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ACUSON SC2000 Z6Ms Volume Imaging Fundamentals

ACUSON SC2000 Z6Ms Volume Imaging Fundamentals Job Aid

SIEMENS Healthineers SIEMENS Healthineers .. Z6Ms Transducer Volume Imaging Fundamentals .... ACUSON SC2000 PRIME ultrasound system 1 Unrestricted © Siemens Healthineers 2020 Speaker Notes The purpose of this presentation is to provide an introduction to the basics of volume imaging using the ACUSON SC2000 PRIME ultrasound system and the Z6Ms transducer. Note: Some of the features discussed are contained in 6.0 software only. Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume direct manipulation tools and icons • Describe 4D echocardiography workflow tools 2 Unrestricted © Siemens Healthineers 2020 Speaker Notes The objectives of this presentation include: • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume manipulation tools and icons • Describe 4D echocardiography workflow tools We will begin by explaining some volume imaging terms, definitions and descriptions. Notes No. 2 SIEMENS Healthineers Z6Ms transesophageal transducer SIEMENS . Healthineers ... • Single crystal matrix array transesophageal (TEE) transducer • Real-time, full volume B-mode and color Doppler imaging • Imaging modes: 2D and 4D B-mode and color flow Doppler, M-mode, pulsed and continuous wave spectral Doppler 3 Unrestricted © Siemens Healthineers 2020 Speaker Notes The Z6Ms transesophageal (TEE) transducer provides real-time, full volume B-mode and color Doppler imaging for general and interventional imaging needs. The following imaging modes are available: • 2D and 4D B-mode • 2D and 4D color flow Doppler • M-mode • Pulsed and continuous (PW and CW) spectral Doppler Notes No. 3 SIEMENS Healthineers Z6Ms transesophageal transducer SIEMENS . Healthineers ... Thermal design • Designed to transport heat away from Acoustic Window the electronic components and array ......... • Acoustic window provides thermal insulation between the acoustic array and esophagus to prevent hot spots Front Back • Cool Down State – lowers consumption by ~50% in B-mode and color flow Doppler for uninterrupted imaging 4 Unrestricted © Siemens Healthineers 2020 Speaker Notes The Z6MS has unique thermal design components which prevent excessive over heating that can be common in matrix array transducers. It is designed to transport heat away from the electronic components and the array. The acoustic window provides thermal insulation between the acoustic array and the esophagus to prevent hot spots. The Z6Ms also has a Cool Down State which lowers power consumption by about 50% and B-mode and color flow Doppler for uninterrupted imaging. During this time frame rates and volume rates are reduced by half. Notes No. 4 SIEMENS Healthineers Smart buttons and articulation controls SIEMENS . Healthineers ... Smart buttons • Four configurable options for efficiency (two on each side of transducer handle) Articulation controls • Anterior, Posterior, Left, and Right articulation dials with individual lock mechanism • Quick Rotation (30° increments) and 0/60° (one degree increments) controls located on system 5 Unrestricted © Siemens Healthineers 2020 Speaker Notes There are four smart buttons which offer configurable options for efficiency. There are two located on each side of the transducer handle. There are anterior, posterior, left, and right articulation dials. Both dials have a lock mechanism. The smart buttons can be configured for angle adjustment. Additionally, there are angle controls located on the system. The Quick Rotation control allows 30 degree increments and the 0/60 degree control allows rotation in one degree increments. Notes No. 5 SIEMENS Healthineers Bi-plane+ imaging SIEMENS .. : Healthineers' ... OdB / MI: 0.61 / TIS: 0.32 • Allows two imaging planes with Cardiac / TEE / Z6Ms Lens Temp: 38.2º C different rotation and tilt angles in a 21 fps / 140 mm 65 bpm / General side-by-side format -2D --- H5.5MHZ / -1 dB TEQ: 1 / Offset: 0 dB DR: 57 dB • Angle of each image is indicated by angle indicator • Angles of two images can be adjusted simultaneously or individually by using the 0/60° control Parallel, lateral and free tilt 0/600 • capabilities 6 Unrestricted © Siemens Healthineers 2020 Speaker Notes Bi-plane+ imaging allows two imaging planes with different rotation and tilt angles to be displayed in a side-by-side format. The angle of each image is displayed by the angle indicator and can be adjusted simultaneously or individually by using the 0/60° control, located on the control panel. Press the 0/60° control to toggle through to activate one or both images. If one image is active it will display red and the inactive image will display gray. When both images are active, the reference image (image on the left) displays in red and the image on the right side of the screen displays in green. Bi-plane+ also allows multiple tilt functions: 1. Parallel tilt – both planes either have the same rotation angles or the opposite rotation angles (a difference of 180° between the rotation angles). For angles tilted 1° or more, the planes tilt away from each other. 2. Lateral tilt – the planes remain orthogonal when the user tilts the reference plane on the left side relative to the plane on the right. 3. Free tilt – the planes intersect, but do not have to be orthogonal. Notes No. 6 SIEMENS Healthineers Definitions and descriptions SIEMENS .. ; Healthineers' ... Two-dimensional (2D) image • A static or real time display of a single plane of imaging • Two dimensions Height (vertical) Width (horizontal) • Unit of display is a pixel 7 Unrestricted © Siemens Healthineers 2020 Speaker Notes To review, a two-dimensional (2D) image is comprised of horizontal and vertical (x and y) dimensions and if rotated on its side it becomes a thin line. In ultrasound, the two dimensions are often referred to as height and width. The 2D image unit of display is called a pixel but can also be called a picture element. A pixel is the smallest building block of a digital picture. Notes No. 7 SIEMENS Healthineers Definitions and descriptions SIEMENS .: Healthineers ... Three-dimensional (3D) surface or volume rendered (VR) image • Three dimensions: Height (Azimuthal plane) Width (Coronal plane) Depth (Elevation