V7 Complete

Technical Publications

Vivid 7 Dimension/Vivid 7 PROVersion 7.x.x

User’s ManualVolume 1

GEVU #: FD092052GEVU Rev. 01MHLW No: 21300BZY00416000

Operating Documentation

Copyright © 2007 By General Electric Co.

0470

MANUAL STATUSFD092052-0101/08/2007

© GE Medical Systems. All rights reserved. No part of this manual may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of GE Medical Systems.

COMPANY DATA GE VINGMED ULTRASOUND A/SStrandpromenaden 45, N-3191 Horten, NorwayTel.: (+47) 3302 1100 Fax: (+47) 3302 1350

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Table of Contents

Table of ContentsIntroduction

Attention .........................................................................................1Safety ..............................................................................................1Interference caution.......................................................................1Indications for use ........................................................................2Contraindications...........................................................................2Manual contents.............................................................................3

Finding information................................................................3Conventions used in this manual.................................................4Contact information.......................................................................5Software license acknowledgments.............................................6

Chapter 1Getting started

Introduction ....................................................................................8Preparing the unit for use .............................................................9

Site requirements ..................................................................9Connecting the unit .............................................................10Switching On/Off .................................................................16

Moving and transporting the unit ...............................................18Wheels ................................................................................18Moving the unit ....................................................................20Transporting the unit ...........................................................21Reinstalling at a new location..............................................21Unit acclimation time ...........................................................22

System description......................................................................23System overview .................................................................23Control panel .......................................................................26The Scanning screen ..........................................................39Footswitch operation ...........................................................42Connecting and disconnecting probes ...............................43

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Adjusting the monitor display ..............................................43LCD monitor adjustment......................................................46

Starting an examination ..............................................................48Creating a new Patient record or starting an examination from an existing patient record ....................................................48Selecting a Probe and an Application .................................52

Chapter 2Basic scanning operations

Assignable keys and Soft Menu Rocker ....................................55Using the Soft Menu Rocker ...............................................56

Trackball operation......................................................................57Cineloop operation ......................................................................58

Cineloop overview...............................................................58Cineloop controls.................................................................60Using cineloop.....................................................................61

Storing images and cineloops....................................................62To store a single image.......................................................62To store a cineloop..............................................................62

Using removable media...............................................................63Recommendation concerning CD and DVD handling .........63Formatting removable media...............................................63Ejecting removable media ...................................................65

Recording images on VCR..........................................................66Zoom .............................................................................................67

To magnify an image (Display zoom)..................................68To activate the HR zoom.....................................................68

Performing measurements..........................................................69To perform measurements: .................................................69

Physiological traces ....................................................................70Pinout on AUX connectors ..................................................71Connecting the ECG/Respiration ........................................71Connecting the Phono.........................................................73Connecting the Pulse pressure transducer .........................73Physio overview ..................................................................74Physio controls ....................................................................75Displaying the physiological traces .....................................77

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Adjusting the display of physiological traces .......................77Annotations ..................................................................................79

To insert an annotation........................................................79To edit annotation................................................................82To erase annotation ............................................................82Configuration of the pre-defined annotation list...................83Bodymarks ..........................................................................85

Chapter 3Scanning Modes

Introduction ..................................................................................892D-Mode........................................................................................90

2D-Mode overview ..............................................................902D-Mode controls ................................................................92Using 2D..............................................................................95Optimizing 2D......................................................................95

M-Mode..........................................................................................96M-Mode overview................................................................96M-Mode controls..................................................................98Using M-Mode...................................................................100Optimizing M-Mode ...........................................................101

Color Mode ................................................................................102Color 2D Mode overview...................................................102Color M-Mode overview ....................................................103Color Mode controls ..........................................................105Using Color Mode..............................................................108Optimizing Color Mode......................................................109

PW and CW Doppler ..................................................................110PW and CW Doppler overview..........................................110PW and CW Doppler controls ...........................................112Using PW/CW Doppler modes ..........................................115Optimizing PW/CW Doppler modes ..................................115

Tissue Velocity Imaging (TVI) ...................................................117TVI overview......................................................................117TVI controls .......................................................................119Using TVI...........................................................................122Optimizing TVI...................................................................122

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Tissue Tracking..........................................................................123Tissue Tracking overview..................................................123Tissue Tracking controls ...................................................125Using Tissue Tracking.......................................................128Optimizing Tissue Tracking ...............................................128

Strain rate ...................................................................................130Strain rate overview...........................................................130Strain rate controls ............................................................132Using Strain rate................................................................135Optimizing Strain rate........................................................135

Strain ...........................................................................................136Strain overview..................................................................136Strain controls ...................................................................138Using Strain.......................................................................141Optimizing Strain ...............................................................141

Tissue Synchronization Imaging (TSI) .....................................142TSI overview......................................................................142TSI controls .......................................................................144Using TSI...........................................................................146Optimizing TSI...................................................................147

Additional scanning features....................................................148LogiqView..........................................................................148Compound.........................................................................148B-Flow ...............................................................................149Blood flow imaging ............................................................149

Chapter 4Stress Echo

Introduction ................................................................................152Selection of a stress test protocol template............................153Image acquisition.......................................................................155

Starting acquisition ............................................................156Continuous capture mode .................................................160Analysis .............................................................................168

Quantitative TVI Stress echo analysis .....................................173Accessing QTVI Stress analysis tools...............................175Vpeak measurement .........................................................175

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Tissue Tracking .................................................................179Quantitative analysis .........................................................180References ........................................................................180

Editing/creating a template .......................................................181Entering the Template editor screen .................................181Template editor screen overview ......................................182Editing/Creating a template ...............................................185

Chapter 5Contrast Imaging

Introduction ................................................................................189Data acquisition.................................................................189Quantification ....................................................................190

Data acquisition .........................................................................192Left Ventricular Contrast Imaging......................................192Myocardial Contrast Imaging.............................................197Real-Time Coded Phase Inversion (RTCPI) .....................205Vascular Contrast Imaging ................................................213Abdominal Contrast Imaging .............................................217Rodent Contrast Imaging ..................................................221

Chapter 6Measurement and Analysis

Introduction ................................................................................224About Measurement results display ..................................224

The Assign and Measure modality ...........................................226Starting the Assign and Measure modality........................226Entering a study and performing measurements ..............228

Measure and Assign modality ..................................................230Starting the Measure and Assign modality........................230Post-measurement assignment labels ..............................231

Cardiac Measurements..............................................................2342D Measurements .............................................................234M-Mode Measurements ....................................................238Doppler Measurements .....................................................242TSI Measurements ............................................................245

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Automated Function Imaging ............................................251Vascular measurements............................................................269

B-Mode measurements .....................................................269M-Mode Measurements ....................................................273Doppler measurements .....................................................274

OB measurements .....................................................................280OB graphs .........................................................................280

Measurement package configuration.......................................285Measurement package configuration - example ...............285Normal values ...................................................................287

User-defined formulas ...............................................................290User-defined formula - example ........................................290About units ........................................................................296

Measurement result table..........................................................299Minimizing the Measurement result table..........................299Moving the Measurement result table ...............................299Deleting measurements ....................................................299

Worksheet...................................................................................301Overview ...........................................................................301Using Worksheet ...............................................................301

Chapter 7Quantitative Analysis

Introduction ................................................................................306For TVI: .............................................................................306For Tissue Tracking:..........................................................306For Strain rate: ..................................................................306For Strain:..........................................................................306For Contrast: .....................................................................306

Accessing the Quantitative analysis package ........................307In replay mode:..................................................................307In live .................................................................................307

Quantitative Analysis window ..................................................308Overview ...........................................................................308

Generation of a trace .................................................................315About the sample area ......................................................315To generate a trace ...........................................................315

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Manual tracking of the sample area (dynamic anchored sample area) .....................................................................316Zooming in the Analysis window .......................................317

Deletion of a trace......................................................................318To delete all traces ............................................................318To delete one specific trace ..............................................318

Saving/retrieving Quantitative analysis ...................................318Frame disabling..........................................................................319

Disabling frames................................................................319Re-enabling all frames ......................................................319

Optimizing sample area.............................................................321Reshaping a sample area .................................................321Labelling a sample area ....................................................322

Optimizing the trace display .....................................................323Optimizing the Y-axis ........................................................323Trace smoothing................................................................324

Switching modes or traces .......................................................326To switch mode .................................................................326To switch trace ..................................................................326

Cine compound..........................................................................327Curve fitting analysis.................................................................328

Wash-in curve fitting analysis............................................330Wash-out curve fitting analysis..........................................335

Anatomical M-Mode ...................................................................337Introduction........................................................................337Using Anatomical M-Mode ................................................337Optimizing Anatomical M-Mode ........................................339

Chapter 8Archiving

Introduction ................................................................................342Storing images and cineloops..................................................343

Storing an image ...............................................................345Storing a cineloop..............................................................345Saving stored images and cineloops to a standard format346MPEGVue/eVue................................................................348

Retrieving and editing archived information...........................351

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Locating a patient record...................................................351Selecting a patient record and editing data in the archive.355Deleting archived information............................................361Moving examinations.........................................................363

Review images in archive..........................................................366Review the images from a selected examination ..............366Select images from the Image list screen .........................367

Connectivity................................................................................371The dataflow concept ........................................................371Stand-alone scanner scenario...........................................375A stand-alone scanner and a stand-alone EchoPAC PC environment.......................................................................376A stand-alone scanner and a stand-alone DICOM workstation ........................................................................378A scanner and EchoPAC PC in a direct connect environment.......................................................................379A scanner and EchoPAC PC in a network environment ...383A scanner and a DICOM server in a network....................385

Export/Import patient records/examinations...........................395Exporting patient records/examinations ............................395Importing patient records/examinations ............................404

Disk management ......................................................................408Configuring the Disk management function ......................409Running the Disk management function ...........................411

Data Backup and restore...........................................................416Backup procedure .............................................................417Restore procedure.............................................................421

DICOM spooler ...........................................................................423Starting the DICOM spooler ..............................................423

Chapter 9Report

Introduction ................................................................................427Creating a report ........................................................................428

Working with the report function........................................428To print a report.................................................................431To store a report................................................................431

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Retrieving an archived report ............................................432Deleting an archived report ...............................................432

Structured Findings...................................................................433Prerequisite .......................................................................433Starting Structured Findings..............................................434Structured Findings structure ............................................434Using Structured Findings .................................................436Structured Findings configuration......................................439

Direct report................................................................................450Creating comments ...........................................................450Creating pre-defined text inputs ........................................452

Report designer..........................................................................453Accessing the Report designer .........................................453Report designer overview..................................................454Designing a report template ..............................................457Saving the report template ................................................467To exit the Report designer ...............................................468

Report templates management.................................................469Configuration of the Template selection menu..................469Export/Import of Report templates ....................................471

Chapter 10Probes

Probe overview...........................................................................474Supported probes..............................................................474Probe orientation ...............................................................479Probe labelling...................................................................479Maximum probe temperature ............................................481

Probe Integration .......................................................................483Connecting the probe........................................................483Activating the probe...........................................................486Disconnecting the probe....................................................487

Care and Maintenance...............................................................488Planned maintenance........................................................488Inspecting the probe ......................................................489Cleaning and disinfecting probes ......................................490

Probe safety................................................................................493

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Electrical hazards ..............................................................493Mechanical hazards ..........................................................493Biological hazards .............................................................494

Biopsy .........................................................................................495Precaution concerning the use of biopsy procedures .......495Preparing the Biopsy guide attachment ............................496Displaying the Guide zone ................................................500Biopsy needle path verification..........................................501Starting the biopsy procedure ...........................................501Cleaning, disinfection and disposal ...................................501

Chapter 11Peripherals

Introduction ................................................................................503VCR/DVD operation....................................................................505

VCR/DVD Overview ..........................................................505Using VCR/DVD................................................................506

Printing........................................................................................510To print an image ..............................................................510Printer configuration ..........................................................511

Specifications for peripherals...................................................513

Chapter 12Presets and System setup

Introduction ................................................................................516Starting the Configuration package .........................................519

To open the Configuration package ..................................519Overview .....................................................................................520Imaging .......................................................................................521

The Global setup sheet .....................................................521Application.........................................................................524Application menu...............................................................528

Measure/Text ..............................................................................530The Measurement menu sheet .........................................531The Advanced sheet .........................................................536The Modify calculations sheet ...........................................537

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The OB table sheet ...........................................................538Report..........................................................................................544

The diagnostic codes sheet...............................................545The Comment texts sheet .................................................547

Connectivity................................................................................550Dataflow ............................................................................551Additional outputs..............................................................560Tools..................................................................................562Formats .............................................................................563TCP/IP...............................................................................568

System ........................................................................................569The system settings ..........................................................569

About...........................................................................................573Administration............................................................................574

Users .................................................................................575Unlock Patient ...................................................................578

Chapter 13User maintenance

System Care and Maintenance .................................................580Inspecting the system........................................................580Cleaning the unit ...............................................................581Air filter ..............................................................................581Prevention of static electricity interference........................583

System self-test..........................................................................584System malfunction ...........................................................584

Chapter 14Safety

Introduction ................................................................................588Owner responsibility..................................................................589Important safety considerations...............................................590

Notice against user modification .......................................590Regulatory information..............................................................591

Standards used .................................................................591Device labels ..............................................................................592

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Classifications ...................................................................596Acoustic output..........................................................................597

Definition of the acoustic output parameters .....................597Acoustic output and display on the Vivid 7........................598ALARA...............................................................................599Safety statement ...............................................................599System controls affecting acoustic output .........................599

Patient safety..............................................................................601Patient identification ..........................................................601Diagnostic information.......................................................601Mechanical hazards ..........................................................601Transesophageal probe safety .........................................602Electrical Hazard ..............................................................602

Personnel and equipment safety..............................................603Explosion hazard...............................................................603Implosion hazard ...............................................................603Electrical hazard................................................................603Moving hazard...................................................................604Biological hazard ...............................................................604Pacemaker hazard ............................................................605

Electrical safety..........................................................................606Device classifications ........................................................606Internally connected peripheral devices ............................606External Connection of other peripheral devices...............606

Allergic reactions to latex-containing medical devices .........607Electromagnetic Compatibility (EMC) ......................................608Environmental protection..........................................................610

System disposal ................................................................610Appendix

Product description ...................................................................612System Architecture ..........................................................612Ergonomics .......................................................................613Display Annotations...........................................................613Tissue Imaging ..................................................................614Color Doppler ....................................................................617Spectral Doppler................................................................619Advanced Options ............................................................621Physiological Traces .........................................................624

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Analysis Program ..............................................................624User Interface....................................................................625EchoPAC PC.....................................................................625Wideband probes ..............................................................626Virus Protection .................................................................628Peripherals (options) .........................................................628Physical Dimensions .........................................................629Cart....................................................................................629Electrical Specifications.....................................................630Safety ................................................................................630

Probe/Application overview......................................................631Index

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Introduction

The Vivid 7 ultrasound unit is a high performance digital ultrasound imaging system.

The system provides image generation in 2D (B) Mode, Color Doppler, Power Doppler (Angio), M-Mode, Color M-Mode, PW and CW Doppler spectra, Tissue Velocity imaging and Contrast applications.

The fully digital architecture of the Vivid 7 unit allows optimal usage of all scanning modes and probe types, throughout the full spectrum of operating frequencies.

AttentionRead and understand all instructions in the User's Manual before attempting to use the Vivid 7 ultrasound unit. Keep the manual with the equipment at all time. Periodically review the procedures for operation and safety precautions.

SafetyAll information in Chapter 14, ’Safety’ on page 586, should be read and understood before operating the Vivid 7 ultrasound unit.

Interference caution

Devices not to be used near this equipment:

Devices which intrinsically transmit radio waves such as cellular phones, radio transceivers, mobile radio transmitters,

CAUTION

For USA only:

United States law restricts this device to sale or use by, or on the order of a physician.

CAUTION

Use of devices that transmit radio waves near the unit could cause it to malfunction.

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radio-controlled toys, and so on, should not be operated near the unit.

Medical staff in charge of the unit are required to instruct technicians, patients, and other people who may be around the unit, to fully comply with the above recommendations.

Indications for use The Vivid 7 ultrasound unit is intended for the following applications:• Abdominal• Fetal/Obstetrics• Pediatric• Small Organ• Adult and Neonatal Cephalic• Cardiac• Peripheral Vascular• Musculo-skeletal• Transesophageal• Transrectal• Transvaginal• Interoperative

ContraindicationsThe Vivid 7 ultrasound unit is not intended for ophthalmic use or any use causing the acoustic beam to pass through the eye.

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Manual contentsThe Vivid 7 User's Manual is organized to provide the information needed to start scanning immediately.

If not otherwise specified, the functions described in this manual are common to both Vivid 7 Dimension and Vivid 7 PRO.

Finding informationTable of Contents, lists the main topics and their location.

Headers and Footers, give the chapter name and page number.

Index, provides an alphabetical and contextual list of topics.

CAUTION

The safety instruction must be reviewed before operation of the unit.

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Conventions used in this manualThe term Vivid 7 used throughout the manual refers to both Vivid 7 Dimension and Vivid 7 PRO if not otherwise specified.

2-column layout, the right column contains the main text. The left column contains notes, hints and warnings texts.

Keys and button, on the control panel are indicated by over and underlined text (ex. 2D refers to the 2D mode key)

Bold type, describes button names on the screen.

Italic type: describes program windows, screens and dialogue boxes.

