ACUSON P500, 2.0 Major Modes
A Step by Step document that explores the major modes available on the ACUSON P500 system.
SIEMENS Healthineers Major Modes ACUSON P500™ Ultrasound System, Release 2.0 Product and System Training 11449 HC US MSC S SET Unrestricted C Siemens Medical Solutions USA, Inc. 2017 This presentation provides an overview of the primary imaging modes. Objectives SIEMENS Healthineers Review 2D and M-mode Controls Describe 2D and M-mode Optimization Features . Explain Display Modes Review Doppler Controls Describe Doppler Optimization .--- Features HC US MSC S SET Page 2 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: The Objectives of this presentation are as follows: • Review 2D and M-mode controls • Describe 2D and M-mode optimization features • Explain Display modes • Review Doppler Controls • Describe Doppler Optimization features 2D Controls SIEMENS Healthineers 2D Physio Settings Stress Echo SieScape eSieScan ....... 4 4 4 4 4 4 ................. 4 4 4 4 Biopsy Needle Visual. << Steer Steer > O U/R Flip UID Fli Full Size Trapezoid Dual Split HC US MSC S SET Page 3 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: The 2D image is optimized using three different methods: 1. Control panel 2. Soft Keys 3.Left Panel Control Keys 2D Controls SIEMENS Healthineers 4 4 A 4 A Depth / Zoom 11 2 HC US MSC S SET Page 4 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes The first method is via the control panel. 1. 2D is a dual-function knob. • Press 2D control to activate or return to gray scale imaging • Rotate 2D control to change the overall 2D gain 2. Depth Depth is adjustable using the dual purpose and dual function DEPTH/ZOOM control. A rotary • “twist” adjusts depth. • Imaging depth occurs in 1.0cm increments. • The range is 2cm – 30cm and is transducer dependent. 3. Zoom. To magnify an image, press DEPTH / ZOOM. • • The system activates the zoom function and displays a Z below the image. Rotate DEPTH / ZOOM to adjust the magnification. • To deactivate the zoom function, press DEPTH / ZOOM again. • 4. TEQ • TEQ Ultrasound Technology is a proprietary auto-gain optimization feature. • In 2D, TEQ optimizes the master gain, TGC and lateral gain (LGC) to automatically balance the image grayscale and suppress noise. TEQTM Ultrasound Technology SIEMENS Healthineers ... 13-5 Small Parts Tx Power 100% MI 0.90 TIS 0.1 TIB 0.1 ASC 2 DTCE High Dyn R 75 dB THI 10.7 MHZ -1 dB 61 fps Fr 394 IR 3.5 cm F1394 HC US MSC S SET Page 5 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes Once activated, a gold icon is visualized. It s recommended to set the DGC in the middle prior to activating TEQ. The TEQ control gain will stay in effect until: • The user presses the TEQ technology control button again. The gain is re- optimized following this event. We recommend the user does this for each new scan window. • The user adjusts the gain knob or DGC, which will incrementally override the optimized setting. • TEQ is not supported in Doppler. • TEQ gain is selectable on the soft keys after the gain is adjusted. This allows the user to set the gain for the lighting in the room. 2D Soft Keys SIEMENS Healthineers ... --- 4 4 4 4 4 V A A 4 4 < > 0 4 6 00 Edge Persist Dyn R Map Tint 1 2 70 dB E 12 Image Pre ... MultiHertz Tx Power Focus Adv. SieCl ... THI Number DTCE Focus Posi ... 100% HC US MSC S SET Page 6 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes The second method the user can manipulate the 2D image is the soft keys. They contain the 2D Optimization controls and are customizable in the System Config / Soft Keys. From a functional standpoint: 1. The functionality is displayed on the Touch Screen, which corresponds to gray buttons on the control panel. They can be activated either by pushing the gray soft key OR by “touch” on the Touch Screen. 2. The soft key menus operate on a sideways (horizontal) “slide”. Once the black boxes on the periphery are “touched”, secondary menus will populate in the primary window. 3. For some functionalities, an additional vertical slide will also populate. (e.g. Tint) 2D Soft Keys SIEMENS Healthineers ... 2D ACUSON SIEMENS 05/03/2015 13:00:35 VF 13-5 Small Parts Physio Tx Power 100% Settings Stress Echo MI 0.90 TIS 0.2 TIB 0.2 SieScape esleScan DTCE High Dyn R 75 dB THI 10.7 MHZ -1 dB Biopsy Needl 6 fps Visual Fr 26 < < Steer Steer >> UR Flip U/D Flip Full Size Trapezoid 3.5 cm Dual Split SF:26 Print dear Set Start ... Previous Frame Next Frame DTCE Dyn R Map Tint High Play /Pause Play / Pause 75 dB 12 HC US MSC S SET Page 7 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes The third method the user can manipulate the 2D image is the left side of the Touch Screen using the left panel control keys. The left panel control keys are as follows: 1. Physio Settings have four options, ECG, AUX ECG, RESP & AUX SIGNAL. These are addressed in the Getting Started presentation. 2. SieScape activate SieScape panoramic imaging. 3. Biopsy activates the biopsy guide. Note: the system will prompt the user to ensure the operator is utilizing an a appropriate angle to maximize the effectiveness of the guide. 4. Needle Visual is enhanced Needle Visualization for the linear transducers. This functionality is explained in the Needle Visualization presentation. 