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This year we have been experimenting with the capabilities in fetal diagnostics offered by HDlive on the Voluson* E8.

HDlive is an enhancement and modi-fication to the Surface Rendering post processing tool. It enables Voluson users to alter the position of the virtual light source, giving a more natural image dis-play with optimized depth impression. HDlive is designed to enhance the 3D display of fetal structures and surfaces,

helping the user to detect anatomical and surface abnormalities, such as cleft lips.

Diagnosing cleft lipsThe diagnostic criteria for cleft lips are well known in sonography and establish-ing an exact diagnosis is not difficult. However, the criteria for aesthetic repair, requested of surgeons by parents during antenatal consultations, have not yet been established.

Echo-anatomy is very precise. In prac-tice, the two anatomic planes are the white lip and the red lip (Image 1). We have been using HDlive to help us assess the ratio of red lip to white lip, both on the side of the cleft lip and on the opposite side, as well as to measure the size of the white lip, between the nose aisle and the red lip.

The choice of sur-gery technique –Millar or Tennisson - depends on the ratio between red and white lip on both sides of the cleft lip (Image 2).

Our experience to date is that HDlive can be a useful aid in the diagnosis of cleft lips, one orient-ing towards a pathological process and offering better prognosis.

VolusonClub for Ultrasound Professionals

Tips and Tricks: Visualization - Corpus Callosum

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VolusonClub.

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Exclusive for Club Members – News and Facts.2012/1st edition No.1

www.volusonclub.net

Dr Bernard BENOIT, Princess Grâce hospital, Monaco, and Dr Jean-Marc LEVAILLANT, Kremlin-Bicètre hospital, France

Dear Readers,

The march of technological progress never slows, and when it comes to extending ultrasound capabilities, GE Healthcare is proud to be leading from the front. Our promise to you, our customer, is continual innovation, the tools to enhance your work as a

healthcare professional and help in getting the most from your Voluson system.

Voluson* FOCUS shows how we put this promise into practice. This edition takes a closer look at HDlive, a 3D en-hancement to Surface Rendering for obstetrics. Users can now alter the position of the virtual light source to get a more natural image display of fetal structures and surfaces with optimized depth impression. HDlive is designed to help in the detection of anatomical abnormalities.

If you think back just a few years, ultra-sound examinations were generally two dimensional. Remember how the first 3D images of fetal faces surprised the medical community?

Today, with our help, Volume Ultrasound has conquered the ultrasound lab, be-coming the standard by which health-care professionals analyze anatomic fetal details, and heralding advanced features including STIC, B-Flow or the Inversion Mode. The innovations continue – get ready to welcome new automatic biome-try measurements on the Voluson E series.

Stay ahead of all these advances by joining your colleagues as a member of VolusonClub. Enjoy free access to a wide variety of educational materials and special membership rates for the 160 ultrasound training courses run each year by our International Academy of Medical Ultrasound. Lifelong learning is essential in today’s professional en-vironment, so I invite you to come join us - and use your Voluson system to the max.

Your Michael Stockhammer

General ManagerGE Healthcare Ultrasound Europe

EDITORIAL – Michael STOCKHAMMER

HDlive applications in fetal pathology

Using Ultrasound to diagnose tubal patency

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VolusonClub FOCUS 2012/1st edition

Using ultrasound to diagnose tubal patency – a case study

Dr Caterina Exacoustos, Rome, Italy

Fallopian tube

Uterine cavity

Cervical canal

Ballon inflating syringe

Ballon

Internal os

External os

Vagina

Transvaginal probe

HyCoSy with air bubbles: visualization of tubal course, note the overlapping with the surroun-ding tissues

Automated 3D CCI HyCoSy with gel foam: 2D and multiplanar volume view of the foam in the uterus and tubes

Automated 3D CCI HyCoSy: multiplanar volume view of the gel foam in the uterus and tubes with and without Coded Contrast Imaging (CCI) and automated reconstruction of the volume

HyCoSy and gel foam with different ultrasound techniques

Go to www.volusonclub.net to download the full version of this paper

HyCoSy with gel foam: visualization of tubal course with and without Contrast Tuned Imaging

One in three infertile women will present with a degree of tubal pathology re-sulting in the occlusion of one or both fallopian tubes. Consequently, the eva-luation of tubal status is an initial step in the diagnostic workup of infertile women.

