ACUSON NX3™ Series Ultrasound System Major Modes
This web-based tutorial will supplement installation training and help the student understand the major ultrasound modalities on the ACUSON NX3™ ultrasound system. (version 1.0)
Major Modes ACUSON NX3 Series Ultrasound Systems Upon successful completion of this course, you will be able to: Review B-mode and M-mode controls Describe B-mode and M-mode optimization features Explain display modes Review Doppler controls Describe Doppler optimization features On the next slides we will cover some display modes. Zoom HD Zoom Conventional dual Seamless dual Available on all linear transducers Increases far field visualization Angle varies by transducer and image preset SieScape Cine SieScape Review Dual Split Next we will describe Doppler optimization features. Invert OFF Invert ON Higher Doppler Scale 1220 Hz Lower color Doppler Scale 867 Hz Baseline in the middle Baseline in the middle Display ON Display OFF Color Doppler velocity maps Power Doppler maps Bypass M/D Cursor is Unchecked Bypass M/D Cursor is Checked Zero degree angle 45 degree angle Scale too low Baseline too high Automatically optimizes: Scale Baseline Gain Dynamic Range Map G Tint 8 Sweep Speed Sweep Speed 1 = 18mm/s 8 = 143 mm/s Above the baseline Above and below the baseline 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 Sequoia is a trademark of Siemens Medical Solutions USA, Inc. Copyright © Siemens Healthcare GmbH, 2019 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 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. The information in this material contains general technical descriptions of specifications and options as well as standard and optional features that do not always have to be present in individual cases. Certain products, product related claims or functionalities described 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. Learn more about B-mode and M-mode controls. Select the Learn more button below. B-Mode M-Mode Controls Learn more about B-mode and M-mode controls. Slide NumberText BlocksCalloutsAudio ScriptImage File1Control and ScreensCalloutsImage ScreenTouch ScreenControl PanelThe system powers up in the 2D mode, also known as B-mode, the B stands from the brightness. In 2D, the brightness or darkness of a structure depends on the depth within the body and how much it absorbs sound. The imaging screen on the ultrasound system monitor displays the 2D clinical images together with important 2D imaging parameters. To optimize the differences in sound absorption, adjust controls on the Control panel, or with the soft keys that are above the rotary controls, and on the Touch Screen. 2Image Screen LayoutCalloutsImage ParametersImaging AreaThumbnailsStatus IconsHomebaseThe imaging screen displays the 2D imaging parameters, the current 2D image, and the acquired thumbnail images. The function of the home base controls is mode dependent. Homebase function changes with whatever mode is active at the time, and that corresponding active status icon is at the bottom of the imaging screen. The active function of the home base key can select the rotary controls, the view key, the trackball itself, and the escape key. 3Image ParametersCalloutsTransducerExam Type2D SettingsFrame RateTransmit PowerThis is an example of the image parameters shown on the side of an endovaginal study using the EC10-5w transducer. 42D and M-mode Control Panel LayoutCallouts2D M-ModeDepth and FocusHD Zoom and DualTrackballDGCPress 2D to activate or return to B-mode imaging. Rotate the 2D knob to change overall gain / brightness. Additionally, pressing 2D will exit any imaging mode. Press M to activate M-mode. Rotate the M knob to change the M-mode gain. Slide the DGC pods to the right or to the left, and this will manually adjust gain or brightness at associated depths. Rotate the Depth/Zoom knob to change the imaging depth. Press the Depth/Zoom to activate Zoom region-of-interest or ROI and then rotate to adjust the ROI size. Press Depth/Zoom once again to activate the Zoom this will magnify the image. HD Zoom increases the image size, detail resolution and frame rate in a region of interest. Press to activate the HD Zoom ROI. Rotate the Depth/Zoom control to adjust the ROI size and press Depth/Zoom again or HD Zoom to activate. Rotate the Focus knob to move the focal zone up/down. Press the Focus knob again to activate multiple focal zones. Dual displays two separately acquired images side-by-side. Press Dual to activate and toggle between the images. Roll the trackball at home base to perform functions in 2D such as panning the image while in Zoom, adjusting the position of the HD Zoom ROI, activating the Cine while in Freeze, or moving the Pointer. 