Liver Elastography Using Virtual Touch Quantification Acquisition and Reporting

*Barr R, Ferraioli G, et al. Elastography assessment of On account of certain regional limitations of sales rights liver fibrosis: Society of Radiologists in Ultrasound and service availability, we cannot guarantee that all Consensus Statement. Radiology 2015 Sep;276(3):845-61. products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. Liver Elastography using The information in this document contains general technical descriptions of specifications and options as Virtual Touch well as standard and optional features, which do not always have to be present in individual cases. Siemens reserves the right to modify the design, packaging, specifications, and options described herein without prior notice. For the most current information, please contact Quantification your local sales representative from Siemens. Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced. For USA Distribution Only. Acquisition and Reporting Reference Guide Siemens Healthineers Headquarters Local Contact Information Siemens Medical Solutions USA, Inc. Siemens Healthcare GmbH Henkestr. 127 40 Liberty Boulevard 91052 Erlangen Malvern, PA 19355-9998 Germany USA Phone: +49 9131 84-0 Phone: +1-888-826-9702 siemens.com/healthineers usa.siemens.com/healthineers SIEMENS usa.siemens.com/ultrasound Healthineers Order No. A91USD-171108-P1-4A00 | Online Pdf 08-2017 | © Siemens Medical Solutions USA, Inc., 2017 assist in reporting. handy table of kPa conversion values to acquisition technique as well as the Use this poster to quickly reference proper quantify liver tissue. And you know that it’s key to accurately you know that each patient is unique. If you manage patients with liver disease, Note: Any technical data contained in this document may The information in this document contains general siemens.com/healthineers well as standard and optional features, which do not always have to be present in individual cases. Siemens reserves the right to modify the design, packaging, specifications, and options described herein without prior notice. For the most current information, please contact your local sales representative from Siemens. United States. vary within defined tolerances. Original images always For USA Distribution Only. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen Germany Phone: +49 9131 84-0 lose a certain amount of detail when reproduced. 40 Liberty Boulevard products described herein may not be available in the technical descriptions of specifications and options as and packaging may vary by country and is subject to the Siemens sales organization worldwide. Availability and service availability, we cannot guarantee that all usa.siemens.com/healthineers Phone: +1-888-826-9702 Malvern, PA 19355-9998 Siemens Medical Solutions USA, Inc. change without prior notice. Some/All of the features and Local Contact Information On account of certain regional limitations of sales rights products included in this brochure are available through Order No. A91USD-171108-P1-4A00 | Online Pdf 08-2017 | © Siemens Medical Solutions USA, Inc., 2017 USA Consensus Statement. Radiology 2015 Sep;276(3):845-61. liver fibrosis: Society of Radiologists in Ultrasound *Barr R, Ferraioli G, et al. Elastography assessment of Acquisition and Reporting usa.siemens.com/ultrasound Liver Elastography using Quantification Virtual Touch Reference Guide SIEMENS ACUSON S3000 ULTRASOUND SYSTEM ACUS ULTRAS