Icons, highlight safety issues as follow:

DANGER

Indicates that a specific hazard exists that, given inappropriate conditions or actions, will cause:• Severe or fatal personal injury• Substantial property damage

WARNING

Indicates that a specific hazard exists that, given inappropriate conditions or actions, will cause:• Severe personal injury• Substantial property damage

CAUTION

Indicates that a potential hazard may exist that, given inappropriate conditions or actions, can cause:• Minor injury• Property damage

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Contact informationIf additional information or assistance is needed, please contact the local distributor or the appropriate support resource listed bellow:

EuropeGE Ultraschall KGDeutschland GmbH & Co.Beethovenstraße 239Postfach 11 05 60D-42655 Solingen

Tel: 0130 81 6370Tel: (49)(0) 212-28-02-208

USAGE Medical SystemsUltrasound Service Engineering4855 W. Electric AvenueMilwaukee, WI 53219On-line Applications Support

Tel: (1) 800-437-1171Fax: (1) 414-647-4090

Tel: (1) 800-682-5327or (262) 524-5698

CanadaGE Medical SystemsUltrasound Service Engineering4855 W. Electric AvenueMilwaukee, WI 53219On-line Applications Support

Tel: (1) 800-664-0732

Tel: (1) 800-682-5327or (262) 524-5698

AsiaGE Ultrasound AsiaService Department Ultrasound298 Tiong Gahru Road # 15-01/06Central PlazaSingapore 168730

Tel: (65) 291-8528Fax: (65) 272-3997

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Software license acknowledgments• WindowBlinds ™ OCX © Stardock ®

Latin and South AmericaGE Medical SystemsUltrasound Service Engineering4855 W. Electric AvenueMilwaukee, WI 53219On-line Applications Support

Tel: (1) 305-735-2304

Tel: (1) 800-682-5327or (262) 524-5698

BrazilGE UltrasoundRua Tomas Carvalhal, 711ParaisoCep: 04006-002 - São Paulo, SP

Tel: (55.11) 887-8099Fax: (55.11) 887-9948

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Chapter 1 Getting started

• Preparing the unit for use ............................................................ ....... 9• Site requirements ..........................................................................9• Connecting the unit .....................................................................10• Switching On/Off .........................................................................16

• Moving and transporting the unit ................................................ ..... 18• Wheels ........................................................................................18• Moving the unit ...........................................................................20• Transporting the unit ...................................................................21• Reinstalling at a new location .....................................................21• Unit acclimation time ...................................................................22

• System description ...................................................................... ..... 23• System overview .........................................................................23• Control panel ..............................................................................26• The Scanning screen ..................................................................39• Footswitch operation ...................................................................42• Connecting and disconnecting probes ........................................43• Adjusting the monitor display ......................................................43• LCD monitor adjustment .............................................................46

• Starting an examination ............................................................... ..... 48• Creating a new Patient record or starting an examination from an

existing patient record .................................................................48• Selecting a Probe and an Application .........................................52

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IntroductionOnly qualified physicians or ultrasound sonographers should perform scans of patients for medical diagnostic reasons. Request training, if needed. Ensure that unauthorized personnel do not tamper with the unit.

Service representatives authorized by GE Ultrasound will unpack and install the unit. Do not attempt to install the unit alone.

Never set liquids on the unit in order to avoid spillage into the unit or the control panel. Maintain a clean environment. Turn off the circuit breaker before cleaning the unit. Refer to ’System Care and Maintenance’ on page 580 for cleaning instructions.

To carry out regular preventative maintenance refer to Chapter 13, ’User maintenance’ on page 579.

WARNING

All the warnings in Chapter 14, ’Safety’ on page 586, should be read and understood before operating the unit.

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Preparing the unit for useThe Vivid 7 ultrasound unit must operate within the proper environment and in accordance with the requirements described in this section. Before using the system, ensure that the requirements are met.

Site requirementsOptimal operation of the unit can be obtained by implementing the following requirements:

Power requirements

The Vivid 7 ultrasound unit uses a separate power outlet for 100–120 VAC or 230 VAC, 50–60 Hz.

Operating Environment

Ensure that there is sufficient air flow around the Vivid 7 ultrasound unit when installed in a fixed location.

Environmental requirements

The Vivid 7 ultrasound unit requires constant maintenance of its operational environment. Different temperature and humidity requirements are specified for operation, storage and transportation.

WARNING

Operating the unit with the wrong voltage range causes damages, voiding the factory warranty.

Requirement Temperature Humidity Air Pressure

Operational 10–35 ºC 30–85% 700–1060 hPa

Storage -20–60 ºC 30–95% 700–1060 hPa

Transport -20–60 ºC 30–95% 700–1060 hPa

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Electromagnetic interferences

The Vivid 7 ultra-sound unit is ap-proved for use in hospitals, clinics and other environ-mentally qualified facilities, in terms of the prevention of ra-dio wave interfer-ence. Operation of the unit in an inap-propriate environ-ment can cause electronic interfer-ence to radios and television sets situ-ated near the medi-cal equipment.

Ensure that the unit is protected from electromagnetic interferences as follows:• Operate the unit at least 4.5 meters (fifteen feet) away from

equipment that emits strong electromagnetic radiation.• Shield the unit when operating it in the vicinity of radio

broadcasting equipment, if necessary.

Connecting the unitA GE-qualified person should perform the initial system installation.

Connecting the Vivid 7 ultrasound unit involves preliminary checks of the power cord, voltage level and compliance with electrical safety requirements.

Use only power supply cords, cables and plugs provided by or designated by GE Medical Systems.

Ensure that the power cord and plug are intact and that the power plug is the proper hospital-grade type (where required).

The unit should be connected to a fixed power socket which has the protective grounding connector. Never use an extension cord or adapter plug.

Voltage level check

Check the label near the circuit breaker on the rear side of the system (see Figure 1-1).

WARNING

Failure to provide an adequate earth circuit can cause electrical shock, resulting in serious injury.

WARNING

Connection of additional protective earth conductors or potential equalization conductors is not necessary in most cases and is only recommended for situations involving multiple equipment in a high-risk patient environment to provide assurance that all equipment is at the same potential and operates within acceptable leakage current limits. An example of a high-risk patient would be a special procedure where the patient has an accessible conductive path to the heart such as exposed cardiac pacing leads

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Figure 1-1: The rating label

Check the voltage range indicated on the label:• 100–120 VAC, 50–60 Hz, 10 A

Or• 230 VAC, 50–60 Hz, 5 A

1. Rating label2. Circuit breaker3. Power cable socket4. Potential Equalization

2 34

1

WARNING

If the mains supply is not within the specified range, do not connect the unit to the power source. Contact the dealer to have the unit adjusted to the specific mains supply.

12

Connecting to the electrical outlet

1. Ensure that the wall outlet is of appropriate type, and that the power switch is turned off.

2. Uncoil the power cable, allowing sufficient slack so that the unit can be moved slightly.

3. Secure the power plug in the wall outlet.

Refer to page 502 for further informa-tion on peripherals.

Peripheral/Accessory connection

The external I/O connector is situated on the rear side of the unit See Figure 1-10.

WARNING

POWER OUTAGE MAY OCCUR. The Vivid 7 requires a dedicated single branch circuit. To avoid circuit overload and possible loss of critical care equipment, make sure you DO NOT have other equipment operating on the same circuit.

The unit’s power must be supplied from a separate, properly rated outlet to avoid risk of fire. Refer to ’Power requirements’ on page 9 for rating information.

The power cord should not, under any circumstances, be altered to a configuration rated less than that specified for the current.

Do not use an extension cord or adapter plug.

WARNING

Accessory equipment connected to the analogue and digital interfaces must be certified according to the respective IEC standards (e.g. IEC 60950 for data processing equipment and IEC 60601-1 (1988) for medical equipment). Any person connecting additional equipment to the signal input part or output part is configuring the medical system, and is therefore responsible that the system complies with the requirements of the system standard IEC 60601-1-1 (2000). If in doubt, consult the technical service department or your local representative.

Do not touch the conducting parts of the USB or Ethernet cables when connecting equipment to the unit.

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Figure 1-2: The External I/O Panel

Socket Signal type Device type Note

Audio Out Audio VCR Audio amplifier

Line level 1Vp-pR = RightL = Left

Trig Out Digital synchronization signal

For future use 0 to 3V digital trig pulse corresponding to ECG

Footswitch 3 pedals footswitch

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Serial portRS-232

RS-232 For future use

Remote Remote control of external peripherals

For future use

Modem Analog phone line

Connection to GE OnLine Center or regional hubs for access to InSite remote diagnostic and iLinq assistance tool

Composite Video Out

Composite NTSC/PAL video

VCR or video monitor

Signal level 1Vp-p

Black & White Video Out

Black and white video

B&W printer Signal level 1Vp-p

S Video Out NTSC/PAL S-Video

VCR or video monitor

Signal level 1Vp-p

SVGA Out RGB high resolution video

Computer monitor


15

USB Universal serial bus

Printer

Ethernet 10/100 Base-TX Ethernet IEEE 8023

Network device


16

Switching On/Off

To switch on the unit:1. Switch on the circuit breaker on the rear of the unit (see

Figure 1-4).2. Press (on/off button) on the top left of the control panel

(see Figure 1-4).After initialization the default scanning screen (2D mode) is displayed, the active probe being the one connected to the left most connector socket.

Switching off the unit

When the Vivid 7 is switched off, the system performs an automatic shutdown sequence. It is recommended to perform a full shutdown at least once a week.

ShutdownAfter switching off the system, wait at least ten seconds be-fore turning it on again.

1. Press (on/off button) on the top left of the control panel.The Exit dialogue window is displayed.

Figure 1-3: The Exit dialogue window

In case of total lock-up of the system, hold the on/off but-ton down a few sec-onds to turn the system off.

2. Select Shutdown.The shutdown process takes a few seconds and is completed when the control panel illumination is turned off.

To switch off before moving the unit, follow the additional steps below:1. Set the circuit breaker to OFF.2. Remove the plug from the mains power socket.3. Secure the unit power cable around the cable storage

hooks on the rear of the unit.

17

Figure 1-4: The Circuit breaker and On/Off button

F 1F 1

18

Moving and transporting the unit

WheelsThe wheels of the unit are controlled by the pedals situated between the front wheels of the unit (see Figure 1-5).

Examine the wheels frequently for defects to avoid breaking or jamming.

Figure 1-5: The Vivid 7 ultrasound unit pedals

Wheel Characteristics

Front Swivel, swivel lock and full lock

Rear Swivel, but do not lock

1. Swivel lock pedal (Free position)2. Full lock pedal (Free position)3. Front wheel

1 2

3

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Wheel operation

To engage the pedal in full lock

To release the brake

To engage swivel lock

To release swivel lock

Pedal Action

Press on pedal no. 2

Pedal Action

Press on pedal no.1

Pedal Action

Press on pedal no.1

Pedal Action

Press on pedal no. 2

1 2

1 2

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Moving the unit

To prepare the unit to be moved1. If not locked, push the keyboard console to its park position.2. Turn the system off, including the circuit breaker (see

page 16), and remove the plug from the wall.3. Disconnect all cables linking the unit to any off-board

peripheral devices and network.Note the marks on each cable to recon-nect them later.

4. Secure the unit’s power cable.5. Place all probes in the probe holder. Ensure that the probe

cables do not protrude from the unit or interfere with the wheels.

The park port may also be used for a probe connection al-though it is not ac-tive.

6. Ensure that no loose items are left on the unit7. Unlock the brake (see page 19).

To ensure safety while moving the unit1. Ensure that the keyboard console is in locked position.

2. For systems with LCD monitor: ensure that the LCD monitor is locked (see page 46). You may rotate the monitor 90 degrees to get a better sight.

3. Proceed cautiously when crossing door or elevator thresholds. Grasp the front handle grips or the back handle bar and push or pull. Do not attempt to move the unit using cables or probe connectors. Take extra care while moving the unit on inclines.

4. Ensure that the unit does not strike the walls or door frames.

5. Ensure the pathway is clear.6. Move the unit slowly and carefully.

WARNING

Do not move the unit if the keyboard console is in free position.

Ensure that the hands of the patient are away from the console arm when moving the keyboard console.

21

7. Use two or more persons to move the unit over long distances or on inclines.

Transporting the unitTake extra care when transporting the unit by vehicle. In addition to the moving precautions listed on page 20, follow the procedure described below.1. If not locked, push the keyboard console to its park position.

2. For systems with LCD monitor: ensure that the LCD monitor is locked (see page 46). You may rotate the monitor 90 degrees to get a better sight.

3. Disconnect all probes and secure them in their boxes.4. Ensure that the transporting vehicle is appropriate for the

unit’s weight. The recommended load capacity is a minimum of 190 kg (419 lbs).

5. Park the vehicle on a level surface for loading and unloading.

6. Secure the unit while it is on the lift, to prevent rolling. Do not attempt to hold it in place by hand. Cushion the unit and strap the lower part so that it does not break loose.

7. Ensure that the unit is secured inside the vehicle. Secure it with straps to prevent movement while in transit.

8. Drive cautiously to prevent vibration damage.

Reinstalling at a new location1. When the unit is in place at a new location, lock the wheel

brakes (see page 19).2. Follow the installation procedure described on page 10.

CAUTION

Avoid ramps that are steeper than 10 degrees.

WARNING

Do not move/lift the unit if the keyboard console is in free position.

22

Unit acclimation timeFollowing transport the unit may be very cold or hot. Allow the unit to acclimate before being switched on. Acclimation will take one hour for each 2.5 oC increment when the unit’s temperature is below 10 oC or above 40 oC.

oC 0 2.5 5 7.5 10 35 40 42.5

oF 32 36.5 41 45.5 50 95 104 108.5

Hours 4 3 2 1 0 0 2 3

oC 45 47.5 50 52.5 55 57.5 60

oF 113 117.5 122 126.5 131 135.5 140

Hours 4 5 6 7 8 9 10

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System description

System overview

Figure 1-6: the Vivid 7 ultrasound system

1

2

3

4

5

6

78

9

10

11

12

13

Legend

Display Monitor:Swivels to the left and right, tilts up and down.

1

24

Speakers

Control panel:Contains all the buttons and the alphanumeric keyboard used to operate the system. See page 26 for further details.

Probe and gel holders:Situated on either side of the Control panel.

VCR

Probe ports:Three active and one park phased array probe ports, and two pencil probe ports.

Foot brakes:Control swivel and brake of the wheels. See page 19 for further details.

CD-RW is not supported, only CD-R (recordable).

Portable disks:• Magneto optical disk• CD-ROM

Patient I/O

Black & white video printer

Console swivel operating handle:Situated in the middle beneath the front handles.• Vivid 7 Dimension: swivel and in/out

displacement• Vivid 7 PRO: limited swivel only

Legend

2

3

4

5

6

8

7

9

10

11

25

Console lifting operating handle:Situated in the left front handle.

Color video printer

Legend

12

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Control panelThe following pictures illustrate the layout of the Vivid 7 control panel. The buttons and controls are grouped together for ease of use. A detailed description of the buttons is provided on the following pages.

Figure 1-7: The control panel (left side).

1. TGC sliders2. Loudspeaker volume control3. On/Off button4. Protocol in/out5. Navigation keys: Archiving &

Reporting buttons Pre-examination buttons Video playback

6. Function keys:• On-line manual• System Configuration• Annotations• Body marks• DICOM spooler

7. Alphanumeric keyboard8. 4D mode (Vivid 7 Dimension only)9. Multi-plane mode (Vivid 7 Dimension

only)

Alt. Alt. Alt. Alt.

27

Figure 1-8: The control panel (right side).

10. Active mode gain11. 2D gain12. Scan mode selection keys13. Assignable keys14. Zoom control15. Depth control16. Display format keys17. Measurement, Image store and

menu keys18. Soft menu rocker19. VCR controls and print keys20. Freeze keys21. Trackball operation

Width

11

14

15

16

17 18

20

12

13

1921

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Key illumination

The keys on the control panel are illuminated according to their availability:• Illumination in green: the key function is currently active.• Illumination in yellow: the key function is available (but

not active) in the current state of the scanner.• No illumination: The key is not available in the current

state of the scanner.

Power On/Off key

Navigation keys

The following buttons on the top left of the control panel are used for navigation between different screen or packages on the scanner. They are related to either pre or post-examination operations. Each of these operations are described in more detail in the following chapters.

Key Description

Turns the unit on and off.

Key Description

Displays the Search/Create patient window. Enables the creation of a new patient record.

Displays the Select Probe and Application dialog box that enables the users to select the desired probe and application preset for the current examination. For information about selecting probes, refer to page 52 and page 486.

Displays the Application dialog box that enables the users to select the appropriate application preset for the current examination.

Gives access to controls for physiological traces. The controls appear on the assignable keys.

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Displays the examination report.

Brings the scanner into the Image review mode, that enables the user to select images from the clipboard for analysis, activate the image browser or enter the Image Review screen where bigger previews of the images are shown for image selection. Refer to page 366 for details on the review of images.

Displays the Search/Create patient window if no patient record is currently selected. Enables the user to search a patient record in a patient archive (see page 351). If a patient record is selected, displays the Patient information screen.

Displays the Measurement worksheet where the user may edit or delete measurements, change averaging etc. Refer to page 301 for details on how to operate the worksheet.

Brings scanner into video playback mode that enables the user to look at video tape recordings. For further information about video playback control refer to page 505.

Key Description

30

Scan Mode Selection keys

The following keys are used to select the required scan mode, and to select additional tools that enhance the application’s capabilities. Refer to page 87 for detailed information about scanning.

Key Description

Displays the 2D live acquisition mode that is the default scanning screen for the unit. For further information on 2D scanning, refer to page 90.

M-Mode can be added from a 2D scan also in replay.

Displays the M-Mode examination screen and enables M-Mode functions. Used for viewing motion patterns. For further information, refer to page 96.

Displays the examination screen in Color Flow Mapping mode. Used to display color-coded blood flow information. For further information, refer to page 102.

In replay mode with TVI the velocity trace mode will be toggled on by the PW key.

Displays the examination screen in Pulsed Wave Doppler mode. Used for displaying the Doppler spectrum of blood flow at a selected part of the anatomy. For further information, refer to page 110.

CW mode is not available on all scanning probes.

Displays the examination screen in Continuous Wave Doppler mode. Allows examination of blood flow data all along the Doppler CW cursor. For further information, refer to page 110.

Displays the tissue velocity overlay on 2D and M-Mode scans. If TVI is on, the Doppler modes (PW/CW) will also be optimized for tissue velocity. For further information, refer to page 117.

Depending on the options installed on the scanner, this key will bring up the menu for selection of additional scanning modes.

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Basic Mode Parameter Adjustment Controls

The following controls are used to modify and adjust the unit’s display to best suit the user’s requirements, such as color, gain, zoom and image depth, according to the mode being operated by the user.

Controls Description

2D Gain Controls the total gain of the gray scale images in 2D Mode.

Active mode Gain

Controls the total gain of other activated modes, such as, M-Mode, Color, PW, or CW Doppler mode.

TGC Sliding keys that compensate for depth-related attenuation in an image. The upper slider corresponds to the smallest depth.