5Touch Screen 2D ControlsCalloutsSoft Keys, Page1Soft Keys, Page 2This is an example of the touch screen controls in 2D; there are two pages available in 2D. Touch the controls located in the touch area to activate. The rotary key assigned to each of the soft keys is below, rotate or press the rotary keys to change the controls. Split activates two simultaneous images in a dual format. Select each one to activate or deactivate. 4B displays four separately acquired images. Select to activate and press the freeze button to add images — Press 2D on the control panel to exit. The offset allows you to scroll the 2D image vertically and/or horizontally. Select Offset, and roll the trackball to scroll the image vertically and/or horizontally. TGO tissue grayscale optimization technology Gain is a user-definable threshold that accommodates different user preferences for gain settings and various room lighting conditions. Full Size maximizes the field of view when the sector size is decreased. Clip Capture designates the clip capture parameters: capture type either prospective or retrospective, the acquisition rate, and trigger type if an ECG is used. Rotate will rotate the image 90 degrees by turning the rotary key clockwise or counterclockwise. This is found under the soft key selection called ‘Rotate. 2D FOV changes the sector angle for transducers displaying a sector format. Turn the rotary key assigned to the 2D FOV soft key to adjust the angle. DTO Dynamic tissue Optimization is a technology that detects and optimizes hyperechoic signals (blooming whites) in real-time to prevent over saturation. L/R or Left/Right and U/D or Up/Down Flip changes the orientation of the image. Modify Map displays controls to modify the shape of the current Gray Map. SynAps (synthetic aperture technology) improves lateral resolution at depth. It is a two pulse technology, so the frame rate is reduced. 6M-ModeCalloutsM-Mode Control PanelM-mode displays a 2D reference image and an M-mode sweep. M-mode allows a graphic display of motion over time. M-mode can be used for tracing a fetal heart rate or, in the example shown, a lung ultrasound to check for pneumothorax. The cursor or M-line indicates the path used to obtain the M-mode tracing. Anatomy that remains stationary displays as a straight line while curved or peaked lines mirror the moving anatomy. To activate M-mode: Press M on the control panel to access the 2D image/M-mode sweep on the imaging screen and the M-mode menu on the touch screen. Roll the trackball to position the M cursor. Select Full M on the touch screen to enter/exit full-screen sweep. Rotate the M to change the overall gain or brightness of the M-mode sweep. To exit M-mode, press the M or 2D control knob on the control panel. There are four 2D / M-mode imaging formats that are displayed. You can display one half with 2D and one half with M-mode trace; one-third 2D and two-thirds M-mode trace; two-thirds 2D and one-third M-mode trace; or Side by side. These formats are configurable under the Presets, then Exam Configuration, then 2D/M & 2D/Doppler Display Format menu. Configure the system under Presets, then Display, then Doppler/M-Mode>Bypass M/D Cursor Display. Uncheck to display the full-screen 2D with the M cursor after pressing M. Check to bypass the initial full-screen 2D with the M cursor and immediately activate it in the 2D / M-mode sweep format. Next we will cover B-mode and M-mode optimization features. Select the Learn more buttons below. B-Mode and M-Mode Optimization I Learn more about B-mode and M-mode optimization. Slide NumberText BlocksCalloutsAudio ScriptImage File1Image Presets: Penetration, General, and Detail Quick image optimization of multiple parameters Image Presets can optimize multiple image parameter settings for the active exam and transducer. Select Image Presets on the touch screen and then select: Pen (Penetration) for improved penetration. Gen (General) for general settings. Det (Detail) for improved resolution. Select Image Presets again to return to the main menu. 2TGO tissue greyscale optimization technologyAutomatically optimizes: 2D - Gain and dnamic range PW - Baseline, scale, gain, and dynamic range Press TGO tissue grayscale optimization technology during the 2D exam to automatically optimize gain and dynamic range. You can also use TGO during Spectral Doppler to perform Doppler Auto Optimization (DAO). Parameters that can be automatically optimized include Gain, Dynamic Range, Scale, Baseline. Use the system presets to select parameters under Presets, then Display, then Doppler/M-mode, and Doppler Auto Optimization. This provides workflow efficiency, decreasing keystrokes and may decrease exam time. 3Tissue Harmonic Imaging (THI): Listens to the harmonic frequency to produce an image Increase contrast and lateral resolution Reduces noise and clutter Tissue Harmonic Image (THI) activates selectable harmonic