Contrast-Enhanced Echocardiography - ACUSON Juniper™ Ultrasound System

Continue Continue Contrast-Enhancement Echocardiography ACUSON Juniper™ Ultrasound System Contrast-Enhancement for Left Ventricular Opacification Online Course This course is a high-level overview of contrast-enhancement echocardiography for left ventricular opacification (LVO) and LVO functionality on the ACUSON Juniper system. Understand the physical properties and behaviors of the microbubble within the acoustic field 1 Relate instrumentation on the ACUSON Juniper system that influences the microbubble 2 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 Welcome Base Slide - Welcome: welcome_lvo.mp3 Welcome to the ACUSON Juniper™ Ultrasound System, Contrast-Enhancement for Left Ventricular Opacification Online Training. This course is a high-level overview of contrast-enhancement echocardiography for left ventricular opacification (LVO) and LVO functionality on the ACUSON Juniper system. These are the two learning objectives that will be covered in this course. Introduction When clinically indicated, contrast-enhanced echocardiograms for Left Ventricular Opacification (LVO) can facilitate wall motion assessment and provide diagnostic confidence. The ACUSON Juniper system has an intuitive touch-screen layout that is streamlined to include only the functions necessary to confidently perform LVO exams. Introduction Base Layer - Introduction: 1.2_lvo.mp3 When clinically indicated, contrast-enhanced echocardiograms for Left Ventricular Opacification (LVO) can facilitate wall motion assessment and provide diagnostic confidence. The ACUSON Juniper system has an intuitive touch-screen layout that is streamlined to include only the functions necessary to confidently perform LVO exams. Microbubble for LVO Contrast-enhancement echocardiography improves the endocardial border detection and facilitates wall motion assessment. LVO is appropriate when two or more adjacent segments of the left ventricle are suboptimal, limiting the evaluation of the structure and function. Select each of the tab arrows to learn more about LVO. History Benefit Microbubble Resonating Non-Linear Microbubble Base Layer- Microbubble: 1.3_lvo.mp3 Contrast-enhancement echocardiography improves the endocardial border detection and facilitates wall motion assessment. LVO is appropriate when two or more adjacent segments of the left ventricle are suboptimal, limiting the evaluation of the structure and function. Select each of the tab arrows to learn more about LVO. Layer 1. History: No Audio Contrast-enhancing agents are microbubbles that generate harmonic energy within the acoustic field, providing a stable grey-scale enhancement. However, first-generation contrast-enhancing agents (CEA) were developed for echocardiography in the era before harmonic imaging. The U.S. FDA approved the first generation CEA in 1994 that was an air-based CEA. This first-generation CEA did improve Doppler spectral profiles and provided some grey-scale enhancing effect but proved to be highly diffusible lasting about 30 seconds in the left ventricle. In Europe, the two first-generation CEAs were released in 1991 and 1996. Similarly, these CEAs did improve the ultrasound intensity of the blood pool but had small amplitude responses in the acoustic field. Second-generation agents were designed for stability while oscillating within the acoustic field. Harmonic imaging caused the second-generation agents to oscillate and generate harmonic energy within the acoustic field. Layer 2 Benefit: No Audio When the accuracy of the non-enhanced echocardiogram is suboptimal, it may be impossible to accurately assess left ventricular ejection fraction (LVEF). With the addition of contrast-enhancement, LVEF accuracy improves. Enhanced blood pool and endocardial borders improve the diagnostic confidence of intracardiac abnormalities. Examples can include ventricular non-compaction, hypertrophic cardiomyopathy, myocardial infarction, variants within or near the apex, ventricular aneurysm, or thrombus. Layer 3. Microbubble: No Audio Microbubbles are engineered to persist in the body by using a low molecular weight gas core that is surrounded by a flexible shell. Microbubble contrast agents are introduced into the bloodstream from a diluted bolus injection or by continuous infusion (IV). The microbubble and blood cells have a similar size to red blood cells, and the microbubbles can travel anywhere within the body's vascular system. When the contrast agent microbubble is exposed to the high and low pressures of the ultrasound field, microbubbles will resonate, rapidly increasing and decreasing in size creating a large amount