HELX If you manage patients with liver disease, you know that each patient is unique. And you know that it’s key to accurately HELX EVOLUTION quantify liver tissue. HELX Use this poster to quickly reference proper EVOLUTION acquisition technique as well as the ACUSON handy table of kPa conversion values to assist in reporting. ooown specifications, and options described herein without prior always have to be present in individual cases. Siemens reserves the right to modify the design, packaging, siemens.com/healthineers notice. For the most current information, please contact your local sales representative from Siemens. Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced. For USA Distribution Only. well as standard and optional features, which do not Local Contact Information 40 Liberty Boulevard Malvern, PA 19355-9998 USA Phone: +1-888-826-9702 usa.siemens.com/healthineers Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen Siemens Medical Solutions USA, Inc. technical descriptions of specifications and options as The information in this document contains general United States. Consensus Statement. Radiology 2015 Sep;276(3):845-61. liver fibrosis: Society of Radiologists in Ultrasound *Barr R, Ferraioli G, et al. Elastography assessment of Germany Order No. A91USD-171108-P1-4A00 | Online Pdf 08-2017 | © Siemens Medical Solutions USA, Inc., 2017 On account of certain regional limitations of sales rights Phone: +49 9131 84-0 products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the and service availability, we cannot guarantee that all usa.siemens.com/ultrasound Reference Guide Acquisition and Reporting Virtual Touch Liver Elastography using Quantification SIEMENS ON S2000 OUND SYSTEM HELX If you manage patients with liver disease, you know that each patient is unique. And you know that it’s key to accurately quantify liver tissue. Use this poster to quickly reference proper CUSON acquisition technique as well as the handy table of kPa conversion values to assist in reporting. OOONU Best Practices for Liver Elastography Acquisition Technique Suggested Technique Comments The fibrotic liver is less compliant than normal Fasting for 4 to 6 hours liver tissue. In the nonfasting state, the fibrotic liver can have falsely increased elastography values. Supine or slight (30°) left lateral decubitus position Optimal Positioning with right arm elevated above head to improve intercostal access. Valsalva or deep inspiration can cause an undesired Shallow, brief breath hold increase in central venous pressure, which can falsely elevate elastography values. Use intercostal transducer placement to target segments 5 or 8. Avoid increased subcapsular reverberation by placing ROI perpendicular to and Optimal ROI Placement 1-2 cm below Glisson’s capsule. Note: The transducer-specific lens focus is typically about 4-5 cm below the transducer, thus the best measurements are in this region. Ample gel throughout the examination (particularly Ample gel during the collection of the entire set of measurements) is necessary for the optimal acoustic coupling. This will ensure maximum transfer of sound. The Liver Assessment report calculates either Shear Velocity Measurements or the 0.62 (1.2) 0.58 (1.0) 0.59 (1.0) 0.61 (1.1) 0.74 (1.6) 0.75 (1.7) 0.60 (1.1) 0.63 (1.2) 0.73 (1.6) Reporting The kPa conversion is calculated by the following equation: 0.65 (1.3) 0.72 (1.6) 0.66 (1.3) 0.76 (1.7) 0.67 (1.3) 0.71 (1.5) 0.68 (1.4) 0.69 (1.4) 0.64 (1.2) 