ACUSON Sequoia™ Ultrasound System 3D/4D Gynecology Online Training

Continue Continue Continue Continue Sequoia 3D/4D gyn training ACUSON SequoiaTM Ultrasound System 3D/4D Gynecology Online Training This online training introduces you to the volume feature on the ACUSON Sequoia Ultrasound System. This course will cover these three objectives. Demonstrate the Set key functions of the 3D data set. 1 Optimize the Multiplanar Rendering (MPR). 3 Relate the X, Y, and Z axis to control panel rotary keys. 2 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 Welcome Audio file: sequoia-3d-gyn-001.mp3 Audio script: Welcome to the ACUSON Sequoia ultrasound system 3D, 4D gynecology online training. This online training introduces you to the volume feature on the ACUSON Sequoia ultrasound system. This course will cover these three learning objectives. Description of course: This course provides the learner with a guide to acquiring, manipulating, optimizing, performing measurements, and the acquisition of the 3D data set. PEPconnect ID 90024072 Key words: ACUSON Sequoia, Sequoia, 3D, 4D, gynecology, endovaginal, MPR, multiplanar rendering, multiplanar reconstruction, multislice, reset curve, Min IP, minimum intensity projection, Max IP, maximum intensity projection, region of interest, ROI, volume of interest, VOI, sync key, VR, volume rendering, open spline This course is a reuse in parts from the course X, Y, & Z of 3D (HOOD05162002862410) – Glossary & Resource document; ACUSON Sequoia 3D/4D Gynecology Knobology presentation (HOOD05162003129358) – video content and measurement slide. Navigation Tips and Terminology Note: There is no audio on these slides. Page styles and functionality differ throughout the course. This slide is a Tab page Three, 3D volume acquisition terms, ROI, VOI, and MPR also have further explanations. Select each of the Tab arrows to the right of each subject to learn more about features and terminology used in this training. Navigation Resources 2D and 3D Graphics VOI Adjustment MPR Navigation Tips and Terminology No audio. MPR The abbreviation, MPR, has multiple meanings in Siemens products. You will see both multiplanar reconstruction and multiplanar rendering. Either of the terms, or MPR, describe the display of the A (acquisition), and the reconstructed B, and C image. In this MPR image, the cut plane (green dotted line) on the A and B image bisects an ovarian cyst seen with a tissue phantom. A B C Press the in the upper right hand corner when finished with this page. Region of Interest and Volume of Interest Graphics These green brackets indicate the depth of the VR. Press the in the upper right hand corner when finished with this page. Region of Interest and Volume of Interest Graphics The green brackets indicate the volume of interest (VOI) boundaries. The green line close to the transducer is the cut plane. The area between the cut plane and transducer does not display on the volume rendering (VR). Click on the cut plane to continue. Region of Interest and Volume of Interest Graphics The blue outline is the 2D-mode region of interest (ROI). Image data within this area appears on the A (acquisition) plane along with the B and C reconstruction. Click in the blue ROI to continue. Adjusting the Volume of Interest (VOI) To adjust the number of 2D-mode images acquired within the data set, select the angle size. Press the in the upper right hand corner when finished with this page. Adjusting the Volume of Interest (VOI) The green indicators show the volume width Click a VOI depth indicator to continue. and depth. Navigation Select to view the next slide. Press the in the upper right hand corner when finished with this page. Navigation Select the CC icon to display closed captioning (subtitles). Click Next to continue. Next Navigation The timeline displays the slide progression. Slide the orange bar to adjust the timeline. Click Next to continue. Next The Resources area has additional information important for your understanding of the topic. Resources Click or tap Resources. Select the document. The document appears in a new browser window. You may download a copy to your computer after reviewing the content. Press the in the upper right hand corner when finished with this page. The Resources area has additional information important for your understanding of the topic. Resources Select the document. Click or tap Resources. The Resources area has additional information important for your understanding of the topic. Resources Click or tap Resources. Select the document. The document appears in a new browser window. You may download a copy to your computer after reviewing the content. Press the Next to move to next slide. Beginning to End 2D-mode image has two planes Y axis on the vertical plane, and X axis on the horizontal plane 3D data set has three planes Both 2D-mode planes, and A Z-plane adding depth 4D imaging All 3D planes, and Time A review of general concepts pertaining to the 3D feature is available in the Resources