5. Steer controls unidirectional 2D beam steering, as illustrated here. Note: this will automatically deactivate SieClear spatial compounding. As the user scrolls through the steering options, the angles applied are 15/7.5/0/- 7.5/-15 deg. 6 . L/R Flip U/D Flip L/R flip and U/D flip re-orient the image. The “a” icon will indicate the activated orientation, as indicated here. Clinical examples where U/D may be utilized include prostate imaging. Technical reasons one may use L/R flip is to adjust the 2D image orientation if the user holds the transducer back to front. L/R flip and U/D flip is available both in real time and in cine review. 7. Trapezoid The trapezoid function action key will angle the periphery of the 2D image on the linear transducers. This is useful clinically to demonstrate entire anatomies (e.g. testicle, thyroid or soft tissue mass). This function adds 15 degrees to either side of the image area. 8. Dual This is the functionality to acquire two images side-by-side. There are a number of different dual modes which will be explored later in the presentation. 9. Split allows for simultaneously viewing of two identical images in real-time. Examples include 2D/2D, 2D / Color, 2D / Clarify VE. M-Mode SIEMENS Healthineers ... M ACUSON SIEMENS P4-2 EM Tx Power 100% MI 0.81 TIS 0.5 TIB 1.0 THI F 3.6 MHZ 3 dB 38 fps Stwee>> AAAAAA Full M Tint 14 Map Dyn R MultiHertz Edge Sweep 55 OR 3.6 MHZ Full M HC US MSC S SET Page 8 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: M or “motion” mode is the functionality whereby the system represents temporal changes in echoes, where the distance (depth) of the structure is displayed along the vertical axis and time is displayed along the horizontal axis. The M-mode Control on the control panel is a dual-function knob. • Press M-mode control to activate • Rotate M-mode to change overall gain When M-mode is launched, the left panel controls keys will convert to M-mode relevant options. Full M allows the user to remove the 2D image and scan M-mode trace only. On the ACUSON P500 system, M-mode is available on all imaging array transducers. Objectives SIEMENS Healthineers . Review 2D and M-mode Controls Describe 2D and M-mode Optimization Features . Explain Display Modes Review Doppler Controls Describe Doppler Optimization .--- Features HC US MSC S SET Page 9 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Next , we will review the Display modes. 2D Optimization SIEMENS Healthineers ... 4 4 4 4 4 4 4 4 A 4 Edge Persist Dyn R Map Tint 1 2 70 dB E 12 Image Adv. Presets SieClear DTCE MultiHertz THI Focus Position Detail High 9.4 MHZ On W HC US MSC S SET Page 10 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: 2D Optimization occurs largely using the soft keys. Depth and Gain controls are located on the Control panel and should be optimized first prior to adjustments of other controls. Soft Key options include: Edge is a 2D control designed to increase the contrast resolution of subtle borders. Increasing edge will enhance/sharpen borders (clinically useful in instances such as interventional ultrasound). Decreasing edge will smooth borders (some users prefer this look for breast and gynecological imaging). Settings range from 1-4. Persistence controls the number of images the system will average per frame. • A Persistence of 0 updates the image with every sweep of the Transducer. (excellent for fetal hearts, bowel, venous imaging). A persistence to 1 results in the averaging of 2 images, and so on. • Increasing the persistence increases the number of images averaged reducing noise and making the image appears smoother. An average persistence setting is 2 or 3. Settings range from 0-4. Dynamic Range (DR) affects the range of returning signal amplitudes that are displayed. Higher dB settings produce a “softer” 2D image; lower dB settings produce a more high contrast image. Dynamic range is available as a post-freeze processing control, as well as during real time scanning. Typically a slightly lower dynamic range is used in Vascular and cardiac applications but is more user-preference. Maps - Gray maps enhance aesthetics by adjusting greyscale assignments to modify image contrast (note: aesthetics change only. Maps do not affect data content). Map A is a linear Map then from low to high contrast. Changing the Map is available as a post-freeze processing function. Tint - Tint adds color to the entire 2D image. Clinical utilizations include, but are not limited to, nerve imaging and fetal echocardiography. Used frequently in Doppler to enhance the spectrum quality and display range of velocities. It can be adjusted live, or after freeze. Tints are numbered 1-15 and appear on a vertical slide when selected. R/S - RES / Speed Balances line density (spatial resolution) and frame rate. Increase to improve image detail. Decrease to improve frame rate. TX Power manual adjustment of the power setting. All of these controls may not be visible as there are more options than placeholders. If the setting required is not visible, go to System/ Config / Soft Keys and assign the choice to a key. 2D Optimization SIEMENS Image Presets Healthineers ... SIEMENS ACUSON 11/06/2017 11:17:35 VF 10-5 Small Parts Tx Power 100% MI 1.01 TIS 0.3 TIR 03 ASC 2 DTCE Med Dyn R 80 dB THI 9.4 MHZ -1 dB 39 fps Pen Gen Detail Image Presets Edge Persist Gen ...................... Edge Persist RIS Image Presets Focus Position Detail HC US MSC S SET Page 11 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Image Presets is the user’s control over the line density, or the number of acoustic scan lines per frame. • “Detail” increases the line density and improves detail resolution (but reduces the frame rate). • “General” is the primary Scanning mode. • “Penetration” reduces the frequency for overall better penetration. • When the setting changes, settings that are affected will briefly change in yellow on the image data settings. There is no reference in the data field as to which image preset was used. It is displayed on the soft key menu in real- time scanning. This is accessed on the soft key menu. If the choice is not displayed on the soft keys, go to System Config/ Soft Keys and add as one of the selections. 