Keys Nyquist Limit In PW Doppler instrumentation, the Nyquist limit is the highest velocity that can be displayed in either direction. The Nyquist limit is twice the PRF. CW Doppler is not effected by the Nyquist limit. Doppler Gate 7 The PW Doppler sampling occurs within the a region called the Doppler Gate. The Rotary Control beneath the ‘Gate’ Soft Key controls the size of the Doppler gate. The position of the Gate is moved using the Trackball. In the examples below, the gate has been angle corrected using the Angle Key on the Control Panel. < Return to the Soft Keys Tint 7 Tint applies a color to the spectral Doppler signal to aid in visualization of subtle differences that can be seen in the Spectral Doppler signal. The Spectral Doppler Tint can be changed on a live or frozen image. < Return to the Soft Keys Dynamic Range (Dyn R) 7 This control adjusts the overall contrast resolution of the spectral Doppler signal. Use a higher Dyn R for softer appearing spectral with more grey Doppler signals. A lower Dyn R will yield a brighter spectral Doppler signal with more white tones. < Return to the Soft Keys 7 Filter is sometimes referred to a wall filtering or reject and is used to remove low velocity signals that can be caused by adjacent soft tissue movement. < Return to the Soft Keys Filter MultiHertz imaging adjusts the PW or CW transducer frequency range independent of the CDV frequency or 2D-mode frequency and helps to achieve the best sensitivity for every imaging mode. This feature allows the highest spectral Doppler resolution while using other modes. MultiHertz multiple frequency imaging 7 < Return to the Soft Keys Select each of the PW / CW Spectral Doppler Soft Keys one through ten that are highlighted in orange below to learn more about some of the Spectral Doppler Soft Key adjustments available on the ACUSON Juniper System. 7 1. MultiHertz 5. Gate 6. Scale 7. Baseline 8. Sweep 9. Map 2. Filter 3. Dyn R 4. Tint PW or CW Spectral Doppler Adjustments Auto Stat The Auto Stat control, shown here framed in orange, automatically traces the spectral Doppler waveform. Adjust the direction from the spectral baseline (above, below, or both directions). Choose the spectral tracing sensitivity. Also, a Mean velocity trace can be added to the spectral Doppler measurement profile. 6 Spectral Doppler – Touch Screen 5 To measure timing and velocity from the myocardial tissue, select DTI from the touch screen to display the PW spectral signal - with or without color DTI. Spectral Doppler – Touch Screen 4 Full D displays the spectral waveform alone. The Invert control reverses the spectral waveform. The Mute control completely silences the audio from the spectral signal. Adjust the volume with from the Soft Key menu shown here framed in orange. Full D Inverted Pulse Wave – Touch Screen Options Activate from the Touch Screen to simultaneously display the 2D-mode with CDV, and Spectral Doppler. 3 eSieImage™ Multiparametric Optimization 2 During real-time imaging, this feature automatically optimizes and continuously adjusts key imaging and Doppler parameters. Select the orange marker shown beneath the eSieImage icon for Doppler Auto Optimization configuration. eSieImage Optimization Configuration To configure the eSieImage optimization parameters go to System Configuration > Display > Doppler / M-Mode. Spectral Doppler - Activate Activate PW or CW from the Control Panel, shown here framed in orange. The behavior of the PW or CW cursor will depend on the transducer and whether the Bypass Cursor feature is enabled. Review each of the markers shown on the Control Panel and Touch Screen for more information. 1 Steer When a linear transducer is selected, use the Steer key on the Control Panel to tilt the cursor to the right, center, or to the left. Angle Correction Use the Angle to correct or change the degree of angle correction for spectral (PW or CW) Doppler. Soft Keys The push rotary controls mimic workflow seen with 2D-mode and CDV imaging Navigate between the top and bottom rows by pressing the control. Turn the rotary control clockwise or counterclockwise to adjust each Soft Key parameter. Touch Screen The Touch Screen functionality remains consistent across modes (i.e. 2D-mode, Color Doppler). On the two pages, active sections highlight in blue, available options display as gray, while unavailable functions have a dithered appearance. Bypass Cursor Configure > Display> then go to Doppler / M-Mode. Check ‘Bypass Cursor Mode’ to activate the Doppler cursor and spectral signal with one click. Uncheck ‘Bypass Cursor Mode’ to activate the Doppler cursor separately from spectral Doppler activation (two clicks). Bypass Cursor is a global setting across transducers and presets. Tap or touch the image below to zoom and increase the image size. Tap or touch the image a second time to close the window. Trackball and Update in Spectral Doppler Position the CW cursor using the trackball. In PW Doppler position the Doppler Gate with the cursor. Use the Update located above the Trackball to toggle between spectral Doppler (PW or CW) and real-time imaging. Course Review Congratulations. You have completed the ACUSON Juniper™ Ultrasound System Major Modes Training. Select the objectives listed below to review the material before proceeding to the final assessment. 