0.57 (1.0) 0.70 (1.5) Y = 3c2 0.56 (0.9) 0.55 (0.9) 0.78 (1.8) 0.97 (2.8) 0.82 (2.0) 0.92 (2.5) 0.96 (2.8) 0.84 (2.1) 0.85 (2.2) 0.95 (2.7) 0.86 (2.2) 0.77 (1.8) 0.94 (2.7) 0.81 (2.0) m/s (kPa) Conversion Table 0.88 (2.3) c = Shear Wave Velocity (m/s) 0.89 (2.4) 0.93 (2.6) Y = Young’s Modulus (kPa) 0.90 (2.4) Young’s Modulus of Elasticity in kPa. 0.91 (2.5) 0.87 (2.3) 0.80 (1.9) 0.83 (2.1) 0.98 (2.9) 0.79 (1.9) 1.03 (3.2) 1.04 (3.2) 1.06 (3.4) 1.11 (3.7) 1.19 (4.2) 1.09 (3.6) 1.08 (3.5) 1.01 (3.1) 1.15 (4.0) 1.05 (3.3) 1.16 (4.0) 1.20 (4.3) 1.10 (3.6) 0.99 (2.9) 1.02 (3.1) 1.07 (3.4) 1.17 (4.1) 1.00 (3.0) 1.13 (3.8) 1.14 (3.9) 1.12 (3.8) 1.18 (4.2) 1.38 (5.7) 1.31 (5.1) 1.40 (5.9) 1.30 (5.1) 1.39 (5.8) 1.27 (4.8) 1.23 (4.5) 1.29 (5.0) 1.21 (4.4) 1.32 (5.2) 1.34 (5.4) 1.24 (4.6) 1.36 (5.5) 1.35 (5.5) 1.22 (4.5) 1.26 (4.8) 1.25 (4.7) 1.37 (5.6) 1.28 (4.9) 1.33 (5.3) 1.41 (6.0) 1.42 (6.0) 1.55 (7.2) 1.50 (6.8) 1.45 (6.3) 1.60 (7.7) 1.53 (7.0) 1.58 (7.5) 1.51 (6.8) 1.59 (7.6) 1.61 (7.8) 1.56 (7.3) 1.52 (6.9) 1.44 (6.2) 1.57 (7.4) 1.54 (7.1) 1.43 (6.1) 1.48 (6.6) 1.64 (8.1) 1.62 (7.9) 1.63 (8.0) 1.47 (6.5) 1.49 (6.7) 1.46 (6.4) 1.79 (9.6) 1.66 (8.3) 1.69 (8.6) 1.81 (9.8) 1.86 (10.4) 1.85 (10.3) 1.80 (9.7) 1.68 (8.5) 1.76 (9.3) 1.70 (8.7) 1.82 (9.9) 1.75 (9.2) 1.74 (9.1) 1.78 (9.5) 1.77 (9.4) 1.72 (8.9) 1.71 (8.8) 1.65 (8.2) 1.73 (9.0) 1.83 (10.0) 1.84 (10.2) 1.67 (8.4) 1.96 (11.5) 1.99 (11.9) 1.93 (11.2) 1.87 (10.5) 2.08 (13.0) 2.07 (12.9) 1.91 (10.9) 1.88 (10.6) 1.98 (11.8) 1.94 (11.3) 1.95 (11.4) 1.89 (10.7) 2.00 (12.0) 2.06 (12.7) 2.03 (12.4) 1.92 (11.1) 2.05 (12.6) 2.04 (12.5) 1.97 (11.6) 2.02 (12.2) 1.90 (10.8) 2.01 (12.1) 2.90 (25.2) 3.37 (34.1) 3.15 (29.8) 3.61 (39.1) 3.39 (34.5) 2.27 (15.5) 3.62 (39.3) 3.17 (30.1) 2.49 (18.6) 2.71 (22.0) 2.29 (15.7) 3.59 (38.7) 2.51 (18.9) 2.95 (26.1) 2.73 (22.4) 2.93 (25.8) 2.24 (15.1) 2.46 (18.2) 2.68 (21.5) 3.34 (33.5) 3.12 (29.2) (5.4kPa) 3.56 (38.0) 2.25 (15.2) 3.40 (34.7) Mild/No Stiffness 2.28 (15.6) 2.50 (18.8) 3.58 (38.4) 3.36 (33.9) 3.14 (29.6) 2.92 (25.6) 2.70 (21.9) 2.48 (18.5) 2.26 (15.3) 2.72 (22.2) Acoustic Radiation Force Impulse (ARFI) 2.94 (25.9) 3.16 (30.0) 3.38 (34.3) 3.60 (38.9) 2.30 (15.9) 2.52 (19.1) 2.74 (22.5) 2.96 (26.3) (14.5kPa) 3.57 (38.2) 3.35 (33.7) 3.13 (29.4) 2.91 (25.4) 2.69 (21.7) 2.47 (18.3) Imaging Values as Predictor of Tissue Stiffness* 3.18 (30.3) 2.2m/s 1.34m/s 3.50 (36.8) 3.33 (33.3) 3.44 (35.5) 2.13 (13.6) 2.35 (16.6) 2.57 (19.8) 2.79 (23.4) 3.01 (27.2) 3.23 (31.3) 3.45 (35.7) 2.14 (13.7) 2.36 (16.7) 3.22 (31.1) 2.58 (20.0) 3.02 (27.4) 3.24 (31.5) 3.46 (35.9) 2.15 (13.9) 2.37 (16.9) 2.59 (20.1) 2.81 (23.7) 3.03 (27.5) 3.25 (31.7) 3.47 (36.1) 2.80 (23.5) 3.00 (27.0) 2.78 (23.2) 2.56 (19.7) 2.09 (13.1) 2.31 (16.0) 2.53 (19.2) 2.75 (22.7) 2.97 (26.5) 3.19 (30.5) 3.41 (34.9) 2.10 (13.2) 2.32 (16.1) 2.54 (19.4) 2.76 (22.9) 2.98 (26.6) 3.20 (30.7) 3.42 (35.1) 2.11 (13.4) 2.33 (16.3) 2.55 (19.5) 2.77 (23.0) 2.99 (26.8) 3.21 (30.9) 3.43 (35.3) 2.12 (13.5) 2.34 (16.4) 2.16 (14.0) 2.38 (17.0) 2.60 (20.3) 2.82 (23.9) 2.86 (24.5) 3.08 (28.5) 3.30 (32.7) 3.52 (37.2) 2.21 (14.7) 2.43 (17.7) 2.65 (21.1) 2.87 (24.7) 3.09 (28.6) 3.31 (32.9) 3.53 (37.4) 2.22 (14.8) 2.44 (17.9) 2.66 (21.2) 2.88 (24.9) 3.10 (28.8) 3.32 (33.1) 3.54 (37.6) 2.23 (14.9) 2.45 (18.0) 2.67 (21.4) 2.89 (25.1) 3.11 (29.0) 2.64 (20.9) 3.55 (37.8) 2.42 (17.6) 3.51 (37.0) 3.04 (27.7) 3.26 (31.9) 3.48 (36.3) 2.17 (14.1) 2.39 (17.1) 2.61 (20.4) 2.83 (24.0) 3.05 (27.9) 3.27 (32.1) 3.49 (36.5) 2.18 (14.3) 2.40 (17.3) 2.62 (20.6) 2.84 (24.2) 3.06 (28.1) 3.28 (32.3) Moderate Stiffness 2.19 (14.4) 2.41 (17.4) 2.63 (20.8) 2.85 (24.4) 3.07 (28.3) 3.29 (32.5) 2.20 (14.5) High Stiffness Liver Elastography Best Practices for Acquisition Technique Suggested Technique Comments m The fibrotic liver is less compliant than normal Fasting for 4 to 6 hours liver tissue. In the nonfasting state, the fibrotic liver can have falsely increased elastography values. 