2D Optimization SIEMENS Advanced SieClear™ Spatial Compounding Healthineers ... Image Adv. Presets SieClear DTCE MultiHertz THI Focus Position Detail 3 High 9.4 MHZ On VF13-5 THYROID VF13-5 Tx Power 100% THYROID MI 0 90 Tx Power 100% TIS 0:2 MI 0 90 TIB 0:2 TIS 0.1 DTCE High TIB 0.1 Dyn R 80 dB ASC 3 THI 10.7 MHZ DTCE High 2 dB Dyn R 80 dB 24 fps THI 10.7 MHZ Fr 221 3 dB 64 fps Fr 800 2.5 cm E1 F221 2.5 cm I Fr000 Without SieClear With SieClear HC US MSC S SET Page 12 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Advanced SieClear compounding is proprietary spatial compounding that increases contrast resolution and enhances border definition. Setting range from Off to 3 and are transducer and mode dependent. The higher the number the higher the number of interrogating angles. These multiple scanning angles combine to reduce artifacts and increase tissue differentiation. As seen in the above image, a higher Advanced SieClear compounding setting provides a smoother image. To enhance clinical markers (cyst, GB stone, shadowing) reduce the compounding. 2D Optimization SIEMENS Dynamic TCE™ Tissue Contrast Enhancement Technology Healthineers ... Image Adv. Presets SieClear DTCE MultiHertz THI Focus Position Detail 3 High 9.4 MHZ On CH5-2 Renal CH5-2 Tx Power 100% Renal MI 0.90 Tx Power 100% TIS 0.4 MI 0.90 TIB 0.4 TIS 0.4 ASC 1 TIB 0.4 Dyn R 75 dB ASC 1 THI 3.6 MHZ DTCE High -4 dB Dyn R 75 dB 23 fps THI 3.6 MHZ Fr 92 -4 dB 23 fps Fr 166 13 cm Without DTCE With DTCE HC US MSC S SET Page 13 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes Dynamic TCE tissue contrast enhancement technology is proprietary, advanced post- processing method for speckle reduction. It: • Enhances anatomic border definition and subtle tissue contrast. • Is compatible with other advanced imaging modes including Advanced SieClear compounding, THI and TEQ. • Is compatible with all exam-specific applications, in both 2D and in Color • Is available in 3 levels : low, medium and high. • In applications where a lot of color Doppler will be used, it is recommended to use lower levels of speckle reduction. • In this image of the kidney, the borders are more clearly defined and the image is overall less noisy using a higher DTCE level. 2D Optimization SIEMENS MultiHertz™ Multiple Frequency Imaging Healthineers ... 4 4 4 4 4 4 4 4 4 4 4 Edge Persist Dyn R Map Tint 2 70 dB E 12 Image Adv. DTCE MultiHertz THI Focus Presets SieClear Position Detail 3 High 9.4 MHZ On HC US MSC S SET Page 14 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes. MultiHertz - Multihertz enables the user to adjust the transducer center frequency, in order to improve resolution (increase frequency) or increase depth penetration (reduce frequency). Multiple fundamental and harmonic frequencies are available on each transducer. It is suggested for MSK imaging, to try both Fundamental and Harmonic as depending on the specific clinical image, fundamental provide a better overall image aesthetic. THI works independently in 2D and Color Doppler. 2D Optimization SIEMENS Tissue Harmonic Imaging (THI) Healthineers ... Image Adv. Presets SieClear DTCE MultiHertz THI Focus Position Detail 3 High 9.4 MHZ On CH5-2 Renal CH5-2 Tx Power 100% Renal MI 0.63 Tx Power 100% TIS 0.6 MI 0.90 TIB 0.6 TIS 0.4 ASC 1 TIB 0.4 DTCE Med ASC 1 Dyn R 75 dB DTCE Med 3.6 MHZ Dyn R 75 dB 1 dB THI 3.6 MHZ 60 fps -7 dB 23 fps Fr 109 13 cm 13 cm Without THI With THI HC US MSC S SET Page 15 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Tissue harmonic imaging is an advanced signal processing technique, which – when activated – means that the system will only process the harmonic pulse component for image formation. The effect of this is: • improved contrast resolution and border delineation • improved visualization of clinical markers • improved lateral resolution • reduced clutter Harmonic imaging is used frequently in most applications. This is an example in the urinary bladder where the near field noise is reduced by applying THI. 2D Optimization SIEMENS Clarify ™ Vascular Enhancement (VE) Technology Healthineers .. Configuration Soft Keys 2D LV 20 FIZ| CLV| CFIZ| PLV| PFIZ| ML| MFIZ| DL D FIZ | General 1 L10-5v General 2 Custom Keys CV Display Tx Power 100% Exam Physio Settings Stress Echo Soft Keys MI 0.91 M&R SieScape eSieScan TIS 0.6 Report Text Annotation TIB 0.6 Body Marker Wireless Biopsy Tx Power Needle Visual. RIS Clarify VE 7 TEQ Gain Network THI ASC 1 Service << Steer Focus Position DTCE Low Clip Store Focus Number Archive DTCE Dyn R 55 dB Adv. SieClear Authorization THI 8.0 MHZ Printer UR Flip UND Flip Image Presets Clarify VE Barcode Clarify VE Levels 0 dB Utility DTI Full Size << RIGHT 24 fps Stress Echo Trapezoid Blank Fr 157 eSieScan Dual Split Tx Power Map Tint TEQ Gain| Focus Number Focus Position Default Clear Page