eSie Valves™ Advanced Analysis Package – Software 5.1 Release - USA

Welcome to the Siemens Healthineers eSie Valves™ Advanced Analysis Package with 5.1 software release online course.    During this course, there will be a lot of detailed information given. There is more information available in the form of links placed on the page.  To successfully complete this course, please view all available content.   We hope you enjoy this e-learning course.                                                                                                                                                                                                                              Congratulations! You have completed the eSie Valves Advanced Analysis Package – 5.1 software release online course. Listed below are the key points presented in this course. Take time to review the material before you try the final assessment.   Download and print a copy of the detailed Course Review   Download and print a copy of eSie Valve package Quick Reference Card   In this tutorial you have learned to:   Apply eSie Valve package to appropriate 4D volume data sets   Understand workflow of the eSie Valve package   Activate edits when needed Upon completion of this tutorial, the learner will be able to:   Apply eSie Valve package to appropriate 4D volume data sets Understand workflow of the eSie Valve package Activate edits when needed Valvular heart disease (VHD) affects 2.5% of the global population.  Valve repair or replacements are not only complex, but one of the most expensive and riskiest cardiac procedures performed, contributing to 3.36% of in-hospital death rates.¹   The gold standard for these procedures has been open heart surgery.  Although within the last five years an emergence of less invasive solutions are more common in use.  These solutions are delivered via trans-catheter versus the traditional open-heart procedures.    With either procedure, the Surgeon will need to assess the best possible method of treatment of the VHD for each patient. Including a comprehensive assessment of the affected valve or valves with detailed structural anatomy, hemodynamic and statistical information. To perform these assessments, advanced imaging technologies help to reduce the complexity of obtaining data needed for correct evaluation of VHD.                                                                                                           ¹Mansi,T., Houle,H., Voigt,I., Quantifying Heart Valves: From Diagnostic to Personalized Valve Repair – White Paper, JASE, 2015.   It has been suggested by the American College of Cardiology (ACC) and the American Heart Association (AHA) that 3D volume imaging can be helpful in the evaluation of heart anatomy.²   Several medical equipment companies have developed advanced imaging tools that can be used with volume imaging to assist in the evaluation of VHD.   During the examination the patient can present imaging challenges during a volume acquisition.  These challenges can hinder evaluation of the impacted valve(s).  A few of the common imaging challenges with 3D volume acquisition are arrhythmia, (i.e. Atrial fibrillation, cardiac electrical impulse anomalies such as left bundle branch block (LBBB), etc.), the inability of the patient to suspend breath or to remain still.    Some of the equipment developed delivers a 3D volume data set using a gated acquisition method.  Two, four or six smaller volumes are stitched together over a timed acquisition to display the larger volume at a higher frame rate (FR) with improve image quality.  This is called a gated acquisition.   If movement occurs during the acquisition, discordance between and within these smaller volume interfaces can be seen.  Depending on the amount of movement determines the amount of stitching discordance between the smaller volumes.   Therefore, real-time 4D volume is a better acquisition method.  Real-time 4D volumes acquired with multiple heart cycles eliminates the need for gating and allows for better evaluation of multiple volumes for averaged results with patients that present with the physical challenges as well as arrhythmias.    ²Kavinsky,C., Poulin, M-F., Mack, M., Training in Structural Heart Disease – Call to Action: AHA, 2018. Please review the links below for further information.  