Transvaginal ultrasound is a diagnostic tool used to evaluate various pelvic conditions such as uterine malforma-tions and endometrial pathologies that can be responsible for infertility, but it does not permit evaluation of the pat-ency of the fallopian tubes. It is, however, a valuable technique for evaluating in-fertility as it is non-invasive, inexpensive, quick and easy to perform, and provides information on both pelvic disorders.

HyCoSyHystero-Salpingo-Contrast-Sonography (HyCoSy) is performed to assess tubal patency or occlusion in patients with in-fertility or who have undergone previous tubal surgery. HyCoSy was introduced in the early 1980s and is a simple out-patient technique. It can be performed in the same setting and at the same time as transvaginal ultrasound, giving additional information on tubal patency.

2D HyCoSyHyCoSy is performed during the prolifer-ative phase of the cycle (day 5 to 12). After inserting a speculum, a 5Fr salpin-

gographic balloon catheter is placed in the uterine cavity and filled in with 1 to 2 ml of air. This ensures that the cervical canal is closed, preventing leakage of fluid and keeping the catheter in pos-ition. The vaginal ultrasound probe is then inserted and a transversal section of the uterus is taken to localize the interstitial part of the tube.

When the intrauterine injection of con-trast fluid is visualized by ultrasound, the contrast media is first seen in the tube, if proximally patent, before spilling into the abdominal cavity, if distally and totally patent. Where there is tubal occlusion, the contrast medium remains concentrated only in the uterus or in the tubes. Where the contrast medium fails to spill into the abdominal cavity then further solution is injected slowly and with constant pressure. Should the pro-cedure become intolerable, or at the patient‘s request, then the examination is interrupted for a short period to allow the tubal spasm to pass. Common ad-verse effects include pelvic pain and cramps, for which analgesic drugs are administered after the procedure. Vagi-nal reactions, with symptoms including nausea, bradycardia, sweating and hy-potension, are rare.

Saline solution and other contrast mediaIn initial studies, saline solution was applied transcervically before perform-ing transabdominal sonography. How-ever, although excellent for visualizing intrauterine pathology (sonohysterogra-phy), saline solution is not particularly accurate in determining the state of fallopian tubes and their patency. Com-bining transvaginal ultrasonography with color Doppler sonography and/or ultrasound positive-contrast media

increases the accuracy of this method.

The most simple and inexpen- sive contrast medium is saline solution mixed with air. Media such as albumin or galactose micro air bubbles are more stable and have a more hy-perechoic appearance, mak-ing them easier to visualize moving through the tubes. The latest contrast media, gas microspheres, are used in Contrast Coded Imaging (CCI), their substantial harmonic response at low acoustic pressure making them clearer and visible for longer.

3D CCI HyCoSy3D CCI HyCoSy is the most advanced development in HyCoSy, combining 3D sonography with CCI to automatically acquire the volume of the uterus and tubes and reconstruct the tubal course. Images can be stored, shared and ana-lyzed with other clinicians. The method has a high diagnostic feasibility and is simple and reproducible.

Salpingographic balloon catheter

Depending on which system and soft-ware options are enabled, there are several ways of achieving visualization of the Corpus Callosum:

• VCI-C• OmniView• Sectional planes• Render mode

The first two techniques, VCI-C and OmniView, are optional features and may not be enabled on your system. The second pair, Sectional planes and Render Mode, can also be used to visualize the Corpus Callosum. Each of the 4 techniques is explained in greater detail in this article.

Corpus Callosum via “VCI-C ”Starting plane in 2D is an axial section, parallel to the skull base and midline of the brain – Cavum Septum Pellucidi must be visible. Adjust depth and focal position to optimize image representation and zoom when necessary.

Activate 4D, and select “VCI-C plane “ as acquisition mode (Default VCI-C user setting is fine). Don’t forget to select an appropriate slice thickness - in case of the Corpus Callosum 3 – 5 mm. Move the horizontal dotted green line with the trackball to the midline of the fetal brain. If necessary, adjust the inclination of the line through the Z-axis (+/- 45°) and start the acquisition. A similar visuali-zation of the Corpus Callosum can be seen below:

Corpus Callosum via “OmniView ”Starting plane in 2D is an axial section, parallel to the skull base and midline of the brain – Cavum Septum Pellucidi must be visible. The same level as where you would measure BPD and HC (look at the image in the A-plane below).