Default Clear Page Clear All Pages Save Cancel THI Dyn R Clarify VE Clarify VE Levels Map TEQ Gai Adv. SieCI ... MultiHertz Position Tint 14 Position DTCE Focus Posi ... HC US MSC S SET Page 16 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes” Clarify VE technology is a unique imaging technology from Siemens that reduces image noise and artifacts in vascular studies, producing exceptional definition that promotes the detection of vascular disease. Clarify VE technology uniquely utilizes power Doppler flow information to enhance 2D-mode imaging in real-time, adaptive, pixel-by-pixel analysis which provides exceptional contrast resolution for clear delineation of vessels. This application is great for any vascular studies such as: carotids, abdominal aorta and calf veins, especially with technically difficult exams where noise is an issue. In addition, for abdominal imaging, to view the pancreas, Clarify VE will enhanced the vasculature around the pancreas, providing greater delineation of the head, body and tail. User Tip: Select Split to view conventional 2D and Clarify VE technology side by side as shown in this carotid image. Clarify VE technology is available on all linear and curved transducers on live imaging only. Adjusts levels of sensitivity when using Clarify VE technology: Select a higher level to increase sensitivity. Select a lower level to decrease sensitivity. Clarify VE technology does not change the B-mode image in nonvascular structures, e.g., within the gallbladder or urinary bladder. Note: Clarify VE is not set as one of the soft keys as a factory default. It is important to go into the Configuration menu / Soft Keys and assign the keys. One option is to change Power and Map to Clarify / Clarify VE levels, the change focus number to Maps. 2D Optimization SIEMENS Focus Healthineers ... SIEMENS 04/02/2015 16:49:01 CH5-2 OB Tx Power 100% MI 0.88 TIS 0.5 TIB 0.5 ASC 1 DTCE Med Dyn R 75 dB THI 4.4 MHZ 5 dB 31 fps Fr 559 ........ 12 cm ............. Image Adv. DTCE MultiHertz THI Focus Presets SieClear Position Detail 3 High 9.4 MHZ On HC US MSC S SET Page 17 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Focus - Both the focal position and the number of focal zones are selected using the soft keys. It is recommended to place the focal zone at or below the area of interest for best results. Post-Processing Features SIEMENS Healthineers ... M System Serial Number : PP3018 ACUSON $503/2015 11:16:11 20 System Serial Number : PP3008 ACUSON 2001/2015 14:02.25 P4-2 EC9-4 EM GYN Tx Power 100% Physio Tx Power 100% Physio MI 1.34 MI 0.83 TIS 0.4 TIB 3.4 TIB 0.4 THI F 3.6 MHZ ASC 1 -7 dB 13 DTCE Med Dyn R 85 dB THI 9.4 MHZ 2 dB 147 Full M Markers Cine Rate UR Flip UND Flip U Dual F1262 Print Clear Delete Dyn R Sweep Map Tint Set start Set End M Previous Next Frame DICE 35 da Play/Pause PlayfPause 2 int MayPause mappe PYMR Map Med 85 GB HC US MSC S SET Page 18 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes In 2D and M-mode, once the image is frozen, the post-processing features will be seen in the soft-key menu. The following can be changed. 2D DR, Gray Map, Tint Map, Measurements, Reports, Annotations, Body Marker, Zoom/Pan, DTCE, L/R flip, U/D flip M-Mode DR, Gray Map, Tint Map, Measurements, Reports, Annotations, Body Marker, Sweep Speed Objectives SIEMENS Healthineers Review 2D and M-mode Controls Describe 2D and M-mode Optimization Features . Explain Display Modes Review Doppler Controls Describe Doppler Optimization Featur .--- HC US MSC S SET Page 19 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Next, we will explain the display modes. Trapezoid SIEMENS Healthineers ... 2D ACUSON SIEMENS VF13-5 Small Parts Tx Power 100% Physio ettings Stress Echo MI 0.68 TIS 0.1 TIB 0.1 SieScape SC 2 eSieScar DTCE Med Dyn R 75 dB THI 8.9 MHZ Biopsy Needle 0 dB Visual. 15 fps Fr 88 << Steer Steer >> UR Flip U/D Flip U Full Size Trapezoid Dual Split HC US MSC S SET Page 20 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Trapezoid imaging expands field of view when using a linear transducer. It sometimes referred to as Virtual Format and is available on all linear transducers. Each side expands approximately 15 degrees on each side. Trapezoid imaging is great for displaying large thyroid glands, masses, MSK imaging, reference anatomy in breast imaging and vascular anatomy. Advanced SieClear and DTCE stays on when Trapezoid imaging is activated. If trapezoid is on and the user enters, Dual Mode, the image will stay in trapezoid imaging after exiting Dual mode. Dual Mode SIEMENS Healthineers ... SIEMENS 2D 06/08/2015 17:26:28 CH5-2 Trim2rout IR Physio Settings Stress Echo Tx Power L1000/ MI 0.86 SeScape eSieScan TIS 0.5 TIB 0.5 ASC 1 Biopsy DTCE Med Dyn R 80 dB THI 5.0 MHZ << Steer Steer >> 3 dB 23 fps Fr 626 UR Flip UID Flip U Full Size Trapezoid Dual Split DTI RIS Edge Focus Nu ... Persist Focus Posi ... TWIN A 13 cm TWIN B 13 cm HC US MSC S SET Page 21 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Dual is the functionality on the system which allows two separate images to be viewed and/or acquired adjacent to each other and is activated by touching the left panel control keys. In dual mode, the user is able to annotate, measure and place body markers on each adjacent image. Color Dual is available on this system. Seamless dual can be activated in the Config / Exam menu. This will remove the depth markers from the left image such that the dual images “seamlessly blend” together. This is useful for imaging a single structure over the two screens (eg testicle, thyroid or tendon.) Please note two system behaviors: 1. The on-screen “a” icon will indicate image orientation as well as identify the active image. 