of acoustic backscatter. Layer 4. Resonating: No Audio With each pulse of acoustic pressure, the microbubbles of the contrast agent will begin to expand and contract within the acoustic field. The microbubble responds to each pulse of the pressure wave, getting smaller during the compression and larger during the rarefraction of the pressure wave. When the resonating bubble is exposed to higher and higher ultrasound pressures, the magnitude of expansion is greater to expand much more than it will contract. Layer 5. Non-Linear: No Audio This disproportionate expansion and contraction cycle means that bubble echoes no longer scale directly with the acoustic ultrasound transmit pressure. This disproportionate scaling behavior is commonly termed as non-linear and has the observable effect that echoes start to reflect harmonics - or signals at an integer multiple of the fundamental frequency. Twice the fundamental frequency is the second harmonic. The harmonic echoes from the microbubbles help to define the tissue boundary interfaces used for LVO. Non-Linear This disproportionate expansion and contraction cycle mean that bubble echoes no longer scale directly with the acoustic ultrasound transmit pressure. This disproportionate scaling behavior is commonly termed as non-linear and has the observable effect that echoes start to reflect harmonics - or signals at an integer multiple of the fundamental frequency. Twice the fundamental frequency is the second harmonic. The harmonic echoes from the microbubbles help to define the tissue boundary interfaces used for LVO. [1-3] Resonating With each pulse of acoustic pressure, the microbubbles of the contrast agent will begin to expand and contract within the acoustic field. The microbubble responds to each pulse of the pressure wave, getting smaller during the compression and larger during the rarefraction of the pressure wave. When the resonating bubble is exposed to higher and higher ultrasound pressures, the magnitude of expansion is greater to expand much more than it will contract. Microbubbles Microbubbles are engineered to persist in the body by using a low molecular weight gas core that is surrounded by a flexible shell. Microbubble contrast agents are introduced into the bloodstream from a diluted bolus injection or by continuous infusion (IV). The microbubble and blood cells have a similar size to red blood cells, and the microbubbles can travel anywhere within the body's vascular system. When the contrast agent microbubble is exposed to the high and low pressures of the ultrasound field, microbubbles will resonate, rapidly increasing and decreasing in size creating a large amount of acoustic backscatter. Benefit of LVO When the accuracy of the non-enhanced echocardiogram is suboptimal, it may be impossible to accurately assess left ventricular ejection fraction (LVEF). With the addition of contrast-enhancement, LVEF accuracy improves. Enhanced blood pool and endocardial borders improve the diagnostic confidence of intracardiac abnormalities. Examples can include ventricular non-compaction, hypertrophic cardiomyopathy, myocardial infarction, variants within or near the apex, ventricular aneurysm, or thrombus. [8-10} Brief History of LVO Contrast-enhancing agents are microbubbles that generate harmonic energy within the acoustic field, providing a stable grey-scale enhancement. However, first-generation contrast-enhancing agents (CEA) were developed for echocardiography in the era before harmonic imaging. The U.S. FDA approved the first generation CEA in 1994 that was an air-based CEA. This first-generation CEA did improve Doppler spectral profiles and provided some grey scale enhancing effect, but proved to be highly diffusible lasting about 30 seconds in the left ventricle. In Europe, the two first-generation CEAs were released in 1991 and 1996. Similarly, these CEAs did improve the ultrasound intensity of the blood pool but had small amplitude responses in the acoustic field. Second-generation agents were designed for stability while oscillating within the acoustic field. Harmonic imaging caused the second-generation agents to oscillate and generate harmonic energy within the acoustic field. Instrumentation Impact on the Microbubble In this section, you will review the initial instrumentation on the ACUSON Juniper system that impacts the microbubble. Select the numbered steps below to learn more about the effect that instrumentation has on the microbubble. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 LVO Instrumentation on the ACUSON Juniper System Base Layer – LVO Instrumentation on the Juniper: 1.4_lvo.mp3 In this section, you will review the initial instrumentation on the ACUSON Juniper system that impacts the microbubble. Select the numbered steps below to learn more about the effect that instrumentation has on the microbubble. Layer 1. 