tab. Select the orange tab arrows to learn more about functions available for the 3D data set. Acquisition Display Images and Clips Editing Review Beginning to End Audio file: sequoia-3d-gyn-002.mp3 Audio script: The ultrasound system acquires and stores a group of sequential 2D images into what we call a 3D volume or data set. During the 4D acquisition, the ultrasound system continuously acquires and displays the volume information in a real-time format. Also known as real-time 3D ultrasound, time becomes the fourth dimension. There are many features available to help you use the acquired data set using the ACUSON Sequoia system. Select the tab arrows to learn more about functions available for the 3D data set. Acquisition audio script: The Touch Screen will display the 3D/4D Setup tab. The 3D and 4D function keys are available and the active function and will be backlit in blue. The 3D key activates the 3D imaging functionality in order to perform an automatic sweep. The 4D key activates the 4D imaging functionality in order to view a real-time 3D image. Select the Set key to toggle between the VOI size, VOI position and ROI curve using the Set key while using the trackball to adjust the areas of interest. The ROI and VOI curve graphics will change from a solid line to a dotted line during resizing and curve adjustment. The Reset Curve key resets the curve of the VOI to the default position. The quality soft key adjusts the number of slices to balance between detail and temporal resolution. Available selections are Low, Mid and High. The high setting enhances the detail resolution of the rendered volume but decreases the volumes per second. The volume angle determines the distance of the volume sweep. A large angle is equivalent to a larger sweep. The angle range is 20 degrees to 145 degrees. To activate a volume acquisition, press the update key. The volume acquisition will be displayed on the imaging screen. Volume acquisition imaging parameters such as gain, quality, opacity, and brightness are displayed in the upper right corner of the image. The home base display indicates the functionality of the Update and Set keys. (PEPconnect ID 15121) Display audio script: Once a 3D volume is acquired, the Touch Screen displays the available functions for manipulation. The three tabs available are 3D, Multislice and Editing. Some tabs contain additional options on the second page. The display format allows the user to select a desired layout. This selection displays all four quadrants. This key displays the A-plane and rendered volume. This key displays the A-plane and B-plane on top of the rendered volume, and this key displays any selected plane in a full view format. The quadrant selection allows the user to easily switch between the quadrants for manipulation. The quadrants are referred to as A, B, C, and VR, with quadrants A, B, and C containing the MPR planes of the volume: A is the acquisition plane, B is the elevation plane, C is the coronal plane, the fourth quadrant contains the rendered volume. When a plane is selected any manipulation performed using the X, Y and Z controls will apply to the selected quadrant. The selected plane will be outlined in white on the imaging screen and backlit in blue on the Touch Screen. MPR is the abbreviation for Multi-Planar Rendering also known as Multiplanar reformatting and is the term used to refer to the three orthogonal planes collectively. (PEPconnect ID 16673) Images and Clips audio script: When acquiring volume images, the volume will automatically be stored any time an image or clip is acquired. This enables the user to perform further manipulation on any image or clip acquired while in 3D or 4D modes. The volume clip will be exported in AVI format. Press the Image control to save individual images. To store a 4D clip press the Clip control. The default clip length or type, Prospective versus Retrospective, may be adjusted on the second page of the Touch Screen menu, or in the System Configuration menu. Alternatively, you may hold down the clip control for up to 10 seconds for a customized clip capture. Stored volumes are marked with a cube graphic. Stored volume clips are marked with a cube containing a “play” icon. Note that the maximum length of volume 4D Cine store is 10 seconds. (PEPconnect ID 15123) Editing audio script: The editing tab contains additional tools for removing unnecessary data from the rendered volume. To use the Line editing tool, use the trackball and Set keys to draw a line delineating a border for the removal area. Place the caliper in the image segment that you want to remove and press Set. The area in the area of the caliper will be removed. To use the Open Spline editing tool, use the trackball and Set keys to draw a line segment delineating a partial border for the removal area. Continue to use the trackball and Set keys to add as many connecting segments as desired, then either double click the Set key or select the Update key to end the line placement. Place