Depth Controls the displayed depth of tissue scan. Has no effect in replay.

Toggles the cursor display on/off in 2D scanning mode.

Changes the Doppler ultrasound beam angle on linear probes. The steering angles are fixed for each linear probe. This key has no effect with sector imaging probes.

Toggles the high resolution (HR) zoom on/off. The key has no effect in replay. The HR zoom concentrates the image processing to a user selectable portion of the image, resulting in an improved image quality and a higher frame rate in the chosen ROI

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Freeze keys

The freeze keys are used to freeze images and cine loops in all modes for on-line analysis and storage for future use.

Display format keys

The following keys provide different view formats to best suit the user’s requirements.

Display Zoom Controls image magnification. Rotate clockwise to activate zoom mode and increase zoom factor. Rotate counterclockwise to decrease and turn off zoom. Zoom is available in both live and replay.

Key Description

Stops or restarts all data acquisition. When scan is frozen, the Trackball can be used to scroll through the cine loop.

Activates or freezes 2D mode. In simultaneous mode, pressing 2D FREEZE will activate or deactivate the 2D image, leaving the other mode display unchanged. In freeze mode, stops/starts the cineloop.

Key Description

Toggles the display priority of 2D-Mode or Doppler/M-Mode and top/bottom or side by side display when working in combined mode.

Enables multiple image display windows in which two or four images can be viewed simultaneously. When reducing the number of images, the active window will always been kept.

In combined mode, switches between the mode specific assignable controls of the currently used modes.

Controls Description

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Measurement controls

The following keys are used to take measurements and perform calculations.

Toggles the active window in multiple imaging mode. The active window is indicated by a highlighted frame. All imaging controls are normally applied only to the active window.

Key Description

Activates the Measurement & Analysis (M&A) calculation program. This program is context sensitive and will display relevant measurements to the current mode and application. See page 222 for further details on M&A.

Activates measurement tools (unassigned measurement). See page 222 for further details on M&A.

Key Description

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Clear, Menu, and Image Store keys

VCR Control and Print key

Trackball operation

The Trackball area consists of the trackball and five surrounding keys. Three of these have the very same function

Key Description

Used for navigation between menus and screens. CLEAR brings the display back to the previous state.

Activates menu with additional options and controls not available from the assignable keys.

Stores the currently active imaging window to disk. The stored information depends of the configuration of the current application. Stored images are shown on the clipboard.

Key Description

Rec/Pause Toggles the VCR to Record or Pause. For further information about using VCR, Refer to page 502.

Prints the current imaging screen content to a selected (configurable) printer. For more information about printing. Refer to page 502. The PRINT key can also be configured for alternative storing of images (Refer to page 560.).

Prints the current imaging screen content to a printer assigned to a second port (configurable). For more information about printing, Refer to page 510. The ALT key can also be configured for alternative storing of images (Refer to page 560.).

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(the select function) for ergonomic reasons.

Assignable keys and rotary knobs

The functions of the assignable keys vary according to the mode and/or module in which the user is working.

Key Description

Trackball Used for navigation and together with the surrounding keys, to move, select or activate objects on the screen.

Trackball key Toggles between the trackball functional groups (see page 57).

Select Depending on the situation (see page 57):• Performs the selected control or highlighted

menu item.• Toggles between the Trackball functions within

the active group.The key is duplicated for ergonomic reasons.

Update Menu In live mode, toggles between 2D imaging and live time-motion imaging (Doppler/M-Mode). In freeze, displays the function-specific menu (same function as MENU, on page 34).

Key Description

Assignable rotary knobs

Four rotary knobs, whose functions vary according to the scan mode and position that is currently active. The assigned functions are indicated above the rotary on the LCD display. The mode-specific functions for these rotary knobs are described in Chapter 3, ’Scanning Modes’ on page 87.

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The soft menu rocker

The 4D and Multi-plane keys

Assignable Buttons

Five buttons, whose functions vary according to the scan mode and position that is currently active. The assigned functions are indicated above the button on the LCD display. The mode-specific functions for these buttons are described in Chapter 3, ’Scanning Modes’ on page 87.

Gives access to additional controls from the assignable buttons.

Key Description

Soft Menu Rocker

A 4-way rocker used to access mode-specific menus, select a menu option and adjust option-related values.• The vertical arrows are used to select the menu

options.• The horizontal arrows are used to adjust the

values. The mode-specific menus are described in Chapter 3, ’Scanning Modes’ on page 87.

Key Description

Starts the 4D application (probe dependent), Vivid 7 Dimension only.

Starts the Multi-plane application (probe dependent), Vivid 7 Dimension only.

Key Description

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The alphanumeric keyboard

Key Description

Displays the on-line version of the user manual.

Displays the configuration dialog box, allowing user configuration of various settings on the scanner. Some settings are configured for each application, press APPL. to access to application-specific settings.

Displays the DICOM spooler window. The DICOM spooler is used for checking the current job’s status when a job is saved or when the total spooler status on the right of the Archive windows displays an error.

Displays the available body marks for the current application.

Erases all previously typed annotations (and body marks.

Activates a cursor for selection of a single annotation to be deleted from an image.

Displays an arrow that can be used to point at a specific structure in the image.

Enables text annotation to be inserted on the image in two layers.

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Inserts predefined annotation on the image.

Key Description

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The Scanning screen

Figure 1-9: The scanning screen

1. Current patient data2. Institution3. Date & time4. Operator ID5. Probe6. Application7. Mechanical & Thermal Index8. VCR counter (replay)9. VCR status10. Date & time11. Heart rate12. Parameter window13. Frame counter and timer14. Soft menu window15. Pull-down soft menu

16. Trackball assignment17. Status bar18. Prompt/Status information19. Clipboard20. Service and iLinq (future use)21. Caps on/off22. Measurement result table (measurement mode)23. Probe orientation marker24. Scanplane indicator (for TE probe)25. Greyscale/Color bar26. Measurement27. Physiological traces (ECG, Phono, Resp)28. Focal zone and depth scale

1 7 102 5 9 113 4 6 8

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13

15

14

1620 171821 19

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25

2322

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26

28

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The scanning screen is divided in several areas as follows:

The title bar

From the left:

The patient infor-mation displayed on the Title bar is con-figurable (see page 563).

Patient InformationDisplays the information that uniquely identifies the patient, such as patient name, identification number and birth date. This information is entered in the New patient window, as described on page 48.

Institution nameThe institution name is entered from the configuration package. See page 569 for more detailed information.

Operator IDIdentification code of the operator. See page 575 for creating operator ID’s.

Date and timeDisplays the current date and time or for a retrieved image, the date and time at which it was stored.

Probe and ApplicationDisplays the currently selected probe and application or for retrieved image the probe and application that were used. See page 52 and page 486 for further information on how to select probe and application.

Live scanning related informationDisplays, if available, the current values for • Mechanical Index (MI), for the current active image• Thermal Index (TI), for the current active image• probe temperature (for TE probe)• Heart rate (HR)

VCR counter and statusDisplays the VCR counter as it changes in real time, and a status icon, which indicates the current operating status of the VCR.

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Archive InformationDisplays the currently selected patient and image archives.

Parameters window

Displays scan mode or application specific parameters. In scanning mode the parameters for the active mode are highlighted. This window also displays zoom information, stress template and image groups in image browser.

Soft menu window

Displays the mode specific controls operated from the 4-way rocker on the control panel. The mode-specific menus are described in Chapter 3, ’Scanning Modes’ on page 87. For operating procedure of the 4-way rocker see page 56.

Clipboard

Displays the thumbnail images representing the acquired data during the current examination.

The status bar

Consists of three information fields as follows:

Caps on/off indicatorLocated on the left side of the status bar, the word CAPS is highlighted when the caps lock function is on. The caps function is activated by pressing CAPS LOCK key on the alphanumeric keyboard.

Prompt/status fieldDisplays system messages or prompts the user for actions.

Trackball assignments fieldsDisplays the available assignments of the trackball. The current assignment is highlighted.

The acquisition window

Displays the ultrasound image with relevant indicators such as depth, focus, probe orientation marker, physiological traces...etc.

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Footswitch operationThe footswitch is used to free the hands of common key operations, such as select keys, video recording, etc. The three switches have different function assignments depending on the current application (see page 524).

Connecting the footswitch

1. Connect the footswitch to the input marked on the External I/O panel (see Figure 1-10).

Figure 1-10: The Footswitch connector on the External I/O Panel

WARNING

The standard footswitch is not for use in the operation room.

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Connecting and disconnecting probes The connector panel situated in the front of the unit has three imaging probe ports, one parking port (inactive) and one pencil probe port.

To connect probes

1. Hold the probe connector vertically with the cable pointing upward.

Probes can be con-nected or changed any time while the unit is on.

2. Turn the connector locking handle to the horizontal position.

3. Align the connector with the probe port and carefully push into place.

4. Rotate the locking handle to the full vertical position to lock in place.

To disconnect probes1. Rotate the lock handle counter-clockwise to the horizontal

position to unlock the connector.2. Remove the connector.

Adjusting the monitor display

CRT monitor

The display monitor’s contrast and brightness controls may need periodic adjustment due to changes in ambient light. They are adjusted from the three buttons on the front part of the display monitor.

To adjust contrast1. Press the Center button on the display monitor once (see

Figure 1-11).2. Press the Right button to increase contrast.

CAUTION

Handle the probes gently while connecting and disconnecting.

WARNING

Do NOT touch the patient and any of the connectors on the ultrasound unit simultaneously, including ultrasound probe connectors.

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Press the Left button to decrease contrast.

To adjust brightness1. Press the Center button on the display monitor twice (see

Figure 1-11).2. Press the Right button to increase brightness.

Press the Left button to decrease brightness.

Figure 1-11: Contrast and brightness adjustment

LCD monitor

Only the brightness and the blue tint can be adjusted. To aid in the adjustment, a test image can be displayed by pressing ALT + Q on the keyboard.

To adjust brightness1. Press on the LCD monitor to increase brightness.2. Press on the LCD monitor to decrease brightness.

1. Decrease2. Contrast (press once), Brightness (press twice)

3. Increase

1 2 3

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To adjust the blue tint1. Press ALT + > on the keyboard to increase the blue tint.2. Press ALT + < on the keyboard to decrease the blue tint.

46

LCD monitor adjustmentThe LCD monitor can be swiveled and tilted. Before moving or transporting the system make sure to lock the LCD monitor as described below.

To swivel the LCD monitor1. Grab the left and right sides of the LCD monitor frame and

swivel the monitor to the desired position. The LCD monitor must be unlocked.

To tilt the LCD monitor1. Grab the top and bottom sides of the LCD monitor frame

and tilt the monitor up and down to the desired position.

To lock/unlock the LCD monitor

The monitor arm can swivel around the main arm axis and around the arm joint.

To lock the LCD monitor1. Slide the locking knob at the base of the arm into the locked

position (see Figure 1-12). Move the arm until it locks into place.

2. Slide the locking knob at the arm joint into the locked position (see Figure 1-12). Move the arm until it locks into place.

To unlock the LCD monitor1. Slide the locking knob at the base of the arm into the free

position (see Figure 1-12).2. Slide the locking knob at the arm joint into the free position

(see Figure 1-12).

CAUTION

To avoid injury or damage, make sure nothing is within the range of motion before moving the monitor and monitor arm. This includes both objects and people.

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Figure 1-12: LCD arm locking mechanism

Locking knob positions

Locked Free

Arm base

Arm joint

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Starting an examinationBeginning an exam consists of three steps:• Creating a new patient record or starting a new examination

from an existing patient record (see below)• Selecting Probe and Application (see page 52)• Start scanning (see page 52)

Creating a new Patient record or starting an examination from an existing patient record

Connectivity on the Vivid 7 ultrasound unit

Refer to page 550 for further informa-tion on connectivity setup.

The connectivity on the Vivid 7 Ultrasound unit is based on the Dataflow concept. A Dataflow is a set of pre-configured services (e.g. DICOM services like storage, worklist, verify...etc. or other service types like video print, standard print or messaging). When starting an examination, the user selects a pre-configured Dataflow that will automatically customize the ultrasound unit to work according to the services associated to the Dataflow.

Starting an examination1. Press NEW EXAM.

To create an opera-tor ID, see page 575.

If the unit is password protected a Log In window will appear asking for operator ID, and password.

Figure 1-13: The Operator login window

2. Press Log on when completed.

1. Data stored only for the duration of the current examination

2. Select the operator

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The Search/Create Patient window is displayed (see Figure 1-14).

3. Type the patient Last Name, and/or ID.

The unit can be con-figured to automati-cally generate a patient ID (see page 563).

When default configured, the system automatically searches to see if the patient is already in the database. The result of this search is displayed in the Patient List field.

If the Patient name is on the patient record list:To restrain the search to special category of patient record, press More and use the search-ing filters.

1. Trackball to the actual patient and double-click the Trackball SELECT key (or press SELECT once and then Select patient).The unit is ready for scanning or the Patient information window is displayed (Figure 1-15) depending on system configuration (see page 563).

If the Patient name is not on the patient record list:The automatic search tool display-ing matching pa-tient information in the Patient list can be turned off (see page 563).

1. press Create Patient.The unit is ready for scanning or the Patient information window is displayed (Figure 1-15) depending on system configuration (see page 563).

If the unit is configured to display the Patient information window, follow the steps below:1. Enter additional patient information if required.

Select between cardiac, obstetric, gynecology... etc. to enter application specific patient info (Displayed when the button More is depressed, see Figure 1-15.).

Press EXAM. LIST to display the previous examinations and diagnosis informa-tion for the selected patient.Enter addi-tional patient infor-mation if required.

2. Press Begin exam or any active scanning key to start the examination.In the scanning screen, the patient information is displayed on the left side of the Title bar (see Figure 1-16).

CAUTION

Do NOT use '\' or '^' in patient information fields, as these characters might cause problems with some DICOM devices.

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Figure 1-14: The Search/Create Patient window

1. Press one of the headings to sort the list accordingly.

2. Select the column heading border and drag to adjust column width.

3. Select new archive and other pre-defined services.

4. Extended menu5. The system can be configured to display the

Advanced search tool as default (see page 563).

6. Expended Patient record displaying belonging examinations

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Figure 1-15: The Patient Information window

Figure 1-16: The Patient information on the scanning screen

1. The date format is configurable (see page 569).2. The window can be configured to display the

expanded patient info as default (see page 563).

3. The Address field is configurable (see page 563).

4. Select patient information category.

1. The patient information on the scanning screen is configurable (see page 521).

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Selecting a Probe and an ApplicationThe combination Probe-Application may be user-de-fined. See page 524 for information on probe/application configuration.

Probes and their related applications are selected from the Probes and applications pop-up menus as described below. Only probes currently connected are displayed in the pop-up menu. Only applications appropriate for the type of probe selected are shown.

To select a probe and an application1. Press PROBE on the control panel.

To change applica-tion without chang-ing the current probe, press APPL. on the control pan-el.

A list of the connected probes is displayed.2. Trackball to the desired probe.3. Press SELECT.

An Application menu for the selected probe is displayed.4. Trackball to the desired application.

To select a probe with the default ap-plication, press SELECT twice on the actual probe.

5. Press SELECT to launch the application.

CAUTION

Make sure that the probe and application names displayed on the screen correspond to the actual probe and application selection.

Check that the correct TI category is displayed (see ’Thermal Index’ on page 597). TIB must be displayed when a fetal application is selected.

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Chapter 2 Basic scanning operations

• Assignable keys and Soft Menu Rocker .................................... ..... 55• Using the Soft Menu Rocker .......................................................56

• Trackball operation ...................................................................... ..... 57• Cineloop operation ....................................................................... ..... 58

• Cineloop overview ......................................................................58• Cineloop controls ........................................................................60• Using cineloop ............................................................................61

• Storing images and cineloops .................................................... ..... 62• To store a single image ..............................................................62• To store a cineloop .....................................................................62

• Using removable media ............................................................... ..... 63• Formatting removable media ......................................................63• Ejecting removable media ..........................................................65

• Recording images on VCR .......................................................... ..... 66• Zoom .............................................................................................. ..... 67

• To magnify an image (Display zoom) .........................................68• To activate the HR zoom ............................................................68

• Performing measurements .......................................................... ..... 69• Physiological traces ..................................................................... ..... 70

• Connecting the ECG/Respiration ................................................71• Connecting the Phono ................................................................73• Connecting the Pulse pressure transducer .................................73• Physio overview ..........................................................................74• Physio controls ...........................................................................75• Displaying the physiological traces .............................................77• Adjusting the display of physiological traces ..............................77

• Annotations ................................................................................... ..... 79

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• To insert an annotation ...............................................................79• To edit annotation .......................................................................82• To erase annotation ....................................................................82• Configuration of the pre-defined annotation list ..........................83• Bodymarks ..................................................................................85

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Assignable keys and Soft Menu Rocker

Figure 2-1: A: the 4-Way Rocker and Soft Menu. B: the assignable keys and rotary knobs on the control panel.

To toggle between modes in combined mode, press ACT. MODE.

The function of the assignable keys and the controls assigned to the soft menu vary according to the mode in which the system is running. A detailed description of each function is provided each scanning mode in the following imaging mode sections. In combined modes (i.e. combined Color flow and PW Doppler), one mode is active (live) while the other is frozen. In this case, the assignable keys and rotary knobs control the active mode. Switching the active mode will change the key and rotary assignments accordingly.

1. Active mode & status2. Filling gauge3. Selected control shows highlighted

frame4. Access to additional controls

A

B

23

4

1

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Using the Soft Menu RockerThe Soft menu Rocker on the control panel enables the adjustment of controls mapped in the Soft menu Window (see Figure 2-1).

The first row of the soft menu indicates the active mode and its status (freeze/live). The following rows list the mode specific controls. The last row (marked with a ) gives access to additional mode specific controls.

The relative setting of each control is indicated by a gauge bar filling the cell as the control value increases.

To select a control from the menu1. Press the vertical arrows on the 4-way Rocker to navigate

up or down through the menu. The frame of the selected row is highlighted.

To adjust values1. Press one of the horizontal arrows on the 4-way Rocker to

adjust the setting of the selected control. - Right arrow increases control setting.- Left arrow decreases control setting.