2. The system will unfreeze a full screen image when launching into dual. Split Mode SIEMENS Healthineers ... 2D VF 10-5 11.3 PV-Venous Tx Power 100% Physio Settings Stress Echo MI 0.99 TIS 0.1 eSieScan TIB 0.1 SeScape 5.3 MHZ 1563 Hz Biopsy Flow Med -1 dB cm/s 20 fps << Steer Steer >> Fr 219 UR Flip UID Flip U Full Size Trapezoid Dual Split DTI RVS 3 cm Edge Focus Nu ... Persist Focus Posi ... 1 Fr219 HC US MSC S SET Page 22 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Split Mode provides simultaneous dual images in real time. This was added in the 2.0 release. Modes include: 2D, 2D with Clarify, 2D and 2D with Color / Power Doppler. This feature is great to demonstrate reference gray scale image next to an image with Color or when using Clarify VE technology. SieScape™ Panoramic Imaging SIEMENS Healthineers ... SIEMENS 2D L10-5v Breast Tx Power 100% MI 0.47 Settings Stress Echo TIS 0.1 TIB O. ieScape SieScar ASC 1 DTCE Med Dyn R|70 dB Biopsy Needle THI 8.0 MHZ Visual, 0 dB 45 fps << Steer Steer >> Fr 510 UR Flip U/D Flip U ull Size Trapezoid Dual Split HC US MSC S SET Page 23 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: A new application for the latest ACUSON P500 system release 2.0 is SieScape panoramic imaging. This feature allows acquisition and display of grayscale images up to 60 cm in length to a maximum curvature of 360 degrees. It is available on all curved and linear transducers. This slide demonstrates an image across the entire breast. Some applications are: Thyroid (nodules, goiters) - Breast (masses, areas of inflammation, reference anatomy) - Musculoskeletal (Baker’s cysts) - Vascular (anastomoses, varicose veins) - The SieScape imaging steps follow the same workflow as all the other ACUSON Siemens systems. To launch this application, select the Siescape soft key which is located on Left Panel Controls. Follow the steps: 1. Press SieScape, a white ROI will appear. 2. Press Start, located next to Touch Pad. 3. Sweep slowly, when complete, press End or Freeze. Zoom SIEMENS Healthineers ... VF13.5 Small Parts Tx Power 100% MI 0.84 TIS 0.2 TIB 0.2 ASC 2 DTCE High Dyn R 75 dB THI 10.7 MHZ 0 dB 61 fps Fr 878 Depth / Zoom 3.5 cm HC US MSC S SET Page 24 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: ZOOM is controlled by the Depth/Zoom knob, located on the right hand side of the control panel. It is available in both real-time or when the image is frozen. PUSH activates the zoom window, and is indicated on screen by the crop cursors. Pressing the key again exits zoom. PUSH-TURN magnifies the pixels (up to 10 x). The direction to TURN the key to increase/decrease zoom is customizable in the Config >> Custom Keys menu. When ZOOM is active, sliding on the touch-pad will PAN the image around the screen, such that the user can center the ROI. Zoom also works when in Color Doppler. When in Split Mode, the 2D/Color image can also be Zoomed. System behavior note: The ZOOM (or magnification) function on the ACUSON P500 is a read-zoom functionality. This means that the image size is increased by magnifying the pixels, therefore the chosen area of the image will appear magnified. A decrease in spatial resolution is typically seen. Objectives SIEMENS Healthineers Review 2D and M-mode Controls Describe 2D and M-mode Optimization Features . Explain Display Modes Review Doppler Controls Describe Doppler Optimization Features HC US MSC S SET Page 25 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Next we will review the Doppler Controls. Doppler Controls SIEMENS Healthineers 2D C PW 2D C Physio physio Settings Settings Auto Stat Sensi- eSieScar tivity Off 5 eSieScan Volume O O 11 << Steer Steer >> << Steer Steer >> Color Display Full D CW A Simult CW Dual Split 4 4 4 HC US MSC S SET Page 26 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: The Doppler controls are manipulated using three different methods: 1. Control panel 2. Soft Keys 3. Left Panel Control Keys (these change depending on the Mode) Control panel Keys include: • C- Enters and exits Color Doppler and control color gain. • PW- Enters and exits PW Doppler and control PW gain. Update on the Home base cycles between the image and Doppler tracing. • Scale: In Color Doppler, adjust the range of displayed color velocities by adjusting the scale factor of pulse repetition frequency (PRF). In PW or CW Doppler adjust the scale factor of pulse repetition frequency (PRF) to improve flow sensitivity or to control aliasing. • Baseline: In Color Doppler extend the range of displayed velocities in one direction by repositioning the color baseline . When in PW or CW Doppler extends the range of displayed velocities by repositioning the Doppler baseline. Angle: Correct the flow angle Pressing the control adjusts the flow angle in 60° increments (60°, 0°, and -60°). • Rotating the control adjusts the flow angle in 1° increments. • Invert: In Color Doppler, invert the colors depicting forward and reverse flow in the color ROI and in the color bar. In PW or CW Reverse the Doppler spectrum relative to the baseline and invert the Doppler audio Soft Keys are the Doppler optimization keys including RES/Speed, Smoothing, Filter, Persistence, Flow States, Priority and Entering CDE (Power Doppler). We will discuss these in the optimization slides. Objectives SIEMENS Healthineers Review 2D and M-mode Controls Describe 2D and M-mode Optimization Features Explain Display Modes Review Doppler Controls .