Adjust depth and focal position to opti-mize image representation and zoom when necessary. Activate 3D, adjust the ROI so that it includes the full skull; make sure that the volume angle is large enough (55° or more) and start the ac-quisition. Choose “Sectional Planes” and select your A-plane image (this should be an image similar to the one below.) Then activate OmniView, select Line and indicate the starting and end point on the midline in the A-plane. Confirming the endpoint will result in the image below:

To enhance the contrast of the Corpus Callosum representation, VCI (Volume Contrast Imaging) can be activated via the touchscreen, selecting a size of 3 – 5mm. A similar visualization of the Cor-pus Callosum can be seen as below:

Corpus Callosum via “Sectional Planes”Starting plane in 2D is an axial section, parallel to the skull base and midline of the brain - Cavum Septum Pellucidi must be visible. The same level as where you would measure BPD and HC (look at the image in the A-plane below).

Adjust depth and focal position to opti-mize image representation and zoom when necessary. Activate 3D, select “Sectional planes”, adjust the ROI so that it includes the full skull; make sure that the volume angle is large enough (55° or

more) and start the acquisition. Select the A-plane and place the reference dot (indi-cating the intersection of the 3 orthogonal planes) on the midline. Use X, Y or Z-axis to adjust if necessary. In the C-plane, you will find a mid sagittal view of the fetal brain, including Corpus Callosum. If some fine adjustment is needed, please select the C-plane and use parallel shift to get the optimum visualisation of that section. Corpus Callosum via “Render” modeAgain, your starting plane in 2D is an axial section, parallel to the skull base and midline of the brain - Cavum Septum Pellucidi must be visible. The same level as where you would measure BPD and HC (look at the image in the A-plane below).

Adjust depth and focal position to op-timize image representation and zoom when necessary. Activate 3D, select “Render” (default rendering will do fine) and adjust the ROI so that it includes the full skull; make sure that the volume angle is large enough (55° or more) and start the acquisition.

Select the A-plane and reduce the ROI box to a very thin slice as indicated above. Put the green line almost on the midline. Activate the C-plane and make sure your ROI box includes the whole section of the Corpus Callosum.

Now you will have 2 vizualisations: a single reconstructed 2D slice of the Cor-pus Callosum and a thicker 3D slice, thus more contrast in the rendered section.

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VolusonClub FOCUS 2012/1st edition

TIPS AND TRICKS – APPLICATION NEWS

Visualization methods for Corpus Callosum

ViewPoint - ultrasound quality and efficiencyOriginally, the OB department of the Academic Hospital in Uppsala was look-ing for an ultrasound image archiving tool. The solution they chose also allowed them to standardize their workflows and to improve their skills.

The need for appropriate archiving “We were looking for a solution that pro-vides long term storage for all kinds of ul-trasound data – single- and multiframes – including measurement data, annotations and tags. And we needed easy and instant access. Our PACS just couldn’t provide us with that.” Dr. Eva Bergman explained.

Thus, the OB department decided to go with ViewPoint*, GE’s dedicated ultra-sound workflow solution for reporting and image management. The scanners now automatically provide all data to a central ViewPoint server. While the stu-dies can be accessed and processed via workstations, the server is also the gate-way towards the PACS, making sure all relevant information is included with the images. When asked if ViewPoint also helped to improve quality of care, Dr. Bergman added: “Yes, our sonographers compare their earlier findings with the actual results and so improve their skills.”

Making full use of the built-in reporting solutionThe OB department quickly recognized the value of ViewPoint reporting capabili-ties. “Today we can provide one standard in reporting on all routine scans. We have standardized what we look at, the way we describe it and the indication and pro-cedure codes we assign to it . Structured reports guide us through the examination, making sure nothing is missed and the final reports are generated with just a few mouse clicks.” said Dr. Bergman.

Improved efficiency to comeThe integration request into the local HIS is currently queuing with similar requests from other departments. “I can’t wait for the day this is done. Once we have it , we just need a few clicks to generate our reports and the rest will be taken care

of - a significant improvement in efficiency.” explained Dr. Bergman.

Dr. Eva Bergman is Head Doctor in the OB de-partment of the Academic Hospital of Uppsala, Sweden. The Hospital has around 1,100 beds and is located 70km north of Sweden’s capital Stockholm.