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Trackball operationDifferent functions can be assigned to the trackball depending on the current active mode. The trackball functions are organized in functional groups. The trackball functional groups are displayed in the lower right corner of the screen. Each group can have one or more controls that can be selected using the keys on the trackball area as described below:

The trackball area consists of:• The trackball: used as a cursor control in acquisition mode,

scrolling control in freeze mode and as a selecting tool (like a mouse cursor) in post-processing mode.

• Three SELECT keys (identical): depending on the situation, the SELECT keys toggle between the trackball functions within the active functional group or perform the selected control or highlighted menu item.

• The TRACKBALL key: toggles between the trackball functional groups.

• The UPDATE MENU key: enables quick access to image related functions from a pop-up menu (see Figure 2-2).

Figure 2-2: The Trackball area

1. Trackball key: toggles between trackball functional groups.2. Select keys:

• Toggles between the functions within the active group. Groups with several functions are marked with a + symbol.

• Performs the selected control or highlighted menu item3. Update Menu key: display a pop-up System menu.

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Cineloop operationWhen no ECG is connected, a cine gauge is displayed indicating the cur-rent frame. in the cineloop.

When the scan mode is frozen, the unit automatically displays cineloop boundary markers on either side of the last detected heart cycles. The cineloop boundaries can be adjusted using the cineloop assignable controls to cover one or more heart cycles.

Cineloop overview

Figure 2-3: The cineloop controls display

1. ECG2. Left marker3. Current frame

4. Right marker5. Cine speed (replay)

1 2 3 4 5

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Figure 2-4: The cineloop controls on the front panel

1. Assignable keys:• Left marker• Right marker• Cycle select• Number of cycles• First Cycle• Last Cycle• Sync• Cineloop• Select all

2. Image Store3. Freeze: Start/stop

cineloop4. Trackball:

• Scroll (in freeze)• Cine speed (in replay)

3

2

1

4

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Cineloop controls

cineloop assignable controls

Left / Right MarkerMove the left and right markers to expand or trim the cineloop boundaries.

Cycle selectSelects the heart cycle to be played back.

Number of cycleControls the number of heart cycles to be included in the loop.

First cycle / Last cycleSelects the first or last heart cycle to be played back.

SyncPhase synchronizes multiple cineloops.

CineloopStarts cineloop acquisition.

Cineloop Freeze Control

2D FreezeToggles between replay and freeze modes.

Cineloop trackball controls

ScrollWhen the scan mode is frozen, trackball to move the current marker and review the images

Cine speedIn cine replay mode, trackball to adjust the speed of the cineloop playback.

Select AllSelect all heart cycles.

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Using cineloop

Selection of a cineloop1. Press FREEZE.

The left and right markers on the ECG trace are displayed on either side of the last detected heart cycle.

2. Press the CINELOOP assignable.The selected heart beat is played back.

3. Press the 2D FREEZE assignable to freeze the cineloop.4. Use the Trackball to scroll through the acquisition and find

the sequence of interest.To jump directly to the first or to the last heart beat press the assignables FIRST CYCLE or LAST CYCLE.

5. Rotate the assignable CYCLE SELECT to move from heart beat to heart beat to select the heart cycle of interest.

6. Rotate the assignable NUM CYCLES clockwise to increase the number of heart beats to be played back.

7. Rotate LEFT MARKER and RIGHT MARKER assignables to trim or expand the cineloop boundaries.

Adjustment of cineloop playback1. If in freeze mode, press the assignable 2D FREEZE to start

cineloop replay.2. Use the Trackball to increase or decrease the speed of the

cineloop playback.The speed factor is displayed on the right side of the ECG (see Figure 2-3).

To view a cineloop frame by frame1. If not in freeze mode, press the assignable 2D FREEZE to

freeze the cineloop.2. Use the Trackball to scroll through the cineloop frame by

frame.OrPress the alphanumeric ARROW keys.

Synchronized playback of multiple cineloops1. If in freeze mode, press the assignable 2D FREEZE to start

cineloop replay of the displayed cineloops.2. Press the assignable SYNC to phase synchronize the loops.

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Storing images and cineloopsImages stored on the clipboard dur-ing the scanning session are for im-mediate purposes. At the end of the ex-amination, the data should be archived in the patient ar-chiving system (re-fer to page 340).

Images and cine-loops can be stored at any time during the scanning session. A thumbnail of the stored image is displayed on the clipboard on the scanning screen. An icon will also be displayed in the Image Browser and Image Selection screens. Protocol based stored images will also be displayed in the protocol grid in the Parameters window.

The amount of data stored from 2D live is defined by the settings of the current application. The application setting controls the number of cycles included (or time span if ECG is not active), time span before R-wave...etc (refer to page 521 and page 524 for further information).

The amount of data stored in images from 2D replay is determined by the defined cineloop.

Images can be stored in either DICOM and GE Raw Data formats or DICOM format only, depending in the dataflow configuration (refer to page 551 for further information).

To store a single image1. Press FREEZE.2. Press IMG. STORE to store the image digitally.

The thumbnail of the image is displayed on the clipboard.See also page 343 for further information.

To store a cineloopCineloops may be stored directly or after preview, depending on how the system is configured. The procedure for cineloop storage is described on page 343.

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Using removable mediaThe following removable media can be used for data storage:• DVD-R• CD-R (CD-RW is not supported.)• USB Flash card• 5 1/4” R/W Magneto Optical disk (MOD) (from Sony only,

1.2, 1.3, 2.3, 2.6, 5.2, 8.6 and 9.1 Gb) (Option)

Recommendation concerning CD and DVD handlingTo avoid data loss, never touch the recordable surface of a disk. Handle the disk only by the outer edge. Do not place it face down on a hard surface. Fingerprints or scratches will make the disk unusable. Before usage, verify that the disk surface has no visible scratches. If there are any scratches, do NOT use the disk.

Formatting removable mediaMOD, CD-R and DVD-R have to be formatted before use as described below.

Note: Removable media used during Disk space management or Backup do not need to be formatted, the formatting process is part of these procedures.

CAUTION

CD/DVD:• Do not use CD-R/DVD-R for permanent storage of patient data.• Use only 24x or higher CD-R.

USB Flash card:• Use only shielded USB Flash cards that are verified for EMC

performance according to EN55011 Class B. The use of other USB Flash cards may cause interference on the system itself or on other electronic devices.

CAUTION

The formatting process will erase any data present on the disk.

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To format a removable media:1. Insert the media in the drive.2. Press CONFIG (F2).3. If required, log on to the system.

The Configuration package is opened.4. Select the category Connectivity and select the sheet

Tools (Figure 2-5).

Figure 2-5: The Tools sheet

5. Select the removable media from the Media pop-up menu.6. Enter a name for the removable media in the Label field.

Note: Only the following characters and signs can be used when labelling a media: A - Z, a - z, 0 - 9, “_” and “-”. Do not use more than 11 characters or signs. Do not use space.

7. Select Format.A confirmation window is displayed.

8. Select OK to continue.9. Wait for the display of the Information window indicating

that the formatting process is completed.10. Select OK.

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11. Eject the media as described below.

Ejecting removable mediaAlternative: Press F3. Do not eject the CD using the but-ton on the CD drive.

1. Press ALT+E to eject the disk.The Eject device menu is displayed (Figure 2-6).

Figure 2-6: The Eject device menu

2. Select the relevant media.The selected media is ejected.

CAUTION

When ejecting a MOD, the disk is half way ejected from the MOD station. To avoid unintentional automatic re-insertion, take out the MOD from the MOD station.

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Recording images on VCRVCR recording is started and stopped from the RECORD/PAUSE key on the control panel. The status of the VCR is indicated by a symbol on the Title bar (for detail about how to use VCR recorder, refer to ’VCR/DVD operation’ on page 505).

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ZoomThe unit supports two types of zoom: the display zoom and the high resolution (HR) zoom.• The Display zoom magnifies the image display in both

frozen and live 2D, M-Mode and combined modes.• The HR zoom concentrates the image processing to a user

selectable portion of the image, resulting in an improved image quality and a higher frame rate in the chosen ROI.

Figure 2-7: The zoom controls

1. High Resolution Zoom2. Magnification control3. Position the zoom area

21

3

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To magnify an image (Display zoom)The Display zoom is available in live and replay.

1. Rotate the Zoom knob clockwise.The resulting magnified image appears in the acquisition window while the un-magnified image is displayed in the control window showing the outlined zoom region.

2. Use the Trackball to position the zoom area over the desired portion of the image.

3. To turn off the Display zoom, rotate the Zoom knob counter clockwise.

To activate the HR zoomAs a default setting, the zoom area is centered to the cur-sor/color area if present.

1. Press ZOOM.The resulting zoomed image appears in the acquisition window and a frozen reference image is displayed in the control window showing the outlined zoom region.

2. Use the Trackball to position the zoom area over the desired portion of the image.

3. Increase size as desired by turning the zoom knob clockwise.

4. Press ZOOM one more time to turn off the HR zoom.

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Performing measurements

To perform measurements:1. Press MEASURE to enter the Measurement mode.

Refer to page 222 for further information.

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Physiological tracesThe physiological module consists of four channels: ECG/Respiration, Phono, AUX1 and AUX2. The two channels AUX1 and AUX2 are both capable of handling external ECG signals from other diagnostic ECG devices. AUX2 is also capable of handling a pulse/pressure signal. The scanned image that is displayed is synchronized with the ECG, respiration and phono traces. In M-Mode or Doppler, the traces are synchronized to that particular mode's sweep.

The operator can control the gain, the position and the sweep rate of the traces using the assignables on the control panel.

CAUTION

Use only GE Medical Systems accessories

Conductive parts of electrodes and associated connectors for applied parts, including neutral electrodes should not contact other conductive parts, including earth.

Simultaneous use of two or more applied parts will cause summation of patient leakage currents.

1. Phono2. ECG

3. AUX 14. AUX 2 (Pressure/Pulse)

1 2 3 4

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Figure 2-8: The patient (I/O) connection panel

Pinout on AUX connectorsThe pinout for the AUX connectors is described in the table below:

AUX1 and AUX2 are default a 1 Vpp (Volt peak-peak) input with a max frequency of 300 Hz. The inputs are differential. For a single ended sensor signal, the pin 1 (input -) should be connected to the gnd of the sensor.

AUX2 has a programmable high gain mode with a maximum input signal of 300 mVpp (millivolt peak-peak).

Connecting the ECG/Respiration

Overview

The ECG cable is a modular cable consisting of two different cables parts:• The Trunk: a single cable connecting to the system at one

end, and providing a cable splitter device at the other end (see Figure 2-9).

• The triple color-coded electrode cable: to be inserted in the splitter device. Each electrode cable hooks up to the appropriate stick-on electrode by a color-coded clip type connector.

AUX11. pin 1: input -2. pin 2: input +3. pin 3: gnd

AUX21. pin 1: input -2. pin 2: input +3. pin 3: gnd4. pin 4: nasal sensor 15. pin 5: nasal sensor 2

AUX1

AUX2(Pressure/Pulse)

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The color-coding of the electrodes follows one of two standards that are common in different parts of the world. The cable splitter device has a drawing defining the color codes, names and body location for the two standard color codes (see Figure 2-9).

Figure 2-9: The cable splitter device with electrode placement conventions

To connect the internal ECG1. Connect the ECG trunk cable into the rectangular-shaped

socket marked ECG on the patient trace (I/O) panel. The patient trace (I/O) panel is located in the front left of the ultrasound unit (see Figure 2-8).

2. Hook up the electrode cables to the electrodes, following the appropriate convention (see Figure 2-9).

AHA (USA) IEC (Europe, Asia, ROW)

1. RA: White2. LA: Black3. LL: Red

1. R: Red2. L: Yellow3. F: Green

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Connecting the Phono

Overview

The phono consists of a microphone with a cable and a connector.

Figure 2-10: The phono device

To connect the Phono1. Plug the connector into the socket marked Phono on

Patient (I/O) panel (see Figure 2-8).

Connecting the Pulse pressure transducer

Overview

The pulse pressure transducer consists of pulse transducer with a cable and a connector.

Figure 2-11: The Pulse pressure transducer

To connect the pulse pressure transducer1. Plug the pulse pressure cable into the socket marked

AUX2 Pressure/Pulse on Patient (I/O) panel (see Figure 2-8).

1. Microphone2. Connector

1

2

1. Pulse transducer2. Connector

1 2

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Physio overview

Figure 2-12: The physios controls on the front panel

1. Assignable keys:• ECG• Horizontal sweep• Gain• Position• ECG Lead• ECG• ECG Trig• Dual Trig• Timer Trig• Beep• Phono• Horizontal sweep• Gain• Position• Phono• Phono filter• Respiration• Horizontal sweep• Gain• Position• Reap Lead• Resp• AUX 1and AUX 2• Gain• Position• AUX1• AUX2/Press

2. Soft menu• ECG Trig 1• Dual Trig delay• ECG Trig interval• Timer delay

2

1

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Physio controls

Physio assignable controls

Common controlsHorizontal sweep

Adjust the refresh rate of the physiological trace. This control is active only in 2D and color modes. The sweep speed of the physio traces in M-Mode and Doppler is identical to the M-Mode or Doppler horizontal sweep adjusted by the user.

GainEnables the user to change the amplitude of the physiological trace displayed on the screen.

PositionEnables the user to move the physiological trace on the screen.

ECG specific controlsECG Lead

Enables the user to choose the lead from which the ECG is recorded:• Lead I: ECG recorded between right and left arm.• Lead II: ECG recorded between right arm and left leg.• Lead III: ECG recorded between left arm and left leg.

ECGTurns the ECG trace on and off.

ECG TrigEnables intermittent imaging based on the ECG.

Dual TrigEnables intermittent imaging with two ECG triggered frames (primary and secondary). In this mode the scanner also activates a dual display, where the primary frames are displayed on the left side, whereas all frames (both primary and secondary) are displayed on the right side.

Timer TrigEnables intermittent imaging based on a timer.

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BeepTurns beep sound on and off.

Press MORE to ac-cess to the Phono and Respiration controls.

Phono specific controlsPhono

Turns the phono trace on and off.

Phono filterSelect a phono filter to apply from a pop-up menu.

Respiration specific controlsRespiration

Turns the respiration trace on and off.

AUX specific controlsAUX1

Turns the AUX1 physiological trace on and off.

AUX2/PressTurns the AUX2 physiological trace on and off.

Physio Soft menu controls

ECG Trig 1Specifies the delay (ms) from R-wave to triggered frame.

Dual Trig DelaySpecifies the delay (ms) from the first triggered frame (ECG Trig 1) to the second triggered frame. Only active when Dual Trig is turned on.

ECG Trig IntervalControls the number of cardiac cycles between triggered images.

Timer DelayControls time between triggers when timer triggering is turned on.

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Displaying the physiological traces

Display of the ECG

To turn the ECG display off, press PHYSIO and press the assignable ECG.

Cardiac applicationsThe ECG is turned on by default in all cardiac applications.

Other applications1. Press PHYSIO on the control panel to get access to the ECG

controls.2. Press the assignable ECG to display the trace.

Display of the phono trace1. Press PHYSIO on the control panel.2. Press MORE to display the assignables for the phono trace.3. Press the assignable PHONO to display the trace.

Display of the respiration trace1. Press PHYSIO on the control panel.2. Press MORE twice to display the assignables for the

respiration trace.3. Press the assignable RESP. to display the trace.

Display of the pulse pressure trace1. Press PHYSIO on the control panel.2. Press MORE three times to display the assignables for the

auxiliary traces3. Press the assignable AUX 2 to display the pulse pressure

trace.

Adjusting the display of physiological traces

Adjusting the trace sweep speed (ECG, phono and respiration)1. Press PHYSIO on the control panel.2. Turn the assignable rotary Horizontal Sweep to change

the sweep speed.

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Adjusting the trace amplitude (ECG, phono, respiration and pulse pressure)

The ECG signal's amplitude may vary between patients due to different skin moisture and other physiological pa-rameters.

1. Press PHYSIO on the control panel.2. Press MORE to select the actual assignable set.3. Turn the assignable rotary Gain to adjust the amplitude of

the trace.

Adjusting the trace position (ECG, phono, respiration and pulse pressure)1. Press PHYSIO on the control panel.2. Press MORE to select the actual assignable set.3. Turn the assignable rotary POSITION to move the trace

vertically.

ECG Trigging1. Press PHYSIO on the control panel to access to the ECG

controls. 2. Press the assignable ECG TRIG.3. Adjust Trig 1 to position the first trig on the ECG (delay in

ms from R-wave to triggered frame).4. Adjust ECG Trig Interval (number of cardiac cycles

between triggered images).5. Press DUAL TRIG if dual triggering is desired.6. Adjust Dual Trig delay (delay in ms from the first triggered

frame to the second triggered frame).

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AnnotationsText annotations may be inserted anywhere on the screen. The annotation can be free text or a pre-selected text from a mode-specific annotation menu or a user-defined library.

To insert an annotation

Free textWhile typing, use BACKSPACE to de-lete backward.

1. Type the required text.A suggested word corresponding to the entered characters is displayed while typing. Press TAB to enter the suggested word.

2. Trackball the text entered to the insertion position.3. Press SELECT to add the annotation.

Pre-defined annotation

Word selection from the Annotation menu1. Press the alphanumeric key TEXT.

A list of application specific pre-defined texts is displayed (see Figure 2-13).To display a list from another application, select the heading and choose another application.

2. Trackball to the required abbreviation.3. Press SELECT.4. Trackball to the position at which the annotation is to be

inserted.5. Press SELECT to add the annotation.

To draw an arrow1. Press Arrow in the Annotation menu.2. Trackball to the start position of the arrow to draw.3. Press SELECT to anchor the arrow.4. Trackball to the end position of the arrow to draw.5. Press SELECT to fix the arrow.

CAUTION

Annotations (text, arrow or bodymark) are created on separate layers. When viewing annotated images on a different system or when zooming the image, the position of the annotations on the image may be slightly changed.

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Figure 2-13: The mode-specific annotation menu

Word selection from the LibraryPre-defined text can be organized in a user configurable, application dependent library with three different sections.The user can easily select a pre-defined text from the Library using the ARROW keys.

Creating a Library1. Press F2 (CONFIG).2. In the Configuration package, select Measure.3. In the Measure category select Customize.