frequencies to improve contrast and spatial resolution by reducing noise and clutter within the image. The body creates a harmonic signal that is twice the frequency originally transmitted into the body by the transducer. So, for example; if a 2 MHz signal goes into the body, the transducer uses the 4 MHz signal that returns from the body. Select THI on the touch screen to activate or deactivate. The system will display THI next to the frequency value when activated. To change the THI frequency turn the rotary control knob assigned to the MultiHertz soft key. 4MultiHertz Multiple Frequency Imaging: Adjusts center frequency Higher frequency for higher resolution Lower frequency for improved penetration The MultiHertz rotary soft key allows the user to control the MultiHertz imaging functionality of the system. Changing the frequency will enable the user to improve image resolution or penetration. For example, selecting a high-frequency will help to improve image resolution or choosing a low-frequency will help increase penetration. The frequency for 2D, THI, color, and spectral Doppler can be changed independently for optimal image resolution, penetration, and Doppler sensitivity. The MultiHertz soft key adjusts both native and harmonic imaging frequencies. MultiHertz imaging operation depends on two things: 1. Broad bandwidth transducer element sensitivity to a range of returning frequencies. 2. Digital signal processing to select the frequency bandwidth of interest. The user can control the Bandwidth in Multihertz imaging. Bandwidth is described as a percentage of the center frequency. 5Advanced SieClear Spatial CompoundingAdvanced SieClear spatial compounding incorporates SieClear compounding technologies to create exceptional improvements in image quality. Advanced SieClear spatial compounding uses up to seven steering angles on linear transducers and five steering angles on curved array transducers. SieClear compounding receives two angled beams to produce a compound image, and Advanced SieClear compounding uses three, five, or seven received beams. SieClear is setting 2 under Adv.SieClear and Advanced SieClear compounding are settings 3, 4, or 5, respectively. Select a setting of zero will turn all compounding off. The clinical benefit of SieClear and Advanced SieClear spatial compounding is improved contrast resolution and tissue border detection. This is an image of the carotid artery using the VF12-4 transducer. The Advanced SieClear spatial compounding is set at “5” as noted on the imaging parameters area on the screen. Note the well-defined intimal medial border and the contrast resolution. 6Dynamic TCE TIssue Contrast Enhancement: Enhances tissue contrast Reduces speckle Compatible with other technologies Dynamic tissue contrast enhancement technology (DTCE) is Siemens Healthineers proprietary post-processing method for speckle reduction. Speckle is displayed as a granular pattern formed from interferences of backscattered ultrasound waves which substantially lowers image contrast and obscures image details. Dynamic TCE Technology has settings of Off, Low, Medium or High. A high level of Dynamic TCE technology will emphasize borders and strong reflectors in the image. The benefits of this technology include enhanced contrast in subtle tissue areas. Dynamic TCE Technology is compatible with other technologies such as Advanced SieClear Spatial compounding, color, and power Doppler. This is an example of a uterus using the EC9-4 endocavity transducer. In this example, Dynamic TCE technology is set to Medium and demonstrates contrast resolution of the uterine fundus, body, and the cervix. Note the detailed look of the endometrial lining. B-Mode and M-Mode Optimization II Learn more about optimizing B-mode and M-mode. Slide NumberText BlocksCalloutsAudio ScriptImage File1Dynamic range: Enhances contrast resolution Higher setting results in a softer / grayer appearance Lower setting results in a more black / white appearance Dynamic Range adjusts how many shades of gray that are displayed on the image. A low dynamic range setting increases the image contrast and is more black and white. A high dynamic range decreases the image contrast and has increased grey levels. This is why the dynamic range selected also changes the contrast resolution. To change the Dynamic Range, turn the rotary control assigned to the DR soft key. The Dynamic Range settings in 2D are transducer-dependent and change in increments of 5 decibels. 