--- Describe Doppler Optimization Features HC US MSC S SET Page 27 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Next we will review the Doppler Optimization Controls. Color Doppler Optimization SIEMENS Healthineers ... SIE ACUSON SIEMENS 18 20/10/2016 10:58:37 VF 16-5 22.6 CV Tx Power 100% MI 0:85 TIS 0:1 5.3 MHZ Flow Med -111 2.5 cm Map Filter Smooth Priority MultiHertz CDE Flow Tx Power 2 RIS Persist 2 4 Position Position 5.3 MHZ Med HC US MSC S SET Page 28 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: When in Color, the soft key menus provide the optimization controls. The soft keys are customizable in the configuration menu. To change the parameters on the soft keys, select (using the pointer) or touch the desired parameter. In addition, the hard keys below the soft keys on the control panel also make the changes. Select Flow to toggle between low (small parts, low volume flow), med (general abdomen, vascular, OB), and high flow (aorta, fetal heart, cardiac). • Filter: Reduces clutter by adjusting the level of motion discrimination during real-time imaging. Setting are 0-3 (low to high). • Smooth: Adjusts the level of spatial (both axial and lateral) averaging used to smooth the flow pattern display. Settings are 0-3 (low to high). • Priority: Adjusts the threshold for overlaying color pixel information on the 2D image. Setting are 0-4. • MultiHertz: 3 frequencies depending on transducer (independent of 2D). • CDE or CDV: Activates Color Doppler Velocity or Color Doppler Energy (Power Doppler). • DTI /DTE: Activates Doppler Tissue Imaging or Doppler Tissue Energy • Flow: Select an image preset to optimize hemodynamic flow conditions. Tap Flow and then tap the required setting: Low provides maximum sensitivity to low velocity flows by incorporating the lowest possible filter settings and lower – pulse repetition frequency. You may experience increased flash (motion artifacts). Med (Medium) produces an optimal balance between flash suppression and maximum sensitivity by using an adaptive – wall filter. High optimizes the system for the high arterial flow common to pulsatile vessels and stenotic conditions. – • R/S: Adjusts the balance between the image line density (resolution) and the frame rate (speed) . Settings are 0-5 (low- resolution, high- frame rate). • Map: Assigns color to velocity or energy information. Choices are A-I. Velocity and Velocity Variance maps are available. • TX Power: Adjusts Transmit Power. 0-100% • Persist: Adjusts the time that the colors corresponding to blood flow velocity remain in the region of interest before decaying or being replaced by another color. Settings are 0-4 (low to high). Dynamic Persistence & Auto Flash Suppression SIEMENS Healthineers* SIEMENS 11/06/2017 13:40:21 VF 16-5 14.1 PV Tx Power 100% . Dynamic Persistence adjusts MI 0.80 TIS 0.2 TIB 0:2 persistence relative to user 5.3 MHZ 1950 Hz Flow Low 14.1 motion 5 dB cmis 17 fps Auto Flash Artifact Control applies flash suppression relative to user motion 2.5 cm* HC US MSC S SET Page 29 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: On the ACUSON P500 system, there are two unique technologies for Color Doppler. Dynamic Persistence and Auto Flash Artifact Control. Dynamic Persistence technology applies in 2D and Color Doppler. • Prevents “ghosting” motion • Enhances static color sensitivity • Reduces static B-mode noise Auto Flash Artifact technology applies in Color Doppler. When scanning with Color Doppler, there are less flash artifacts when moving the transducer around with Color on. • Prevents motion artifacts • Enhances color sensitivity • Allows high quality scanning at a fast pace DTI™ Doppler Tissue Imaging Capability SIEMENS Healthineers ... P4-2 20 C SIEMENS 12 24.03 Cardiac Tx Power 100% P4-2 Cardiac Tx Power 100% TIS 1.2 Settings MI 0.78 TIB 1.7 TIS 0.8 TIB 0.8 3.3 MHZ 2.2 MHZ 1953 Hz 610 Hz Gate 3.0 mm Flow Med 0 dB cing 27 fps 87 6pm 72 bpm 73 mm 16 cm Cine Rate CW Dust to Frame Set Start .. 46.5 mm/s ES Femme Set End M. Next Frame Mop Priority HC US MSC S SET Page 30 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: The system has DTI capability for Cardiac imaging with the P4-2 and P8-4 transducers. System Spectral Doppler DTI capability utilizes real time Doppler shift information from moving tissue to better visualize and quantify myocardial diastolic function. The spectral Doppler DTI calculation package provides guided velocity and acceleration measurements and includes a measurement report package. Color DTI capability can be used for qualitative evaluation of wall motion and displays the relative change of velocities Clinical Note: DTI is part of many standard exams. This is increasingly important with individuals who are undergoing chemotherapy because a side effect is heart failure. Chemo patients will have serial exams to check the function of their heart. These evaluations give the patient’s physicians an insight as to whether their chemo type or dosage should be modified. There are 5 maps available to select: A, B, C, D and E. Steps: 1. Select C for color Doppler, DTI will appear as a soft key option. 