More Information Learn about Evaluation with Volume Imaging Continued. Slide NumberText BlocksCalloutsAudio ScriptImage File1ACC/AHA Standards The ACC and the AHA have developed and continue to contribute to standards and guidelines for assessment and treatment protocols for VHD².  The ACC and AHA have published and continue to update these developments on their web pages.  Please refer to the ACC and AHA websites for detailed information.   ²Kavinsky,C., Poulin, M-F., Mack, M., Training in Structural Heart Disease – Call to Action: AHA, 2018.The ACC and the AHA have developed and continue to contribute to standards and guidelines for assessment and treatment protocols for VHD.² The ACC and AHA have published and continue to update these developments on their web pages. Please refer to the ACC and AHA websites for detailed information.2 Z6Ms TEE transducer design   The Z6Ms was designed with the user in mind.  There are many useful and meaningful functions incorporated to help the user with their workflow.    This unique transducer has an imaging array with over 2,000 elements and utilizes up to 64 parallel beams.  The Z6Ms delivers exceptional 2D imaging, color Doppler sensitivity as well as real-time Bi-plane access for better anatomy appraisal in multiple views. Real-time 4D volumes, as well as real-time 4D and color Doppler volume data sets can be easily acquired with high VPS (volume per second) rates. This allows the user to focus on imaging the anatomy needed instead of focusing on image optimization methods.   The Z6Ms was designed with the user in mind. There are many useful and meaningful functions incorporated to help the user with their workflow. This unique transducer has an imaging array with over 2,000 elements and utilizes up to 64 parallel beams. The Z6Ms delivers exceptional 2D imaging, color Doppler sensitivity as well as real-time Bi-plane access for better anatomy appraisal in multiple views. Real-time 4D volumes, as well as real-time 4D and color Doppler volume data sets can be easily acquired with high VPS rates. This allows the user to focus on imaging the anatomy needed instead of focusing on image optimization methods.3The Z6Ms has several thermal management innovations that help achieve uninterrupted imaging, higher sensitivity, and assists with higher volume rates.  In addition, the transducer is fully Electro-Magnetic Interference (EMI) shielded.  This deters interference from other devices used during procedures, minimizing effects of electrical interference during image acquisition.   For a swift workflow the Z6Ms has programmable Smart Buttons that allow the user to customize shortcuts for up to four separate system controls.  This includes clip capture, color Doppler On/Off, and image plane rotation.The Z6Ms has several thermal management innovations that help achieve uninterrupted imaging, higher sensitivity, and assists with higher volume rates. In addition, the transducer is fully EMI shielded. This deters interference from other devices used during procedures, minimizing effects of electrical interference during image acquisition. For a swift workflow the Z6Ms has programmable Smart Buttons that allow the user to customize shortcuts for up to four separate system controls. This includes clip capture, color Doppler On/Off, and image plane rotation.4Siemens’ Solutions for Real-time 4D Volume Imaging   Siemens ACUSON SC2000 PRIME™ ultrasound system with the Z6Ms transesophageal transducer (TEE) allows for real-time 4D volume and real-time 4D color Doppler volume acquisitions. This combination of equipment delivers high volume per second (VPS) acquisition at clinically relevant volume sizes, (90x90).  The ACUSON SC2000 PRIME solution allows high VPS data set acquisition, instead of traditional frames per second (FPS).  Higher FR as well as high VPS is easily achieved even with color volume data included. The ideal acquisition rate is 15 VPS or higher.  Real-time 4D volume data sets with volume color Doppler should try to achieve this goal. Siemens ACUSON SC2000 PRIME™ ultrasound system with the Z6Ms transesophageal transducer (TEE) allows for real-time 4D volume and real-time 4D color Doppler volume acquisitions. This combination of equipment delivers high volume per second acquisition at clinically relevant volume sizes, (90x90). The ACUSON SC2000 PRIME solution allows high VPS data set acquisition, instead of traditional frames per second (FPS). Higher FR as well as high VPS is easily achieved even with color volume data included. The ideal acquisition rate is 15 VPS or higher. Real-time 4D volume data sets with volume color Doppler should try to achieve this goal.5To increase the VPS the user should first evaluate the 4D and color Doppler volume size.  