The Customize sheet is displayed (see Figure 2-14).4. Select a pre-defined text in the Application pane.5. Select Add in the desired section.6. Repeat step 4 and 5 to populate the library.7. To remove a pre-defined text from the library, select the

pre-defined text to remove and press Del.8. To order the pre-defined text in a section, select the

pre-defined text to move and select Up or Down buttons to move the word accordingly.

9. To exchange sections order, enter the sections to swap next to Swap columns button and press Swap columns.

1. Select to display annotation for other applications

2. Free text3. Draw an arrow4. Edit previous annotation5. Pre-defined application specific

annotations6. Exit annotation mode

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10. Press Save to store the library.

Figure 2-14: The Customize sheet

Using the Library1. Press any ARROW key.

The pre-defined texts from the last used group are displayed in the Status bar at the bottom of the screen, with the active word within square brackets.

2. To select a pre-defined text within a section, press ARROW UP or ARROW DOWN until the desired word is selected.

3. To change section, Press LEFT ARROW until the desired section is displayed in the Status bar.

4. To insert the selected pre-defined text, press RIGHT ARROW.

1. The Application pane2. Library section3. Insert selected pre-defined text in the section.4. Remove selected pre-defined text from the section.5. Move pre-defined text within the section.6. Re-order sections.7. Save Library

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Text overlays

There are 2 layers of text in annotations, which can be selected by toggling the F10 (TEXT1/TEXT2) key. This function enables the user to show/hide different annotations on the same image. When displaying both layers (i.e Text1/Text2), any editing will be assigned to layer 1. In order to write or edit on layer 2, the user must press F10 to make Text2 visible.

To edit annotation1. Press the alphanumeric key TEXT.2. Press Edit in the Annotation menu.

The pointer is changed to a cross marker.3. Trackball to the annotation to edit.4. Press SELECT.

Once selected, the annotation can be moved freely. The text can be edited using the following alphanumeric keys:• RIGHT ARROW: moves the text cursor forward.• LEFT ARROW: moves the text cursor backward.• TAB: moves the text cursor by word forward.• SHIFT + TAB: moves the text cursor by word backward.• BACKSPACE: deletes backward.• DELETE: deletes the selected word.• INSERT: toggles the text entry state from overwrite to

insert mode.5. Do the appropriate changes to the annotation.6. Press SELECT to anchor the edited annotation.

To erase annotationThe user can erase all annotations on the screen in one operation or erase annotations one by one.

To erase all annotations1. Press the alphanumeric key PAGE ERASE (F7).

If using text overlays, page erase applies only to the displayed layer(s).

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To erase one annotation1. Press the alphanumeric key LINE ERASE (F8).

The cursor is changed to a cross marker.2. Trackball to the annotation to delete.3. Press SELECT to erase the annotation.

Configuration of the pre-defined annotation list1. Press F2 (CONFIG).2. In the Configuration package, select Measure.3. In the Measure category select Annotation.

The Annotation sheet is displayed where the user can add, delete or re-arrange the annotation text (see Figure 2-15).

To re-arrange the annotation list1. Trackball to the actual annotation text.2. Press SELECT.3. Press the relevant button (i.e Delete, Move up or Move

down) to apply change.4. Press save to store the new annotation list.

To add an annotation text1. Trackball to the text entry field (see Figure 2-15).2. Press SELECT to activate the text cursor.3. Type the new annotation text.4. Press add.

The new annotation text is added at the end of the list.5. Press save to store the new annotation list.

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Figure 2-15: The Annotation sheet

1. Rearrange list2. Delete selected text3. Reset to factory default4. Add new text to the list5. Enter new text

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BodymarksBodymarks are small graphic images that represent the anatomy being examined. Using bodymarks, the user can indicate the position that the probe was in during the examination.

Inserting a bodymark1. Press the alphanumeric key BODYMARK (F6).

The Bodymark menu is displayed showing a selection of bodymarks relative to the selected exam category.

Figure 2-16: The Bodymark menu

2. Trackball to the desired bodymark and press SELECT.The bodymark with a probe marker is displayed on the scanning screen.

Figure 2-17: The bodymark with probe marker

3. Using the trackball, adjust the position of the probe marker and press SELECT.

1. Select and display bodymark list for other applications

2. Edit probe marker position and orientation

3. Erase bodymark4. Bodymark list for the current

application5. Insert an arrow6. Insert user-defined text

1. Probe marker

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4. Using the trackball, adjust the probe marker orientation and press SELECT.

Editing a bodymark1. Press the alphanumeric key BODYMARK (F6).

The Bodymark menu is displayed2. Press Edit.3. Using the trackball, adjust the position of the probe marker

and press SELECT.4. Using the trackball, adjust the probe marker orientation and

press SELECT.

Deleting a bodymark1. Press the alphanumeric key BODYMARK (F6).

The Bodymark menu is displayed2. Press Delete.

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Chapter 3 Scanning Modes

• 2D-Mode ........................................................................................ ..... 90• 2D-Mode overview ......................................................................90• 2D-Mode controls .......................................................................92• Using 2D .....................................................................................95• Optimizing 2D .............................................................................95

• M-Mode .......................................................................................... ..... 96• M-Mode overview .......................................................................96• M-Mode controls .........................................................................98• Using M-Mode ..........................................................................100• Optimizing M-Mode ...................................................................101

• Color Mode .................................................................................... ... 102• Color 2D Mode overview ..........................................................102• Color Mode controls ..................................................................105• Using Color Mode .....................................................................108• Optimizing Color Mode .............................................................109

• PW and CW Doppler ..................................................................... ... 110• PW and CW Doppler overview .................................................110• PW and CW Doppler controls ...................................................112• Using PW/CW Doppler modes .................................................115• Optimizing PW/CW Doppler modes ..........................................115

• Tissue Velocity Imaging (TVI) ...................................................... ... 117• TVI overview .............................................................................117• TVI controls ...............................................................................119• Using TVI ..................................................................................122• Optimizing TVI ..........................................................................122

• Tissue Tracking ............................................................................ ... 123• Tissue Tracking overview .........................................................123

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• Tissue Tracking controls ...........................................................125• Using Tissue Tracking ..............................................................128• Optimizing Tissue Tracking ......................................................128

• Strain rate ...................................................................................... ... 130• Strain rate overview ..................................................................130• Strain rate controls ....................................................................132• Using Strain rate .......................................................................135• Optimizing Strain rate ...............................................................135

• Strain ............................................................................................. ... 136• Strain overview .........................................................................136• Strain controls ...........................................................................138• Using Strain ..............................................................................141• Optimizing Strain ......................................................................141

• Tissue Synchronization Imaging (TSI) ....................................... ... 142• TSI overview .............................................................................142• TSI controls ...............................................................................144• Using TSI ..................................................................................146• Optimizing TSI ..........................................................................147

• Additional scanning features ...................................................... ... 148• LogiqView .................................................................................148• Compound ................................................................................148• B-Flow .......................................................................................149• Blood flow imaging ....................................................................149

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IntroductionThe Vivid 7 ultrasound scanner provides several basic scanning modes and several options for combining the use of these modes.

The following scanning modes are described in this chapter:• 2D Mode Imaging• M-Mode Imaging• Anatomical M-Mode (straight and curved)• Color Mode Imaging• Angio• Doppler Mode Imaging• Tissue Velocity Imaging

See page 343 for further information on image and cineloop storage. Refer to page 502 for more informa-tion on VCR re-cording.

When performing an examination using any of these modes, images and image sequences (cineloops) can be stored. The examination or part of it can also be stored on video tape.

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2D-Mode

2D-Mode overview

Figure 3-1: The 2D screen (cardiac)

1. Focus marker2. Probe orientation marker3. Status window4. Soft menu

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Figure 3-2: The 2D controls on the front panel

The 2D mode displays a two-dimensional gray scale image of the tissue within the probe's field of view. 2D mode can be combined with:

In combined mode, press ACT. MODE to toggle between modes and access to the mode specific controls.

• M-Mode, see ’M-Mode’ on page 96• Color Mode, see ’Color Mode’ on page 102• CW or PW Doppler Mode, see ’PW and CW Doppler’ on

page 110• Color and Doppler Modes (triplex)

Controls marked with R are also available in freeze and cine replay

1. Assignable keys:• Width• Frequency/Resolution• Focus• Frame rate• Up/Down R• Left/Right R• Cineloop (in Freeze, only)• Dual focus• B color maps• Select all

2. Zoom3. Depth4. Soft menu

• Tilt• Compress R• Reject R• Dynamic Range• DDP R• Adaptive reject R• UD Clarity• Speckle reduce• Contour• Diff On/Off• Power

5. Freeze6. 2D7. Gain

5

1

2

4

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7

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2D-Mode controls

2D assignable controls

WidthControls the size or angular width of the 2D image sector. A smaller angle generally produces an image with a higher frame rate.

FocusChanges the location of the focal point(s). A triangular focus marker indicates the depth of the focal point.

Frame rateAdjusts frame rate (FPS). Rotate the knob clockwise to increase frame rate. The relative setting of the frame rate is displayed in the status window. When adjusting frame rate, there is a trade off between spatial and temporal resolution.

Frequency/ResolutionOn some low fre-quencies, the sys-tem switches automatically to second-harmonic mode. The word �“Octave�” appears in the status win-dow.

Enables the adjustment of the probe's operating frequency. Rotate the knob clockwise to increase the frequency. The selected frequency is displayed in the status window. For some probes/applications the lowest frequency settings will be Octave imaging settings.

Invert• Left/Right Invert: enables a mirror image of the 2D image

to be created. The left/right reference marker V moves to the other side of the image.

• Up/Down Invert: enables the 2D image to be flipped 180 degrees.

Dual focusActivates Dual focus mode. To adjust the Dual focus, rotate the FOCUS assignable.

Color mapsDisplays a color map menu to optimize the greyscale presentation. The menu enables an option from a list of non-linear gray-curves or different 2D-colorized curves to be selected.

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Cineloop (in Freeze only)Starts cineloop acquisition.

GainWhen rotated clockwise, increases the overall gain applied to the received echo signals equally for all depth.

Time Gain Compensation (TGC)compensates for depth-related attenuation in an image. The sliders nearest the operator affect the far field. TGC amplifies returning signals to correct for the attenuation caused by tissue at increasing depths.

Automatic Tissue Optimization (ATO)ATO provides an automatic optimization of the 2D image by adjusting the gray scale curve. Press the 2D GAIN rotary to toggle ATO on or off. When activated, ATO is displayed in the information window.

DepthSets the maximum (far field) distance that will be imaged. Decreasing the depth may allow higher frame rates.

2D Soft menu controls

CompressControls the amount of contrast in the 2D image. An index number is displayed in the status window to indicate the relative level of compression.

RejectAdjust reject level. When this control is increased, low-level echoes are rejected and appear darker in the 2D image. An index number is displayed in the status window to indicate the relative level of rejection.

Dynamic RangeEnables control of the dynamic range or contrast of the image. When dynamic range is set high, the image is softer and more low-level data is visible.

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DDP (Data Dependent Processing)Performs temporal processing which reduces random noise without affecting the motion of significant tissue structures. An index number is displayed in the status window (under Proc) to indicate the relative DDP level.

TiltEnables the axis of the 2D image to be tilted to the left or right. By using this control in combination with angle control the image can be “aligned” to the direction of interest, and frame rates be optimized. By default the axis of symmetry of a 2D image is vertical.

UD ClarityEnables the user to create a personalized appearance of the tissue. Moving the paddle to the left creates a smoother image, though keeping boundaries sharp. Moving the paddle to the right creates a crisper image.

Adaptive rejectReduces near field haze and blood pool artifact without diluting tissue appearance of moving structures.

Contour Controls image processing related to the extent of edge enhancement applied to an image.

Diff On/OffAffects the level of reverberations in the image. When turned on, the frame rate (or the number of focal zones) will decrease, while the reverberations will be attenuated.

PowerWhen power is re-duced, it reduces the signal-to-noise ratio, so that the im-age may become noisier.

Controls the amount of acoustic power applied in all modes. When power is set to maximum, it is equal to or less than the maximum acoustic power permitted by the FDA. The Thermal Index (TI) and the Mechanical Index (MI) are displayed on the screen.

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Using 2DRefer to page 524 about creating pre-sets.

The 2D-Mode is the system's default mode.1. Press 2D on the control panel to access 2D mode.

Check the Display's brightness and con-trast setting before adjusting the unit imaging controls

2. Optimize the image by adjusting the image controls described in the previous section.If necessary use preset for optimum performance with minimum adjustment.

Optimizing 2DThe following controls can be adjusted to optimize the 2D Mode display:• Use the Gain and TGC controls to optimize the overall

image.• Use the Depth control to adjust the range to be imaged.• Use the Focus control to center the focal point(s) around

the region of interest.• Use the Frequency (move to higher frequencies) or the

Frame rate control (move to lower frame rate) to increase resolution in image

• Use the Frequency (move to lower frequency) to increase penetration.

• Use the Reject control to reduce noise in the image.• Use the DDP control to optimize imaging in the blood flow

regions and make a cleaner, less noisy image.

WARNING

Always use the minimum power required to obtain acceptable images in accordance with applicable guidelines and policies.

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M-Mode

M-Mode overview

Figure 3-3: The cardiac M-Mode screen (top/bottom)

1. Time motion cursor conventional M-Mode2. Time motion cursor curved anatomical M-Mode3. Time motion cursor anatomical M-Mode4. Depth scale5. Focus marker6. Time scale7. Status window8. Soft menuNote: the sweep speed information displayed in the bottom right corner of the image represents the user selected sweep speed and should be used only as a reference to confirm that the image was acquired at the selected sweep speed. It is not to be used for measurements or analysis. This is not an absolute value, but simply a reference number. Users performing studies using standardized protocols may find this sweep speed information useful for reading studies from other institutions.

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Figure 3-4: The M-Mode controls on the front panel

This unit has three types of M-Mode: • Conventional M-Mode (MM): displays a distance/time plot

of a cursor line in the axial plane of the 2D-image.• Anatomical M-Mode (AMM): displays a distance/time plot

from a cursor line, which is independent from the axial plane. AMM is available in greyscale, color, TVI, Tissue Tracking, Strain rate and Strain modes.

• Curved Anatomical M-Mode (CAMM): displays a distance/time plot from a free-drawn cursor line. CAMM is available in greyscale, color, TVI, Tissue Tracking, Strain rate and Strain modes.

Controls marked with R are also available in freeze and cine replay.

1. Assignable keys:• Horizontal sweep R• Frequency/Resolution• Focus• Contour• Up/Down• Color maps

2. Zoom3. Img Size4. Soft menu

• Compress R• Reject R• Dynamic Range• Power

5. Freeze6. M-Mode7. Access to AMM & CAMM8. Gain R

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M-Mode and 2D Mode display areas can be side by side or top/bottom. Conventional M-Mode can be combined with Color (see ’Color M-Mode overview’ on page 103).

M-Mode controls

M-Mode assignable controls

Horizontal sweepAdjusts the horizontal refresh rate of the M-Mode area of the display. Horizontal sweep does not change the acquisition resolution, so that user can change the horizontal sweep in replay (with no loss of quality).

On some low fre-quencies, the sys-tem switches automatically to second-harmonic mode. The word �“Octave�” appears in the status win-dow.

Frequency/ResolutionEnables the adjustment of the probe's operating frequency. Rotate the knob clockwise to increase the frequency. The selected frequency is displayed in the status window. For some probes/applications the lowest frequency settings will be Octave imaging settings.

FocusChanges the location of the focal point(s). A triangular focus marker indicates the depth of the focal point.

ContourControls image processing related to the extent of edge enhancement applied to an image.

Up/DownFlips the M-Mode display 180 degrees.

Color mapsDisplays a color map menu to optimize the greyscale presentation. The menu enables an option from a list of non-linear gray-curves or different colorized curves to be selected.

M-Mode Soft menu controls

CompressControls the amount of contrast in the image. An index number is displayed in the status window to indicate the relative level of compression.

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RejectAdjust reject level. When this control is increased, low-level echoes are rejected and appear darker in the image. An index number is displayed in the status window to indicate the relative level of rejection.

PowerWhen power is re-duced, it reduces the signal-to-noise ratio, so that the im-age, spectrum or color scan may be-come noisier.


Dynamic RangeEnables control of the dynamic range or contrast of the image. When dynamic range is set to High, the image is softer and more low-level data is visible.

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Using M-Mode

Conventional M-Mode1. To access M-Mode from any other scan mode, press MM on

the control panel.2. Use the trackball to position the cursor over the required

area of the image.Gain, Frequency, Focus, Dynamic Range and Com-pression affect also the 2D image.

3. Adjust horizontal sweep, Gain, Frequency, Focus, Dynamic Range, Compression and Contour to optimize the display if necessary.

4. Press FREEZE to stop imaging.

Anatomical M-ModeAnatomical M-Mode can also be used with previous-ly acquired digitally stored 2D images.

1. From the 2D Live or M-Mode view, press ALT. The alternative modes are displayed on the assignable.

2. Press AMM

OR1. From the 2D Live, press FREEZE.2. Press MM to access the Anatomical M-Mode.

The Trackball as-signable Pos (Posi-tion) is activated.

3. Use the trackball to position the cursor over the required area of the image.

The Trackball as-signable Angle is activated.

4. Press TRACKBALL to allow free rotation of the solid full-length cursor line throughout the 2D image.

5. Rotate the solid cursor line to the desired direction.The Trackball as-signable Pos is acti-vated.

6. Press TRACKBALL twice and reposition the intersection point to the desired position along the cursor line.

7. Repeat steps 4. and 5. to change the angle of the solid cursor line if necessary.

The M-Mode area of the display updates as the M-Mode sig-nal is constructed.

8. Press TRACKBALL to activate scrolling control on the trackball.

9. Use the trackball to scroll through the data acquired at that location. The M-Mode display will vary accordingly.

Curved Anatomical M-ModeCurved Anatomi-cal M-Mode can al-so be used with previously ac-quired digitally stored 2D images.

1. From the 2D or M-Mode view press ALT. The alternative modes appear on the assignable display.

2. Press CURVED AMM.

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3. Use the trackball to position the starting point of the time motion curve.

The time motion curve can be edited by following the curve back to the de-sired point and re-drawn as desired. Following the curve back to the starting point will delete the time motion curve.