plane) • Unit of display is a voxel 8 Unrestricted © Siemens Healthineers 2020 Speaker Notes A three-dimensional (3D) surface or volume rendered image contains three dimensions: height (azimuthal), width (coronal) and depth (elevation). A 3D surface or volume rendered image is displayed as a still image whereas a four-dimensional (4D) volume image is displayed as a moving structure(s). In the next slide, we will further define 4D volume imaging. An example of a 3D surface image would be a “fetal face” ultrasound exam. In echocardiography, we utilize 4D volume imaging. The unit of display in 3D/4D imaging is called a voxel but it can also be known as a volumetric pixel. A voxel is a unit of graphic information that defines x, y, z points in a three-dimensional space. Notes No. 8 SIEMENS Healthineers Definitions and descriptions SIEMENS. Healthineers' ... OdB / MI: 0.89 / TIS: 0.29 TEE* / Z6Ms Four-dimensional (4D) full volume Lens Temp: 40.0º C rendered (VR) image 19 vps / R 8.400 mm 69 bpm / General* --- 4D --- 4.5MHZ A DR: 60 dB • Sometimes referred to as “real- time” display three imaging dimensions—height, width, depth. The fourth dimension is time. B • Unit display is a voxel C 9 Unrestricted © Siemens Healthineers 2020 Speaker Notes Four-dimensional (4D) volume echocardiography which is sometimes referred to as real-time three-dimensional (3D) imaging of the heart with volumes per second (vps) or frame rates that are sufficiently high enough to evaluate the fast motion of important anatomical structures, such as the mitral and aortic valves or even the left ventricle. The 4D full volume rendered image, contains three dimensions such as height, width and depth but also includes time. The unit of display is a voxel. In the slide example, we notice the 4D volume image and three additional multiplanar rendered (MPR’s) images labeled A, B, C. MPR’s are reference planes extracted from the volume. In the next slide, we will review the MPR’s in greater detail. Notes No. 9 SIEMENS Healthineers Volume imaging planes SIEMENS. Healthineers ... A Azimuthal 19 vps 71 bpm / General* 68/46 mmHg ..- 4D --- 5MHZ 6 dB DR: 60 dB 52 Coronal C B Elevation 10 Unrestricted © Siemens Healthineers 2020 Speaker Notes As discussed in an earlier slide, a volume image consists of three dimensions— azimuthal, elevation and coronal. We will further breakdown the planes individually. In the volume image dataset above, the first imaging plane is the red box which is the “Home” view is called the azimuthal plane or “y” plane (Label A). This plane can also be referred to the lateral plane. The azimuthal plane allows the user to manipulate the dataset from right-to-left. The green box/imaging plane is called the elevation plane or “z”plane (Label B) which allows the user to manipulate the dataset from front-to-back. Finally, the coronal plane or C plane is seen as the light blue box, and allows the user to manipulate the dataset from top-to-bottom. The coronal plane displays both the azimuthal and elevational planes at the same time at a single cross sectional plane. Notes No. 10 SIEMENS Healthineers Volume acquisition SIEMENS. Healthineers' ... • Optimal 2D imaging is essential to a quality volume acquisition 15 vps 85-bpm / General --- 4D --- 4.5MHZ 10 dB DR: 62 dB • Prior to acquisition it is important to evaluate all three reference planes for boundaries • Alignment is important for assessment of specific anatomy 11 Unrestricted © Siemens Healthineers 2020 Speaker Notes As with any type of volume acquisition, the volume rendered image will reflect the original two-dimensional (2D) image. Thus, it is essential to begin with the best possible 2D image. If the 2D image is not appropriately optimized with parameters such as overall gain, dynamic range, dynamic tissue contrast enhancement (DTCE), frequency, etc., the volume image may be clinically undiagnostic. Additionally, prior to acquisition it’s important to closely evaluate the multiplanar rendered (MPR’s) imaging planes to ensure anatomical structures of interest remain within the field-of-view. If not, the catheter may need to be manipulated or changed position to view the structure of interest. To adjust the MPR’s, the user can adjust the axis markers within each plane. It is best to adjust the axis markers in the azimuthal and elevational planes. Use the coronal planes for reference as it display both the azimuthal and elevational plane simultaneously. Notes No. 11 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume direct manipulation tools and icons • Describe 4D echocardiography workflow tools 12 Unrestricted © Siemens Healthineers 2020 Speaker Notes We will now discuss beginning an exam and volume acquisition. Notes No. 12 SIEMENS Healthineers Beginning an exam SIEMENS . Healthineers ... 1. Press the Power key 2. Enter the Patient 1 Information Power 2 ...... Enter Patient Information 13 Unrestricted © Siemens Healthineers 2020 Speaker Notes The first step to operating the ultrasound system is to connect the system to an approved power source / outlet. The POWER button is located on the upper left corner of the control panel. This control flashes green when the system is connected to a power supply and shut down. The control illuminates green when the system is connected to a power supply and powered on. It should be noted, operating the ultrasound system in close proximity to other equipment can cause reciprocal interference. You should observe and ensure normal operation of the ultrasound system and other equipment. Notes No. 13 SIEMENS Healthineers Image optimization SIEMENS . Healthineers ... 