5P1 on the Juniper: No Audio The ACUSON Juniper has an intuitive touch screen layout and streamlined workflow for LVO. Simply select the 5P1 transducer, initialize the Adult Echo exam preset, and select LVO from the touch screen. Please select the 5P1 transducer to begin the exam. Layer 1a. LVO initiated: No Audio Select LVO on the touch screen to learn more about the contrast-enhancement technology. Layer 1b. LVO off: No Audio If you need to deactivate LVO during the exam, simply press LVO once more on the touch screen. Please select the number two to learn about contrast harmonic Imaging (CHI) technology, a low MI contrast imaging technique. Layer 2 – CHI on the Juniper: No Audio The ACUSON Juniper System uses Contrast harmonic imaging (CHI) for LVO. CHI is a two-pulse sequence where the second transmission pulse is identical to the first transmission pulse except that it is inverted (pulse inversion). Pulse inversion uses two pulses of equal amplitude but opposing values. Please select the image to learn more about CHI. Layer 2a – CHI2: No Audio While using CHI during an LVO study, the reflected tissue signal, which is mostly linear, is canceled out while the non-linear microbubble signal that returns from the contrast agent is augmented. Some tissue signals may also reflect non-linear echoes and therefore may also generate an augmented signal. A benefit of CHI is that the two pulse technique allows for increased frame rates and less impact on the microbubble. Select number three to proceed. Layer 3- MI on the Juniper: No Audio MI is a unitless measure of the magnitude of the pulse pressure and describes the acoustic power emitted out into the acoustic field. A MI of less than 0.20 is ideal for LVO exams. A low Mechanical Index (MI) helps to maintain an optimal environment for the microbubble so that the microbubble can resonate. Remember that resonating is the non-linear behavior which is key to imaging with the contrast agent effectively. When LVO Contrast is enabled from the touch screen, the Transmit Power (Tx Power) is reduced to 3.20%. On LVO exams the Juniper uses a Low MI setting and depending on imaging depth the MI setting is at or near 0.18. Layer 4 – Transmit Power on the Juniper: No Audio Further changes to MI are controlled by the Tx Power softkey on the Juniper Ultrasound System shown framed in orange. Layer 5 – MIF on the Juniper: No Audio Depending on the depth of the focus, the Mechanical Index at the Focus (MIF) is at or near 0.08. Position the focus caret lower in the field of view to minimize MIF impact on the microbubble. The MI and MIF will impact the microbubble, however, since microbubbles have strong non-linear behavior, even at lower pressures, using CHI is an ideal choice for non-linear detection of the microbubbles. Layer 6 – PRF on the Juniper: No Audio The pulse duration and PRF will also affect the microbubble. As the PRF increases, so does the number of acoustic pulses that impact with the microbubble and this leads to bubble destruction. Reduce the dwell time during active imaging and optimize the imaging depth, targeting the ventricles in all of the orthogonal views. Please select the Depth / Focus image outlined in orange to learn more about dwell time. Layer 6a. – Dwell Time: No Audio Reducing dwell time can be achieved simply by transient imaging or simply temporarily ‘freezing’ or lifting the transducer when not actively imaging during LVO. Electrocardiographic (ECG) gating is a method to reduce the amount of dwell time by actively imaging during a portion or portions of the cardiac cycle. Select the number seven to proceed. Layer 7 – Doppler on the Juniper: No Audio Color Doppler and pulse wave (PW) and continuous wave (CW) spectral Doppler are located on the on the control panel. Color Doppler and PW Doppler are pulsing intermittently and as such, do not increase the transit power but may impact pulse repetition frequency. However, CW Doppler is continuously pulsing, and this will impact the microbubble and increase the pulse repetition frequency. Layer 8 – Frequency on the Juniper: No Audio The transmit frequency for LVO is a balance between achieving diagnostic image quality while maintaining bubble integrity. The frequency is optimized on the Juniper Ultrasound System for LVO at 3.7 MHz. Frequency can be adjusted using the Frequency soft key. High frequency settings will disrupt the microbubble. Please select the Frequency soft key, that is outlined with the orange frame. Layer 