2. To measure, press Freeze, then select Measure. Color Doppler Energy (CDE) SIEMENS Healthineers ... 2D P ACUSON SIEMENS 11/1 1/2016 10:56:34 CH5-2 Abdomen Settings Tx Power 100% MI 1.08 TIS 0.6 TIB 0.6 2.7 MHZ 1220 Hz Flow Med 6 dB 5 fps Fr 45 Markers Cine Rate Display Dual Map Filter Smooth Priority MultiHertz CDE Flow Tx Power RIS Persist 2 Position Position 5.3 MHZ Med HC US MSC S SET Page 31 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: To select Color Doppler Energy or Power Doppler, press CDV on the Touch Screen. It will change the active mode to CDE. The Mode Menu will change to P for Power and the optimization or soft keys will change for Power Doppler parameters. This will remain the active color mode unless CDE is pressed again to return to CDV. CDE is best used for low volume, low velocity flow states to demonstrate the presence or absence of flow. Color Doppler Functionality SIEMENS Adjusting Color Region of Interest (ROI) Healthineers ... Size Size HC US MSC S SET Page 32 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: The color box will appear with a solid green line. To adjust the color box size, it will appear like the image on the right with dotted lines. There are 3 ways to adjust the Color Box. 1. Press Select, use the touch pad to adjust size, then press Select to set. 2. Tap the touch pad once, use touch pad to adjust size, then tap once to set. 3. Pinch the touch screen to adjust size. 4. Once it is set, use the touch pad to adjust the location. Color Doppler Functionality SIEMENS Steering the Color ROI Healthineers ... << Steer Steer >> HC US MSC S SET Page 33 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: To steer the color box use the steer right and left key located on the left panel control keys. Note that steer will cycle through the angles and it is not necessary to push left or right steer. Press steer right continuously and it will cycle through all the angles. Tip: Customize a user-defined key to Steer thus providing all Doppler keys on the Control Panel for easier workflow. The steering angles are 0/7.5 and 15 degrees on both sides. Pulsed Wave Doppler Functionality SIEMENS Healthineers Display Available option to bypass Monitor DGO Screen Saver Delay 20 minutes V DGC Invert with Image Invert bringing up cursor System Power Off 2 hours DGC Curve Display Time Out Brightness 44 DGC Control Current Image Depth Patient Banner Patient Data Age Date of Birth Doppler / M-Mode Doppler / M-Mode  Bypass Cursor Mode Bypass Cursor Mode Doppler Frequency/Velocity Frequency . Velocity Doppler Frequency/Velocity HC US MSC S SET Save Cancel Page 34 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: For PW Functionality the user has the option to bypass the curser. This is selected in the Configuration Menu / Display. The behavior with Bypass Cursor Mode on: Press PW and it will bypass the cursor and go straight into PW Doppler. PW / CW Doppler Optimization SIEMENS Healthineers ... 20 C PW System Serial Number : 391635 ACUSON $1106/2017 12:35:50 20 C PW CH5-2 Abdomen Tx Power 100% ..... Settings MI 0.72 TIS 0.9 TIB 2.6 Settings Auto Stat 2.7 MHZ 2790 Hz Gate 4.0 mm Auto Stat 44 dB Off tivity Volume 10 fps 66 mm 15 cm 2 . Volume Full D Full D CW Tint Map Dyn R 3 Sweep 70 GB Play Update Rate Update Filter Map Dyn R MultiHertz Gate Tx Power Sweep 188 Hz A 50 dB 5.3 MHZ 2.0 mm 3 Tint Position Position HC US MSC S SET Page 35 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: When in PW, the soft key menus provide the optimization controls. The soft keys are customizable in the configuration menu. To change the parameters on the soft keys, select (using the pointer) or touch the desired parameter. In addition, the hard keys below the soft keys on the control panel also make the changes. • Tint: Changes the color of the Doppler spectrum by adding blue, red, yellow, or green to the gray in a gray map. • Dynamic Range: Adjusts the overall contrast resolution (dynamic range) of the spectral display in 5 dB increments Lower levels are more black/white and higher levels show a greater range of velocities. Choices are 10 dB to 80 dB. • Sweep: Adjusts the scrolling speed of the Doppler spectrum. Decrease to display more heart cycles and increase to display less. Choices are .5 to • Map: Selects a processing curve that assigns echo amplitudes to gray levels. • Filter: Rejects signals below the selected frequency setting, for example, signals generally caused by tissue clutter. Increase to reduce clutter. Settings available are 94-969HZ (7 Selections depending on transducer). • Update Rate: Adjusts the interval for refreshing the 2D image . Choices are off, 1-8 seconds. • Gate: Increase the Size of the Doppler Cursor Gate. Increase to acquire greater sample size. Setting choices are 1.0- 10.0 mm. • When in Split Mode, the user can also Zoom the image. This can be done in a live or frozen mode. • The Left Panel control keys are customizable in the System Config menu as well. • Full Screen Doppler: Displays only the Doppler spectrum and hides the 2D image. Auto Stats: statistics, including pulsatility index (PI), resistive index (RI), systolic/diastolic ratio (S/D), and heart rate. Tap Auto Stat in the • left panel: Off disables the display of Doppler statistics. – Above displays statistics for Doppler data above the baseline. – Below displays statistics for Doppler data below the baseline. – Both displays statistics for Doppler data above and below the baseline. – Tap Sensitivity in the left panel and then select the required sensitivity level of the detection. • Volume: Adjusts the Doppler Audio volume. • Simult: Enables or disables the simultaneous display of the 2D and color image and Doppler spectrum in real time • Physio Settings: Adjusts the ECG controls when in Cardiac imaging. PW / CW Doppler Optimization SIEMENS Healthineers ... 