2D image optimization 1. Increase or decrease the 1 O overall 2D gain with 2D Gain 4 control 2 2. Press TEQ (Tissue Equalization 3 Technology) for image uniformity 3. Increase or decrease the Depth control if necessary 4. Press Clip Capture control key to store a moving image 14 Unrestricted © Siemens Healthineers 2020 Speaker Notes Once the Z6Ms transducer has been introduced into the esophagus and imaging has begun, the overall gain will likely require optimization. The overall 2D gain / brightness of the image can be adjusted based on user preference by rotating the mode specific 2D Gain control or the Gain Freeze / Cine Rotary Knob. The 2D gain setting will vary depending on patient and exam. Another image optimization option available to the user is Tissue Equalization Technology (TEQ). TEQ can be a very useful tool in the intracardiac laboratory because it allows for instant 2D B-mode optimization providing overall B-Mode uniformity of the image brightness in the field-of-view (FOV) with a single push of a button. TEQ optimizes the master gain, TGC and lateral gain (LGC). TEQ helps in standardizing image quality across users and improves workflow by reducing exam time. TEQ has 3 levels: 1- Manual, 2 - Semi-dynamic, and 3 - Dynamic. The ACUSON SC2000 Ultrasound system employs a technology called InFocus Coherent Technology. InFocus technology allows for hands-free, dynamic focusing throughout the entire field-of-view. This feature is enabled as a default during active imaging. When imaging in the intracardiac lab, the Depth control will need to be identified Notes No. 14 SIEMENS Healthineers because anatomical structures can vary in depth. Image depth may be adjusted by rotating the Depth rotary control on the control panel. Image depth is displayed on the image screen and will be captured in stored / printed images. It is important to note that the range of depth settings will vary based on the transducer. Once the images are ready to be stored to the patient’s study file, locate the Clip Capture to store a moving or a static image. Notes No. 14 SIEMENS Healthineers Image optimization SIEMENS . Healthineers ... Color flow Doppler optimization 1. Increase or decrease the O 2 1 O overall color flow Doppler 3 gain with C Gain control 2. If necessary, press the Freeze / Scroll to scroll through the image 3. Press Clip Capture control key to store a moving image 15 Unrestricted © Siemens Healthineers 2020 Speaker Notes If color flow Doppler imaging is necessary, the user can activate by selecting the C Gain rotary control. Color Doppler uses Doppler technology to provide a qualitative display of the blood flow to an organ, through a vessel, our being pumped in the heart. The colors are defined by flow towards and away from the transducer. The brighter the color, the higher the mean velocity. When evaluating discreet jets of blood flow, it may be required to use the Freeze / Scroll rotary wheel to scroll the an image frame-by-frame. Once the images are ready to be saved to the patient’s study file, locate the Clip Capture to store a moving or a static image. Notes No. 15 SIEMENS Healthineers Image optimization SIEMENS . Healthineers ... Pulsed wave Doppler optimization 1. Increase or decrease the O 2 O 1 overall pulsed wave Doppler 3 gain with PW Gain control 2. If necessary, press the Freeze / Scroll to scroll through Doppler waveform 3. Press Clip Capture control key to store an image 16 Unrestricted © Siemens Healthineers 2020 Speaker Notes In certain clinical scenarios spectral Doppler imaging may be necessary for further pathology interrogation and diagnosis. The user can activate spectral Doppler by selecting the PW or CW rotary control. Spectral Doppler display is a graphic technique which displays peak, mean, and range of velocities. The baseline is zero velocity with flow toward the transducer on top and flow away from the transducer on the bottom. Velocities increase in speed the further away from the baseline. When evaluating discreet jets of blood flow, it may be required to use the Freeze / Scroll rotary wheel to scroll the spectral Doppler waveform frame-by-frame. Once the images are ready to be saved to the patient’s study file, locate the Clip Capture to store a moving or a static image. Notes No. 16 SIEMENS Healthineers Review SIEMENS . Healthineers ... 1. Press Review key to view O 1 the acquired images • Double-click a thumbnail to enlarge the image Review 17 Unrestricted © Siemens Healthineers 2020 Speaker Notes To review a study or acquired images with an exam: 1. Press Review on the control panel. Images will appear in a quad format. • To view an image 1:1, double-click the thumbnail to enlarge the image. Different icons will illustrate what type of capture the image is – volume capture, clip capture, or still image. There is also an image counter number on each image for ease of recognition and tracking. The total number of clips and the types of clips are located at the bottom of the thumbnails in the task pane section of the monitor. Totals: S = Still; C = Clip; V = Volume. Notes No. 17 SIEMENS Healthineers Calculations and measurements SIEMENS .: Healthineers ... Measurements ........... Task Pane Adult Echo .......... ....... Measurement Category Left Ventricle ................. Measurement Group Calculations 2D D M RVD d PLAX Manual Measurement IVS d PLAX LVID d PLAX LVPW d PLAX ................ eSie Measure Contextual Generic automated measurements 2D Measurements 18 Unrestricted © Siemens Healthineers 2020 Speaker Notes The measurement function provides general measurement tools and reporting capabilities for all patient studies. Calculation packages have measurement groups with specific measurement tools, measurement labels, calculations, and results. When entering Measurements through the Calculation button on the control panel, the measurement menu is contextual and is activated to generic measurement calipers. For example: in 2D, the generic measurement default caliper is distance. The active generic measurement is highlighted white. The Task Pane displays the measurement groups. eSie Measure automated measurements are in 2D, M-mode and spectral Doppler and are represented by the ACUSON A symbol next the measurement. Notes No. 18 SIEMENS Healthineers Measurements on the volume* SIEMENS .. : Healthineers ... • Ability to perform generic / MI: / TIS: / TIB: / TEE* / Z6Ms 90% measurements on volume .58 m/s 10 vps / 90 mm rendered image 67 bpm / General --- 4D --- 4.5MHZ 3 dB TEQ: 1 / Offset: 0 dB DR: 60 dB 0.58 m/s --- Color --- • Available during acquisition or CDV / 3.3MHZ 0 dB 15 / 19 volume review; not in image/clip review • Distance, trace, ellipse, angle, volume, area ratio, and distance ratio 1 Distance = 1.12 cm 2 Distance = 1.31 cm 19 *This feature is available on 6.0 software only. Unrestricted © Siemens Healthineers 2020 Speaker Notes Users are able to perform generic measurements on a volume rendered image. The functionality