1 1 1 2 2 2 Describe the 2D-mode and Doppler controls Examine controls used to optimize 2D and Doppler ? ? Course Review Describe the 2D-Mode and Doppler Controls Activate 2D, Color, PW, and CW (Major Modes) from the control panel and adjust the overall gain with the same push rotary controls. Active Soft Key push rotary controls for all Major Modes are positioned above the control panel and correspond to the Soft Key controls listed above on the Touch Screen. There are two pages of Touch Screen controls for all Major Modes, active selections are highlighted in blue, available controls are in grey, and unavailable controls for the transducer are dithered out. Trackball and set keys control the size and placement of the FOV, CDV ROI, and the placement of the spectral Doppler cursor during real-time imaging. 2D and Doppler dynamic range, maps, tints, baseline, filter, overall gain, zoom, color off, and velocity tagging can be adjusted and/or activated during real-time imaging or frozen image. DGC, Split, Dual, DGC, HD Zoom, color off, velocity tagging, spectral Doppler, eSieImage multiparametric image optimization dynamic persistence, auto flash suppression, Multi Hertz™ Multiple Frequency Imaging, Advanced SieClear™ spatial compounding, clarify VE technology, and CTI must be activated during real-time imaging. Examine Controls Used to Optimize 2D and Doppler MultiHertz™ Multiple Frequency Imaging allows for the transmit frequency of each of the Major Mode to be controlled independently. eSieImage multiparametric image optimization for automated real-time image optimization. Tissue harmonic imaging improves contrast and spatial resolution. Clarify VE technology is a real-time adaptive pixel by pixel analysis that reduces noise and artifacts. Advanced SieClear™ spatial compounding combines multiple images acquired at different steering angles to produce a compounded image. Dynamic TCE technology is an advanced method for speckle reduction. Dynamic persistence technology prevents blurring motion in both two-dimensional (2D) and color Doppler imaging. Custom tissue imaging, CTI adjusts the speed of sound based on the speed of sound appropriate for specific tissue types. Velocity tag assigns a color hue that labels a single velocity or a range of blood flow velocities. Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (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. ACUSON Juniper is a trademark of Siemens Heathineers. Clarify™ Vascular Enhancement (VE) Technology, eSieImage™ multiparametric optimization, MultiHertz™ Multiple Frequency Imaging, Dynamic TCE™ tissue contrast enhancement technology, Advance SieClear™ Spatial Compounding, fourSight™ 4D transducer technology, and Advanced fourSight™ technology are a trademarks of Siemens Medical Solutions USA, Inc. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2021. Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127\ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com Disclaimer ? Disclaimer Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. You have completed the ACUSON Juniper™ Major Modes Training. Completion Help Slides Select the icon above to open the menu. Click Next to continue. Next Menu Help Choose the desired tab to view the glossary or menu. Click Next to continue. Next Prev Glossary Help Click or tap each orange marker to expand the data. Click or tap once more to exit the marker popup. Click Next to continue. Next Prev Orange Marker Expanded Information Subpage X close Help Click or tap each of the numbered slides to view subpages. Click Next to continue. Next Prev Slideshow Help Click or tap each of the orange arrows to view subpages. Click Next to continue. Next Prev Tab Arrow Slide Select the X to close the subpage. Click Next to continue. Next Prev Subpage X close Help Select the in the upper right to exit this navigation help. X Exit Help HOOD05162003162313 | Effective Date 15-March-2021 4B 4B displays four separately acquired still frame