20 C PN System Serial Number: 391635 CH5-2 Abdomen Tx Power 100% MI 0 72 TIS 09 Auto Sut TIB 2.6 2.7 MMz 2790 Hz Gate 4.0 mm 10 fps - 20 ..................... < O 6 8 19 W Tint Map Dyn R ................. Sweep 3 70 dB Play Play HC US MSC S SET Page 36 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: When in PW or CW Doppler, to change the tint of the Spectral Display, press Tint and a pop- up menu is displayed to allow selection of the tint. Pulsed Wave Doppler Functionality SIEMENS Angle Correction Healthineers ... SIEMENS ACUSON 16/04/2015 12:59:43 VF 10-5 31.2 CV Tx Power 100% MI 0.53 TIS <0.1 TIB <0.1 5.3 MHZ 6250 Hz Gate 2.0 mm 31.2 0 dB Angle 15 fps 14 mm 3.5 cm -100 50 61 º 14 mm -cm/s € 50 HC US MSC S SET Page 37 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Angle: Adjusting the angle: Rotate Angle knob to change the Angle. When the angle is changed, the angle will be highlighted. Once over 60 degrees, the angle will be highlighted in green. Press the angle knob to g from 0/60/0 degrees. Pulsed Wave Doppler Functionality SIEMENS Auto Stats Healthineers ... 2D C PW 2D C PW System Serial Number : 391537 ACUSON SIEMENS 32/05/2017 13:50:18 Physio Tx Power 100% Settings MI 0.62 TIS 0.4 TIB 0.7 Auto Stat Sensi Auto Stat Off 5.3 MHZ tivity 6250 Hz Both Above Gate 1.5 mm -7 dB cimis Volume Below 17 fps 10 91 bpm 57 Both 100 Settings ......................... Auto Stat Off O Sensi- Full D S/D = 4.14 PS = 74.7 cm/s TAmax = 33.0 cm/s Both Above ED = 18.1 cm/s CW TAmean = 19.3 cm/s Below Volume 1 46.5 mm/s Both 10 Map Dyn R Sweep 60 dB Play HC US MSC S SET Page 38 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: The Auto Stat option is available when in PW Doppler. Choose from above the baseline, below the baseline or both. Note, the heart rate is also displayed. The measurements that are calculated with Auto Stat are: PI= Pulsatility Index S/D= Systole/ Diastole ratio ED= End Diastole Tamean= Time Average mean RI=Resistive Index PS=Peak Systole Tamax= Time Average Max With the 2.0 release, the Sensitivity key was added. To adjust the sensitivity, select Sensitivity which is also located on the Left Panel Control keys. The user sets the sensitivity settings to match the yellow PSV line and adjust to include more or less of the spectrum via Sensitivity. Increase for higher sensitivity. Auto Stats is available on live and frozen images. Equalization and sound tuning of speakers for PW Doppler exams was done in the 2.0 release. Pulsed Wave Doppler Functionality SIEMENS Simultaneous (Triplex) Healthineers ... 2D PW SIEMENS 11/06/2017 13:50:11 VF 16-5 40.3 physio Settings PV Tx Power 100% MI 0.80 Auto Stat TIS 0.2 tivity TIB 0.8 Off 5.3 MHZ eSieScan Volume 5580 Hz Gate 1.0 mm 11 5 dB << Steer Steer > 51 2 cm Z 100 50 Full D -cm/s Simult CW HC US MSC S SET Page 39 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: Simultaneous is the triplex mode. With this mode, the color and Doppler will be live at the same time. Select SIMULT on the left panel control keys to activate. Note, when in SIMULT, the frame rate will be lower. The user can also select the Update rate on the Soft keys, to update from 1-8 seconds. This is an image of the posterior tibial artery. (show video live) . Continuous Wave Doppler Functionality SIEMENS Healthineers ... CWS Ped Echo Tx Power 100% MI 0.05 TIS 1.2 P4-2 61.3 TIB 2.5 5.0 MHZ EM 19.5 KHz 0 dB Tx Power 100% 67 bpm MI 0.70 TIS 0.9 TIB 0.9 DTCE Low Dyn R 60 dB THI 3.6 MHZ 0 dB 18 fps Fr 165 100 mm 18 cm 100 -cm/s -- 100 HC US MSC S SET Page 40 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: CW Doppler: The System also has imaging CW Doppler and Aux CW 2.0 option for adult Cardiac and 5.0 for pediatrics and vascular. CW Doppler is accessed via the left panel control keys, but can be assigned to a user- defined key (System Config / Custom Keys menu) for easier access. Selecting the AUX CW transducer enables the non-imaging CW Doppler. Full Screen Doppler SIEMENS Healthineers' ... VF10-5 CV 60 Phyto Tx Power 100% 120 Settings MI 0.53 TIS <0.1 Auto Stat Volume TIB <0.1 100 5.3 MHZ Off Off 6250 Hz Gate 2.0 mm 80 -7 dB 60 << Steer Steer > 40 20 Full D cm/s Simult CW HC US MSC S SET Page 41 | Unrestricted @ Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: This mode allows the user to have a full imaging screen of just Doppler in PW and CW Doppler.. CW Doppler only works with the Cardiac and pediatric exam preset using the P8-4 and P4-2 transducer. Summary SIEMENS Healthineers . Review 2D and M-mode Controls Describe 2D and M-mode Optimization Features . Explain Display Modes Review Doppler Controls Describe Doppler Optimization .--- Features HC US MSC S SET Page 42 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Speaker Notes: We have • Reviewed 2D and M-mode Controls • Described 2D and M-mode Optimization Features • Explained Display modes • Reviewed Doppler Controls • Described Doppler Optimization Features Questions HC US MSC S SET Page 43 | Unrestricted C Siemens Medical Solutions USA, Inc. 2017 Questions?
- ACUSON P500
- Major Modes