40 Supine or slight (30°) left lateral decubitus position Optimal Positioning with right arm elevated above head to improve intercostal access. Valsalva or deep inspiration can cause an undesired Shallow, brief breath hold increase in central venous pressure, which can falsely elevate elastography values. Use intercostal transducer placement to target SIEMENS 6C1 HD Abdomen-Now segments 5 or 8. Avoid increased subcapsular Detail Site TIB: 1.4 reverberation by placing ROI perpendicular to and E=3.7 kPa MI: 1.6 Vs-1.11 m/s 13fps Depth=3.9 cm 2D-100% THI Optimal ROI Placement 1-2 cm below Glisson’s capsule. H4.50 MHZ 13dB/DR65 SC Off DTCE M Note: The transducer-specific lens focus is typically MapC/ST2 about 4-5 cm below the transducer, thus the best measurements are in this region. Ample gel throughout the examination (particularly during the collection of the entire set of measurements) Ample gel Site 1: 6 Valld/6 Total 11cm is necessary for the optimal acoustic coupling. This will ensure maximum transfer of sound. 1.98 (11.8) 0.67 (1.3) 0.89 (2.4) 1.11 (3.7) 1.33 (5.3) 1.55 (7.2) 1.77 (9.4) 1.99 (11.9) 0.68 (1.4) 0.90 (2.4) 1.12 (3.8) 1.34 (5.4) 1.56 (7.3) 1.78 (9.5) 2.00 (12.0) 0.69 (1.4) 0.91 (2.5) 1.13 (3.8) 1.35 (5.5) 1.57 (7.4) 1.76 (9.3) 1.54 (7.1) 1.32 (5.2) 1.10 (3.6) 1.07 (3.4) 1.29 (5.0) 1.51 (6.8) 1.73 (9.0) 1.95 (11.4) 0.64 (1.2) 0.86 (2.2) 1.08 (3.5) 1.30 (5.1) 1.52 (6.9) 1.74 (9.1) 1.96 (11.5) 0.65 (1.3) 0.87 (2.3) 1.09 (3.6) 1.31 (5.1) 1.53 (7.0) 1.75 (9.2) 1.97 (11.6) 0.66 (1.3) 0.88 (2.3) 1.79 (9.6) 2.01 (12.1) 1.61 (7.8) 0.92 (2.5) 0.74 (1.6) 0.96 (2.8) 1.18 (4.2) 1.40 (5.9) 1.62 (7.9) 1.84 (10.2) 2.06 (12.7) 0.75 (1.7) 0.97 (2.8) 1.19 (4.2) 1.41 (6.0) 1.63 (8.0) 1.85 (10.3) 2.07 (12.9) 0.76 (1.7) 0.98 (2.9) 1.20 (4.3) 1.42 (6.0) 1.64 (8.1) 1.86 (10.4) 2.08 (13.0) 2.05 (12.6) 1.83 (10.0) 0.85 (2.2) 1.39 (5.8) 1.14 (3.9) 1.36 (5.5) 1.58 (7.5) 1.80 (9.7) 2.02 (12.2) 0.71 (1.5) 0.93 (2.6) 1.15 (4.0) 1.37 (5.6) 1.59 (7.6) 0.70 (1.5) 1.81 (9.8) 0.72 (1.6) 0.94 (2.7) 1.16 (4.0) 1.38 (5.7) 1.60 (7.7) 1.82 (9.9) 2.04 (12.5) 0.73 (1.6) 0.95 (2.7) 1.17 (4.1) 2.03 (12.4) 0.63 (1.2) Reporting 1.24 (4.6) 1.88 (10.6) 1.68 (8.5) 1.92 (11.1) 1.46 (6.4) 1.67 (8.4) 1.45 (6.3) 1.23 (4.5) 1.66 (8.3) 1.01 (3.1) 1.87 (10.5) 0.61 (1.1) 0.83 (2.1) 1.05 (3.3) 1.27 (4.8) 1.49 (6.7) 1.71 (8.8) 1.02 (3.1) 1.65 (8.2) 1.70 (8.7) 1.26 (4.8) 0.78 (1.8) 1.00 (3.0) 0.59 (1.0) 0.81 (2.0) 1.03 (3.2) 1.25 (4.7) 1.47 (6.5) 1.48 (6.6) 1.69 (8.6) 1.89 (10.7) 1.91 (10.9) 1.90 (10.8) 1.44 (6.2) 0.60 (1.1) 0.82 (2.0) 1.04 (3.2) 1.22 (4.5) 1.43 (6.1) 0.56 (0.9) 1.93 (11.2) The Liver Assessment report calculates either Shear Velocity Measurements or the Young’s Modulus of Elasticity in kPa. The kPa conversion is calculated by the following equation: Y = 3c2 1.94 (11.3) 1.21 (4.4) 1.50 (6.8) 1.28 (4.9) 1.06 (3.4) 0.84 (2.1) 0.62 (1.2) 0.57 (1.0) Y = Young’s Modulus (kPa) c = Shear Wave Velocity (m/s) m/s (kPa) Conversion Table 1.72 (8.9) 0.99 (2.9) 0.80 (1.9) 0.58 (1.0) 0.79 (1.9) 0.77 (1.8) 0.55 (0.9) 2.15 (13.9) 