the caliper in the image segment that you want to remove and press Set. The area in the area of the caliper will be removed. To use the Closed Spline editing tool, use the trackball and Set keys to draw a line segment delineating a partial border for the removal area. Continue to use the trackball and Set keys to add as many connecting segments as desired, then either double click the Set key or select the Update key to end. The system will automatically draw a line from the first caliper to the last caliper closing the spline. Place the caliper in the image segment that you want to remove and press Set. The area in the area of the caliper will be removed. The user has the option to remove any performed edits using the options shown here. The Undo All Key reverses all edits performed by replacing all removed areas. The Undo Last key function varies depending on when it is used in the editing process. If one or more edits have been completed the last area removal will be undone. If an editing function is active, the last line segment or caliper placement will be undone. The Redo Last key operates in a similar way. If one or more edits have been completed the last edit reversed using the Undo Last key will be redisplayed. If an editing function is active, the last line segment or caliper placement reversed using the Undo Last key will be redisplayed. (PEPconnect ID 15158) Review audio script: To review the stored volumes, press the Review key on the Touch Screen. Stored volumes are marked with a cube graphic. Stored volume clips are marked with a cube containing a “play” icon. To manipulate a stored volume, use the pointer and set key to select the desired volume. Select the 3D/4D tab to activate the volume manipulation tools. If a 4D clip has been activated you may use the cine review controls as required. (PEPconnect ID 15122) Acquisition Optimization Technical factors 2D-mode image quality Patient factors Uterine and ovarian condition and size Woman’s age Pelvic and adnexal pathology Select the orange tab arrows to learn more about optimizing the 3D data set. Volume Rendering (VR) Multiplanar Rendering Optimization Audio file: sequoia-3d-gyn-004.mp3 Audio script: The 3D or 4D image depends directly on the quality of the 2D-mode image and patient body habitus. If the grayscale image is low-quality, the resulting data set will be suboptimal. VR Opt audio script: The VR and MPR keys activate specific tools applicable to the selected modes or quadrants. When VR is selected the soft keys will display adjustable parameters for the rendered volume. When MPR is selected the soft keys will reflect parameters that will affect the MPR planes. We will first review the Volume Rendering tools. Threshold sets the threshold for opacity curve. Decreasing the value of Threshold will fill in the surface rendered volume with more low-level echoes or voxels and soft tissues will be enhanced. Increasing the value of Threshold will remove low level echoes. It may help to enhance the image when noise, artifacts or low-level echo structures are present. Opacity adjusts the percentage of opacity on overall rendered volume density to create a more soft or sculptured appearance. Decrease the value for a more transparent look or increase the value for more solid look. Opacity level may be increased up to 86 percent to enhance pathology such as myoma, fibroma, endometrium disease or hemorrhagic cysts. The Smooth adjustment affects the display of the surface rendered volume. Select from a range of 0 - 3. Brightness enhances the voxel saturation. An increase in brightness increases the saturation of voxels. Optimal selection is dependent on the 2D gain during acquisition. Contrast allows greater visualization of voxels next to each other. An optimal contrast setting will enhance depth perception and delineation of anatomy such as the endometrium. When VR is selected the Tint key applies the selection to the rendered volume. Determine which tint color is preferred for the volume display. It is recommended to adjust Tint prior to adjusting other parameters. Re-optimization for Threshold, Dynamic Range, Brightness and / or Contrast may be necessary after applying a different tint. (PEPconnect ID 15160) MPR Opt audio script: When MPR is selected the soft keys will reflect parameters that will affect the MPR planes. Dynamic Range affects the number of gray shades that are displayed. Increase the Dynamic Range to produce a “softer” image or decrease the settings to produce an image with more contrast. The Map tool selects a processing curve that assigns gray shades to echo amplitudes. The maps affect all three MPR images. When MPR is selected the Tint key applies the selection to the three MPR planes. (PEPconnect ID 15165) Manipulation Orthogonal – Planes at right angles anchored at a pivot point or reference marker (dot). X, Y, and Z are the axis determining the rotation direction of planes. Multislice – Display of sequential images. Select the orange tab arrows to