The region of interest (ROI), for each mode should be narrowed if possible.  The ROI should be narrowed sufficiently to include only the focused anatomy.  But care should be taken not to remove important landmarks as well as cut off anatomy within the ROI during the entire cardiac cycle.  To increase the volume per second the user should first evaluate the 4D and color Doppler volume size. The region of interest for each mode should be narrowed if possible. The region of interest should be narrowed sufficiently to include only the focused anatomy. But, car should be taken not to remove important landmarks as well as cut off anatomy within the region of interest during the entire cardiac cycle.6The use of the Space/Time control to increase spatial or temporal resolution should be considered next.  The user can use this control to move towards temporal resolution, to increase FR and VPS, or implement spatial resolution for more detailed resolution. This link is now finished, please close the link with the X in the upper right.The use of the Space/Time control to increase spatial or temporal resolution should be considered next. The user can use this control to move towards temporal resolution, to increase frame rate or volumes per second, or implement spatial resolution for more detailed resolution. Tip Tip for real-time 4D Volume Acquisition. Simplifying Real-time 4D Volume Acquisition Utilizing retrospective image capture: Press Freeze image Press Clip Capture control This will allow the capture of the previous three beats.   This technique can apply to 2D imaging as well as when in real-time 4D Volume mode. This workflow can help when imaging difficult patients   The eSie Valve package is an automated Artificial Intelligence Powered (AI-Powered) algorithm that will generate an Aortic valve (AV) or Mitral valve (MV) modeling within five seconds.¹  These modes are derived from TEE, real-time 4D volume data set and can be viewed either in static or dynamic format.  These dynamic valve models can also be played with real-time volume color Doppler to better identify the location and severity of Valvular regurgitation and/or Para-valvular leaks within the Valvular apparatus.     ¹Mansi,T., Houle,H., Voigt,I., Quantifying Heart Valves: From Diagnostic to Personalized Valve Repair – White Paper, JASE, 2015 eSie Valve Package Learn More About the eSie Valves Package. Instructions:Flash File:HTML5 File:/content/generator/Course_90022577/eSieValves_1/index.htmlPDF File: So how is all this accomplished?  For a short explanation, the eSie Valve packages relies on advanced machine learning technology to produce comprehensive models of the valves within the left heart (LH). Within the eSie Valve package there is a large database of different valve sizes, shapes and disease states that are annotated and expertly traced for both the MV and arotic (AO) valve TEE data sets.  These database models are then used to train the eSie Valve package algorithms.  Studies have shown 0.941 correlations to CT for Aortic annulus diameter.²   eSie Valve package enables the ability to now easily address problematic patients presenting with:  Irregular heart rhythms With real-time 4D volume acquisition utilizing the ACUSON SC2000 PRIME and the Z6Ms TEE transducer, multiple volumes can be evaluated so that the best representing cardiac cycle can be used or averaging of volumes for better global results The need of VHD workup, but patient has existing issues and sensitivity to radio-opaque contrast Quick AO valve measurements for TAVR sizing Editing tools are available if needed.  This process will be reviewed in an easy step-by-step process later in this course.   The robust eSie Valve package provides quick, accurate and reproducible key measurements and calculations for the user giving quantitative valve analyses.   ²Kavinsky,C., Poulin, M-F., Mack, M., Training in Structural Heart Disease – Call to Action: AHA, 2018. Please review the links below for further information. Image Menu Review of Image Menu Instructions:Flash File:HTML5 File:/content/generator/Course_90022577/ImageMenu_1/index.htmlPDF File: Let’s look at the steps to begin this process. Identify a TEE 4D volume data set that is focused on the valve of choice, (either AO or MV). This can be from Review, Thumbnails, or frozen acquisition. Bring active arrow onto volume image and press Next control. Choose eSie Valves and press Select. The User will note that there are step-by-step instructions on the right side of the image in the Task Pane.  