8a. - Frequency1: No Audio The MultiHertz transmit frequency selections for LVO on the Juniper Ultrasound System include: 2.7 MHz 3.0 MHz 3.7 MHz 4.0 MHz Frequency The MultiHertz transmit frequency selections for LVO on the Juniper Ultrasound System include: 2.7 MHz 3.0 MHz 3.7 MHz 4.0 MHz 8 Frequency 8 The transmit frequency for LVO is a balance between achieving diagnostic image quality while maintaining bubble integrity. The frequency is optimized on the Juniper Ultrasound System for LVO at 3.7 MHz. Frequency can be adjusted using the Frequency soft key. High frequency settings will disrupt the microbubble. Please select the Frequency soft key, that is outlined with the orange frame. Doppler 7 Color Doppler, pulse wave (PW) and continuous wave (CW) spectral Doppler are located on the on the control panel. Color Doppler and PW Doppler are pulsing intermittently and as such, do not increase the transit power but may impact pulse repetition frequency. However, CW Doppler is continuously pulsing, and this will impact the microbubble and increase the PRF. Dwell time is the time spent actively imaging during the LVO exam. Dwell time can be reduced simply by transiently imaging, temporarily ‘freezing’, or lifting the transducer when not actively imaging during the LVO exam. Electrocardiographic (ECG) gating is a method to reduce the amount of dwell time by actively imaging during a portion or portions of the cardiac cycle. Select the number seven to proceed. Dwell Time 6 The pulse duration and PRF will also affect the microbubble. As the PRF increases, so does the number of acoustic pulses that impact with the microbubble and this leads to bubble destruction. Reduce the dwell time during active imaging and optimize the imaging depth, targeting the ventricles in all of the orthogonal views. Please select the Depth / Focus image outlined in orange to learn more about dwell time. Pulse Duration and Pulse Repetition Frequency (PRF) 6 Mechanical Index at the Focus (MIF) Depending on the depth of the focus, the Mechanical Index at the Focus (MIF) is at or near 0.08. Position the focus caret lower in the field of view to minimize MIF impact on the microbubble. The MI and MIF will impact the microbubble, however, since microbubbles have strong non-linear behavior, even at lower pressures, using CHI is an ideal choice for non-linear detection of the microbubbles. 5 Transmit Power 4 Further changes to MI are controlled by the Tx Power softkey on the Juniper Ultrasound System shown framed in orange. Low Mechanical Index (MI) 3 MI is a unitless measure of the magnitude of the pulse pressure and describes the acoustic power emitted out into the acoustic field. A MI of less than 0.20 is ideal for LVO exams. A low Mechanical Index (MI) helps to maintain an optimal environment for the microbubble so that the microbubble can resonate. Remember that resonating is the non-linear behavior which is key to imaging with the contrast agent effectively. When LVO Contrast is enabled from the touch screen, the Transmit Power (Tx Power) is reduced to 3.20%. On LVO exams the Juniper uses a Low MI setting and depending on imaging depth the MI setting is at or near 0.18. While using CHI during an LVO study, the reflected tissue signal, which is mostly linear is canceled out while the non-linear microbubble signal that returns from the contrast agent is augmented. Some tissue signals may also reflect non-linear echoes and therefore may also generate an augmented signal. A benefit of CHI is that the two pulse technique allows for increased frame rates and less impact on the microbubble. Select number three to learn about MI. Contrast Harmonic Imaging (CHI) 2 Contrast Harmonic Imaging (CHI) 2 The ACUSON Juniper System uses Contrast harmonic imaging (CHI) for LVO. CHI is a two-pulse sequence where the second transmission pulse is identical to the first transmission pulse except that it is inverted (pulse inversion). Pulse inversion uses two pulses of equal amplitude but opposing values. Please select the image to learn more about CHI. 1 If you need to deactivate LVO during the exam, simply press LVO once more on the touch screen. Please select the number two to learn about contrast harmonic Imaging (CHI) technology, a low MI contrast imaging technique. Deactivate LVO Now select LVO on the touch screen to initiate LVO settings for contrast-enhancement. 