ACUSON Sequoia™ Ultrasound System Virtual Touch 2D SWE-Liver | VA11 Software Release

This quick reference guide helps you understand 2D SWE of the liver using the ACUSON Sequoia ultrasound system with the VA11 software.

ACUSON Sequoia Virtual Touch 2D SWE Quick Reference Card Sequoia Using 2D shear wave elastography (SWE) to measure shear velocity (Vs) in meters per second (m/s) or elasticity (E) in kilopascal (kPa) | Liver Application Either Velocity (m/s) or Elasticity (kPa) can be displayed on TIP the report – customize prior to report generation under: Step 6 System Configuration > Measurement & Report > Measurement > General > Shear Wave > Measurement Units Press Caliper • Select same measurement label each time. • ................ Step 1 5C1 Site Liver Segment Mass Select compatible transducer* and Abdomen • Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Abdomen exam preset. Site 7 Site 8 Site 9 Site 10 Step 2 Press VT (Virtual Touch) located on VT Step 7 • control panel. Roll trackball to position ROI Diameter • measurement ROI. Step 3 Vs Median=1.30 m/s O SWE If needed, rotate ROI Diameter • Std Dev=0.03 m/s Select SWE tab on touch screen. to resize measurement ROI. E Median=5.1 kPa • Std Dev=0.0 kPa If needed, roll trackball to reposition Shear wave measurements and • • 2D SWE region of interest (ROI). measurement ROI depth and Depth=5.00 cm Diam=1.00 cm If desired, press Set key and roll trackball diameter are displayed next to image. • to resize ROI. Step 8 Step 4 ......... To enter measurement into report: Update Press Update on control panel to Press Image to store image or, • • begin acquisition. Press right or left Set key • Note: During freeze, a cooling timer indicates remaining seconds ..... until transducer is available for image acquisition. During a short Step 9 cooling time (e.g., 1–2 seconds), the timer appears and then disappears very quickly. Unfreeze, repeat steps 4–9 to make YIX • additional measurements. Freeze Step 5 ..................... Step 10 When acquisition is complete, system automatically Report • freezes, emits one audible “beep” and applies Velocity Select Report. • • or Elasticity display mode. View, delete, store, print or transfer Adjust Min and/or Max Velocity or Elasticity to adjust shear wave measurements. • range of measurements displayed in ROI. Liver Site 1 Median (m/s) (m/s) Std Dev Maximum Depth Diam (m/s) (m/s) (cm) (cm) Increase range if measured value exceeds range by 1.17 0.02 1.21 3.99 1.00 - 1.17 0.02 1.20 4.00 1.00 displaying “High” or, 1.16 0.03 1.20 4.00 1.00 1.17 0.01 1.20 3.98 1.00 Decrease range if better visualization of velocity of 1.16 0.03 1.23 4.02 1.00 1.12 0.03 1.17 4.04 1.00 - 1.07 0.02 1.13 4.02 1.00 stiffness differences is needed. 1.17 0.02 1.19 3.99 1.00 1.15 0.01 1.16 3.99 1.00 1.20 1.20 0.03 1.24 4.04 1.00 8000 VOLUMIOWN- Rotate Shear Wave to view Quality and Displacement • Mean 1.15 m/s displays. Std Dev 0.04 m/s 1.17 m/s 0.02 m/s IQR/Median 0.02 Shear Wave Min Velocity Max Velocity Overall Statistics Velocity Mean 1.15 m/s Std Dev 0.04 m/s Median 1.17 m/s IQR 0.02 m/s IQR/Median 0.02 0.5 4 Note: Shear Wave Speed and Elasticity values may vary among manufacturers! If desired, select SWE Display to SWE • * hide /display 2D SWE or, Display 2D SWE imaging is compatible with 5C1, DAX: General, Abdomen; 10L4: Select Live Dual to assess B-mode General, Thyroid, Breast. • image or, Live Dual Rotate VT on control panel to • change transparency of 2D SWE. SIEMENS Note: Live Dual can be selected before or after VT Healthineers acquisition and can be saved to a user-defined preset. HOOD05162002896649 · Printed in Germany · © Siemens Medical Solutions USA, Inc., 2018 Abdomen TIB:0.74 TIC:1.68 E Median=2.8 kPa TIS:0.74 Std Dev=0.0 kPa MI:1.39 Vs Median=0.97 m/s 22fps Std Dev=0.04 m/s 98% Virtual Touch 2D SWE Depth=5.01 cm Diam=1.00 cm 2D H Mid 2dB/DR60 SWE Liver Application O Elasticity Transp: 60% 13cm Liver Site 1: 9 Valid/9 Total Fig. 1: Optimal Technique Best Practice Techniques Fasting for 4–6 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 ROI between 3–6 cm deep (use The default ROI depth best represents the transducer-specific lens default ROI depth whenever possible focus for that transducer; thus, the best measurements are in this for optimal results) and at least 1–2 cm region. Avoid increased subcapsular reverberation by placing ROI below liver capsule (Fig. 1) perpendicular to and at least 1–2 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 artifacts, propagation of the shear wave from the Acoustic Radiation Force optimize B-mode image (Fig. 1) so liver Impulse (ARFI) push pulse. 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 10 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 ≤ 0.3 range. It is the recommended quality control measure for adequate technical quality. ACUSON Sequoia and Virtual Touch are trademarks of Siemens Medical Solutions USA, Inc. 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 Phone: 1-888-826-9702 Published by Siemens Medical Solutions USA, Inc. · Order No. A91US-564-1C-4A00 · HOOD05162002896649 · Printed in Germany · CIT11963 06180.5 © Siemens Medical Solutions USA, Inc., 2018