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ACUSON Sequoia™ Ultrasound System Virtual Touch 2D SWE-Liver | VA25 Software Release

This quick reference guide helps you understand 2D SWE of the liver using the ACUSON Sequoia ultrasound system with the VA25 software.

ACUSON Sequoia ultrasound system VA25 SW release Virtual Touch 2D SWE Quick Reference Card siemens-healthineers.com/ultrasound Using 2D shear wave elastography (SWE) to measure shear velocity (Vs) in meters per second (m/s) and elasticity (E) in kilopascal (kPa) | Liver Application Step 1 5C1 Step 3 Abdomen SWE • Select compatible transducer1 and • Select SWE tab on touch screen Abdomen exam preset • If needed, roll trackball to reposition 2D SWE region of interest (ROI) Step 2 • If desired, press Set key and roll Press VT (Virtual Touch) located on trackball to resize ROI • VT control panel Step 4 Update • Press Update on control panel to begin acquisition Note: During freeze, a cooling timer indicates remaining seconds until transducer is available for image acquisition. During a short cooling time (e.g., 1–2 seconds), the timer appears and then disappears very quickly. 1 2D SWE imaging is compatible with 5C1, DAX: General, Abdomen; 10L4: General, Thyroid, Breast, MSK; 18L6: General, Thyroid, Breast. SIEMENS Healthineers Step 5 Step 7 ROI Diameter • When acquisition is complete, system automatically • Roll trackball to position freezes, emits one audible “beep” and activates measurement ROI 1 Vs Median=1.44 m/s Velocity or Elasticity display mode E Median=6.3 kPa Depth=4.72 cm • If needed, rotate ROI Diameter Diam=1.00 cm • Adjust Min and/or Max Velocity or Elasticity to adjust to resize measurement ROI range of measurements displayed in ROI • Shear wave measurements and Increase range if measured value exceeds range by measurement ROI depth and - displaying “High” or, diameter are displayed next to Decrease range if better visualization of velocity of image - stiffness differences is needed • Rotate Shear Wave to view Quality and Displacement displays Step 8 Shear Wave Min Velocity Max Velocity To enter measurement into report: Velocity 0.5 4 • Press Image to store image or, • If desired, select SWE to hide / display • SWE Press right or left Set key Image 2D SWE or, • Rotate VT on control panel to change transparency of 2D SWE VT Step 9 • Unfreeze, repeat steps 4–9 to make If desired, select Unit m/s to display additional measurements Freeze • the 2D SWE image as an elasticity Unit image in kPa m/s If desired, select Live Dual to display Live Dual Step 10 • Report the 2D SWE image in full-screen • format Select Report • View, delete, store, print or transfer shear wave measurements Step 6 Liver Site 1 Median ( m/s) Mean ( m/s) (m/s) Median (kPa) Mean (kPa) Max (kPa) Depth ( cm) ( cm) • Press Caliper 1.81 1.98 11.7 4.59 1.33 1.35 1.79 9.6 4.54 1.35 1.38 1.79 9.6 4.59 Select same measurement label each time 1.29 1.29 1.74 5.0 9.1 4.38 • 1.40 1.43 1.79 9.6 4.75 1.28 1.31 1.76 4.9 9.3 4.39 Site Liver Segment Mass 1.28 1.27 1.48 6.6 4.33 1.38 1.42 1.79 9.6 4.72 1.42 1.46 1.92 11.0 4.68 1.32 1.34 1.79 9.6 4.51 8888888888 000 VOUSAWN- Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Mean 1.39 1.40 1.78 9.6 Std Dev 0.16 0.15 0.13 1.3 Median 1.34 1.37 1.79 9.6 IQR 0.11 0.12 0.03 0.3 Site 7 Site 8 Site 9 Site 10 IQR/Median 0.08 0.07 0.00 0.0 Overall Statistics Mean 1.39 m/s Std Dev 0.16 m/s Median 1.34 m/s IQR 0.11 m/s JOR/Median 0.08 Mean 5.8 kPa Std Dev 1.5 kPa Median 5.4 kPa IQR 0.8 kPa QR/Median 0.1 Note: Shear Wave Speed and Elasticity values may vary among manufacturers! 