2.25 (15.2) 2.12 (13.5) 2.13 (13.6) 2.10 (13.2) 2.19 (14.4) 2.22 (14.8) 2.23 (14.9) 2.20 (14.5) 2.30 (15.9) 2.28 (15.6) 2.26 (15.3) 2.18 (14.3) 2.17 (14.1) 2.29 (15.7) 2.16 (14.0) 2.21 (14.7) 2.09 (13.1) 2.14 (13.7) 2.24 (15.1) 2.11 (13.4) 2.27 (15.5) Imaging Values as Predictor of Tissue Stiffness* 2.49 (18.6) 2.31 (16.0) 2.50 (18.8) 2.46 (18.2) 2.36 (16.7) 2.52 (19.1) 2.48 (18.5) 2.38 (17.0) 2.43 (17.7) 2.40 (17.3) 2.39 (17.1) 2.32 (16.1) 2.51 (18.9) 2.33 (16.3) 2.42 (17.6) 2.41 (17.4) 2.34 (16.4) 2.45 (18.0) 2.37 (16.9) 2.44 (17.9) 2.47 (18.3) 2.35 (16.6) Acoustic Radiation Force Impulse (ARFI) Mild/No Stiffness (5.4kPa) 1.34m/s 2.68 (21.5) 2.70 (21.9) 2.60 (20.3) 2.61 (20.4) 2.62 (20.6) 2.59 (20.1) 2.63 (20.8) 2.64 (20.9) 2.53 (19.2) 2.58 (20.0) 2.65 (21.1) 2.54 (19.4) 2.66 (21.2) 2.69 (21.7) 2.71 (22.0) 2.72 (22.2) 2.57 (19.8) 2.67 (21.4) 2.56 (19.7) 2.74 (22.5) 2.55 (19.5) 2.73 (22.4) 2.76 (22.9) 2.93 (25.8) 2.77 (23.0) 2.85 (24.4) 2.95 (26.1) 2.82 (23.9) 2.83 (24.0) 2.84 (24.2) 2.81 (23.7) 2.86 (24.5) 2.75 (22.7) 2.80 (23.5) 2.87 (24.7) 2.92 (25.6) Moderate Stiffness 2.79 (23.4) 2.89 (25.1) 2.96 (26.3) 2.90 (25.2) 2.78 (23.2) 2.91 (25.4) 2.88 (24.9) 2.94 (25.9) (14.5kPa) 2.2m/s High Stiffness 2.97 (26.5) 3.18 (30.3) 2.98 (26.6) 3.17 (30.1) 3.00 (27.0) 3.01 (27.2) 3.16 (30.0) 3.12 (29.2) 3.10 (28.8) 3.09 (28.6) 3.13 (29.4) 3.02 (27.4) 3.14 (29.6) 3.07 (28.3) 3.08 (28.5) 3.11 (29.0) 2.99 (26.8) 3.04 (27.7) 3.05 (27.9) 3.15 (29.8) 3.03 (27.5) 3.06 (28.1) 3.23 (31.3) 3.32 (33.1) 3.27 (32.1) 3.19 (30.5) 3.28 (32.3) 3.24 (31.5) 3.30 (32.7) 3.40 (34.7) 3.29 (32.5) 3.31 (32.9) 3.25 (31.7) 3.38 (34.3) 3.26 (31.9) 3.33 (33.3) 3.20 (30.7) 3.39 (34.5) 3.34 (33.5) 3.21 (30.9) 3.37 (34.1) 3.36 (33.9) 3.22 (31.1) 3.35 (33.7) 3.58 (38.4) 3.50 (36.8) 3.59 (38.7) 3.49 (36.5) 3.42 (35.1) 3.60 (38.9) 3.47 (36.1) 3.43 (35.3) 3.57 (38.2) 3.46 (35.9) 3.52 (37.2) 3.61 (39.1) 3.48 (36.3) 3.56 (38.0) 3.53 (37.4) 3.45 (35.7) 3.41 (34.9) 3.54 (37.6) 3.44 (35.5) 3.55 (37.8) 3.51 (37.0) 3.62 (39.3) Optimal ROI Placement Acquisition Technique Liver Elastography Shallow, brief breath hold Optimal Positioning Fasting for 4 to 6 hours Suggested Technique Ample gel Comments Best Practices for about 4-5 cm below the transducer, thus the best Note: The transducer-specific lens focus is typically 1-2 cm below Glisson’s capsule. reverberation by placing ROI perpendicular to and segments 5 or 8. Avoid increased subcapsular Use intercostal transducer placement to target Ample gel throughout the examination (particularly elevate elastography values. increase in central venous pressure, which can falsely Valsalva or deep inspiration can cause an undesired intercostal access. with right arm elevated above head to improve measurements are in this region. ensure maximum transfer of sound. can have falsely increased elastography values. liver tissue. In the nonfasting state, the fibrotic liver The fibrotic liver is less compliant than normal is necessary for the optimal acoustic coupling. This will during the collection of the entire set of measurements) Supine or slight (30°) left lateral decubitus position Reporting Acoustic Radiation Force Impulse (ARFI) The Liver Assessment report calculates either Shear Velocity Measurements or the Imaging Values as Predictor of Tissue Stiffness* Young’s Modulus of Elasticity in kPa. 2.2m/s 1.34m/s The kPa conversion is calculated by the following equation: (14.5kPa) (5.4kPa) Y = 3c2 Y = Young’s Modulus (kPa) Mild/No Stiffness Moderate