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eSie VVI™ Velocity Vector Imaging Technology 5.1 Software Release (USA)

This online course will help the learner understand the application and workflow for the eSie VVI™ Velocity Vector Technology with 5.1 software release.
Successful completion of this training is eligible for American Society or Radiology Technician (ASRT) Category A continuing education units (CEU).
 

Welcome to the Siemens Healthineers eSie VVI™ Velocity Vector Imaging Technology online course.  Within this course we will take a high level view on the use of ultrasound to analyze myocardial strain and some of the enhancements that come with the 5.1 software release.   During the course, there is a lot of detailed information presented.   This tutorial has more information in the form of links placed on the page.  To successfully complete this course, please view all available content.     Congratulations! You have completed the eSie VVI™ Velocity Vector Technology with 5.1 software release online course. Listed below are the key points presented in this tutorial. Take time to review the material before you try the final quiz. In this tutorial you have learned the following: Understand the limitations of traditional biplane Simpson’s method of ejection fraction calculation and why myocardial strain is a better answer for critical patients How the American Society of Echocardiography (ASE), the European Association of Cardiovascular Imaging (EACVI), and the Strain Task Force committees have made recommendations to help standardize strain results Recognize image quality needed to perform good myocardial strain What imaging parameters are needed for accurate strain results ACUSON SC2000 PRIME ultrasound system adjustments to help deliver accurate results Alternative protocols for imaging difficult patients Utilize the eSie VVI technology package effectively Steps to activate 2D images into the eSie VVI technology package Definitions for Image Menu icons Download and print a copy of the detailed Course Review. Download and print a copy of the eSie VVI Velocity Vector Imaging Quick Reference Card. Upon completion of this tutorial, you will be able to:   Understand the limitations of traditional biplane Simpson’s method of ejection fraction calculation and why myocardial strain may be a better answer for critical patients   Recognize image quality needed to perform good myocardial strain   Utilize the eSie VVI technology package effectively         Within the ultrasound study there are demands on the clinician to understand and identify many complex findings in the evaluation of the heart.  The most common demand is to establish if there is normal function or not.  This information is commonly assessed using the ejection fraction (EF).  This data can be accomplished using different methods, (i.e. Simpson’s biplane method of disks-MOD, visual estimation, etc.).                                                                                                                The EF is used as a number to establish overall the amount of blood delivered from the heart out to the body.  The EF can be affected by many different occurrences, either instantaneously or over a period of time.  A few of the conditions that can influence EF and/or heart function: are pharmacology influences, patient blood pressure, etcetera.   These conditions as well as others, present the need to follow the global evaluation of the heart over a period of time allowing for detection of improvement or decline in function.  This would indicate the need for sequential exams to be evaluated from the initial baseline results.                                                                                                                                                                                                                                                                                                                                                                                 The eSie VVI technology package at 5.1 software is up to date and compliant with the latest joint ASE, EACVI  and the Strain Task Force recommendations.    eSie VVI technology can be activated from standard 2D imaging clips and can also be used with left ventricular opacification (LVO) contrast imaging.   eSie VVI technology delivers myocardial strain results by using speckle tracking technology.  The tissue position is established with speckle pattern recognition then tracked from sequential image frames.  This allows subtle as well as discernible wall motion abnormalities to be measured and assessed.   Along with the myocardial strain results, a modified Simpson’s ejection fraction is also given along with other valuable results. Click each link below to view more information. Image Menu Learn more about the Image Menu Instructions:Flash File:HTML5 File:/content/generator/Course_90022752/VVI_ImageMenu_final/index.htmlPDF File: Analysis Learn about Analysis Instructions:Flash File:HTML5 File:/content/generator/Course_90022752/VVI_anaylsis_c/index.htmlPDF File: Analysis & Display Learn more about the Analysis and Display The Segmental icon identifies and tracks the endocardial layer using the American Heart Association (AHA) 16 or 17 segmented bullseye analysis model for the LV.  Chose the 16 or 17 segmented bullseye analysis model needed from the Image Menu.   