learn more about available data set manipulation tools. Rotation Indicators and VOI X, Y, and Z Tools – Page 1 Tools – Page 2 Multislice Manipulation Audio file: sequoia-3d-gyn-005.mp3 Audio script: The 3D data displays on three planes that differ from 2D imaging. The reconstructed images display anatomy as a volume rather than the traditional slice seen with 2D imaging. The first thing to understand is manipulation of the 3D images using orthogonal planes and tools located on the ACUSON Sequoia system. Rotation Indicators and VOI audio script: The rotation indicator, or reference marker is the pivot point used to manipulate the MPR planes around either the X, Y or Z axis. It represents the point where the A, B, and C plane intersect. Move the MPR to position the point on a specific target in order to display the anatomy in all three planes. The VOI can be resized, repositioned and curved after acquisition. Use the set keys to toggle between the tools. Position allows the user to pan the image to the desired location. Size enables resizing of the VOI. The user can curve the rendering view line of the VOI box to exclude extraneous information if desired. A curved VOI can allow demonstration out of plane anatomy, such as the endometrium on the rendered volume. (PEPconnect ID 15760) X, Y, and Z Rotations audio script: The control panel of the system contains rotary dial keys that allow the user to manipulate the MPR slicing as well as the X, Y, and Z axis of the acquired volume. The MPR Slicing function is manipulated using the 3D/4D control, the X axis is manipulated using the M-mode control, the Y axis is manipulated using the PW Doppler control, and the Z axis is manipulated using the color Doppler control. (PEPconnect ID 15757) Tools – Page 1 audio script: This volume rendering rotation area allows the user to quickly rotate the rendered volume regardless of the selected plane. In this example the volume has been rotated 90 degrees. The Z axis control may also be used to adjust the volume; however, the VR quadrant must be selected. The Reset All key restores the default or user defined preset parameters and orientation for all quadrants. User-defined settings are those that were in effect when the current volume was first displayed. The Reset Curve key restores the VOI curve to a linear orientation. Reset Orientation restores the original acquisition orientation for all quadrants. Flip reverses the render direction. The Sync key synchronizes or aligns the selected plane and volume rendering orientation. (PEPconnect ID 15170) Tools – Page 2 audio script: On the second page additional selections are available. The surface mode smooths the image contours, creating a soft sculptured appearance for highlighting surface features. When selected this option uses the mode specific selections for opacity percentage and threshold. This is an optimal setting in gynecology for uterus, and ovaries. Min IP, or Minimum Intensity Projection, limits the display to minimum-value pixels with the highest value along each projection of the volume. It is a helpful tool when visualizing hypoechoic lesions, and large vascular structures especially in the adnexa. Max IP, or Maximum Intensity Projection, limits the display to maximum-value pixels with the highest value along each projection of the volume. This option, may be useful for visualizing intrauterine devices. The Inversion tool, renders the volume to display anechoic portions of the volume as echogenic areas, and echogenic areas as anechoic, to allow for enhanced evaluation of cystic structures, such as ovarian cysts, and hydrosalpinx. These options control the rotation of the volume rending allowing the user to quickly achieve the desired view. (PEPconnect ID 15171) Multislice Tool audio script: The Multislice tab contains options for viewing multiple slices of the selected MPR plane at the same time. It is often referred to as a CT or MRI view. Select the desired plane as previously discussed using the A, B and C keys. The rendered volume is disabled in multislice mode. This area allows the user to choose the desired layout. This controls how many slices are displayed on the imaging screen. The slice graphic is made up of a yellow solid line, as well as dashed and solid white lines. The yellow line indicates the center slice in the range which appears outlined in white on the displayed pane. The solid white lines indicate displayed slices and the dashed white lines represent available slices that are not currently displayed due to layout or range position. The Slices soft key defines how many slices are available. Options are 1 through 17 in odd number increments. The distance soft key determines the distance between the slices. Increase distance to spread out displayed slices in order to obtain a more global view of the region. Decrease to reduce area between slices and provide greater detail. The position of slices key defines the entire area of interrogation. It is indicated by the slice graphic