is available during acquisition or volume review. As these are generic unlabeled measurements, the values will not populate to the report. In this example, the axis markers are aligned with an atrial septal defect and measurements are performed on the volume. Measurements can also be made on the MPRs. Note: This feature is available on 6.0 software only. Notes No. 19 SIEMENS Healthineers End an exam SIEMENS .. : Healthineers ... SIEMENS SC2000 1. Select the Check Mark to Acquisition Transducer 4V1c end the exam Exam Preset Cardiac" 2D Persistence TEQ OFF 2 3 DTCE OFF Capture Preview Off Review 1 V 20 Unrestricted © Siemens Healthineers 2020 Speaker Notes Select the check mark to indicate to end the exam. Notes No. 20 SIEMENS Healthineers Shut down system SIEMENS.: Healthineers ... X or C System Shutdown X Complete background jobs before shutting down. Shut Down Cancel 21 Unrestricted © Siemens Healthineers 2020 Speaker Notes After concluding the study with the selection of the checkmark, shut down the system using the X mark in the Access bar or using the Power button on the control panel. Either one will provide a System Shutdown dialogue box. Choose between completing background jobs before shutting down or select the Shut Down selection. The system takes approximately 30 seconds to shut down. Notes No. 21 SIEMENS Healthineers Volume acquisition SIEMENS . Healthineers ... Optimize the 2D image O O 1 2 1. Press 4D 2. To acquire a volume, select the Clip Capture key 22 Unrestricted © Siemens Healthineers 2020 Speaker Notes In the intracardiac laboratory, most users utilize a time based capture but an R-wave capture can also be used if ECG cables are properly positioned on the patient. Once the desired image has been identified and properly optimized, press 4D on the control panel. Next, select the Clip Capture key to obtain a full volume data acquisition. The ACUSON SC2000 PRIME ultrasound system can be configured for Prospective or Retrospective capture. Notes No. 22 SIEMENS Healthineers 4D RES Enhanced Resolution Imaging SIEMENS . Healthineers ... 1. Select RES key O 2. Use the trackball to 1 4 position RES box over the anatomy of interest 3. Use the Next key to 3 toggle between adjusting position or size 4. Press 4D to display the magnified region of interest 23 Unrestricted © Siemens Healthineers 2020 Speaker Notes RES enhanced resolution imaging (aka Acoustic Zoom or write zoom) re-optimizes and re-scans the selected region of interest to increase temporal resolution (frame rate) and enhance visualization. RES is easily accessible from the control panel. Res is especially useful when imaging if the user desires to increase magnification of specific anatomy such as the left atrial appendage or the cardiac valves. To acquire a live 4D RES enhanced resolution image: 1. Select RES key. 2. Position RES box over region of interest. 3. Use Next key to toggle between adjusting position or size. 4. Press 4D knob to display the magnified region of interest. NOTE: To exit the enhanced resolution image, select the Exit RES soft key. Notes No. 23 SIEMENS Healthineers Volume imaging controls SIEMENS . Healthineers' ... Real-time two-dimensional (2D) acquisition control menu Acquisition Lens Temp: 39.3º C Transducer Z6Ms 39 fps / R 19.10 mm Exam Preset TEE 64 bom ..- 2D Cool Down State Off H5.5MHZ / -1 dB DR: 65 dB 2D Persistence 0 TEQ OFF 2 3 DTCE OFF Capture Preview Off Preset 1 / Preset 2 Set TEQ Offset 2D FOV Review Select 24 Unrestricted © Siemens Healthineers 2020 Speaker Notes It’s important to note the different options available in real-time two-dimensional (2D) or four-dimensional (4D) imaging. In this slide, we will review the real-time 2D image acquisition control menu. On the left side the of the monitor, selectable imaging parameters are available such as: Transducer-Lists the connected transducers Exam Preset-Lists the available exam presets for the connected transducer. The system provides predefined image optimization settings to accommodate different tissue types. The number and types of image presets available depend on the active transducer and exam type. Begin with selecting the appropriate transducer and the appropriate preset. Once an image look has been Persistence-Controls how rapidly an image appears to change over time. Use lower levels for rapidly changing anatomy as in cardiac valves. Higher levels provide a smoother image for slow moving structures Tissue Equalization Technology (TEQ)-Optimizes the overall uniformity of the image brightness in the field of view (FOV) with a single push of a button. TEQ optimizes the master gain, TCG and lateral gain (LGC). Helps in standardizing image quality across users and improves workflow by reducing exam time. TEQ has 4 levels: OFF 1- Manual, 2 - Semi-dynamic, and 3 - Dynamic. Notes No. 24 SIEMENS Healthineers Dynamic Tissue Contrast Enhancement (DTCE)-Speckle reduction algorithm that also adjusts the smoothing and contrast noise. DTCE has 4 Levels: OFF, 1-Low, 2-Medium, 3-High. If the image appears to be too noisy it may be beneficial to use a DTCE level of 3 to decrease the additional speckle in the image. If more speckle information is necessary, then a DTCE level of 1 of OFF may be required. Additional 2D imaging options are available on the home base keyboard. Notes No. 24 SIEMENS Healthineers Volume imaging controls SIEMENS .. ; Healthineers' ... Real-time four-dimensional (4D) volume control menu Lens Temp: 40.1º C R vps / R 28.80 mm 66 bom 4D P Volume Enhance 2 Persistence O TEQ OFF 1 2 3 DTCE OFF Capture Preview Off Slice Single V : On /Off Reset Orientation Box Edit: On/Off Adjust Cine 25 Unrestricted © Siemens Healthineers 2020 Speaker Notes Next, we will review the real-time four-dimensional (4D) image acquisition control menu. On the left side of the control menu, selectable imaging options are available such as Volume Enhance, Persistence, Tissue Equalization Technology (TEQ), and Dynamic Tissue Contrast Enhancement (DTCE). Additionally, 4D volume visualization controls are available during live and review. We will review the volume visualization controls in depth in the next slides. The home base design also has 4D imaging options such as, Reset Orientation, Volume Tilt, Slice, Single (On / Off), Box Edit (On / Off). Prior