When the Segmental icon is activated, each of the three apical LV views and the 4CH RV images are divided into six even sectors, (i.e. two-basal, two-mid and two-apical).  Each sector is identified as a color and displayed with a matching color wave form on the graph.  An average of all sector wave forms is displayed as a white dotted wave form.  This allows easy identification of individual wall segment or overall global results.   Using this same model, the short axis (SAX) images of the basal and mid views are also divided into six uniform sectors.  The SAX apical view is divided into four segments for the 16-segment model.  The 17-segment model is divided into two even layers with a top apical cap.   As mentioned before, up to two individual segments can be eliminated from each view.  This allows removal of sectors that are not tracking correctly because of inadequate image quality or other factors.  This has little to no change on the GLS results because analysis is calculated from a single line deformation. The user has the ability to analyze images from the thumbnails or while in review.  It is suggested to gather all of the images to be analyzed within the same stage of the examination.  This helps to eliminate images with changes in heart rate or cardiac patterns.    It is also suggested that when performing serial exams on critical patients (such as oncology patients) the same vendor system as well as the same software level should be used as with the previous exams.  This ensures that data is comparable with previous results. Click each link below to view more information. Alternative Protocols Alternative Protocols for difficult patients As in most facilities many of the patients present with difficult imaging challenges during the examination.  Gathering three good apical views can be very challenging sometimes.  If this is the case a single good 4 Chamber (4CH) LV view can give the most inclusive data for a single view.  For best reproducibility, it is easier to obtain a high-quality 4CH view for processing than obtaining good quality 4CH, 2CH and 3CH views on these difficult cases.   From the 4CH view all of the coronary branches can be assessed.    By applying only the 4CH view, small localized lesions may not be included, but the abnormal deformation will translate through the myocardium effecting the 4CH strain results.¹                                          Coronary Arteries¹ The ASE, EACVI and the Strain Task Force has clarified that a single 4CH view is adequate for LV, RV, RA and LA strain when difficult patient imaging is present.  Care should be taken that foreshortening is avoided.  With this in mind, only the LV 4CH view will be used for examples within this course.   As always the clinician should follow the departmental practices when acquiring images and these suggestions should not automatically override those protocols put into practice at these facilities.   RV Recommendations Recommendations for the RV acquisition The joint ASE, EACVI and the Strain Task Force recommend the RV should be assessed with GLS, radial and longitudinal displacement.   When performing RV strain, a clear statement within in the report should be made as to measurement parameters.  It should be noted if endocardial or mid/full wall approach was performed.   The RV, 2D speckle tracking has been used (but is not limited to) assisting with diagnosis and management of pulmonary arterial hypertension, pulmonary embolism, acute coronary syndromes, left ventricular failure, arrhythmia cardiomyopathy and congenital heart diseases.4   To review these recommendations please review these standards and guidelines on the ASE, EACVI and the Strain Task Committee websites. The following steps can be used to activate and complete a strain tracing for the heart.   With the eSie VVI technology package the user can derive global longitudinal strain (GLS), global circumferential strain (GCS) or global radial strain (GRS) results using the appropriate views for LV, RV, LA or RA utilizing the following steps. To activate, the user will move the active arrow over the image to be used.  This can be from either the thumbnails or from the review mode.  Press the Next control (right click). ​The eSie Access™ measurement interface offers measurements appropriate to the mode being used.  Choose eSie VVI from drop-down list and press Select. Image will launch in the eSie VVI technology package.  Stop cine and use trackball to move to cardiac phase that best visualizes myocardial boarders. Ensure the icon indicating the focused ventricle or atrium being evaluated is activated on Image Menu.  The default is the 4CH LV.  The 4CH LV is automatically ready to trace. Focusing on the LV, move active arrow to interventricular septal (IVS) area.  Note arrow icon becomes a cross hair. Starting at the medial mitral valve (MV) leaflet hinge point start tracing the LV along the endocardial boarder.  Pressing Select at periodic points.   Each point is where the trace line can change direction or later be edited. Points should be evenly distributed along the endocardial border. Continue tracing LV and finish tracing on the lateral side, right click Next to end tracing.  