4. Press SELECT to anchor the starting point of the time motion curve.

5. Use the trackball to position the second point of the time motion curve.

6. Press SELECT to anchor the second point of the time motion curve.

7. Repeat step 5. and 6. up to seven times to draw a complete time motion curve.

Optimizing M-ModeRefer to page 524 about creating pre-sets.

The use of preset gives optimum performance with minimum adjustment. If necessary, the following controls can be adjusted to further optimize the M-Mode display:• Adjust Horizontal sweep to optimize the display resolution.• Adjust Gain and TGC controls to adjust the range to be

imaged.Except for Con-tour, all the con-trols listed in the optimizing M-Mode section will also affect the 2D image.

• Use the Frequency (move to higher frequencies) or the Frame rate control (move to lower frame rate) to increase resolution in image.

• Use the Frequency (move to lower frequency) to increase penetration.

• Adjust Focus to move the focal point(s) around the region of interest in the M-Mode display.

• Adjust Dynamic range to optimize the useful range of incoming echoes to the available greyscale.

• Adjust Compress and Contour to further optimize the display.

• Adjust Reject to reduce noise while taking care not to eliminate significant low-level diagnostic information.

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Color Mode

Color 2D Mode overview

Figure 3-5: The Color Mode screen

1. Probe orientation marker2. Color bar3. Color sector marker4. Status window5. Soft menu

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Color M-Mode overview

Figure 3-6: The Color M-Mode screen (top/bottom display)

1. Time motion cursors2. Color bar3. Focus marker4. Flow sector marker5. Time scale6. Status window7. Soft menu

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Figure 3-7: The Color Mode controls on the front panel


1. Assignable keys:• Horizontal sweep (Color M-Mode only) R

• Scale• Baseline• Frame rate• Invert R• Variance R• Simultaneous• Dual focus• Color maps• Angio (Color 2D only)• Cineloop (in Freeze, Color 2D mode only)

MORE• Up/Down R• Left/Right R

2. Zoom• Display zoom• HR zoom

3. Depth4. Img Size (Color M-Mode)5. Soft menu

• Tissue Priority R• Sample Volume• DDP (Color 2D only) R• Frequency• Lateral avg.• Radial avg.• Power

6. Freeze7. Color8. Access to AMM & CAMM9. Gain R

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Color Mode controls

Color Mode assignable controls

Horizontal sweep (Color M-Mode only)Adjusts the horizontal refresh rate of the M-Mode area of the display.

ScaleAdjusts the repetition rate of the Doppler pulses transmitted to acquire the data for color flow mapping. The Scale (Nyquist limit) should be adjusted so that no aliasing occurs, while still having good resolution of velocities. The Nyquist limit should be somewhat above the maximum velocity found in the data.

BaselineAdjusts the color map to emphasize flow either toward or away from the probe. Baseline is available in both Live and Freeze.

InvertEnables the color scheme assigned to positive and negative velocities to be inverted. Invert is available in live and cine replay.

VarianceControls the amount of variance data added to a color display. Variance enables computer-aided detection of turbulent flow (e.g. jets or regurgitation). Variance is available in live and cine replay.

Dual focus (Color 2D mode only)Activates Dual focus mode. To adjust the Dual focus, press ACT. MODE and rotate the FOCUS assignable.

Color mapsDisplays a menu of color map options. Use the trackball to point to a color map and press SELECT to activate the desired color map. Each color map is assigning different color hues to different velocities.

Cineloop (in Freeze, Color 2D mode only)Starts cineloop acquisition.

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Color-Mode Soft menu controls

Tissue priorityEmphasize either the color of the color mode or the greyscale tissue detail of the 2D image. Tissue priority is available in both Live and Freeze.

Sample volumeAdjusts the size of the color flow Doppler sampling area. Lower setting gives better flow resolution while a higher setting increases sensitivity and helps to locate turbulent flows.

LVR (Low Velocity Rejection)Color data produced by very low flow may cause interfer-ence.

LVR, also called Wall motion filter, enables the extent of low velocity removal to be adjusted.

FrequencyEnables the adjustment of the transmission frequency to control the sensitivity or the level of penetration. The selected frequency is displayed in the status window. Adjusting Frequency may affect Sample Volume and LVR settings.

Lateral Averaging (Color 2D only)Smooths the image by averaging collected data along the same horizontal line. An increase of the lateral averaging will reduce noise, but this will also reduce the lateral resolution.

Radial AveragingSmooths the image by averaging collected data along the same radial line. An increase of the radial averaging will reduce noise, but this will also reduce the radial resolution.



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Trackball controls

ROI (Region Of Interest) sizeWhen the trackball command Size is selected (see also ’Trackball operation’ on page 57), the height and width of the color area (or ROI) is adjusted from the trackball.

ROI (Region Of Interest) positionWhen the trackball command Pos (position) is selected (see also ’Trackball operation’ on page 57), the position of the color area (or ROI) is adjusted with the trackball.

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Using Color Mode

Color 2D1. From an optimized 2D image press COLOR.2. Use the trackball to position the ROI frame over the area

to be examined.The assignable con-trols of the trackball are displayed in the trackball status bar in the bottom right corner of the screen.

3. Press SELECT. The instruction Size should be highlighted in the trackball status bar. If not, press SELECT again to select Size.Note: If the trackball control Pointer is selected, press TRACKBALL to be able to select between Position and Size controls.

4. Use the trackball to adjust the dimensions of the ROI.To enlarge or narrow the ROI, move the trackball to the left or right.To lengthen or shorten the ROI, move the trackball up or down.

5. Press IMG. STORE.

Color M-Mode1. From M-Mode press COLOR.2. Use the trackball to position the color area in the M-Mode

display.3. Press SELECT. The instruction Size should be highlighted in

the trackball status bar. If not, press TRACKBALL again to select Size.Note: If the trackball control Pointer is selected, press TRACKBALL to be able to select between Position and Size controls.

4. Use the trackball to adjust the dimension of the color area.To enlarge the color area, move the trackball upTo narrow the color area, move the trackball down.


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Optimizing Color ModeRefer to page 524 about creating pre-sets.

The use of preset gives optimum performance with minimum adjustment. If necessary, the following controls can be adjusted to further optimize the Color Mode display:• Adjust the Active mode gain to set the gain in the color

flow area.The scale value may affect FPS, Low Ve-locity Reject, and Sample Volume.

• Adjust Scale to the highest setting that provides adequate flow detection.

• Adjust Low Velocity Reject to remove low velocity blood flow and tissue movement that reduces image quality.

• Adjust Variance to detect flow disturbances.• Adjust Sample volume (SV) to a low setting for better flow

resolution, or a higher setting to more easily locate disturbed flows

Frequency setting may affect FPS, SV and Low Velocity Reject.

• Adjust Frequency to optimize the color flow display. Higher settings improve resolution. Lower settings improve depth penetration and sensitivity. This does not affect the frequency used for 2D and M-Mode.

The Power setting affects all other op-erating modes.

• Adjust Power to obtain an acceptable image using the lowest setting possible.

Adjust the following settings to further optimize display of the image:• Use Invert to reverse the color assignments in the color

flow area of the display.• Use Tissue priority to emphasize either the color flow

overlay, or the underlying greyscale tissue detail.• Use Baseline to emphasize flow either toward or away

from the probe.• Use Radial and Lateral Averaging to reduce noise in the

color flow area. Radial and Lateral Averaging smooths the image by averaging collected data along the same horizontal line. An increase of the lateral averaging will reduce noise, but this will also reduce the lateral resolution.

CAUTION

Use all noise reduction controls with care. Excessive application may obscure low level diagnostic information.

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PW and CW Doppler

PW and CW Doppler overview

Figure 3-8: The PW/CW Doppler Mode screen

1. Sample volume (PW only)2. Angle correction marker3. Velocity scale4. Low velocity reject5. Nyquist velocity6. Doppler baseline7. Frequency scale (optional, see page 522)8. Status window9. Soft menuNote: the sweep speed information displayed in the bottom right corner of the image represents the user selected sweep speed and should be used only as a reference to confirm that the image was acquired at the selected sweep speed. It is not to be used for measurements or analysis. This is not an absolute value, but simply a reference number. Users performing studies using standardized protocols may find this sweep speed information useful for reading studies from other institutions.

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Figure 3-9: The PW/CW controls on the front panel


1. Assignable keys:• Horizontal sweep R• Scale• Baseline R• LVR• Invert R• LPRF (in PW mode)• Color maps RMORE• Quick angle• Angle correction

2. Zoom:• Display zoom• HR zoom

3. Img Size:• Small/large 2D display• Top/bottom display• Side by side display

4. Soft menu:• Sample Volume (PW)• Compress R• Reject R• Frequency• Frame rate• Power

5. Freeze6. CW7. PW8. Gain R

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PW and CW Doppler controls

PW and CW Doppler assignable controls

Horizontal sweepAdjusts the horizontal refresh rate of the Doppler area of the display. Horizontal sweep is available in live and cine replay.

ScaleAdjusts the velocity scale to accommodate faster/slower blood flow velocities. Velocity scale determines pulse repetition frequency.

BaselineEnables the Doppler baseline to be shifted up and down. The default Doppler baseline is set at the center of the vertical aspect of the Doppler display, dividing evenly the flow toward and away from the probe. By adjusting the baseline a larger portion of the analysis is assigned to the flow direction present. Baseline is available in live and cine replay.

Maximum velocity depends on sample volume size, sample volume position and frequency set-tings.

Velocity rangeEnables the vertical scale of the Doppler spectrum and the maximal detectable velocity to be modified. Velocity range directly controls the pulse repetition frequency, which is responsible for the setting of the Nyquist limit (the ability to detect maximum velocity without aliasing).

Low velocity rejectEnables the low velocity portions of the spectrum to be filtered, since the Doppler spectrum and audio may contain strong wall-motion signals. The amount of Low Velocity Reject. is indicated by the green vertical bar at the right end of the baseline.

If the Doppler mode is combined with Color mode, the col-or map will be also inverted.

InvertEnables the Doppler spectrum to be flipped 180 degrees, so that negative velocities are displayed above the baseline and positive velocities below the baseline. Invert is available in live and cine replay.

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LPRF (PW mode)Sets the pulse repetition frequency for the PW Doppler acquisition of flow data. Enables toggling between high and low Pulse Repetition Frequency (PRF). When the Doppler PRF is raised beyond a certain limit, more than one Doppler gate is displayed on the screen.

Color mapsDisplays a drop down menu of different Doppler colorization maps.Use the trackball to select the desired map and press SELECT to activate the map.

Quick angle and Angle correctionIn non-cardiac ap-plications, Angle correction is con-trolled from the Trackball.

Enables correction of the Doppler velocity scale by defining the angle between the Doppler beam and the investigated blood vessel or blood flow. A thin cross bar on the Doppler cursor will rotate as the control is adjusted. Angle correction is available in both Live and Freeze.

Quick angle adjusts the angle by 60 degrees.

Angle correction adjusts the angle between zero and 90 degrees with one degree increment.

PW/CW Doppler Soft menu controls

Sample volumeIn PW mode, set the longitudinal size of the region to be sampled for measurement. Adjusting Sample volume may affect the PRF (Nyquist limit) settings. SV does not apply to CW mode, where the volume sampled is the full length of the area indicated by the cursor line.

CompressEnables control over the contrast of the Doppler spectrum. When compression is raised, the spectrum image becomes softer and some low level background noise may appear. Compress is available in both Live and Freeze.

RejectEnables undesirable background noise to be removed from the Doppler spectrum resulting in a darker background. Reject is available in both Live and Freeze.

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FrequencyAdjusts the transmission frequency in Doppler to control sensitivity or level of penetration. The selected frequency is displayed in the status window. Adjusting Frequency may affect Sample Volume (PW) and LVR settings.

Frame rateAdjusts the frame rate. The relative setting of the frame rate is displayed in the status window (under 2D).



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Using PW/CW Doppler modesControls and opera-tions for PW and CW mode are the same unless other-wise noted.

There are two ways to start PW/CW Doppler:

Alternative 11. Press PW or CW. A scanning screen is displayed with a

Doppler cursor on the 2D mode image and a Doppler spectrum in the lower part of the screen.

2. Use the trackball to position the Doppler cursor line and in PW the sample volume location over the area of interest.

Sample Volume ad-justment may affect the Scale, Frame rate and LV rej. set-tings.

3. In PW, with the Soft menu rocker key, adjust the sample Volume (SV):To enlarge the SV, press the Right arrow of the rockerTo narrow the SV, press the Left arrow of the rocker.

Alternative 21. Press CURSOR on the control panel. A cursor line is

displayed on the 2D image.2. With the trackball adjust the position of the cursor line.3. Press PW or CW.

Optimizing PW/CW Doppler modesRefer to page 524 about creating pre-sets

The use of preset gives optimum performance with minimum adjustment. If necessary, the following controls can be adjusted to further optimize the PW/CW modes display:• Adjust the Active mode gain to set the gain in the spectral

Doppler area.• Adjust Low velocity reject to reduce unwanted low

velocity blood flow and tissue movement.• In PW mode, adjust Sample volume to low setting for

better resolution, or higher setting to more easily locate the disturbed flows.

• Adjust the Compress setting to balance the effect of stronger and weaker echoes and obtain the desired intensity display.

Frequency and Frame rate settings may affect the Low Velocity Reject.

• Adjust Frequency to optimize flow display. Higher setting will improve resolution and the lower setting will increase the depth penetration.

• Adjust Frame rate to a higher setting to improve motion detection, or to a lower setting to improve resolution.

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The Doppler Power setting affects only Doppler operating modes.

• Adjust Power to obtain an acceptable image using the lowest setting possible. This is particularly important in CW mode, as the energy duty cycle is 100% (constant).

Adjust the following settings to further optimize the display of the image.• Use the Horizontal sweep to optimize the sweep speed.• To view signal detail, use the Velocity range to enlarge the

vertical spectral Doppler trace.• Use Invert to reverse the vertical component of the spectral

Doppler area of the display.• Use Angle correction to steer the ultrasound beam to the

blood flow to be measured (Not typically required during cardiac studies).

CAUTION

Use all noise reduction controls with care. Excessive application may obscure low level diagnostic information.

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Tissue Velocity Imaging (TVI)

TVI overview

Figure 3-10: The TVI Mode screen

1. TVI sector marker2. Status window3. Soft menu

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Figure 3-11: The TVI Mode controls on the front panel

Tissue Velocity Imaging (TVI) calculates and color-codes the velocities in tissue. The tissue velocity information is acquired by sampling of tissue Doppler velocity values at discrete points. The information is stored in a combined format with greyscale imaging during one or several cardiac cycles with high temporal resolution.


1. Assignable keys:• 2D Width• Scale• Baseline R• Frame rate• Invert R• TSI• Simultaneous R• Dual focus• TSI visible• Cineloop (Freeze only)• Q-Analysis (Freeze only)MORE• Color mapsALT• Curved AMM R• AMM R• Tissue Tracking R• Strain rate R• Strain R


3. Soft menu• Compress R• Reject• Threshold• Transparency• Frequency• Lateral avg.• Radial avg.• Power

4. Freeze5. TVI6. 2D7. Alternatives

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TVI controls

TVI assignable controls

2D widthControls the angular width of the 2D image sector.

Lower scale value allows greater depth and lower Nyquist limit.

ScaleAdjusts the repetition rate of the Doppler pulses transmitted to acquire the data for color mapping.The Scale value influences the Nyquist limit (the ability to detect maximal velocity without color-aliasing).

BaselineAdjusts the color map to emphasize tissue motion either toward or away from the probe. Baseline is available in both Live and Freeze.

Frame rateControls the line density. When adjusting frame rate, there is a trade off between spatial and temporal resolution.

InvertEnables the color scheme assigned to positive and negative tissue velocities to be inverted. Invert is available in live and cine replay.

TSIStarts TSI mode (see page 142).

SimultaneousEnables simultaneous display of 2D image and 2D image with TVI color.

Dual focusActivates Dual focus mode. To adjust the Dual focus, press ACT. MODE and rotate the FOCUS assignable.

TVI visibleTurns TVI display on/off.


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Color mapsDisplays a menu of color map options. Use the trackball to point a color map and press SELECT to activate a desired color map. Each color map is assigning different color hues to different velocities.

Q-analysis (in Freeze only)Starts the Quantitative analysis application (see Chapter 7, ’Quantitative Analysis’ on page 304).

Alternative assignable controls

Press ALT to access to the following modes:• Curved Anatomical M-Mode (see page 96)• Tissue Synchronization Imaging (see page 142)• Tissue Tracking (see page 123)• Strain rate (see page 130)• Strain (see page 136)

TVI Soft menu controls

CompressControls the amount of color compression. The color bar is adjusted accordingly.

Reject (low velocity rejection)Adjust the cut-off level for the low velocity of TVI to be discarded when generating the color image.

ThresholdControls the level of greyscale intensity that is used as a threshold for color.

TransparencyControls the degree of transparency of the TVI color.

FrequencyEnables the adjustment of the transmission frequency to control the sensitivity or the level of penetration.

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Lateral AveragingUse Averaging con-trols with caution so as not to obscure significant diagnos-tic information

Smooths the image by averaging collected data along the same horizontal line. An increase of the lateral averaging will reduce noise, but this will also reduce the lateral resolution.


When power is re-duced, it reduces the signal-to-noise ratio, so that the im-age may appear noisier.

PowerControls the amount of acoustic power applied in all modes. When power is set to maximum, it is equal to or less than the maximum acoustic power level permitted by regulatory standards. The Thermal Index (TI) and the Mechanical Index (MI) are displayed on the screen.

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Using TVI1. Select the desired probe.2. While in 2D mode press TVI on the control panel.3. Use the trackball to position the ROI frame over the area



5. Use the trackball to adjust the dimensions of the ROI.To enlarge or narrow the ROI, move the trackball to the left or right.To lengthen or shorten the ROI, move the trackball up or down.

Optimizing TVIRefer to page 524 about creating pre-sets.

The use of preset gives optimum performance with minimum adjustment. If necessary, the following controls can be adjusted to further optimize the TVI display:

The Scale value also affects the frame rate. There is a trade off between the frame rate and quantification noise.

• To reduce quantification noise (variance), the Nyquist limit should be as low as possible, without creating aliasing. To reduce the Nyquist limit: Reduce the Scale value from the assignables on the control panel.