2Frame Rate: How many times an image is updated per second Impacted by the image depth, width, and number of focal zones Higher frame rates provide increased temporal resolution How often a system updates, the image is called “Frame Rate.” Temporal resolution is the system’s ability to display closely spaced time events and represent rapidly moving structures. The Frame Rate determines the temporal resolution. Temporal resolution or frame rate should be higher when assessing moving structures, like a heart valve. The higher the frame rate, the more accurately the movement can be displayed. To improve frame rate and temporal resolution, you can decrease the image depth; or you can reduce the number of focal zones or narrowing the image field of view. These changes will reduce the time needed to acquire an image and improve the frame rate. In this venous valve example, note that the frame rate is 41 frames per second. This was achieved by reducing the image depth to a shallow 4 centimeters. Remember frame rate is especially important when imaging moving objects. Higher frame rates are necessary for all cardiac imaging and imaging the fetal heart. A faster frame rate will catch venous value movement and help distinguish peristalsis in the bowel. 3Resolution / Speed (R / S): Balance between image line density and frame rate Lower R / S settings decrease image detail and increase the frame rate Higher R / S settings improve image detail and decrease frame rate You can increase or decrease the number of acoustic scan lines per frame for 2D images. Increasing the scan lines or line density improves image detail, but it will also decrease the frame rate. The Resolution/Speed (R/S) setting adjusts the balance between the image line density (resolution), and the frame rate. Select R/S on the touch screen to increase or decrease resolution or speed. Selections in 2D include 0 through 5. Clinical Benefits include optimization of specific anatomy for the maximum resolution (for example, the breast or a small parts study. Or to provide a higher frame rate when needed, for example in a fetal heart or an arterial study. The example shows a testicular image using the EC10-5w transducer with the R/S set at 4. Notice how it favors resolution. The frame rate is not affected (30 frames per second) since this is a superficial organ. Using the resolution setting on deeper structures will impact the frame rate 4Edge and PersistenceEdgePersistenceEdge Enhancement known as ‘Edge’ distinguishes the contours of a structure during real-time imaging and suppresses changes in brightness across the image to enhance or smooth borders. A sharper image is created by combining adjacent signals. This will show higher contrast and brighter edges of structures. Higher edge settings provide increased border enhancement. Lower settings smooth the edges or boundaries. Select Edge on the touch screen to select a setting. Settings range from 0 through 3. Persistence provides a visible smoothing effect to the 2D image by temporarily maintaining lines of image data for each frame of imaging. The amount of persistence used determines the number of images the system combines into the final image. For example, when the persistence is set at 0, the image updates with every sweep of the transducer. A Persistence of 1 results in the averaging of two images, and so on. At higher settings, the number of images averaged is higher. This will reduce noise and make the image appear smoother. Select Persist on the touch screen to select a setting. Settings range from 0 through 4. Persistence is not available if Advanced SieClear compounding settings are turned on. Reduce Adv.SieClear control to a SieClear compounding of 2 or set to 0 to turn off. 5Map HMap FMapsThe Map parameter is used to select a processing curve that assigns echo amplitudes to gray levels. The active Map is depicted by a gray bar, which is displayed on the right side of the image screen. The gray bar represents the range of gray shades available for the selected Map. A gray map determines how dark or light you prefer to show each level of white/gray/black based upon the strength of the ultrasound signal. The Map control can be activated during real-time imaging or when the system is in freeze. Turn the rotary assigned to the Maps soft key selection to select a gray map. Settings are from A through I. A shows lower contrast and Map I shows higher contrast. There are three customizations (setting 1 through 3) to the maps. By modifying a map, you are redistributing the range of echo amplitudes assigned to the available gray shades. You can reposition the variation of grey within a specific range. The system automatically recalculates the curve and updates the image. 6TintsTint 2Tint 9Adding a “Tint” changes the color of the image by adding up to 16 tints. Rotate the soft key on the Control Panel below the touch screen. Adding a “Tint” to the image can assist in visualizing subtle changes in tissue. This is an example of a jugular vein image using the VF12-4 transducer applying a ‘Tint’. Note that you can see the spontaneous flow and valve detail. 