User can edit at this time or return to Contour Tab and edit at a later time. Press Analysis Tab to see results. Please review the links below for further information. eSie VVI Technology eSie VVI Technology activation example Instructions:Flash File:HTML5 File:/content/generator/Course_90022752/NormalVVI_1.mp4PDF File: eSie VVI Technology Contrast eSie VVI Technology activation example: with Contrast Instructions:Flash File:HTML5 File:/content/generator/Course_90022752/ContrastVVI(1).mp4PDF File: With the release of 5.1 software, the right atrial and left atrial strain data does conform to the 2018 recommendations made by the ASE, EACVI Strain Task Force committee.   Both the right atrial and left atrial strain tracing can be completed from the four-chamber view.  Ensure that the atrium being evaluated is not foreshortened.   The steps mentioned on the Activating eSie VVI Technology page can be repeated to complete the right atrial or left atrial strain tracing.  Use the following methods to perform the tracing for either the RA or LA.   To perform the LA Tracing:  Start the trace at the medial MV annulus. Trace along the septal endocardial border, ​Atrial roof​, continuing to the LA lateral wall and ending at the opposite MV annulus position.  To perform the RA Tracing:  Start the trace at the lateral Tricuspid annulus. ​Trace the endocardial border on the lateral wall, tracing the Atrial roof, continue to the Septal Wall and ending at the opposite Tricuspid annulus position.   Some of the applications for LA strain include (but are not limited to) patients with heart failure, reduced EF, heart valve diseases and atrial fibrillation.³ Explore the links below for the Glossary, References and further reading opportunities. Glossary Glossary Ac – Aortic Valve Closure AO – Aortic Ao – Aortic Valve Opening AV – Aortic Valve Ac – Aortic Valve Closure IVS – Inter-ventricular Septum LA – Left Atrium LV – Left Ventricle LVO – Left Ventricular Opacification (achieved with Echo Contrast) Mc – Mitral Valve Closure Mo – Mitral Valve Opening MV – Mitral Valve ms – Millimeters per Second RA – Right Atrium RV – Right Ventricle SAX – Short Axis View of the Heart VVI – Velocity Vector Imaging 4CH – Four Chamber View of the Heart 2CH – Two Chamber View of the Heart 3CH – Three Chamber Apical Long Axis View of the Heart   References References   ¹H. Houle, S. Datta, E. Hunter, T. Green., eSie VVI Velocity Vector Imaging Technology -2D Speckle Tracking, A White paper from Siemens Healthineers Ultrasound   ²L. Badano, T. Kolias, D. Muraru, T. Abraham., Standardization of left atrial, right ventricular, and right atrial deformation imaging using two dimensional speckle racking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. European Heart Journal – Cardiovascular Imaging, Volume 19, Issue 6 June 2018 Pages 591-600. Doi.org/10.1093/ehjci/jey042   ³E. Donal, A Behagel, D. Feneon., Value of left atrial strain: a highly promising field of investigation. EurHeart J Cardiovasc Imaging 215;16:356-7   4ML Haeck, RW Scherptong, NA Marsan, ER Schalij., Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. CircCardiovascImaging 2012,5:628-36.   L. Badano, T. Kolias, D. Muraru, T. Abraham., Standardization of left atrial, right ventricular, and     right atrial deformation imaging using two dimensional speckle tracking echocardiograpy: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging.  European Heart Journal-Cardiovascular Imaging (2018) 19, 591-600 doi:,10.1039/ehjci/jey042    E. Unluer, A. Karagoz, H. Akoglu, S. Bayata., Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians. West J Emerg Med, 2014 Mar, 15(2): 221-226. Dol: 10 5811/westjem.2013.9.16185   J. Lemarie, O Huttin, N. Girerd, D. Mandry.,  Usefulness of Speckle-Tracking Imaging for Right Ventricular Assessment after Acute Myocardial Infarction:  A Magnetic Resonance Imaging/Echocardiographic Comparison with the Relation between Adldosterone and Cardiac Remodeling after Myocardial Infartion Study. Journal of the American Society of Echocardiography, Volume 28, Issue 7, July 2015, Pages 818-827.e4, Elsevier   Glossary Glossary Continued ED - End Diastolic EF – Ejection Fractions End Diastolic (EDV) and End Systolic (ESV) Volumes ES - End Systolic   Average (c) – the peak value of the average curve.  The average curve is the result of averaging the six sentimental curves.   Average (s) – is the average of the six overall peaks from each sentimental curve.    Endo/Epi tracking – ability to track epicardium independently, or average epicardium, mid and endocardium movements.   GLS/GCS/GRS – global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS)   Myocardial displacement and velocity – refers to how much the myocardial tissue moves and how fast.    Strain – the measure of regional and global myocardial deformation   Strain Rate – is the rate of deformation or the velocity difference per length change.   Velocity vectors – a visual display of the direction and speed of the moving tissue       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.   All names and data of patients, parameters and configuration dependent designations are fictional and are examples only.   eSie VVI™ velocity vector imaging technology is a trademark 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                                                In some instances, it is critical to see small trending changes in the heart function.  