PW will be opti-mized for Tissue Velocities when ac-tivated from inside TVI.

• TVI provides velocity information only in the beam direction. The apical view typically provides the best window since the beams are then approximately aligned to the longitudinal direction of the myocardium (except near the apex). To obtain radial or circumferential tissue velocities, a parasternal view must be used. However, from this window the beam cannot be aligned to the muscle for all the parts of the ventricle.

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Tissue Tracking

Tissue Tracking overview

Figure 3-12: The Tissue Tracking Mode screen

1. Color sector marker2. Tissue Tracking color bar3. Status window4. Soft menu5. Track start and track end markers6. Tracking start and end from R-peak

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Figure 3-13: The Tissue Tracking controls on the front panel

Tissue Tracking calculates and color-codes the displacement in the tissue over a given time interval, typically the systole. The displacement is defined as the distance the tissue move during this time interval. The displacement is found as the time integral (sum) of the tissue velocities during this interval.

Only displacements in the beam direction are found. Only positive (systolic) displacements are mapped into colors, negative displacements are mapped into greyscale.


1. Assignable keys:• Track start R• Track end R• Track scale R• Frame rate• Invert R• TSI• Simultaneous R• Dual focus• Color maps R• Cineloop (Freeze only)• Q-Analysis (Freeze only)MORE• 2D widthALT• Curved AMM R• AMM R• Tissue Tracking R• Strain rate R• Strain R

2. Zoom3. Soft menu:

• Threshold R• Transparency R• Frequency• Lateral avg.• Radial avg.• Power• Cine compound (Freeze only)

4. Freeze5. TVI6. 2D

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Tissue Tracking controls

Tissue Tracking assignable controls

Tracking startThe time after ECG R-peak when the integration should start.

Tracking endThe time after tracking start when the integration should end.

Tracking scaleControls the color cut-off value of max displacement displayed. The chosen values is shown on the color bar when the assignable is activated.


InvertEnables the color scheme assigned to positive and negative tissue velocities to be inverted. Invert is available in live and cine replay.


SimultaneousEnables simultaneous display of 2D image and 2D image with Tissue Tracking color.


Color mapsDisplays a menu of color map options. Use the trackball to point a color map and press SELECT to activate a desired color map.


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2D width (More menu)Controls the angular width of the 2D image sector.



Tissue Tracking Soft menu controls

ThresholdControls the level of greyscale intensity that is used as a threshold for color.

TransparencyControls the degree of transparency of the Tissue Tracking color.


Use Averaging con-trols with caution so as not to obscure significant diagnos-tic information

Lateral AveragingSmooths the image by averaging collected data along the same horizontal line. An increase of the lateral averaging will reduce noise, but this will also reduce the lateral resolution.


PowerControls the amount of acoustic power applied. When power is reduced the signal to noise ratio is reduced, so that the image may become noisier.

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Cine Compound (Freeze only)Calculates and displays cineloops generated from a temporal averaging of multiple consecutive heart cycles. The number of cycles averaged is controlled from the Soft menu rocker. The number of averaged cycles i displayed on the top left corner.

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Using Tissue Tracking1. From TVI Mode, press ALT on the control panel and press

the TISSUE TRACKING assignable.2. Adjust TRACKING START (assignable) close to the R-peak.3. Adjust TRACKING END (assignable) near the T-wave.4. Use the trackball to position the ROI frame over the area



6. Use the trackball to adjust the dimensions of the ROI.

Optimizing Tissue Tracking• To reduce quantification noise (variance), the Nyquist limit

should be as low as possible, without creating aliasing. To reduce the Nyquist limit, reduce the scale while in TVI.

• To check for aliasing, freeze the loop and apply velocity trace (Press FREEZE and Q-ANALYSIS), see also Chapter 7, ’Quantitative Analysis’ on page 304).

• The main use of Tissue Tracking is to map positive systolic displacements. This means that TRACKING START and TRACKING END assignables should be adjusted to pick out the systolic phase of the cardiac cycle: Adjust Tracking start close to the R-Peak. Adjust Tracking end near the T-wave.

• Negative displacement can be mapped by pressing INVERT. TRACKING START and TRACKING END must then be adjusted to pick out the diastolic phase of the cardiac cycle.

• The maximum displacement that is color-coded can be adjusted using the TRACKING SCALE assignable. If set too low, most of the wall will show the color indicating maximum displacement. If set too high, the maximum displacement color is never reached.

• Tissue Tracking provides velocity information only in the beam direction. The apical view typically provides the best window since the beams are then approximately aligned to the longitudinal direction of the myocardium (except near

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the apex).

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Strain rate

Strain rate overview

Figure 3-14: The Strain rate mode screen

1. Color sector marker2. Status window3. Soft menu4. Strain sample size

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Figure 3-15: The Strain rate mode controls on the front panel

Strain rate calculates and color-codes the deformation per unit time i.e the speed at which the tissue deformation occurs.

Strain rate is defined as the spatial gradient of velocity data.


1. Assignable keys:• 2D width• SRI scale R• Frame rate• Invert R• TSI• Simultaneous R• Dual focus• Color maps R• Q-Analysis (Freeze only)• Cineloop (Freeze only)ALT• Curved AMM R• AMM R• Tissue Tracking R• Strain rate R• Strain R


3. Soft menu:• Strain Length• SRI Reject R• Compress R• Threshold R• Transparency R• Frequency• Lateral avg.• Radial avg.• Power• Cine compound R (Freeze only)


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Strain rate controls

Strain rate assignable controls

2D widthControls the angular width of the 2D image sector.

SRI scaleDefines the scale for the color coding of the strain rate.


InvertEnables the color scheme assigned to strain rate to be inverted. Invert is available in live and cine replay.


SimultaneousEnables simultaneous display of 2D image and 2D image with Strain rate color.





Press ALT to access to the following modes:• Curved Anatomical M-Mode (see page 96)• Tissue Synchronization Imaging (see page 142)• Tissue Tracking (see page 123)

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• Strain rate (see page 130)• Strain (see page 136)

Strain rate Soft menu controls

Strain lengthDetermines the strain sample volume size.

SRI RejectAdjust the cut-off level of the low tissue velocity to be discarded when generating the color image. Rejected values are displayed in green.

CompressControls the amount of color compression. The color bar is adjusted accordingly.

TransparencyControl the degree of transparency of the strain rate color.

ThresholdControls the level of greyscale intensity that is used as threshold for color.



Use Averaging con-trols with caution so as not to obscure significant diagnos-tic information.



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Using Strain rate1. From TVI Mode, press ALT on the control panel and press

STRAIN RATE.2. Use the trackball to position the ROI frame over the area




Optimizing Strain rate• To reduce quantification noise (variance), the Nyquist limit

should be as low as possible, without creating aliasing. To reduce the Nyquist limit, reduce the scale while in TVI.

• To check for aliasing, freeze the loop and apply velocity trace (Press FREEZE and Q-ANALYSIS), see also Chapter 7, ’Quantitative Analysis’ on page 304).

• Strain rate provides velocity information only in the beam direction. The apical view typically provides the best window since the beams are then approximately aligned to the longitudinal direction of the myocardium (except near the apex).

• There is a trade-off between noise and spatial resolution controlled by the Strain length. To minimize noise the Strain length should be maximized.

• The maximum Strain rate that is color-coded can be adjusted using the SRI SCALE assignable. If set too low, most of the wall will show the color indicating maximum Strain rate. If set too high, the maximum Strain rate color is never reached.

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Strain

Strain overview

Figure 3-16: The Strain mode screen

1. Color sector marker2. Strain color bar3. Status window4. Soft menu5. Strain start and end markers6. Strain start and end from R-peak and Strain sample size

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Figure 3-17: The Strain Mode controls on the front panel

Strain calculates and color-codes the extent of tissue deformation (lengthening or shortening) relative to the original size over a given time interval, typically the systole.


1. Assignable keys:• Strain start R• Strain end R• Strain scale R• Frame rate• Invert R• TSI• Simultaneous R• Dual focus• Color maps R• Q-Analysis (Freeze only)• Cineloop (Freeze only)MORE• 2D widthALT• Curved AMM R• AMM R• Tissue Tracking R• Strain rate R• Strain R


3. Soft menu:• Strain Length R• Strain Reject R• Threshold R• Transparency R• Frequency• Lateral avg.• Radial avg.• Power• Cine compound R (Freeze only)


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Strain controls

Strain assignable controls

Strain startThe time after ECG R-peak when the strain calculation should start. The strain start time is displayed on the screen and is represented on the ECG by a red marker.

Strain endThe time after strain start when the strain calculation should end. The strain end time is displayed on the screen and is represented on the ECG by a red marker.

Strain scaleDefines the scale for the color coding of the tissue deformation.


InvertEnables the color scheme assigned to shortening and elongation tissue deformation to be inverted. Invert is available in live and cine replay.


SimultaneousEnables simultaneous display of 2D image and 2D image with Strain color.



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2D width (More menu)Controls the angular width of the 2D image sector.



Strain Soft menu controls

Strain lengthDetermines the strain sample volume size.

Strain RejectAdjust the cut-off level of the low tissue velocity to be discarded when generating the color image. Rejected values are uncolored.


TransparencyControl the degree of transparency of the strain color.



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Use Averaging con-trols with caution so as not to obscure significant diagnos-tic information.




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Using Strain1. From TVI Mode, press ALT on the control panel and press

STRAIN.2. Adjust STRAIN START close to the R-peak.3. Adjust STRAIN END near the T-wave.4. Use the trackball to position the ROI frame over the area




Optimizing Strain• From an optimized Strain rate display adjust strain tracking

to pick out the systolic phase.• The main use of Strain is to map negative systolic

deformation. This means that STRAIN START and STRAIN END should be adjusted to pick out the systolic phase of the cardiac cycle: Adjust STRAIN START close to the R-Peak. Adjust STRAIN END near the T-wave.

• Positive deformation can be mapped by pressing INVERT. STRAIN START and STRAIN END must then be adjusted to pick out the diastolic phase of the cardiac cycle.

• The maximum deformation that is color-coded can be adjusted using the STRAIN SCALE assignable. If set too low, most of the wall will show the color indicating maximum deformation. If set too high, the maximum deformation color is never reached.

• Strain provides velocity information only in the beam direction. The apical view typically provides the best window since the beams are then approximately aligned to the longitudinal direction of the myocardium (except near the apex).

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Tissue Synchronization Imaging (TSI)

TSI overview

Figure 3-18: The TSI mode screen

1. TSI start/end and TSI Cut-off2. TSI start and end markers3. QRS marker4. TSI color bar5. Status window6. Soft menu

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Figure 3-19: The TSI mode controls on the front panel

TSI calculates and color-codes the time from onset of QRS to a detected event, typically the time to peak systolic velocity.


1. Assignable keys:• Frame rate• TSI R• Simultaneous R• Color maps R• Cineloop (Freeze only)• Q-Analysis (Freeze only)MORE• 2D widthALT• Tissue Tracking R• Strain rate R• Strain RPHYSIO + MORE twice• QRS visible

2. Zoom3. Soft menu:

• TSI Cut-off R• Threshold R• Transparency R• Frequency• Power• Cine compound (Freeze only)


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TSI controls

TSI assignable controls

InvertInvert is available for TEE acquisitions. When applied, the time to peak negative velocity is calculated (instead of the time to peak positive velocity). Invert makes it possible to use TSI on TEE acquisitions where the image sector is inverted.


TSIStarts/stops TSI.


SimultaneousEnables simultaneous display of 2D image and 2D image with TSI color.




Press ALT to access to the following modes:• Tissue Synchronization Imaging (see page 142)• Tissue Tracking (see page 123)• Strain rate (see page 130)• Strain (see page 136)

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Physio assignable control

Press PHYSIO and MORE twice to access to the following control.

QRS visibleShows/hides the QRS marker on the ECG.

TSI Soft menu controls

TSI Cut-offControls the cut-off time: using this control it is possible to color all parts of the TSI image that has a time to peak less than a certain cutoff time.


TransparencyControl the degree of transparency of the TSI color.




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Using TSI1. From TVI, Tissue Tracking, Strain or Strain rate mode,

select TSI.2. Optionally adjust THRESHOLD.3. Use the trackball to position the ROI frame over the area




TSI markers adjustments

The default TSI markers settings are:• TSI start: 60 ms from onset of QRS (estimated aortic valve

opening)• TSI end: estimated End Systole + 200 ms.

The system can be configured to automatically adjust the TSI start marker to Aortic Valve Opening, providing that this event is measured. If not measured, the default setting is used (60 ms).

The system can be configured to automatically adjust the TSI end marker relatively to the to Aortic Valve Closure (AVC) or Mitral Valve Opening (MVO) event, providing that these events are measured. If not measured, the TSI end marker is adjusted relatively to the estimated End Systole.

The configuration alternatives are:• TSI start: 60 ms, 80, 100, 120, AVO or Manual control• TSI end: AVC - 200 ms, AVC - 150 ms, AVC - 100 ms,

AVC - 50 ms, AVC, AVC + 50 ms, AVC + 100 ms, AVC + 150 ms, AVC + 200 ms, MVO, MVO + 100 ms, MVO + 160 ms, MVO + 200 ms, MVO + 260 ms or Manual control.Note: Manual adjustment of TSI start and TSI end markers is available in Q Analysis. (Press MORE and adjust TSI START and TSI END.). To store the modified marker

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settings, press IMG STORE and choose the configuration setting Manual control to avoid automatic adjustment of the markers.

To configure TSI markers:1. Press CONFIG (F2) and select the category Measure.2. In the Measure category, select the sheet Advanced.3. In the Application specific parameters section adjust TSI

start and TSI end parameters by selecting a new value from the combo menu displayed upon selection.

Optimizing TSI• Use apical view when imaging.• Activate TSI from an optimized TVI or Strain rate display.

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Additional scanning features

LogiqViewLogiqView provides the ability to construct and view a static 2D image which is wider than the field of view of a given transducer. This feature allows viewing and measurements of anatomy that is larger than what would fit in a single image.

LogiqView constructs the extended image from individual image frames as the operator slides the transducer along the surface of the skin in the direction of the scan plane. The quality of the resulting image is somewhat user-dependent and requires some additional skill and practice to develop proper technique.

LogiqView is available with linear probes in 2D mode only.

Using LogiqView1. Perform a detailed examination of the anatomy/pathology.

Optimize parameters for tissue texture and visible window prior to activating LogiqView.

2. Press the assigned key LOGIQVIEW.3. To start acquiring the image, press 2D FREEZE key.

Scan slowly and in a uniform motion lengthwise.• Continuous contact is required throughout the length of

the extended image.• Always keep the transducer perpendicular to the skin

surface.• Keep the motion within the same scan plane.• Do not make abrupt changes in speed of motion.

4. If required, press 2D FREEZE again to restart the acquisition.5. To complete the scan, press FREEZE.6. Adjust the assigned rotary LOGIQVIEW ROTATE to rotate the

acquisition.7. Press IMG STORE.

CompoundCompound is a process of combining two, three (default) or five frames from different steering angles into a single frame. The

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combined single image has the benefits of reduced speckle noise, reduced clutter, and continuity of specular reflectors. Therefore, this technique can improve contrast resolution.

Compound is available with linear probes in 2D and Color Flow live modes. Compound is on by default.

Using Compound1. To toggle Compound on/off, press COMPOUND.2. To change the number of compounded frames, adjust

Compound frames to two, three or five frames.

B-FlowB-Flow provides an intuitive representation of non quantitative hemodynamics in vascular structures. B-Flow enables visualization of complex hemodynamics and highlights moving blood and tissue. There are no artifacts such as bleeding, blooming, or aliasing.

B-Flow is available Color flow mode with linear probes only.

Using B Flow1. While in Color flow, press the assigned key B-FLOW.2. Adjust the soft menu control TEXTURE GAIN. Increased gain

enhances hemodynamic.

The greater the speed, the better the image scatter density and size. If the scan direction is the same as the flow direction, then the image scatter is elongated; if the scan direction is the opposite as the flow direction, then the image scatter is tighter. Therefore, have the scan direction opposite to that of flow direction. Switch the way you hold the probe, with the probe orientation marker inferior to maintain correct orientation on the monitor. Flow starts from where the focal zone is located.

Blood flow imagingBlood flow imaging (BFI) is a Color flow mode with added speckle information. The speckle information visualizes the blood flow direction.

Note: when scanning in BFI triplex mode it is normal to have a time delay between the Doppler display/Doppler audio and the BFI color display.

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Using Blood flow imaging1. While in Color flow, press the assigned key BFI.2. Adjust the soft menu control BFI GAIN. Increased gain

enhances hemodynamic.See page 102 for Color flow image optimization.

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Chapter 4 Stress Echo

• Introduction ................................................................................... ... 152• Selection of a stress test protocol template .............................. ... 153• Image acquisition ......................................................................... ... 155

• Starting acquisition ...................................................................156• Continuous capture mode .........................................................160• Analysis ....................................................................................168

• Quantitative TVI Stress echo analysis ........................................ ... 173• Accessing QTVI Stress analysis tools ......................................175• Vpeak measurement .................................................................175• Tissue Tracking ........................................................................179• Quantitative analysis .................................................................180• References ...............................................................................180

• Editing/creating a template .......................................................... ... 181• Entering the Template editor screen .........................................181• Template editor screen overview ..............................................182• Editing/Creating a template ......................................................185

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IntroductionThe Vivid 7 ultrasound unit provides an integrated stress echo package, with the ability to perform image acquisition, review, image optimization, and wall segment scoring and reporting for a complete, efficient stress echo examination.

The stress package provides protocol templates for exercise, as well as, pharmacological stress examinations. In addition to preset factory protocol templates, templates can be created or modified to suit users' needs. Users can define various quad screen review groups, in any order and combination, that will suit their normal review protocol. When reviewing stress examination images, the images are viewed at their original image quality, and different post-processing and zoom factors may be applied to the images under review for effective image optimization. The protocol template may be configured for Continuous capture. In addition to standard wall motion scoring analysis, the user can perform quantitative stress analysis based on tissue velocity information (TVI).

A stress echo examination consists of three steps:• Selection of a stress test protocol template (page 153)• Image acquisition (page 155)• Stress analysis (page 168)• Quantitative Stress analysis (page 173)

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Selection of a stress test protocol template1. Press PROTOCOL to enter the stress echo mode.