2 siemens-healthineers.com/ultrasound 5C1 Sequoia 1 Vs Median=0.85 m/s Abdomen E Median=2.2 kPa TIB:0.71 Depth=4.33 cm TIC:1.49 6.5 Diam=1.00 cm TIS:0.71 MI:1.39 26fps 98% 2D H Mid OdB/DR60 Virtual Touch c=1540 SWE Velocity Transp: 60% 2D SWE Liver O Application Best Practice Techniques1 9cm Fig. 1: Optimal technique Fasting for at least 4 hours In the non-fasting state, the liver can have falsely increased values. Position patient supine or slight (30°) left Optimal positioning to improve intercostal access. lateral decubitus position with right arm raised above head Transducer perpendicular (90°) to skin A transducer angle < 50° to the skin surface, or use of inadequate surface using ample gel amount of gel, can result in artificially low shear wave measurements due to loss of transducer contact. Take measurements in right lobe of liver, Optimal ROI placement to obtain reproducible results and avoid in either segment 8 or 5 (Fig. 1), using cardiac motion. intercostal scanning approach Position the measurement ROI at least The 2D SWE ROI can be positioned closer to the liver capsule, if 1.5–2 cm below liver capsule (Fig. 1) reverberation artifacts are avoided; however, the measurement ROI should be positioned at least 1.5-2 cm below the liver capsule. Scanning parallel to ribs and in an Rib shadows on either side of the ROI result in poor generation and intercostal space to avoid rib shadow propagation of the shear wave from the Acoustic Radiation Force artifacts, optimize B-mode image (Fig. 1) Impulse (ARFI) push pulse. so liver parenchyma is bright and large vessels, bile ducts and rib shadows are avoided Perform acquisition during suspended Valsalva or deep inspiration can cause an undesired increase in central respiration; patient may resume normal venous pressure which can falsely elevate shear wave measurements. breathing after audible “beep” is heard Instruct patient to breath normally and then to momentarily stop breathing during acquisition. When acquisition is complete, the system freezes and emits one audible “beep”; resume normal breathing. Obtain 5 measurements at same site Multiple measurements to ensure the median value is reliable. Maintain an Interquartile Range (IQR)/ Indicates variability of measurements lie within reasonable variability Median ratio of ≤ 0.3 for values in range. It is the recommended quality control measure for adequate kilopascals and ≤ 0.15 for values in technical quality. The IQR/Median ratio for elasticity in units of kPa will meters per second be twice the IQR/Median ratio for shear wave velocity in units of m/s as the conversion of m/s to kPa is nonlinear. 1 Barr, RG, et al. (2020), “Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement.” Radiology, 00:1-12. doi.org/10.1148/radiol.2020192437. https://pubs.rsna.org/doi/10.1148/radiol.2020192437 siemens-healthineers.com/ultrasound 3 For the proper use of the software or hardware, please always use At Siemens Healthineers, our purpose is to enable healthcare the Operator Manual or Instructions for Use (hereinafter collectively providers to increase value by empowering them on their journey “Operator Manual”) issued by Siemens Healthineers. This material is towards expanding precision medicine, transforming care delivery, to be used as training material only and shall by no means substitute and improving patient experience, all enabled by digitalizing the Operator Manual. 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ACUSON Sequoia and Virtual Touch are trademarks of Siemens Medical Solutions USA, Inc. Siemens Healthineers Ultrasound owns the rights to all images. Siemens Healthineers Headquarters Legal Manufacturer Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 Ultrasound 91052 Erlangen, Germany 22010 S.E. 51st Street Phone: +49 9131 84-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-healthineers.com/ultrasound Published by Siemens Medical Solutions USA, Inc. · HOOD05162003112648 · 8985 0820 online · ©Siemens Medical Solutions USA, Inc., 2020