Stiffness High Stiffness c = Shear Wave Velocity (m/s) m/s (kPa) Conversion Table 0.55 (0.9) 0.77 (1.8) 0.99 (2.9) 1.21 (4.4) 1.43 (6.1) 1.65 (8.2) 1.87 (10.5) 2.09 (13.1) 3.19 (30.5) 2.97 (26.5) 2.75 (22.7) 2.53 (19.2) 2.31 (16.0) 3.41 (34.9) 0.56 (0.9) 0.78 (1.8) 1.00 (3.0) 1.22 (4.5) 1.44 (6.2) 1.66 (8.3) 1.88 (10.6) 3.42 (35.1) 2.32 (16.1) 3.20 (30.7) 2.10 (13.2) 2.98 (26.6) 2.54 (19.4) 2.76 (22.9) 0.57 (1.0) 0.79 (1.9) 1.01 (3.1) 1.23 (4.5) 1.45 (6.3) 1.67 (8.4) 1.89 (10.7) 2.55 (19.5) 2.77 (23.0) 2.99 (26.8) 3.21 (30.9) 3.43 (35.3) 2.11 (13.4) 2.33 (16.3) 0.58 (1.0) 0.80 (1.9) 1.02 (3.1) 1.24 (4.6) 1.46 (6.4) 1.68 (8.5) 1.90 (10.8) 3.22 (31.1) 2.12 (13.5) 2.34 (16.4) 2.56 (19.7) 2.78 (23.2) 3.00 (27.0) 3.44 (35.5) 0.59 (1.0) 0.81 (2.0) 1.03 (3.2) 1.25 (4.7) 1.47 (6.5) 1.69 (8.6) 1.91 (10.9) 3.45 (35.7) 3.01 (27.2) 2.79 (23.4) 2.57 (19.8) 2.35 (16.6) 2.13 (13.6) 3.23 (31.3) 0.60 (1.1) 0.82 (2.0) 1.04 (3.2) 1.26 (4.8) 1.48 (6.6) 1.70 (8.7) 1.92 (11.1) 2.58 (20.0) 2.14 (13.7) 2.36 (16.7) 2.80 (23.5) 3.02 (27.4) 3.24 (31.5) 3.46 (35.9) 0.61 (1.1) 0.83 (2.1) 1.05 (3.3) 1.27 (4.8) 1.49 (6.7) 1.71 (8.8) 1.93 (11.2) 2.81 (23.7) 2.59 (20.1) 2.37 (16.9) 2.15 (13.9) 3.03 (27.5) 3.25 (31.7) 3.47 (36.1) 0.62 (1.2) 0.84 (2.1) 1.06 (3.4) 1.28 (4.9) 1.50 (6.8) 1.72 (8.9) 1.94 (11.3) 3.26 (31.9) 3.04 (27.7) 2.82 (23.9) 2.38 (17.0) 2.16 (14.0) 3.48 (36.3) 2.60 (20.3) 0.63 (1.2) 0.85 (2.2) 1.07 (3.4) 1.29 (5.0) 1.51 (6.8) 1.73 (9.0) 1.95 (11.4) 2.17 (14.1) 2.39 (17.1) 2.61 (20.4) 2.83 (24.0) 3.49 (36.5) 3.27 (32.1) 3.05 (27.9) 0.64 (1.2) 0.86 (2.2) 1.08 (3.5) 1.30 (5.1) 1.52 (6.9) 1.74 (9.1) 1.96 (11.5) 3.50 (36.8) 3.28 (32.3) 3.06 (28.1) 2.84 (24.2) 2.62 (20.6) 2.40 (17.3) 2.18 (14.3) 0.65 (1.3) 0.87 (2.3) 1.09 (3.6) 1.31 (5.1) 1.53 (7.0) 1.75 (9.2) 1.97 (11.6) 3.51 (37.0) 2.19 (14.4) 2.41 (17.4) 2.63 (20.8) 3.29 (32.5) 2.85 (24.4) 3.07 (28.3) 0.66 (1.3) 0.88 (2.3) 1.10 (3.6) 1.32 (5.2) 1.54 (7.1) 1.76 (9.3) 1.98 (11.8) 2.20 (14.5) 3.52 (37.2) 3.30 (32.7) 3.08 (28.5) 2.86 (24.5) 2.64 (20.9) 2.42 (17.6) 0.67 (1.3) 0.89 (2.4) 1.11 (3.7) 1.33 (5.3) 1.55 (7.2) 1.77 (9.4) 1.99 (11.9) 3.53 (37.4) 3.31 (32.9) 2.43 (17.7) 2.21 (14.7) 3.09 (28.6) 2.65 (21.1) 2.87 (24.7) 0.68 (1.4) 0.90 (2.4) 1.12 (3.8) 1.34 (5.4) 1.56 (7.3) 1.78 (9.5) 2.00 (12.0) 2.66 (21.2) 2.88 (24.9) 3.10 (28.8) 3.32 (33.1) 3.54 (37.6) 2.22 (14.8) 2.44 (17.9) 0.69 (1.4) 0.91 (2.5) 1.13 (3.8) 1.35 (5.5) 1.57 (7.4) 1.79 (9.6) 2.01 (12.1) 3.55 (37.8) 2.45 (18.0) 2.23 (14.9) 2.67 (21.4) 2.89 (25.1) 3.11 (29.0) 3.33 (33.3) 0.70 (1.5) 0.92 (2.5) 1.14 (3.9) 1.36 (5.5) 1.58 (7.5) 1.80 (9.7) 2.02 (12.2) 3.56 (38.0) 3.12 (29.2) 2.90 (25.2) 2.68 (21.5) 2.46 (18.2) 2.24 (15.1) 3.34 (33.5) 0.71 (1.5) 0.93 (2.6) 1.15 (4.0) 1.37 (5.6) 1.59 (7.6) 1.81 (9.8) 2.03 (12.4) 3.57 (38.2) 2.25 (15.2) 2.47 (18.3) 2.69 (21.7) 2.91 (25.4) 3.13 (29.4) 3.35 (33.7) 0.72 (1.6) 0.94 (2.7) 1.16 (4.0) 1.38 (5.7) 1.60 (7.7) 1.82 (9.9) 2.04 (12.5) 3.14 (29.6) 2.92 (25.6) 3.58 (38.4) 2.70 (21.9) 2.48 (18.5) 2.26 (15.3) 3.36 (33.9) 0.73 (1.6) 0.95 (2.7) 1.17 (4.1) 1.39 (5.8) 1.61 (7.8) 1.83 (10.0) 2.05 (12.6) 3.15 (29.8) 3.37 (34.1) 3.59 (38.7) 2.71 (22.0) 2.93 (25.8) 2.49 (18.6) 2.27 (15.5) 0.74 (1.6) 0.96 (2.8) 1.18 (4.2) 1.40 (5.9) 1.62 (7.9) 1.84 (10.2) 2.06 (12.7) 3.16 (30.0) 2.28 (15.6) 2.50 (18.8) 2.72 (22.2) 2.94 (25.9) 3.38 (34.3) 3.60 (38.9) 0.75 (1.7) 0.97 (2.8) 1.19 (4.2) 1.41 (6.0) 1.63 (8.0) 1.85 (10.3) 2.07 (12.9) 3.39 (34.5) 2.29 (15.7) 2.51 (18.9) 2.73 (22.4) 3.61 (39.1) 2.95 (26.1) 3.17 (30.1) 0.76 (1.7) 0.98 (2.9) 1.20 (4.3) 1.42 (6.0) 1.64 (8.1) 1.86 (10.4) 2.08 (13.0) 3.40 (34.7) 2.96 (26.3) 2.74 (22.5) 2.52 (19.1) 2.30 (15.9) 3.62 (39.3) 3.18 (30.3) Optimal ROI Placement about 4-5 cm below the transducer, thus the best Note: The transducer-specific lens focus is typically 1-2 cm below Glisson’s capsule. reverberation by placing ROI perpendicular to and segments 5 or 8. Avoid increased subcapsular Use intercostal transducer placement to target Ample gel throughout the examination (particularly elevate elastography values. increase in central venous pressure, which can falsely Valsalva or deep inspiration can cause an undesired Shallow, brief breath hold intercostal access. with right arm elevated above head to improve Supine or slight (30°) left lateral decubitus position Optimal Positioning can have falsely increased elastography values. liver tissue. In the nonfasting state, the fibrotic liver The fibrotic liver is less compliant than normal Fasting for 4 to 6 hours Comments Suggested Technique during the collection of the entire set of measurements) is necessary for the optimal acoustic coupling. This will ensure maximum transfer of sound. Best Practices for Liver Elastography Acquisition Technique measurements are in this region. Ample gel Reporting Acoustic Radiation Force Impulse (ARFI) The Liver Assessment report calculates either Shear Velocity Measurements or the Imaging Values as Predictor of Tissue Stiffness* Young’s Modulus of Elasticity in kPa. 1.34m/s 2.2m/s The kPa conversion is calculated by the following equation: (5.4kPa) (14.5kPa) Y = 3c2 Y = Young’s Modulus (kPa) Mild/No Stiffness Moderate Stiffness High Stiffness c = Shear Wave Velocity (m/s) m/s (kPa) Conversion Table 1.87 (10.5) 1.21 (4.4) 0.99 (2.9) 0.77 (1.8) 0.55 (0.9) 1.65 (8.2) 1.43 (6.1) 2.09 (13.1) 2.31 (16.0) 2.53 (19.2) 2.75 (22.7) 2.97 (26.5) 3.19 (30.5) 3.41 (34.9) 1.22 (4.5) 1.00 (3.0) 0.78 (1.8) 0.56 (0.9) 1.88 (10.6) 1.66 (8.3) 1.44 (6.2) 2.10 (13.2) 2.32 (16.1) 2.54 (19.4) 2.76 (22.9) 2.98 (26.6) 3.20 (30.7) 3.42 (35.1) 0.57 (1.0) 0.79 (1.9) 1.01 (3.1) 1.23 (4.5) 1.45 (6.3) 1.67 (8.4) 1.89 (10.7) 2.11 (13.4) 2.33 (16.3) 2.55 (19.5) 2.77 (23.0) 2.99 (26.8) 3.21 (30.9) 3.43 (35.3) 1.90 (10.8) 1.68 (8.5) 1.46 (6.4) 1.24 (4.6) 1.02 (3.1) 0.58 (1.0) 0.80 (1.9) 2.12 (13.5) 2.34 (16.4) 2.56 (19.7) 2.78 (23.2) 3.00 (27.0) 3.22 (31.1) 3.44 (35.5) 1.69 (8.6) 0.81 (2.0) 1.03 (3.2) 1.25 (4.7) 1.47 (6.5) 0.59 (1.0) 1.91 (10.9) 2.13 (13.6) 2.35 (16.6) 2.57 (19.8) 2.79 (23.4) 3.01 (27.2) 3.23 (31.3) 3.45 (35.7) 0.82 (2.0) 1.04 (3.2) 1.48 (6.6) 1.70 (8.7) 1.92 (11.1) 0.60 (1.1) 1.26 (4.8) 2.14 (13.7) 2.36 (16.7) 2.58 (20.0) 2.80 (23.5) 3.02 (27.4) 3.24 (31.5) 3.46 (35.9) 0.61 (1.1) 0.83 (2.1) 1.05 (3.3) 1.27 (4.8) 1.93 (11.2) 1.71 (8.8) 1.49 (6.7) 2.15 (13.9) 2.37 (16.9) 2.59 (20.1) 2.81 (23.7) 3.03 (27.5) 3.25 (31.7) 3.47 (36.1) 1.94 (11.3) 1.72 (8.9) 1.50 (6.8) 1.28 (4.9) 1.06 (3.4) 0.84 (2.1) 0.62 (1.2) 2.16 (14.0) 2.38 (17.0) 2.60 (20.3) 2.82 (23.9) 3.04 (27.7) 3.26 (31.9) 3.48 (36.3) 1.73 (9.0) 0.63 (1.2) 0.85 (2.2) 1.07 (3.4) 1.29 (5.0) 1.51 (6.8) 1.95 (11.4) 2.17 (14.1) 2.39 (17.1) 2.61 (20.4) 2.83 (24.0) 3.05 (27.9) 3.27 (32.1) 3.49 (36.5) 1.96 (11.5) 1.52 (6.9) 1.30 (5.1) 1.08 (3.5) 0.86 (2.2) 0.64 (1.2) 1.74 (9.1) 2.18 (14.3) 2.40 (17.3) 2.62 (20.6) 2.84 (24.2) 3.06 (28.1) 3.28 (32.3) 3.50 (36.8) 1.75 (9.2) 1.53 (7.0) 1.31 (5.1) 1.09 (3.6) 0.87 (2.3) 0.65 (1.3) 1.97 (11.6) 2.19 (14.4) 2.41 (17.4) 2.63 (20.8) 2.85 (24.4) 3.07 (28.3) 3.29 (32.5) 