lines. Rotate the control to reposition the area of the slices desired. The Range Position soft key allows the user to choose which slices will be displayed on the current screen, and is represented by the solid lines. This is equivalent to scrolling through the slices. Notice that the position of the slices, indicated by the white dashed lines, has not changed. (PEPconnect ID 15172) Measurements Measurements Audio file: sequoia-3d-gyn-007.mp3 Audio script: Labeled or generic measurements may be performed on the MPR planes. Measurement functionality is not available on the rendered volume. Optimize the Multiplanar Rendering (MPR). Relate the X, Y, and Z axis to control panel rotary keys. Demonstrate Set key functions of a 3D data set. Course Review Congratulations. You have completed the ACUSON Sequoia system 3D/4D Gynecology online training. Select the objectives listed below to review the material. 1 1 1 2 2 2 3 3 3 Course Review No audio Optimize the Multiplanar Rendering (MPR). Volume Rendering (VR) Tools Threshold adjusts our ability to see through (opacity) anatomy Opacity changes the transparency to adjust image contours Smooth adjusts the smoothness of the organ surface Brightness adjusts the blacks and whites of the 2D-mode information Contrast adjusts the differences between shades of gray. Tint adds a color overlay to the VR MultiPlanar Rendering (MPR) Tools Dynamic Range adjusts the number of displayed shades of gray (contrast resolution) Map adjusts the brightness (amplitude) gray levels Tint adds a color overlay to the MPR Begin by optimizing the 2D-mode image quality as the image resolution directly effects the 3D and 4D image quality. Relate the X, Y, and Z axis to control panel rotary keys. The three orthogonal planes and the volume display in a format called the multiplanar image. When the 3D volume anatomy displays as a MultiPlanar Rendering or MPR, the images represent the three planes with orthogonal relationships. These planes are called: The A plane which is the acquisition plane, the X (M-mode) rotary key allows pivoting around the reference marker B plane which is 90 degrees to the A plane, which revolves around the central point using the Y (PW/CW) rotary key C plane which is 90 degrees coronal to the A and B plane, adjustment is through the use of the Z (C) rotary key Remember, manipulations affect ALL planes simultaneously around a central axis, but only the active plane correlates to the respective X-, Y-, or Z-key control maneuvers. Demonstrate the Set key functions of a 3D data set. The Set key, located on the Control Panel at home base, allows adjustment of the following on the acquired 3D data set: Position allows movement of the image in relation to the reference marker. Size which changes the MPR image width and height. Curve which allows adjustment of the anterior slice plane removing out of plane anatomy. 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 examples only. ACUSON Sequoia 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 2021 Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127\ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com Disclaimer Disclaimer 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 Sequoia System 3D/4D Gynecology Online Training. Completion HOOD05162003162771 | Effective Date: 15-February-2021 ACUSON Sequoia System X, Y, & Z of 3D Quick Reference Card 2D, 2-dimensional, or 2D-mode Describes the single slice image acquisition that is used in B-mode imaging. The ultrasound image displayed on the monitor represents two dimensions. 3D imaging Calibrated or freehand single sweep through volume of tissue. 4D imaging Continuous real-time 3D sweeps through volume of tissue using mechanical transducers. A plane Acquisition plane. B plane Ninety degrees to the acquisition plane. C plane Coronal plane to the acquisition plane. Data Set and Volume Saved 3D/4D. EV Endovaginal multiPlanar More than one plane. Multislice Display of sequential images Orthoginal Planes at right angles anchored at a pivot point or reference marker (dot) Pixel Term describing the smallest element of a digital image. Region of Interest (ROI) An area showing width and depht boundaries of both the 2D-mode and 3D Volume Rendering (VR). Surface Rendering Creation of an image structure with a skin-like appearance. Threshold Filters or adds low-level echo information from the 3D volume. Transparency Adjustment of how well we see through a voxel. Volume of Interest (VOI) Defines how to display the volume. Also called a Render Box. Voxel The small, box-like structure within a slice of the data set. X axis Line indicating horizontal rotation around a central point. Y axis Line indicating vertical rotation around a central point. Z axis Line indicating clockwise or counterclockwise rotation around a central point. 1.1 Welcome and Course Objectives 1.2 Navigation Tips and Terminology 1.2 Beginning to End 1.3 Optimization 1.4 Manipulation 1.5 Measurements 1.7 Course Review 1.8 Disclaimer 1.9 Completion