7Clarify Vascular Enhancement (VE) TechnlogyClarify Vascular Enhancement Technology is a unique imaging technology from Siemens Healthineers that reduces image noise and artifacts in vascular studies, producing an exceptional definition that promotes the detection of vascular disease. Clarify Vascular Enhancement Technology uniquely utilizes power Doppler flow information to enhance 2D-mode imaging in real-time. Clarify Vascular Enhancement Technology is an adaptive, pixel-by-pixel analysis that provides exceptional contrast resolution for clear delineation of vessels. Clarify Vascular Enhancement Technology or Clarify VE can also be useful to outline vascularity to increase visualization of surrounding anatomy as in the pancreas. Clarify VE is available on all linear and curved transducers and can enhance vascular studies. Clarify VE technology does not change the B-mode image in nonvascular structures, for example, within the gallbladder or urinary bladder. Next, we will cover Doppler controls. Select the Learn more button below. Doppler Controls Learn more about the Doppler controls. Slide NumberText BlocksCalloutsAudio ScriptImage File1Callouts'C' ColorPower'D' Doppler'CW' Continuous WaveAngleSteerThe primary keys on the control panel are: 1. The ‘C’ control that will enter and exit color Doppler. Rotate the C knob control to change overall color Doppler gain. Gain is from negative 20 dB to positive 20 dB and can be adjusted in one-decibel increments. 2. Press Power to enter or exit power Doppler. Rotate C to change overall power Doppler gain. Gain is from negative 20 to positive 20 decibels and adjusts in one-decibel increments. 3. Press the ‘D’ control to activate the Doppler cursor. Press D again to enter pulsed wave or PW spectral Doppler. Rotate the D to adjust overall spectral Doppler gain. Press the 2D to exit. Gain is from 0 dB to 90 dB in one adjusts in one-decibel increments. 4. Press CW for continuous wave spectral Doppler to activate a steerable continuous wave Doppler. This is only on phased array transducers or the auxiliary CW pencil transducers. Please note for pulsed wave Doppler and steerable continuous wave Doppler, configure the system under Presets, then Display, Doppler/M-Mode, and then Bypass M/D Cursor Display. While you are there uncheck the box to display the full-screen 2D with the Doppler cursor after pressing continuous wave. And finally, check the box to bypass the initial full-screen 2D with the Doppler cursor and immediately activate the 2D and Doppler split format. With this configuration, during 2D with Doppler, you can use the update key to toggle between a real-time 2D image and a frozen Doppler spectrum or a frozen 2D image with a real-time Doppler spectrum. The update status is seen at the lower right of the screen and indicates what active options are available. Let’s continue with the remaining primary keys on the control panel: 5. Use the Steer control to toggle steering between the color Doppler region of interest or ROI and to steer the spectral Doppler cursor right / left. 6. Press Angle to adjust the flow angle from 0° to 60°and back to 0°, or, rotate Angle to adjust the flow angle by 1° increment. Angle depicts the degree of angle correction for the Doppler spectrum. When you first activate any Doppler, the display of the flow angle and cursor will be exam-dependent. The system also displays the values of angles greater than 1° on the screen. When the angle is 65° or greater, the system highlights the value of the angle in green. 7. Press the Set key to toggle the size and position options for the color Doppler ROI. The trackball status at the lower right of the screen indicates the active option. 8. Press TGO Tissue Grayscale Optimization during spectral Doppler to automatically optimize the selected parameters. Use the system presets to select the parameters you wish to display by going to Presets, then Display, then Doppler/M-Mode, then the Doppler Auto Optimization. Parameters that can be automatically optimized include Gain, dynamic range, scale and baseline. 9. Dual, Zoom and HD Zoom are available in color Doppler. Zoom is available for the 2D reference image in spectral Doppler. 10. From the Home base roll the trackball to perform functions in Doppler such as: position the color Doppler ROI, change the size of the ROI in color Doppler, position the spectral Doppler cursor, cine through the frozen Doppler image, cine through a frozen spectral Doppler waveform, and position the pointer. In summary, we covered these controls, features, and optimizations for major modes: Review B-mode and M-mode controls Describe B-mode and M-mode optimization features Explain display modes Review Doppler controls Describe Doppler optimization features Thank you! Complete the self verification section below to verify that you have performed the appropriate tasks.