1 Initiate LVO 5P1 Transducer The ACUSON Juniper has an intuitive touch screen layout and streamlined workflow for LVO. Simply select the 5P1 transducer, initialize the Adult Echo exam preset, and select LVO from the touch screen. Please select the 5P1 transducer to begin the exam. 1 Instrumentation for Image Quality In this section, you will review instrumentation that impacts the image quality for contrast-enhanced echocardiograms for LVO. Select the tab arrows to review the instrumentation on the ACUSON Juniper ultrasound system that impacts image quality for LVO. Dynamic Tissue Contrast Enhancement Gain Dynamic Range 2D Maps Clip Length Image Quality Instrumentation on the ACUSON Juniper System Base Layer – Image Quality Instrumentation on the ACUSON Juniper System: 1.5_lvo.mp3 In this section, you will review instrumentation that impacts the image quality for contrast-enhanced echocardiograms for LVO. Select the tab arrows to review the instrumentation on the Juniper ultrasound system that impacts image quality for contrast-enhanced echocardiograms for LVO. Layer 1 DTCE: No Audio Dynamic Tissue Contrast Enhancement or DTCE reduces speckle in the tissue. Rotate the DTCE key to select the settings: Off disables DTCE. Low DTCE applies a low level of speckle. Medium DTCE applies a medium level of speckle. High DTCE applies a high level of speckle within the tissue. For LVO the default DTCE setting is medium. DTCE will not impact the microbubble. Layer 2 Gain: No Audio On the ACUSON Juniper Ultrasound System, the 2D gain is found intuitively on the right side of the control panel. Users can easily optimize the 2D gain to improve the epicardial contour and the brightness of the received signal from the microbubble during the LVO exam. Time gain compensation (TGC) settings can be adjusted for attenuation and image uniformity as needed. 2D gain and TGC settings will not impact the microbubble. Layer 3 Dynamic Range: No Audio The Dynamic Range or Dyn R is read in decibels (dB) and is sometimes referred to as the overall contrast resolution. Dyn R is the largest-intensity to the lowest-intensity that can be displayed. The intensities are grouped as shades of grey between black (the lowest intensity) to white (the highest intensity). Dyn R settings are typically kept low at 60 dB or less for LVO studies because the subtle grey scale information from the tissue of the left ventricle is typically not the emphasis. Dynamic range does not impact the microbubble. Layer 4 2DMaps: No Audio 2D Tint and Map selections are available from the soft keys found just below the touch screen of the Juniper Ultrasound System. The choice of the 2D Tint and Map differ based on individual preferences and depend on the real-time display and secondary review from a stand-alone workstation display. 2D Tints and Maps are components of post-processing and do not impact the microbubble. Layer 5 Clip Length: No Audio The Clip Length can be optimized for the number of beats or time. The Clip Length selection is located on the touch screen of the Juniper Ultrasound System. Depending on the clinical need, image collection can begin early with initial visualization of contrast, at maximum LVO enhancement, and late stages of LVO. The default LVO setting is Prospective. However, the Clip Length can be configured within the general configuration to save either prospectively or retrospectively. Clip Length will not impact the microbubble. Tint Maps 2D Tint and Map selections are available from the soft keys found just below the touch screen of the Juniper Ultrasound System. The choice of the 2D Tint and Map differ based on individual preferences and depend on the real-time display and secondary review from a stand-alone workstation display. 2D Tints and Maps are components of post-processing and do not impact the microbubble. 2D Tints and Maps Clip Settings The Clip Length can be optimized for the number of beats or time. The Clip Length selection is located on the touch screen of the Juniper Ultrasound System. Depending on the clinical need, image collection can begin early with initial visualization of contrast, at maximum LVO enhancement, and late stages of LVO. The default LVO setting is Prospective. However, the Clip Length can be configured within the general configuration to save either prospectively or retrospectively. Clip Length will not impact the microbubble. Dynamic Range (Dyn R) The Dynamic Range or Dyn R is read in decibels (dB) and is sometimes referred to as the overall contrast resolution. Dyn R is the largest-intensity to the lowest-intensity that can be displayed. The intensities are grouped as shades of grey between black (the lowest intensity) to white (the highest intensity). Dyn R settings are typically kept low at 60 dB or less for LVO studies because the subtle grey scale information from the tissue of the left ventricle is typically not the emphasis. Dynamic range does not impact the microbubble. 