3.51 (37.0) 1.32 (5.2) 1.98 (11.8) 1.10 (3.6) 0.88 (2.3) 0.66 (1.3) 1.54 (7.1) 1.76 (9.3) 2.20 (14.5) 2.42 (17.6) 2.64 (20.9) 2.86 (24.5) 3.08 (28.5) 3.30 (32.7) 3.52 (37.2) 1.33 (5.3) 0.89 (2.4) 0.67 (1.3) 1.11 (3.7) 1.99 (11.9) 1.77 (9.4) 1.55 (7.2) 2.21 (14.7) 2.43 (17.7) 2.65 (21.1) 2.87 (24.7) 3.09 (28.6) 3.31 (32.9) 3.53 (37.4) 0.68 (1.4) 0.90 (2.4) 1.12 (3.8) 1.34 (5.4) 1.56 (7.3) 1.78 (9.5) 2.00 (12.0) 2.22 (14.8) 2.44 (17.9) 2.66 (21.2) 2.88 (24.9) 3.10 (28.8) 3.32 (33.1) 3.54 (37.6) 2.01 (12.1) 1.79 (9.6) 1.57 (7.4) 1.35 (5.5) 1.13 (3.8) 0.69 (1.4) 0.91 (2.5) 2.23 (14.9) 2.45 (18.0) 2.67 (21.4) 2.89 (25.1) 3.11 (29.0) 3.33 (33.3) 3.55 (37.8) 1.80 (9.7) 0.92 (2.5) 1.14 (3.9) 1.36 (5.5) 1.58 (7.5) 0.70 (1.5) 2.02 (12.2) 2.24 (15.1) 2.46 (18.2) 2.68 (21.5) 2.90 (25.2) 3.12 (29.2) 3.34 (33.5) 3.56 (38.0) 0.93 (2.6) 1.15 (4.0) 1.59 (7.6) 1.81 (9.8) 2.03 (12.4) 0.71 (1.5) 1.37 (5.6) 2.25 (15.2) 2.47 (18.3) 2.69 (21.7) 2.91 (25.4) 3.13 (29.4) 3.35 (33.7) 3.57 (38.2) 1.60 (7.7) 0.72 (1.6) 0.94 (2.7) 1.38 (5.7) 1.82 (9.9) 2.04 (12.5) 1.16 (4.0) 2.26 (15.3) 2.48 (18.5) 2.70 (21.9) 2.92 (25.6) 3.14 (29.6) 3.36 (33.9) 3.58 (38.4) 0.73 (1.6) 0.95 (2.7) 1.17 (4.1) 1.39 (5.8) 1.61 (7.8) 1.83 (10.0) 2.05 (12.6) 2.27 (15.5) 2.49 (18.6) 2.71 (22.0) 2.93 (25.8) 3.15 (29.8) 3.37 (34.1) 3.59 (38.7) 1.40 (5.9) 2.06 (12.7) 1.84 (10.2) 1.62 (7.9) 1.18 (4.2) 0.96 (2.8) 0.74 (1.6) 2.28 (15.6) 2.50 (18.8) 2.72 (22.2) 2.94 (25.9) 3.16 (30.0) 3.38 (34.3) 3.60 (38.9) 1.63 (8.0) 0.75 (1.7) 0.97 (2.8) 1.19 (4.2) 1.41 (6.0) 1.85 (10.3) 2.07 (12.9) 2.29 (15.7) 2.51 (18.9) 2.73 (22.4) 2.95 (26.1) 3.17 (30.1) 3.39 (34.5) 3.61 (39.1) 1.86 (10.4) 2.08 (13.0) 1.42 (6.0) 1.64 (8.1) 1.20 (4.3) 0.98 (2.9) 0.76 (1.7) 2.30 (15.9) 2.52 (19.1) 2.74 (22.5) 2.96 (26.3) 3.18 (30.3) 3.40 (34.7) 3.62 (39.3) On account of certain regional limitations of sales rights *Barr R, Ferraioli G, et al. Elastography assessment of and service availability, we cannot guarantee that all liver fibrosis: Society of Radiologists in Ultrasound products included in this brochure are available through Consensus Statement. Radiology 2015 Sep;276(3):845-61. the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. Liver Elastography using The information in this document contains general technical descriptions of specifications and options as Virtual Touch well as standard and optional features, which do not always have to be present in individual cases. Siemens reserves the right to modify the design, packaging, specifications, and options described herein without prior notice. For the most current information, please contact Quantification your local sales representative from Siemens. Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced. For USA Distribution Only. Acquisition and Reporting Reference Guide Siemens Healthineers Headquarters Local Contact Information Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 40 Liberty Boulevard 91052 Erlangen Malvern, PA 19355-9998 Germany USA Phone: +49 9131 84-0 Phone: +1-888-826-9702 siemens.com/healthineers usa.siemens.com/healthineers Order No. A91USD-171108-P1-4A00 | Online Pdf 08-2017 | © Siemens Medical Solutions USA, Inc., 2017 usa.siemens.com/ultrasound you know that each patient is unique. quantify liver tissue. assist in reporting. handy table of kPa conversion values to acquisition technique as well as the Use this poster to quickly reference proper And you know that it’s key to accurately If you manage patients with liver disease,