images in a quadrant format to display, annotate, or measure each quadrant on one image. Advanced SieClear™ Spatial Compounding Reduce speckle and enhance tissue differentiation in 2D images using Advanced SieClear spatial compounding. Compounding combines multiple images acquired at different steering angles to produce a compounded image with less noise, increasing contrast resolution, and improved border delineation. Angle During Doppler, press the push rotary control to adjust the flow angle in 60° increments (60°, 0°, and -60°). Rotate the control to adjust the flow angle in 1° increments. Auto Flash Suppression Technology Auto flash suppression technology prevents motion artifacts relative to user motion. AVI Audio Video Interleaved. Baseline The baseline is the boundary line for the extent of the range of Doppler velocities that are displayed above and below zero. CD-R Compact Disk - Recordable. Clarify™ vascular enhancement (VE) technology Clarify VE technology is a patented technology that uniquely utilizes power Doppler flow information over the 2D image. This technology decreases artifacts in the 2D image and increases the contrast resolution within vascular structures, and enhances boundary detection. Clips The capture of motion image data. Color Doppler Energy (CDE) This modality is often referred to as Power Doppler mode. Color is applied to the received signals based on the amplitudes that are generated by blood flow from vascular structures. A directional component can be added to CDE by selecting Directional Power (Dir Power). Color Doppler Velocity Color Doppler Velocity (CDV) applies color to the velocities and directions of blood flow within the ROI. Custom Tissue Imaging (CTI) CTI optimizes the 2D image by adjusting the speed of sound, resulting in improved lateral resolution and boundary definition. Depth Gain Compensation (DGC) The 2D brightness is raised or lowered at individual zones in the field of view. This is also known as Time Gain Compensation (TGC). DICOM Digital Imaging and Communications in Medicine. Doppler Auto Stat Enables or disables the default display of measurements and graphical traces to the track mean, maximum velocities, or frequencies. Doppler Tissue Imaging (DTI) Doppler Tissue Imaging (DTI) combined with 2D-mode. DTI applies a color Doppler to depict the movement of tissue. DIT a mode that is available for Echocardiography applications using phased array transducers. Adding PW Doppler to DTI will apply a spectral display of the velocity of the tissue over time. Dual and Seamless Dual Dual displays two static images next to one another. Seamless dual combines the two static images so that a measurement can be made across both images. DVD Digital Versatile Disk. Dynamic Persistence Dynamic persistence technology prevents motion artifacts that cause blurring in both two-dimensional (2D) and color Doppler imaging. This technology enhances static color sensitivity and reduces static 2D noise. Also, see Persistence. Dynamic Range Dynamic range controls the number of grey shades that are displayed. Increasing the dynamic range produces an image with a softer appearance. Decreasing the dynamic range setting produces an image with more contrast. Dynamic TCE™ tissue contrast enhancement technology Dynamic TCE technology is a Siemens proprietary advanced method for 2D-mode speckle reduction. This technology enhances visualization of the tissue texture, subtle tissue contrast differences, border definition, and pathology. Edge Distinguish the contours of a structure during real-time imaging using edge enhancement. Electrocardiogram ECG or EKG is the cardiac physiologic waveform generated from leads applied to the skin. End-Diastole (ED) and End-Systole (ES) End-diastolic and end-systolic are a period defined by the ECG or EKG signal. ED or ES are displayed as a single frame for each period. eSieImage™ Multiparametric Optimization Automated real-time image optimization to maintains the uniformity of image brightness within the field of view using eSieImage technology. The system displays the eSieImage icon on the image screen when the feature is activated. eSieImage optimization automatically tracks tissue on a frame-by-frame basis, identifying tissue versus noise, ensuring that the beam image uniformity, quality, and contrast resolution are optimally maintained across different tissue types. eSieScan Workflow Protocols An eSieScan protocol is a predefined checklist to guide you through a clinical workflow. The user can define protocol steps (views) that include an image or clip with measurements, body markers, and annotations. Also, the user can