2D Gain On the ACUSON Juniper Ultrasound System, the 2D gain is found intuitively on the right side of the control panel. Users can easily optimize the 2D gain to improve the epicardial contour and the brightness of the received signal from the microbubble during the LVO exam. The time gain compensation (TGC) settings can be adjusted for attenuation and image uniformity as needed. 2D gain and TGC settings will not impact the microbubble. Dynamic Tissue Contrast Enhancement (DTCE) Dynamic Tissue Contrast Enhancement or DTCE reduces speckle in the tissue. Rotate the DTCE key to select the settings: Off disables DTCE. Low DTCE applies a low level of speckle. Medium DTCE applies a medium level of speckle. High DTCE applies a high level of speckle within the tissue. For LVO the default DTCE setting is medium. DTCE will not impact the microbubble. Relate instrumentation on the ACUSON Juniper system that influences the microbubble Understand the physical properties and behaviors of the microbubble within the acoustic field 1 1 1 2 Course Review Congratulations. You have completed the ACUSON Juniper™ Ultrasound System Contrast-Enhancement Echocardiography for Left Ventricular Opacification course. Select the objectives listed below to review the material before proceeding to the final assessment. Course Review Base Layer- Course Review:No Audio Congratulations. You have completed the ACUSON Juniper™ Ultrasound System Contrast-Enhancement Echocardiography for Left Ventricular Opacification course. Select the objectives listed below to review the material before proceeding to the final assessment. Layer 1 – Objective 1 Understand the physical properties and behaviors of the microbubble within the acoustic field Pressure variation within the acoustic field causes the gas in the microbubble to expand in low pressure and contract in high pressure. Harmonic Imaging causes a non-linear dynamic vibration or oscillation of the microbubble, and each microbubble actively creates a harmonic signal reflection. Low mechanical index (MI) will improve the stability of the microbubble. High MI will destabilize the microbubble. Left Ventricular Opacification or LVO is used in echocardiography to detect the endocardial border. Layer 2 - Objective 2 Relate instrumentation on the ACUSON Juniper system that influences the microbubble Frequency, Power, Focus, Frame Rate will impact the microbubble. Contrast Harmonic Imaging (CHI) augments the non-linear behavior of the microbubbles within the acoustic field. The intensity of the acoustic field at the level of the focus is MI at the Focus or MIF. Dwell time, the amount of time actively imaging and has an impact on the microbubble. Doppler will transiently increase pulse repetition frequency. DTCE, Dynamic Range, 2D gain, 2D maps, and tints, optimize image quality with no impact to the microbubble. Cine-loops can be acquired prospectively or retrospectively. Relate instrumentation on the ACUSON Juniper system that influences the microbubble Frequency, Power, Focus, Frame Rate will impact the microbubble. Contrast Harmonic Imaging (CHI) augments the non-linear behavior of the microbubbles within the acoustic field. The intensity of the acoustic field at the level of the focus is MI at the Focus or MIF. Dwell time, the amount of time actively imaging and has an impact on the microbubble. Doppler will transiently increase pulse repetition frequency. DTCE, Dynamic Range, 2D gain, 2D maps, and tints, optimize image quality with no impact to the microbubble. Cine-loops can be acquired prospectively or retrospectively. Understand the physical properties and behaviors of the microbubble within the acoustic field Pressure variation within the acoustic field causes the gas in the microbubble to expand in low pressure and contract in high pressure. Harmonic Imaging causes a non-linear dynamic vibration or oscillation of the microbubble, and each microbubble actively creates a harmonic signal reflection. Low mechanical index (MI) will improve the stability of the microbubble. High MI will destabilize the microbubble. Left Ventricular Opacification or LVO is used in echocardiography to detect the endocardial border. Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. ACUSON Juniper™ is a trademark of Siemens Healthineers. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2020 Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127\ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com Disclaimer Disclaimer Assessment This assessment will test your retention of the presented content. A passing score of 80% or higher is required to complete the course and earn your certificate. You may repeat the assessment as many times as needed. Start Assessment Contrast Harmonic Imaging Fundamental Imaging Contrast Agents Enhanced endocardial Border The Juniper Ultrasound System uses what technology to elicit the non-linear response from ultrasound contrast microbubbles for LVO? Question 1 of 3 Select the best answer. Multiple Choice Question Incorrect Enhancement is the response not the technology that creates the response. Incorrect Contrast agents are not the technology that creates the non-linear response. Incorrect Fundamental imaging elicits no significant enhancement from the microbubble. Correct This elicits a non-linear response from the microbubble. Microbubble instability Decreased acoustic pressure Microbubble stability Gain has no impact on the microbubble What is the impact on the microbubble if the overall gain is increased and the Transmit Power is increased to 100%? Question 2 of 3 Select the best answer. Multiple Choice Question Incorrect Yes, the 2D gain does not impact the microbubble however increasing the MI will have a negative impact on the microbubble. Incorrect Microbubble integrity is stable with a low MI less than 0.2. Incorrect The power is increasing so the pressure would therefore increase. Correct The High MI results in bubble destruction. Harmonic imaging Fundamental imaging Contrast agents Enhanced endocardial border What technology reduces noise by eliciting non-linear echoes from tissue and ultrasound contrast microbubbles? Question 3 of 3 Select the best answer. Multiple Choice Question Incorrect Enhancement is the response not the technology that creates the response. Incorrect Contrast agents emit the non-linear response. Incorrect Fundamental imaging elicits no significant enhancement from the microbubble. Correct Harmonic imaging elicits a non-linear response Review Review Retry Assessment Results %Results.ScorePercent%% %Results.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Assessment Results You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. You have completed the ACUSON Juniper™ Ultrasound System Contrast-Enhancement Echocardiography for Left Ventricular Opacification Online Training. Completion ACUSON Juniper LVO Course References Appropriateness Contrast is appropriate to use when two or more consecutive segment of the left ventricle are sub-optimal limiting the ability to evaluate structure and function. Attenuation Microbubble absorbing the acoustic energy and casting a shaddow below the cluster of microbubbles. Contrast-Enhancing Agent Manufactured microbubbles that are around 1.0 to 5.0 microns in size and engineered to persist and travel with the blood stream within the body's vascular system. Dwell Time The amount of time spent actively imaging. Harmonics An integer multiple of the fundamental frequency. Twice the fundamental frequency is the second harmonic.  Linear Response Microbubble or tissue does not reflect harmonic signal LVO Left Ventricular Opacification Mechanical Index This is the transmit power and is a unitless measure of the magnitude of the pulse pressure and describes the acoustic power emitted out into the acoustic field. The Mechanical Index is the peak negative pressure of the acoustic pressure wave divided by the square root of the transmitted frequency. Non-linear Response Microbubble reflects harmonic signals in response to the pressure wave in the acoustic field. Package Insert This is a document that is contained within the package of each agent. The Package Insert provides health care providers with drug properties, safety information, contraindications, potential adverse reactions, avaliable formulations, dosing, and how to administer the drug. This document is written in simple language and regulated by the Food and Drug Administration. Pulse Duration Pulse Duration is the length of the transmitted pulse. Pulse Repetition Frequency The PRF is the the number of acoustic pulses that impact with the microbubble and this leads to bubble destruction.  Resonating When the contrast agent microbubble is exposed to the high and low pressures of the ultrasound field, microbubbles will resonate, rapidly increasing and decreasing in size creating a large amount of acoustic backscatter. This is also non-linear behavior. Swirling Contrast microbubbles with either too little concentration or too much power. The concentration creates a swirling pattern near the apex and does not properly enhance the endocardial border. Transmit Power Transmit power is the same as Mechanical Index. 1.1 Welcome 1.2 Introduction 1.3 Microbubble 1.4 LVO Instrumentation on the ACUSON Juniper System 1.5 Image Quality Instrumentation on the ACUSON Juniper System 1.6 Course Review 1.7 Disclaimer 1.8 Assessment 1.13 Completion