This allows quick referral for next step needed. Press Aortic Alignment to automatically align the volume to the MPRs.  ​Scroll to the appropriate frame and use the defined valve timing listed below to gather needed information.  Aortic Valve Use the maximum  valve opening for annulus and valve orifice measurements. Use a closed valve for leaflet measurements. Mitral Valve Use mid-systolic phase for annulus and leaflet measurement​. Use volumes with color Doppler volumes for mitral regurgitation. Press Detect Aortic Valve from the Image Menu. Valve model will be constructed and displayed within five seconds. Moving the cursor to any MPR view to sync the reference planes for quick assessment of model tracking accuracy.  Model is complete!   Note: This is a very comprehensive and complex valve model that has been constructed in a minimal amount of time and effort.  Click the icon below to see an example.   Example of Valve Model Steps Example of Valve Model Steps Instructions:Flash File:HTML5 File:/content/generator/Course_90022577/eSieValve_Final(1).mp4PDF File: Explore the links below for the Glossary, References, and Further Reading opportunities. Glossary Glossary 4D Volume – term used to describe real-time volume acquisitions or data sets TTE – Transthoracic Echocardiogram TEE – Transesophageal Echocardiogram AV – Aortic Valve MV – Mitral Valve LA – Left Atrium LV – Left Ventricle LH – reference to the Left Heart, can include any structure or valve located on the left side of the heart and including LH circulation. MPR – Multiplanar rendering TAVR – Transcatheter Aortic Valve Replacement TAVI - Transcatheter Aortic Valve Implantation VPS – Volumes Per Second FR – Frame Rate is the frequency at which frames in a film, or video sequence are displayed. FPS – Frames Per Second is the number of frames displayed per second within a film or video sequence. References References ¹Mansi, T. PhD., Houle, H., BA, RDCS, FASE, Voigt, I., Szucs, M., BS, Hunter, E., RDCS, Saurabh, D., PhD.,  Comaniciu, D. PhD., Quantifying Heart Valves: From Diagnostic to Personalized Valve Repair – White Paper, JASE,2015.   ² European Heart Journal-Cardiovascular Imaging (2016) 17, 772-778.   ³ Kavinsky, C. MD, PhD, Poulin, M., MD, Mack, M. MD Training in Structural Heart Disease – Call to Action: Circulation 2018; 138:225-228. DOI 10.1161/CIRCULATIONAHA. 117.029072   ⁴Michelle Bierig, MPH, RDCS, FASE, Donna Ehler, BS, RDCS, FASE, Margaret L. Knoll, RDCS, FASE, Alan D. Waggoner, MHS, RDCS. STANDARDS FOR THE CARDIAC SONOGRAPHER: A Position Paper – ASE Guidelines JASE   2009   ⁵Donna  Ehler, BS, RDCS, Dennis K. Carney, RCVT, Ann L. Dempsey, MEd, RDCS, Rick Rigling, BS, RDCS, Carol Kraft, BS, RDCS, Sandra A. Witt, RDCS, Thomas R. Kimball, MD, Eric J. Sisk, BA, RDCS, Edward A. Geiser, MD, Cris D. Gresser, RN, RDCS, and Alan Waggoner, MHS, RDMS, Guidelines for Cardiac Sonographer Education: Recommendations of the American Society of Echocardiography Sonographer Training and Education Committee 2018 Please note that the learning material is for trainingpurposes only! For the proper use of the software or hardware, please always use the Operator Manual or instructions for Use (herinafter collectively "Operator Manual") issued by Siemens Healthineers.  The material is to be used as training material only and shall by no means substitute the Operator Manual.  Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Certain products, product related claims or functionalities (hereinafter collectively "Functionality") may not (yet) be commrcially available in your country.  Due to regulatory requirments, the future availablility 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 autority.  Offenders will be liable for damages. All names and data of patients parameters and configuration dependent designations are fictional and are examples only. eSie Valves™ Advanced Analysis Package is a trademark of Siemens Medical Solutions USA. Inc. ACUSON SC2000™ PRIME ultrasound system is a trademarke of Siemens Medical Solutions USA. Inc. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2019