to an exam or a procedure, it may be helpful to familiarize the users with commonly used controls. Notes No. 25 SIEMENS Healthineers Four-dimensional (4D) volume visualization controls SIEMENS . Healthineers ... Name / Tool Icon Description Screen Format Displays a menu of available display formats: Axis Markers Hides or displays all axis markers on the volume and reference planes Cut Plane Enables or disables the cut plane function for viewing the anatomy of interest in a volume Unsynchronized Cut Enables or disables synchronization of the cut plane with any of the Plane reference planes Box Edit Reset Cancels any changes made to the volume using the box editing tool Wireframe with Cut Hides or displays the wireframe around the volume Plane 26 Unrestricted © Siemens Healthineers 2020 Speaker Notes Various four dimensional (4D) volume visualization controls are available. The table above provides details regarding each of the available controls. The 4D volume visualization controls are available in live imaging and in review. Notes No. 26 SIEMENS Healthineers Four-dimensional (4D) volume visualization controls SIEMENS . Healthineers ... Name / Tool Icon Description Reference Plane Lock Maintains the relative positions of the planes when one of the locked planes is manipulated Reference Plane View Displays reference planes in one view SieShell Animates the volume to display the volume as two vertical halves Image Parameters Enables or disables on-screen image parameters (On / Off) Dual V Animate the volume to display the two horizontal halves Septal Guide Enables or disables the septal guide tool 27 Unrestricted © Siemens Healthineers 2020 Speaker Notes Various four dimensional (4D) volume visualization controls are available. The table above provides details regarding each of the available controls. The 4D volume visualization controls are available in live imaging and in review. Notes No. 27 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume direct manipulation tools and icons • Describe 4D echocardiography workflow tools 28 Unrestricted © Siemens Healthineers 2020 Speaker Notes Next we will review volume direct manipulation tools and icon. Notes No. 28 SIEMENS Healthineers Rotation and manipulation icons SIEMENS . Healthineers ... X / Y rotation tool • Place cursor over area in orange • Allows X and Y axis rotation of the axis markers Z Rotation tool • Place cursor over area in orange • Allows Z axis rotation of axis markers 29 Unrestricted © Siemens Healthineers 2020 Speaker Notes Volume datasets can be manipulated or rotated during live imaging or review. We will review each of the rotation and manipulation options. The X / Y rotation icon rotates the reference plane along the “x” and “y” axis. The Z rotation icon rotates the reference plane around the reference line. The Pan tool allows for ability to reposition the center point of the reference plane. It should be noted that some of these icons will appear on the multiplanar rendered (MPR’s) and the volume rendered image. Notes No. 29 SIEMENS Healthineers Rotation and manipulation icons SIEMENS . Healthineers ... Pan tool • Place cursor over area in orange • Allows panning of reference area Pan tool (single axis marker) • Place cursor over area in orange • Allows PAN of a single axis marker up / down or right / left SieSync volume synchronization tool • Allows automatic synchronization of the 4D volume to any MPR (multiplanar rendered image) • Place cursor in the lower right corner of MPR 30 Unrestricted © Siemens Healthineers 2020 Speaker Notes In this slide, we will review additional rotation and manipulation icons are available only on the multiplanar rendered images (MPR’s). The Z rotation icon rotates the reference plane around the reference line. The Pan tool allows for ability to reposition along the reference line. The SieSync volume synchronization tool tool allows for automatic synchronization of the 4D volume to any MPR. Notes No. 30 SIEMENS Healthineers Rotation and manipulation icons SIEMENS . Healthineers ... 4D Volume X / Y Rotation Tool • Place cursor over area in orange • Allows X / Y axis rotation of the 4D Volume 4D volume Z Rotation Tool • Place cursor over area in orange • Allows Z axis rotation of the 4D Volume 4D volume Pivot Point of Reference Plane • Second level of X / Y 4D volume rotation Tool • Sets pivot point for 4D volume reference plane rotation 31 Unrestricted © Siemens Healthineers 2020 Speaker Notes Finally, there are rotation and manipulation tools and icons available only on the 4D volume such as X / Z rotation, 4D Z Rotation, and 4D Volume Pivot Point of reference plane. The X / Y rotation icon rotates the 4D volume along the “x” and “y” axis. The Z rotation icon rotates the 4D volume around the reference line. The 4D Volume Pivot Point tool allows for a second level of X / Y 4D volume rotation and sets the pivot point for the 4D volume reference plane rotation. Notes No. 31 SIEMENS Healthineers X Y Z rotation controls SIEMENS . Healthineers ... Azimuth Y Z Elevation Baseline Coronal DVR PW X CW 32 Unrestricted © Siemens Healthineers 2020 Speaker Notes On the ACUSON SC2000 PRIME ultrasound system, manipulation of the 4D volume can be performed directly by utilizing X, Y, Z located on the control panel. The user can manipulate the azimuthal plane or “Y” plane with the “Y” rotary control. This plane can also be referred to a the lateral plane. This plane allows the user to manipulate the dataset from right-to-left. If manipulation of the elevation plane or the “Z” plane is desired, the “Z” rotary control allows the user to manipulate the dataset from front-to-back. Finally, the coronal plane or “x” plane which is in the light blue box allows the user to manipulate the dataset from top-to-bottom. The coronal plane displays both the azimuthal and elevational planes at the same time at a single cross sectional plane. Notes No. 32 SIEMENS Healthineers Axis markers and multiplanar reconstructions (MPRs) SIEMENS. Healthineers' ... Three imaging planes Review Volume 16 vps / 90 mm 1. Azimuthal (A) Volume Review 58 bpm / General .