For more information about ViewPoint please contact us at vpinfo@med.ge.com or visit http:// www.gehealthcare.com/euen/ultrasound/ultrasound-it/index.html

Uppsala’s OB department pushes forward in ultrasound quality and efficiency, building on the capabilities of ViewPoint

A-plane

A-plane B-plane

C-plane Rendering image

A-plane B-plane

C-plane

A-plane

A-plane

A-plane

Academic Hospital in Uppsala

Now numbering 11,000 members world-wide, VolusonClub is a truly international group of Voluson ultrasound users. Over 150 new users are signing up for free membership each month, keen to become part of this dynamic group of healthcare

professionals, each determined to get the most from their Voluson system.

VolusonClub website gets a new look and feelTo honor this growth, the VolusonClub

website has undergone a new look and feel, using the latest web technologies to offer users an even better online experience. Easy and comfortable to navi-gate, the VolusonClub website is your first port of call for catching up on local news, product up-dates, new releases and educat-ional offerings.

Download white papers written by fetal ultrasound and gyneco-logy experts, and view application video clips, with GE ultrasound experts walking you through the applications on your Voluson system.

Exclusive member benefitsBe the first to learn about new ultra-sound products and software upgrades. Discuss and exchange information with ultrasound users worldwide and learn about best practices in ultrasound from specialists around the globe. Voluson-Club also runs Annual User Days in your region and hosts VIP lounges at major congresses.

New DVD collection for VolusonClub membersWe are delighted to announce the release of Volume 2 of the Voluson Signature series of DVDs presented by

Dr. Marcin WIECHEC. Both Volume 1 and 2 are available exclusively to club members, either to view online or order, free of charge, from the club website.

Volumes 1 and 2 cover:

• Acquisition of right 2D image• Fetal volume ultrasound• Clinical cases• New 2D features• Volume Ultrasound in gynecology• ViewPoint documentation

Simply log in to the VolusonClub web-site and order your copy.

Not a member yet? Go to www.volusonclub.net to sign up and start enjoying the benefits!

EDUCATION

The extreme sophistication of modern ultra-sound technologies and the increasing num-ber of applications on each Voluson system makes using your ultrasound system to its full capacity an ongoing learning experience.

Users benefit greatly from specialized training on the more advanced technologies, particu-larly on 3D/4D systems. Recognizing this, GE has established the International Academy of Medical Ultrasound (IAMU). The IAMU runs courses aimed at familiarizing physicians with the latest ultrasound innovations and applications and giving them the opportunity to benefit from the experience of respected practitioners in their field.

What started as customer training programs around a decade ago has now developed into a regular series of courses on ultrasound. Courses are now run on a regional basis, both at basic and advanced level, throughout Europe, the Middle East and Africa.

Advanced VISUS courseIn order to meet the high levels of demand,

the advanced VISUS course in Vienna is now being run three times a year, in spring, late summer and autumn. The course focuses on advanced 3D/4D sonography, examining basic procedures as well as the clinical rele-vance of 3D, and is run by Professor Dr. Kratochwil of the University of Vienna.

The 3-day course covers:• Technical aspects of 3D/4D • Obstetrics• Gynecology: IVF, sterility,

benign & malignant tumors• Fetal cardiology

Discounts for VolusonClub membersVolusonClub members benefit from discounts on several courses, including the VISUS courses.

For further details of all these courses and discounts please see the VolusonClub Course Activities 2012 course book, available to download from the VolusonClub website. You can also register for courses online.

www.volusonclub.net

www.volusonclub.net –4–

VolusonClub FOCUS 2012/1st edition

GE ULTRASOUND OFFICE ADDRESSES

VolusonClub – a global meeting point for ultrasound professionals

CONGRESSES 2012/2013

IMPRINT

Printing: Kroiss & Bichler GmbH & CoKG Römerweg 1, A-4844 Regau office@kb-offset.at

Concept and Production:ICS Media GmbHA-4846 Redlham, Austriaoffice@ics-media.at

Editor–in-chief:Gerald Seifriedsberger, Arnaud Dujardin, Roland Hubelnigvolusonclub@ge.com

Publishers:GE Healthcare Austria GmbH & Co OGTiefenbach 15, 4871 ZipfAustria

* Trademarks of General Electric Company.