It has been noted by the American Society of Echocardiography (ASE), the European Association of Cardiovascular Imaging (EACVI), and the Strain Task Force committees that the single use of the Simpson’s biplane MOD or visual estimation can miss early subtle changes in the heart function.    To overcome these difficulties in tracking early changes in the heart function, these committees recommend the use of global longitudinal strain (GLS), to assess global heart function.   It has been determined that global longitudinal strain or GLS of the myocardium will detect heart function changes within the heart earlier than with the use of traditional EF methods alone.   Because of these demands and other needs during the examination, the clinician requires robust and sophisticated tools that will help to simplify these complicated tasks.   To deliver reliable GLS results the user needs to take several factors into account. The first condition to consider is image quality.   Image quality does influence results when performing strain.  Here are a few imaging parameters that are needed to be considered.    Click each link below to view each of the parameter suggestions.                                                                                                                                                                          Frame Rate Learn about Frame Rate impact on Image Quality Frame Rate (FR) – When performing strain, FR should be considered.  It is recommended to have a FR or frames per second (FPS) in a higher range.  The general rule is to achieve a FR between 60 – 150 FPS.  Using this rule, the minimum FPS should not go below 40 FPS and the maximum FPS would not exceed 150.  Above or below these numbers can give inaccurate results.   An example of this practice: If an average heart is beating at 60 beats per minute (BPM) and a cine loop is acquired at 30 FPS you are only evaluating approximately one half of the heart motions during the cardiac cycle.   What can be done do increase the FR?   Narrowing the image sector and reducing depth (eSie VVI technology will give reliable results when the with image sector depth is set just above the atrioventricular valves).  This is good practice unless strain is being used to evaluate the atrium.   There are times when patients present with imaging challenges or different circumstances.  One consideration is the beats per minute (BPM) of the heart.  If there is low heart rate (HR) present, a lower FR can be acceptable. An example is:  HR is presented at 49 BPM. Image acquired for strain evaluation is at 46 FPS. This would allow 93.8% of the entire heart cycle to be evaluated because of the lower HR. Another control to consider for adjusting the FR is the Space Time/Resolution (T/S) control.  Using this control can assist in obtaining higher FR when depth and sector size have been optimized, and FR is still presenting in the lower range.  This control adjusts the system signal between spatial resolution and temporal resolution. Changing to a temporal or T setting moves the ACUSON SC2000™ PRIME ultrasound system towards a temporal resolution optimization that can increase the frame rate.  Frequency Learn about Image Quality and Frequency Image Quality (IQ) - Ensure the image is sufficiently gained throughout the entire image for optimal IQ.  Good myocardial definition is needed so that pixel definition is available for speckle tracking.  Using InFocus™ technology allows automatic IQ adjustment for optimal image settings throughout the whole image.   An over gained image can create noise and is difficult for the speckle tracking algorithms to distinguish between noise and myocardial structures.   MultiHertz™ - Matching the frequency range to the patient being imaged is always important.  Many transducers have multiple steps of frequency shifting capabilities as well as utilizing a wide range of frequency bandwidth for each frequency shift.  This allows for optimal imaging for different patient body habitus.  Ensure the transducer utilized allows the best frequency range for imaging the current patient. Positioning Learn how positioning impacts GLS results Image positioning can change GLS results dramatically.  Always confirm that foreshortening has not occurred.  Miss-aligned images or foreshortened images can give erroneous GLS results.   Positioning the heart image within the imaging sector is also important.  Confirm that all of the walls stay within the imaging sector during the complete cardiac cycle.  If the heart is not centered within the imaging sector or the sector has been narrowed too closely to the walls to increase FR, a portion of one of the walls can move outside of the imaging sector during diastole or from the swing of the heart.  Accurate tracking is not available for images that move outside of the imaging sector. The Siemens Healthcare ACUSON SC2000 PRIME ultrasound system provides the eSie VVI™ technology package, utilizing Artificial Intelligence–Powered (AI-Powered) algorithms for robust, quick and reproducible results. This tool provides a dynamic method to visually measure and display myocardial motion and mechanics for LV, left and right atrium (LA and RA) as well as the right ventricle (RV).

  • ASRT
  • CEU
  • CME
  • eSie VVI
  • VVI
  • easy VVI
  • strain
  • easy strain
  • esy VVI
  • cardiac strain
  • cardiac deformation
  • deformation
  • measurements
  • cardiac oncology
  • velocity vector
  • AI-Powered