- 4D 4.5MHZ -8 dB 2. Elevation (B) R DR: 60 dB 17 3. Coronal (C) A B 4D P Volume Enchance AP Thick Axis markers correspond to the Volume Map Volume Tirá RF MAS MPR of the same color RP Tint Cropping Mode Full R.R DICE OFF .Sie Valves C .Sie IVA Axis markers can be used to crop WVI into the volume and align with Movie Controls Reset Orientation Single V:On/DJ Box Edit : On /517 anatomy of interest 33 Unrestricted © Siemens Healthineers 2020 Speaker Notes The three imaging planes are referred to multiplanar reconstructions. As mentioned earlier in the presentation there are three MPRs: 1. Azimuthal (A) 2. Elevation (B) 3. Coronal (C) The axis markers correlate with each of the three MPRs. The red axis marker correlates with the red/azimuthal MPR; the green axis marker correlates with the green/elevation MPR; and the blue axis marker correlates with the blue/coronal MPR. There are also arrows located on each of the axis markers. These arrows indicate which direction the axis markers are cropping into and viewing the volume. When an axis marker is adjusted, the change can be seen in the corresponding MPR of the same color. Notes No. 33 SIEMENS Healthineers Adjusting axis markers manually SIEMENS. Healthineers' ... Rotation Review Voiuma 16 vps / 90 mm Volume Review 58 bpm / General --- 4D --- 4.5MHZ -8 dB DR: 60 dB 17 4D P Volume Enhanes OR AP Thick Volume Man Volume Tient RP Map Cropping Made DICE OFF e Sie Valves .Sin IVA VVI Movin Contro Reset Orientation Single V : On / 37 Box EdR : On / 2 34 Unrestricted © Siemens Healthineers 2020 Speaker Notes Axis markers can be rotated manually by selecting the edges once the rotation icon appears. Axis markers can be adjusted individually or they can be locked to rotate together. Notes No. 34 SIEMENS Healthineers Adjusting axis markers manually SIEMENS. Healthineers' ... Panning Review Volume 16 vps / 90 mm Volume Review 58 bpm / General --- 4D- 4.5MHZ -8 dB R DR: 60 dB 4D P Volume Enchance AP Thick Volume Map Volume Tirs RP Tint Cropping Mode Full R.R DICE OFF .Sie Valves .Sie IVA WI Movie Cont Reset Orientation Box Edit : On /917 , Cine Adjust 35 Unrestricted © Siemens Healthineers 2020 Speaker Notes Another commonly used function for adjusting axis markers is Pan. Pan allows movement of axis markers within the MPR and the adjustment can be seen within the corresponding MPRs, and sometimes the volume. Notes No. 35 SIEMENS Healthineers SieSync tool SIEMENS. Healthineers' ... • SieSync tool icon will display in Raview Volume Volume Ravira any reference plane R 4.5MHZ Q: 3/ Offset + de 0.58 m/s COV / 3.3MHZ • Volume synchronizes to reference 4D C P Color Val Tranny: Priority plane Cropping Mute Cular Mas • Icon can be anywhere in reference image except on the reference lines Single V :On/ DM 36 Unrestricted © Siemens Healthineers 2020 Speaker Notes The SieSync tool can be very beneficial during intracardiac imaging because it allows for quick synchronization of volume to any of the reference plane images. The slide contains a short video where we demonstrate the SieSync tool icon and function. In this instance, once the axis markers have been adjusted, the SieSync tool is being used to quickly synchronize to visualize the pulmonic valve Notice the shape and placement of the icon as it appears in the reference plane images. Notes No. 36 SIEMENS Healthineers Adjusting axis markers manually SIEMENS. Healthineers' ... A practical example Review To obtain an en face view of the Valuma 19 vps / 90 mm Volume Review 58 bpm / General ..- 4D ... left atrial appendage: 4.5MHZ -8 dB De: 60 dB Axis markers are rotated 4D P • Volume Enhance and panned in azimuthal RP THICK Volume Map Volume Tint and elevation planes RP Tint Cropoona Mude PHIL R.R ----...- • Volume is synced to the DICE OFF .Sie Valves coronal plane for en face «die LVA VVI view OO Movie Controls Volume is rotated Reset Orientation Single V :On/ 317 Box Eda : On /37 • Adium Cine 37 Unrestricted © Siemens Healthineers 2020 Speaker Notes In this video demonstration, the axis markers are adjusted in order to obtain an en face view of the left atrial appendage (LAA). With the axis markers locked, they are rotated and panned in the azimuthal (red) and elevation (green) planes. The volume is then synched to the coronal plane using the SieSync tool, providing the enface view. The volume is then slightly rotated in order to better visualize the LAA. Notes No. 37 SIEMENS Healthineers eSie Lines* SIEMENS. Healthineers' ... • eSie Lines display axis markers on volume image Review Volume 14 VDS Volume Review General • Correlate with axis markers and reference TEQ: 1 0.68 / planes CDV 3.3M 1.5 de 4D C Color Volume En Priority Transparency ... • eSie Lines move on VR when axis markers .Sie Valves are adjusted «Sie IVA WVI • May appear curved – due to display of Movie Controis depth within the volume Reset Orientation Single V : On / Dl Box Edit : On / Dm Adjunto Cine Note: Not available during SieShell mode 38 *This feature is available on 6.0 software only. Unrestricted © Siemens Healthineers 2020 Speaker Notes eSie Lines is a new feature that displays the axis markers from the MPRs onto the volume rendered (VR) image. It is available on all volume transducers during Acquisition and Volume Review modes. The eSie Lines displayed on the volume correlate with the axis markers and reference planes from the MPRs. You will notice in this example that as the axis markers are adjusted within the MPRs, the corresponding eSie Lines also move to provide a reference to the user. The eSie Lines may appear curved. The purpose of this is to display the perception of depth within the volume. eSie Lines is available in modes except Sie Shell. Note: This feature is available on 6.0 software only. Notes No. 38 SIEMENS Healthineers eSie Slice* SIEMENS. Healthineers' ... • Allows user to click anywhere in the Review Only / TEE Now" / Z6Ms 345 volume rendered image for automatic Review Volume Review 0.68 m/s 14 vps 60 tom / General axis marker adjustment 4D Gen -12 dB TEQ 1/ Offset: 3 dB DR: 65 dB 0.68 / -- Color --- CDV / 3.3MHZ -1.5 dB 4D C 15 • Efficient way to adjust axis markers Color Volume Enhance Priority and MPR views with one click; further Transparanty fine tuning may be necessary eSie Valves .Sie LVA VVI • Not available in SieShell mode Movie Controls Single V : On / 20 Box Edit : On / 30 • Available on all volume transducers Adjunto Cine during live imaging and Volume Review 39 *This feature is