change the sequence of views during a protocol, pause, and resume a protocol. Additionally, create new workflow protocols or modify existing protocols, import, or export protocols using a USB storage device. FOV Field of View is the region of the 2D image. Freeze Still image generated by tapping the Freeze key on the control panel. Imaging parameters Displays a list of imaging settings for the active operating mode. Live Imaging This is actively using ultrasound in real-time. MultiHertz™ Multiple Frequency Imaging MultiHertz imaging allows the user to independently select 2D, fundamental, harmonics, color Doppler and spectral Doppler center frequencies for each imaging mode. Patient Banner Displays patient information, operator, institution, the system date, and time. Patient Browser The patient browser displays a list of patient studies in the selected storage location, for example, the local database (hard disk), a configured server, or a USB storage device. Patient Demographics Patients Name, Identification Number, Date of Birth, Age, Gender, Height, Weight, Body Surface Area (BSA), and Blood Pressure (BP mmHg). Persistence The amount of time that a frame of image data persists before the next frame of image data appears. Physio Management This assigns the ECG or EKG lead type for use with the physiologic function. Priority This is an adjustable setting available while imaging with 2D-mode and color Doppler. Priority is used to enhance the signal intensity of either the Doppler flow or the 2D image. Prospective Clip The motion image data is captured in series after activating clip capture. Pulse Repetition Frequency Pulse Repetition Frequency or PRF is the frequency of pulses occurring on one second and is measured in Hertz or Hz. R / S Adjust the balance between the image line density (resolution) and the frame rate (speed). Retrospective Clip The motion image data is captured in series just prior to activating clip capture. ROI A region of interest or ROI is a defined and adjustable boundary. Commonly used to describe the region where Color imaging is used (CDV, CDE, DTI, DTE). Scale The Scale adjusts the maximum and minimum velocities or the velocity range that are displayed for CDV and all Doppler modes. Adjust the range of displayed Doppler velocities by adjusting the pulse repetition frequency (PRF). SieScape™ Panoramic Imaging SieScape imaging is a panoramic image with an extended field of view. Smooth This is level of spatial averaging that is used to smooth the color Doppler display. This is a postprocessing feature that adjust the level of spatial averaging and helps to produce a color Doppler image that has less noise at the blood flow tissue boundary. Split Split is a comparison of 2D to other modes during live imaging. Steer In linear array transducer types, steering adjusts the spectral Doppler cursor and the color Doppler ROI to the left or right in increment angles. System Configuration The location on the ultrasound system where the user can enter the utility menus. System status indicators Displays information about the ultrasound system, for example, the signal strength of a wireless network, printer availability, video recording, and transferring data. TEQ Tissue equalization gain is a user definable threshold that accommodates different user preferences for gain settings and various room lighting conditions. THI Activate Tissue Harmonic Imaging (THI) to enhance visualization, improve image contrast and spatial resolution, or reduce noise. Thumbnail panel Displays reference images of stored clips, images, and volumes. TIFF Tag Image File Format Tissue Harmonic Imaging Tissue harmonic imaging (THI) improves contrast and spatial resolution and reduces noise. Trackball The trackball allows adjustment of the image and Doppler optimization tools (i.e., HD Zoom, Doppler gate, and Color ROI). In this course, the trackball keys are named Set. Transmit Power or Acoustic Output Transmit Power is the acoustic power used to produce ultrasound. Two-Dimensional Two-dimensional or 2D is used to define a non-volumetric ultrasound image. USB Universal Serial Bus. Velocity Tag Velocity tag assigns a color hue that labels a single blood flow velocity or a range of blood flow velocities. Wall Filter Doppler modalities use this filter to minimize or remove a low frequency range that is commonly associated with soft tissue movement. 1.1 Welcome 1.2 Overview 1.3 Two-Dimensional 2D-modes 1.4 2D Soft Key Controls 1.5 Additional 2D Features 1.6 Display Features 1.7 Color Doppler Controls 1.8 Color Doppler - Continued 1.9 Spectral Doppler 1.10 Course Review 1.11 Disclaimer 1.12 Completion