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ACUSON Sequoia™ Ultrasound System Virtual Touch pSWE VA25 Software Release

This quick reference guide helps you understand pSWE in the liver using the ACUSON Sequoia ultrasound system with the VA25 software.

ACUSON Sequoia ultrasound system VA25 SW release Virtual Touch pSWE Quick Reference Card siemens-healthineers.com/ultrasound Using point shear wave elastography (pSWE) 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 PSWE • Select compatible transducer1 and • Select pSWE, if needed Abdomen exam preset • Site 1 is default measurement label • If desired, select an alternate label Step 2 Note: If No Label is selected, measurements • Press VT (Virtual Touch) located on VT will appear next to image but will not be sent control panel to report or added to overall statistics. 1 pSWE imaging is compatible with 5C1, DAX,4V1: General, Abdomen; 10L4: Abdomen. SIEMENS Healthineers Step 4 Step 8 • Roll trackball to position ROI • Unfreeze, repeat steps 5–8 to make (region-of-interest) additional measurements Freeze Note: During freeze, a cooling timer indicates remaining seconds until transducer is available for image acquisition. During a short cooling Step 5 time (e.g., 2 seconds depending on ROI depth), Update the timer appears and then disappears very • Press Update on control panel to quickly. begin acquisition Step 9 Step 6 Liver Site 1 Report Vs=1.34 m/s • Select Report on left side of touch • When acquisition is complete, E=5.4 kPa Depth=6.01 cm screen system automatically freezes, • emits one audible “beep” and View, delete, store, print or transfer displays shear wave measurement shear wave measurements and ROI depth next to image Liver Site 1 Vs E Depth m/s kPa cm 1.30 5.0 4.7 Step 7 1.26 4.8 4.7 1.52 6.9 4.7 1.36 5.6 4.7 To enter measurement into report: Clip 1.28 4.9 4.7 1.37 5.7 4.7 1.34 5.3 4.7 • Press Image to store image or, 1.37 5.6 4.7 1.24 4.6 4.7 Press right or left Set key Image 1.81 9.9 4.7 81000 VOUIOWN - • Mean 1.39 Std Dev 0.17 1.6 Median 1.35 5.4 IQR 0.09 0.8 IQR/Median 0.07 0.1 Overall Statistics Mean 1.39 m/s Std Dev 0.17 m/s Median 1.35 m/s IQR 0.09 m/s IQR/Median 0.07 Mean 5.8 kPa Std Dev 1.6 kPa Median 5.4 kPa IQR 0.8 kPa IQR/Median 0.1 Note: Shear Wave Speed and Elasticity values may vary among manufacturers! 2 siemens-healthineers.com/ultrasound 5C1 Liver Site 1 Abdomen 1 Vs=1.37 m/s TIB:1.10 E=5.6 kPa TIC:2.94 Depth=4.7 cm TIS:1.10 MI:1.39 25fps 98% 2D H Mid dB/DR60 Virtual Touch pSWE C=1540 PSWE Liver Application Best Practice Techniques1 ‘9cm Cooling 1 Liver Site 1: 8 Valid / 8 Total 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 cardiac in either segment 8 or 5 (Fig. 1), using motion. intercostal scanning approach Position the 2 cm cursor depth marker on Avoid increased subcapsular reverberation by placing ROI perpendicular the liver capsule (Fig. 1) to and at least 1.5–2 cm below the liver capsule. This can be achieved by placing the 2 cm cursor depth marker on 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 10 measurements at same site Multiple measurements to ensure the median value is reliable. Fewer than 10 measurements can be made (at least 5); however, the IQR / Median ratio should be within the recommended range. 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. Any material used in this training will not be healthcare. updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the An estimated 5 million patients globally everyday benefit from our training. The Operator Manual shall be used as your main reference, innovative technologies and services in the areas of diagnostic and in particular for relevant safety information like warnings and therapeutic imaging, laboratory diagnostics and molecular medicine, cautions. as well as digital health and enterprise services. Note: Some functions shown in this material are optional and might We are a leading medical technology company with over 170 years not be part of your system. of experience and 18,000 patents globally. With more than 48,000 dedicated colleagues in 75 countries, we will continue to innovate Certain products, product related claims or functionalities described and shape the future of healthcare. in the material (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. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. 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. · HOOD05162003112605 · 8987 0820 online · ©Siemens Medical Solutions USA, Inc., 2020

  • strain
  • elastography
  • breast
  • small parts
  • vt
  • qf
  • quality factor
  • virtual touch
  • area ration
  • distance ratio
  • ACUSON Sequoia
  • Sequoia
  • elasto
  • VA25