available on 6.0 software only. Unrestricted © Siemens Healthineers 2020 Speaker Notes eSie Slice is a feature that enables the user to quickly adjust axis markers from the volume image. To use eSie Slice, simply click anywhere within the volume and the eSie Lines and corresponding axis markers will move. This allows for easier and more efficient cropping of the volume and MPRs. The volume can then be synced to any of the MPRs for the desired display of pertinent anatomy. In this example, eSie Slice is first activated from the Image Menu. Then, by clicking on the paravalvular leak seen on the volume image, the axis markers are instantly aligned withing the MPRs. Further fine tuning of the axis markers may be necessary. Note: This feature is available on 6.0 software only. Notes No. 39 SIEMENS Healthineers eSie Lines and eSie Slice SIEMENS .: Healthineers ... Review • eSie Lines and eSie Slice are activated Volume Volume Review from the Image Menu 1. eSie Lines 2. eSie Slice 1 2 40 Unrestricted © Siemens Healthineers 2020 Speaker Notes eSie Lines are on and available by default. To turn eSie Lines on and off, press the eSie Lines icon (1) in the Image Menu. To activate the eSie Slice feature, press the eSie Slice icon (2) on the Image Menu. eSie Slice allows for a more efficient workflow with volume imaging, especially in interventional cases in which a lot of axis marker manipulation is necessary for cropping. Some examples include left atrial appendage closures, transcatheter valve repairs and replacements, and paravalvular leak repairs. Notes No. 40 SIEMENS Healthineers Objectives SIEMENS . Healthineers ... • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume direct manipulation tools and icons • Describe 4D echocardiography workflow tools 41 Unrestricted © Siemens Healthineers 2020 Speaker Notes Finally, we will describe 4D echocardiography workflow tools. Notes No. 41 SIEMENS Healthineers Single V* SIEMENS . Healthineers ... • Volume of interest showing reference point and viewing direction • Bounds only the area the user wants displayed in the VR • Place reference point on or just above the area of interest Reference point View direction 42 *This feature is available on 6.0 software only. Unrestricted © Siemens Healthineers 2020 Speaker Notes A common pain point in volume imaging is the inability to easily crop through a dataset. Single V allows the user to further refine and display the anatomy of interest in the volume quadrant. Single V makes cropping into the volume quick and seamless. There are three components to Single V, including the reference point, view direction arrow, and the side dimensions. Note: This feature is available on 6.0 software only. Notes No. 42 SIEMENS Healthineers Single V SIEMENS. Healthineers ... • Yellow default box Review Volume 11 vps Volume Review 81 bpm / General 131/89 mmHg --- 4D --- 4.5MHZ • Dot is the starting point 4D Volume Enhante DICE OFF Arrow is direction of LA • Cregoing Mode Extended R - R orientation wSie IVA • Defaults to MPR A, but can Movie Controls Single V : On / Off be adjusted in any MPR by clicking inside 43 Unrestricted © Siemens Healthineers 2020 Speaker Notes Single V allows users to crop the volume dataset from all sides of the region of interest (ROI) on the MPRs. • A yellow default box will appear once Single V is activated from the softkey • The dot is the starting point and the arrow is the direction of orientation • The ROI can be adjusted from any plane (MPR) • Lines will appear green when being modified When color Doppler is active, priority is with the color ROI. Notes No. 43 SIEMENS Healthineers Single V practical example SIEMENS . Healthineers' ... 90 Review Volume Volume Review 20 Vps 87 bpm / General ... 4D ... Gen -14 dB EQ: 1 / Offset: 0 dB DR: 65 dB 16 4D Volume Enhance DICE OFF Cropping Mode Full R-R Extended R - R. OM eSie Valves . Sie LVA VI Movie Controls Reset Orientation Single V : On / Off Box Edit : On / Off Adjust Cine 44 Unrestricted © Siemens Healthineers 2020 Speaker Notes This video shows the default appearance of Single V once it’s turned on from the soft key. The ROI is then adjusted to visualized a clot in the LAA. To adjust the ROI, select the corners to adjust the height and width. Rotate the ROI by selecting the dot or the arrow. Hover anywhere inside the box to activate the “cross- hair” symbol to move the ROI. Notes No. 44 SIEMENS Healthineers Dual V SIEMENS ... Healthineers ... • 4D display option quickly provides enface view Lens Temp: 41.6º C of valves from opposite viewing angles .58 m/s simultaneously 0.58 m • Left reference image is primary imaging plane • Right volume demonstrates opposite viewing direction • Available during live imaging and review 45 Unrestricted © Siemens Healthineers 2020 Speaker Notes Dual V allows volume clips/image to be displayed with two orthogonal reference plane images and two opposing volume views simultaneously. To display a volume in this format, select the Dual V icon in the control area. (e.g. ventricle to atrium view of the MV) Some common uses of Dual V include: • MitraClip procedures for positioning clip properly • Valve repair/replacement • Viewing flow on both sides of valve- flow convergence and regurgitation • Available during live imaging or Volume Review Notes No. 45 SIEMENS Healthineers Dual V SIEMENS .: Healthineers ... To activate Dual V: • Select the Dual V icon on the Image Menu • Region-of-interest (ROI) will appear automatically To optimize Dual V position: • Use trackball to move cursor to center of the arrow and rotate or move ROI • Left click and position arrow so that structure of interest in the center • Press Select to set position • Select any of the four corner to adjust the region-of-interest (ROI) 46 Unrestricted © Siemens Healthineers 2020 Speaker Notes It’s important to review the Dual V feature because once it has been activated, the user will notice tool will likely require adjustment or modification. To activate the Dual V functionality: Select the Dual V • Dual V arrow and ROI box appear automatically • To adjust position: • Use trackball to move cursor to center of arrow • Click and position arrow so that structure of interest is in center • Press Select to confirm desired position • Rotate the volumes displayed when in Dual View by using the X, Y, Z rotation knobs Modify ROI size: • Position cursor over any of 4 corners of ROI box • Press Select to highlight either vertical or horizontal edge of corner selected • Use trackball to adjust ROI vertically or horizontally to desired size • To confirm size, press Select Notes No. 46 SIEMENS Healthineers • Dual V Optimization: Use X, Y, Z knobs to rotate volumes. The volumes can be rotated and manipulated independently. Notes No. 46 SIEMENS Healthineers Dual V practical example SIEMENS. Healthineers ... Review Volume 58 m/s 13 vps Volume Review 84 bpm / General 68/46 mmHg .