AUSTRIA General Electric Austria GmbHFiliale GE Healthcare TechnologiesEURO PLAZA, Gebäude E Wienerbergstrasse 41A-1120 ViennaPhone: (+43) 1 97272 0Fax: (+43) 1 97272 2222

BELGIUM GE Medical Systems Ultrasound Eagle Building, Kouterveldstraat 20 1831 DIEGEM Phone: (+32) 2 719 7204 Fax: (+32) 2 719 7205

CZECH REPUBLIC GE Medical Systems Ultrasound Vyskocilova 1422/1a 140 28 Praha

DENMARK GE Medical Systems Ultrasound Park Allé 295, 2605 BrondbyPhone: (+45) 43295 400 Fax: (+45) 43295 399

FINLAND & ESTONIA GE Medical Systems Kuortaneenkatu 2, 000510 HelsinkiP.O.Box 330, 00031 GE FinlandPhone: (+358) 10 39 48 220Fax: (+358) 10 39 48 221

FRANCE GE Medical Systems Ultrasound and Primary Care Diagnostics France F-78457 Velizy Phone: (+33) 1 34 49 52 70Fax: (+33) 13 44 95 202

GERMANY GE Healthcare GmbH Beethovenstr. 23942655 SolingenPhone: (+49) 212-28 02-0Fax: (+49) 212-28 02 28

GREECE GE Healthcare 8-10 Sorou Str. Marousi - Athens 15125 Hellas Phone: +30 210 8930600 Fax: +30 210 9625931

HUNGARYGE Hungary Zrt . Ultrasound Division, Akron u. 2.Budaörs 2040 HungaryPhone: +36-23-410-314Fax: +36-23-410-390

ITALY GE Medical Systems Italia spaVia Galeno, 36, 20126 Milano Phone: (+39) 02 2600 1111 Fax: (+39) 02 2600 1599

NETHERLANDS GE Healthcare De Wel 18 B, 3871 MV HoevelakenPO Box 22, 3870 CA HoevelakenPhone: (+31) 33 254 1290 Fax: (+31) 33 254 1292

NORTHERN IRELANDGE Healthcare Victoria Business Park, 9, Westbank Road, Belfast BT3 9JL.Phone: 028 90 22 99 00

NORWAY GE Medical Systems Ultrasound Tasenveien 71, 0873 Oslo Phone: (+47) 2202 0800

GE Medical Systems Ultrasound Strandpromenaden 45, P.O. Box 141, 3191 HortenPhone: (+47) 33 02 11 16

POLAND GE Medical Systems Polska Sp. z o.o., ul. Wołoska 902-583 Warszawa, Poland Phone: (+48) 22 330 83 00Fax: (+48) 22 330 83 83

PORTUGAL General Electric Portuguesa, SA. Avenida do Forte, n° 4, Fraccao F, 2795-502 Carnaxide,Phone: (+351) 21 425 1309Fax: (+351) 21 425 1343

REPUBLIC OF IRELAND GE HealthcareUnit F4, Centrepoint Business Park,Oak Drive, Dublin 22Phone: 01 4605500

RUSSIA GE HealthcareKrasnopresnenskaya nab., 18, bld A, 10th floor123317 Moscow, RussiaPhone: +74957396931Fax: +70957396932

SPAIN GE Healthcare EspañaC/ Gobelas 35-37, 28023 MadridPhone: 34 91 663 2500Fax: 34 91 663 2501

SWEDEN GE Medical Systems Ultrasound PO Box 314, 17175 Stockholm Phone: (+46) 0855950010 SWITZERLAND GE Medical Systems AbEuropastrasse 31, 8152 Glattbrugg Phone: (+41) 1 809 92 92 Fax: (+41) 1 809 92 22

U.A.E GE Healthcare HoldingSuite 1101, 11th Floor City Tower 2 Sheik Zayed Rd. Dubai, U.A.EPhone: (+971) 4 3131 207 Fax: (+971) 4 3321802

UNITED KINGDOM GE Medical Systems Ultrasound71 Great North RoadHatfield, Hertfordshire, AL9 5ENPhone: 44 1707 263570Fax: 44 1707 260065

TOPIC LOCATION DATES

ISUOG 2012 Copenhagen, Denmark September 9 - 12, 2012

3 LäNDERTREFFEN Davos, Switzerland September 26 - 29, 2012

FIGO WORLD CONGRESS Rome, Italy October 7-12, 2012

MEDICA 2012 Düsseldorf, Germany November 14 - 17, 2012

ULTRASOUND MEETS MAGNETIC RESONANCE Vienna, Austria June 4 - 8, 2013

ESHRE WORLD CONGRESS London, UK July 7-10, 2013

ESGO Athens, Greece October 5-8, 2013

Learn to use your Voluson system to the full