- 4D- 4.5MHZ -12 dB DR: 60 dB 0.58 m/s Color --- CDV / 3.3MHZ -4.5 dB 4D C P 32 Color Val Baseline Transps Priority: Cropping Mode Full R.R Color Map eSie Valves Movie Controls Reset Orientation Single V : On/ Off Box Edit : On /Off Adlust . Cine 47 Unrestricted © Siemens Healthineers 2020 Speaker Notes This slide contains a short video with Dual V activated and positioned through the mitral valve which allows for simultaneous view of the valve from the left atrium and the left ventricle and visualization of two MitraClips. Notes No. 47 SIEMENS Healthineers Mitral Valve view SIEMENS .: Healthineers ... Mitral Valve view • Provides shortcut to quickly and easily display the enface view of the mitral valve view for diagnosis and a wide variety of surgical / interventional procedures • Available during live imaging and volume review • To activate the Mitral Valve view: • Select Mitral Valve on the Image Menu • Move axis markers or volume for better mitral valve visualization if necessary 48 Unrestricted © Siemens Healthineers 2020 ` Speaker Notes The Mitral Valve view function on the Z6Ms transducer provides a shortcut to switch the volume to an enface view when imaging of the mitral valve is performed. To use: Select the Mitral Valve icon to activate Once activated, system will automatically: • Sync volume to C plane • Move Axis Markers up for better visualization if necessary • Rotate volume to display standard mitral valve orientation • Adjust rotation and orientation further if needed • Press Reset Orientation to and return to previous display format Notes No. 48 SIEMENS Healthineers Mitral Valve practical example SIEMENS. Healthineers ... Review Volume 11 vps Volume Review 66 bpm / General R 142/97 mmHg -4D --- 4.5MHZ R 2 dB DR: 65 dB 31 4D P Volume Enhance Gain DR RP Thick Volume Map Volume Tint RP Map RP Tint Cropping Mode Full R-R DTCE OFF eSie Valves Movie Controls Reset Orientation Single V : On /Off x Edit : On /Dr Adiusto Cine 49 Unrestricted © Siemens Healthineers 2020 Speaker Notes This slide contains a short “How-to-Video” where we demonstrate the Mitral Valve view tool and its function. In this case, adjustment of axis markers is not necessary, the user activates the Mitral Valve tool from the image Menu. From there, the user can rotate/adjust the volume as needed. Notes No. 49 SIEMENS Healthineers Septal Guide SIEMENS. Healthineers' ... • Measures the radius from the mitral 0GB / MI: 0.58 / TIS: 0.34 Cardiac / TEE1" / Z6Ms Lens Temp: 39.0º C annulus to an interatrial septal site Carding 53 fps / 120 mm Acquisition 60 bpm / General Puncture: 4 cm Transducer -- 2D -- Exam Preset H5.5MHz / 7 dB Cool Down Stata DR: 64 dB .. E: +1/01 • Located under Acquisition menu M: C 2D Septal Gekds options TEO OFF 2 DICE OFF Capture Preview • Can be activated in live or frozen mode during active imaging (not from Review) Protot ] / Preset 2 • Use the trackball to adjust the size or Select 20 FOV Septal Guide position 50 Unrestricted © Siemens Healthineers 2020 Speaker Notes Septal Guide is used for transseptal puncture during interventional procedures. The Septal Guide: • Measures the radius from the mitral annulus to an interatrial septal site • It is located under the Acquisition menu options • It can be activated in live or frozen mode during active imaging (not from Review) • The size and position can be adjusted with the trackball Notes No. 50 SIEMENS Healthineers Septal Guide Lines* SIEMENS. Healthineers ... • Two orthogonal lines that can be OdB / MI: 0.58 / TIS: 0.34 Cardiac / TEE1* / Z6Ms rotated within the Septal Guide Lens Temp: 39.0º C Acquistion 53 fps / 120 mm 60 bpm / General Puncture: 4 cm Exam Preset -2D- Cool D ......... H5.5MHz / 7 dB OJO DR: 64 dB ........ 2D E: 41/01 • Available after Septal Guide is TEC OFF 2 activated DICE OFF Capture Preview an • Located under Acquisition menu options Reset Rotation Preset 1 / Preset 2 20 FOV Septal Guide Use the trackball to rotate the guide Select Pos Size Rotation • lines 51 *This feature is available on 6.0 software only. Unrestricted © Siemens Healthineers 2020 Speaker Notes Septal Guide Lines places two orthogonal lines withing the Septal Guide. This can potentially reduce workflow in drawing two separate lines for transseptal puncture during interventional procedures. • Available after Septal Guide is activated • To adjust the Septal Guide Lines, use the Rotate function on the trackball Septal Guide Lines can help with interventional procedures that require specific transseptal crossing locations. For example, left atrial appendage closure and MitraClip. Note: This feature is available on 6.0 software only. Notes No. 51 SIEMENS Healthineers Conclusion SIEMENS . Healthineers ... • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume direct manipulation tools and icons • Describe 4D echocardiography workflow tools 52 Unrestricted © Siemens Healthineers 2020 Speaker Notes In conclusion, we have covered the following topics: • Explain the basics of volume imaging • Discuss beginning an exam and volume acquisition • Review volume manipulation tools and icons • Describe 4D echocardiography workflow tools Notes No. 52 SIEMENS Healthineers Trademarks and disclaimers SIEMENS . Healthineers ... • ACUSON DTCE, eSie Measure, RES, SC2000, SieSync, and TEQ are registered trademarks of Siemens Medical Solutions USA, Inc. • MitraClip is a registered trademark of the Abbott Group of Companies. 53 Unrestricted © Siemens Healthineers 2020 Speaker Notes No speaker notes. Notes No. 53 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS . Healthineers ... Questions? 54 Unrestricted © Siemens Healthineers 2020 Speaker Notes Are there any questions? Notes No. 54