The Protocol screen is displayed (see Figure 4-1) showing the default stress protocol for the current probe.

To create or edit a template see page 181.

2. To use the current template:Turn freeze off to initiate scanning.To use another template:Press the assignable TEMPLATE.The template list is displayed.

3. Trackball to the desired template.4. Press SELECT.5. Turn freeze off to initiate scanning using the new template.

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Figure 4-1: The Protocol screen

1. Projection selection2. Level3. Current acquisition4. Projection5. Group of views

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Image acquisitionImages are acquired in a pre-defined order, according to the selected template. The highlighted cell (green) of the matrix, displayed in the Clipboard window indicates which view is currently being acquired (see Figure 4-2). The names of both the view and the level for the current cell is displayed on the top corner of the image area and under the template matrix.

Figure 4-2: The stress mode acquisition screen

1. Current view label2. Template matrix3. Current view (Green cell)4. Timers

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Starting acquisitionTo use the Timer, see page 159.

1. Turn freeze off to initiate scanning.2. Perform a scan that conforms with the view that is

highlighted in the template matrix on the Clipboard window.Smart Stress is turned on by de-fault in factory tem-plates.

If the selected template has the option Smart Stress turned on (see page 184), a subset of the image acquisition settings for each view in the baseline level will be stored and automatically reused in the corresponding views in the next levels.

3. Press STORE.For further infor-mation on stress test configuration, see page 181.

• If the actual stress level is configured to preview cineloop before storing, use the cineloop controls to select the most appropriate heart cycle and, if desired adjust the loop markers (see ’Cineloop operation’ on page 58 for further information). Press STORE to save the selected cineloop.

• If the actual stress level is not configured to preview cineloop before storing, the system will automatically store the last cardiac cycle.

When storage of the cineloop is completed, the actual highlighted cell in the template matrix displays a 2D icon indicating that the view has been acquired. After storing the loop, the system automatically highlights the next view in the matrix to be acquired.

For further infor-mation on stress test configuration, see page 181.

Stress levels can be configured for side by side display/comparison of the reference loop from baseline or previous level and the loop to acquire (see Figure 4-3).

4. Repeat previous steps until all required views are completed.

The template used can be configured so that analysis is automatically started, displaying the first protocol group. The wall segment scoring diagrams for each view is displayed in the Parameters window on the right side of the screen (see Figure 4-9, page 170).

CAUTION

If using DICOM Server dataflow for stress-echo acquisition, images should not be saved to permanent archive before the complete protocol exam is acquired.

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Figure 4-3: Display of the Reference loop during acquisition

Protocol Pause function

During the stress acquisition it is possible to temporarily exit the protocol acquisition mode to acquire images in any mode outside the stress protocol.1. To temporarily exit the protocol mode, press:

• MORE and PROTO. PAUSE

OR• PROT. IN/OUT key on the control panel.

2. Acquire the desired images outside the protocol.3. Press MORE and PROTO. PAUSE, or PROT. IN/OUT to restart

the protocol acquisition mode and resume the stress acquisition.

Selecting a view during acquisition

A fixed protocol is provided for scanning, based on the selected template. The system automatically highlights the next view to

1. Current acquisition loop2. Corresponding reference loop

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be acquired in the template matrix, as images are stored. However, the order of scanning may be changed manually as follow:

Manual selection of a view during acquisition1. Use the arrow keys on the alphanumeric keyboard to

highlight the cell that represents the view that is to be acquired.The selected cell in the template matrix is highlighted in red, indicating non-default position and is blinking if it contains a previously stored acquisition.

2. Turn freeze off to initiate scanning.3. Scan and save the selected loop as explained in the

previous section.

After storage the system automatically highlights the next available view to be acquired.

Replacing an acquired image1. Use the arrow keys on the alphanumeric keyboard to

highlight the cell that represents the view that is to be replaced.The selected cell in the template matrix is highlighted in red, indicating non-default position.

2. Turn freeze off to initiate scanning.3. Scan and save the selected loop as explained in the

previous section.

After storage the system automatically highlights the next available view to be acquired.

Moving an acquired image

An Image can be moved from one cell to another during acquisition. There are two ways to move images:

Procedure 11. When in the Protocol screen, press MORE (assignable

menu).2. Press the assignable MOVE IMAGES.3. Trackball to the image to move (source cell).4. Press SELECT.5. Trackball to the destination cell.

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6. Press SELECT.The image is moved from the source cell to the destination cell.

Procedure 21. In the Protocol screen, trackball to the cell containing the

image to move (source cell).2. Press and hold down SELECT.3. With the SELECT key still depressed, trackball to the

destination cell.4. Release the SELECT key.

The image is moved from the source cell to the destination cell.

Stored images can-not be moved.

If the destination cell contains an image, the images from the source and destination cells will be exchanged when moving an acquired image.

Timers

Two timers can be displayed in the Stress mode acquisition screen, beside the template matrix (see Figure 4-4).

Figure 4-4: The timers in the acquisition screen

• T1 displays the elapsed time from the start of the stress examination.

• T2 starts when entering live scanning on the second stress level

1. Timers display

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Both T1 and T2 timers can be manually stopped and restarted during the acquisition from the System Menu (Press MENU on the control panel).

The display of T1 and T2 is user-configurable (see page 181).

Continuous capture modeContinuous capture mode enables the user to perform acquisition continuously for all views at any level depending on the selected template configuration. Continuous capture consists of temporary saving images acquired in a storage buffer. To enable best possible use of the limited storage buffer capacity, a Pause/Capture mode is provided, as opposed to the normal Freeze/Scan mode. The Pause mode enables scanning and live display on the screen, without any capture, thereby leaving the buffer available.

To run Continuous capture, the user has to select a template where this feature is activated (see page 181 about template configuration).

The buffer bar

When entering a level with Continuous capture enabled, a Buffer bar is displayed in the Info window (see Figure 4-5). The Buffer bar displays the following information:• The unit's scanning state:

• PAUSE (live scanning without storing)• CAPTURE (live scanning with storing to buffer)

• The percentage of the buffer that is filled• The buffer filling progression showed by a green filling

gauge• The capturing sessions, reflected by the red lines along the

Buffer bar

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Figure 4-5: The buffer bar in Continuous capture

Controlling the capture process

When entering a stress level with Continuous capture enabled, the unit is automatically set in Pause mode.1. Press IMAGE STORE or 2D FREEZE to start image capture.

“Capture” is displayed in the buffer bar, the gauge starts filling and the percentage of filled memory buffer increases (see Figure 4-5, page 161).

2. Press IMAGE STORE or 2D FREEZE again to stop capture.“Pause” is displayed in the buffer bar.

When 90% of the memory buffer is filled up, the text display in the buffer bar turns red.

1. Scanner's state2. Capture session3. Pause session4. Buffer gauge5. Percentage of filled buffer

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The unit enters Freeze mode automatically once the buffer is full and the captured loops are displayed in the Continuous capture selection screen (see below).

Running Continuous capture1. Do all your pre-stress acquisitions in the Cardiac

application.The application Ex-ercise should be used in order to get maximum continu-ous capture buffer.

2. Press PROTOCOL to enter the stress echo mode.The Protocol screen is displayed (see Figure 4-1, page 154).

3. Press Template.The template list is displayed.

4. Select the template Exercise 2x4.The Exercise proto-col template is auto-matically selected when the applica-tion Exercise is ac-tive.

5. Press Begin/Cont.6. Acquire the resting loops in all four views.7. Once the fourth loop is acquired the system enter into a

waiting mode where Continuous Capture is in pause state awaiting the patient to exercise.

8. When the patient is back on the bed, press IMAGE STORE or 2D FREEZE. The Continuous capture acquisition is started.

9. Acquire all your views. The memory buffer gauge increases (Figure 4-5). When memory filling exceeds 90%, the percent number turns red.

10. Press FREEZE to finish.11. Press the SELECT CYCLE assignable.

The Continuous capture selection screen is displayed (see Figure 4-6, page 165).If the buffer is filled up the system will automatically display the Continuous capture selection screen.Refer to the next section if additional image acquisition is necessary after the buffer is filled up.

12. Assign the cineloops to the four views (see page 165).A dialogue window is displayed asking whether the entire Continuous capture acquisition should be saved or not.

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Using Store all to save the entire loop may take up to 15 seconds on Loca-lArch-IntHD and several minutes on LocalArch-MOD.

13. Press Delete to discard the loopORPress Select later if you want to reselect any loops (open the capture again from the Protocol screen).ORPress Store all to keep the entire loop.

14. Perform Analysis and scoring (see page 168).

Continuous capture with additional image acquisitionIf the buffer is filled up before all the image acquisitions are done, additional loops can be stored in the clipboard before doing image assignment to the views:1. Perform Continuous capture as described above (steps 1

to 10).2. If the buffer is not filled up: press MORE and PROTOCOL

PAUSE, or the PROT. IN/OUT key on the control panel. Live scanning is activated.If the buffer is filled up: press Select later in the Continuous capture selection screen. Live scanning is activated.

3. Perform the additional acquisition (e.g. CFM, Doppler). Images will be stored outside the protocol.

4. In order to resume the stress echo exam and assign loops for the views from the Continuous capture buffer, press PROTOCOL.

5. Press on the Continuous capture icon on the lower left corner of the Protocol screen.The Continuous capture selection screen is displayed.

6. Assign the cineloops to the views (see page 165).A dialogue window is displayed asking whether the entire Continuous capture acquisition should be saved or not.

7. Press Delete to discard the loopORPress Store all to keep the entire loop.The normal procedure is to discard the loop. The loop is very big and will take a lot of disk space.

8. Perform Analysis and scoring (see page 168).

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Postponed image assignmentThe assignment of the cineloops to the views can be done on a later stage on a stored Continuous capture acquisition.1. Perform Continuous capture as described in ’Running

Continuous capture’ on page 162 (steps 1 to 11).The continuous capture loop is very big, and ending the exam may take sev-eral minutes if stor-ing through a slow network or storing to MOD.

2. Press Store all.The entire Continuous capture acquisition is stored. The examination can be ended and the image assignment, analysis and scoring can be done on a later stage.

3. Re-open the examination if necessary.4. Press PROTOCOL.

The Protocol screen is displayed.5. Press on the Continuous capture icon on the lower left

corner of the Protocol screen.The Continuous capture selection screen is displayed.

6. Assign the cineloops to the views (see page 165).7. Press Done when finished.8. Perform Analysis and scoring (see page 168).9. When exiting this patient a dialogue window is displayed

asking whether the remaining continuous capture images should be deleted.• Press Yes to delete the remaining continuous capture

imagesOR

• Press No to keep the entire continuous capture acquisition.

The normal procedure is to delete the remaining images as they take a lot of disk space.

Restart capture from the Continuous capture selection screen1. Press RESTART CAPTURE.

The recording in memory is deleted and the Continuous capture is started again.

Resume Continuous capture1. Press CONTINUE CAPTURE.

Resumes Continuous capture recording (only if the Continuous capture buffer is not full).

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Assigning and storing the loops

The cineloops captured in the buffer are assigned to the stress protocol views and stored from the Continuous capture selection screen (see Figure 4-6).

Figure 4-6: The Continuous capture selection screen

Assigning a cineloop to a view1. Trackball to the desired loop in order to assign it to a

particular view of the stress template.The frame of the loop is highlighted.

2. Press SELECT.

1. Rotate CHANGE PAGE assignable to display other pages.

2. Cycle number and total number of cycles3. Highlighted loop

4. Red bar: pause session5. Grey gauge: position of the highlighted loop

within the buffer area

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A pop-up menu is displayed with the view names of the template (see Figure 4-7).

The views that are already assigned are tick marked (see Figure 4-7).

3. Trackball to the required view name.4. Press SELECT.

The name of the view is displayed above the timers in the loop window.

5. Repeat steps Figure 1 through Figure 4 to assign loops to the other views of the level.

6. Press the assignable DONE when completed.A dialogue window is displayed asking whether the entire Continuous capture acquisition should be saved or not.

7. Press Delete to discard the loopSaving the entire loop takes 5 to 10 seconds on Loca-lArch-IntHD and several minutes on LocalArch-MOD.

ORPress Store all to keep the entire loop.The normal procedure is to discard the loop. The loop is very big and will take a lot of disk space.

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Figure 4-7: Loop assignment in Continuous capture

1. Assigned loop2. Highlighted loop3. Views pop-up menu4. Highlighted views5. Already assigned view

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AnalysisAnalysis consists of viewing previously saved loops and assigning scores to each cardiac segment, in order to quantify the function of the muscle, or wall motion.

Depending on the protocol configuration, the analysis stage can be started automatically after completion of the stress test or it can be started manually. In this case, the usual procedure consists of sequentially opening all image groups (if defined) and perform scoring from image to image.

The quad screen is the standard display for comparing heart cycles (Figure 4-9). The heart cycle loops in the display are synchronized to enable comparison. Each loop in the quad screen can be magnified, using the zoom control (see page 67).

Image selection for analysis

Images can be selected manually or from a pre-defined group in the Protocol screen.

Selection of images from a groupIf groups of images have been defined in the protocol template (see page 187), the user can select a group of images for analysis and sequentially analyze all images from all groups from within the analysis screen (see Figure 4-9, page 170).1. In a stress examination, press PROTOCOL.

A preview of the acquisitions is displayed.2. Trackball to a group in the Group list.

The frame of the images belonging to the group are highlighted.

3. Press SELECT to open images in the Analyze screen (see page 170).

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Figure 4-8: Image selection from the Protocol screen

Manual selection of images in the Analysis screen1. When currently in protocol analysis in the Stress analysis

quad screen (Figure 4-9), hold down SHIFT while performing steps 2 to 4.

2. Trackball to the first image to select in the Template matrix.3. Press SELECT.

The selected loop is displayed in the Stress analyze screen and the next window in the quad screen is automatically selected.

4. Repeat steps 2 and 3 to select other images.5. Depress SHIFT.

Manual selection of images in the Protocol screen1. In a stress examination, press PROTOCOL.

A preview of the acquisitions is displayed.2. Trackball to the first image to select.3. Press SELECT.

The frame of the selected loop is highlighted.4. Repeat steps 2 and 3 to select other images.

1. Select a Projection2. Select an image3. Select and open an Image group

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Alternative: Double click on the last se-lected image to open images.

5. Press ANALYZE to open images in the Analyze screen (see page 170).

Scoring acquired loops1. After image selection (see page 168), press ANALYZE.

The Stress Echo Analysis screen is displayed (see Figure 4-9).

Figure 4-9: The stress echo analysis screen (Quad screen)

To edit a score, se-lect it and choose a new score.

2. Trackball to a segment in one of the scoring diagrams and press SELECT.The Score pop-up list is displayed (see Figure 4-10).

3. Trackball to a score.

1. Selected loop (highlighted frame)2. Highlighted segment name3. Wall segment diagrams

4. Change page or enter next image group5. Exit Wall motion scoring6. displayed loops (highlighted frames)

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Alternative: Press the arrow heads at the bottom of the scoring diagram (see Figure 4-9)

4. Press SELECT.The score is displayed in the relevant segment area in the diagram (see Figure 4-10).

5. Repeat steps 1 through 3 to score relevant segments.6. Rotate the assignable CHANGE PAGE to display next group

of images.7. Repeat steps 1 through 3 to score relevant segments on the

new loops.

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Figure 4-10: Segment scoring

1. Selected segment2. Selected score

1. Scored segment

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Quantitative TVI Stress echo analysis

The Vivid 7 Ultrasound unit provides a Quantitative TVI (QTVI) Stress analysis package based on Tissue velocity information (TVI). The TVI data is stored in a combined format with grey scale imaging during stress examination.

When selecting a template supporting TVI data acquisition, the ultrasound unit will automatically store TVI information, generally for the apical views of the stress examination.

The QTVI Stress analysis option currently applies only to Dobutamine stress-echo.

Wall Motion Scoring remains the basis for the diagnosis of CAD in stress echocardiography. QTVI Stress may be used as a guidance tool to check this interpretation.

The current version of QTVI Stress is based on the assessment of peak velocity at peak Dobutamine stress (see reference 1 on page 180). The normal ranges have been validated in the “average” patient presenting for stress testing. The velocity cutoff values for the Vpeak measurement will not work in the following cases: • Submaximal stress (<85% predicted max HR)• Patients at extremes of age (<40 or >70)• Previous myocardial infarction / revascularization• Previous heart-failure / cardiomyopathy / hypertrophy /

arrhythmia / aortic regurgitation

WARNING

QTVI Stress analysis is meant as a guide to wall motion scoring.

Diagnosis must not be based on results achieved by QTVI Stress analysis only.

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Velocity measure-ments in mid and basal segments of the myocard will contain contribu-tions from the api-cal region of the myocard. E.g. if measured value in a mid segment is be-low the cutoff value for this segment then this might re-late to a reduced function in the mid or apical region.

The velocity cutoff values are based on placing the sample volume at center of each cardiac segment at start of systole, the left ventricle myocardial segments are defined by the American Society of Echocardiography 16 segments model. However, the velocity cutoff model does not cover the apical segments (due to low velocities and segment orientation), (see side note).

Tissue Doppler does not have perfect site-specificity because of tethering by adjacent segments. Thus, although an ischemic segment has little thickening (and therefore could be expected to show low velocity), measured velocity may be influenced by local tethering, reflecting contraction in surrounding segments. Conversely, a normal segment may have its velocity reduced by an adjacent segment with reduced velocity. This tethering effect may decrease the sensitivity for single vessel disease, but nonetheless the sensitivity and specificity of the cut-offs are approximately 80% (see reference 1 on page 180).

Three different analysis tools based on TVI data are available:• ’Vpeak measurement’ on page 175, enables the display

of a tissue velocity trace for a selected region of a previously scored segment through the entire heart cycle. In addition Vpeak is color-coded on the 2D image. From the velocity trace, the user can estimate the peak systolic velocity (see reference 1 on page 180).This tool is available in views from peak levels only and only when a segment has been scored in one of these views.

• ’Tissue Tracking’ on page 179, enables visualization of the systolic contraction of the heart by color-coding the myocardial displacement through the systole.

• ’Quantitative analysis’ on page 180, enables further quantitative analysis based on multiple tissue velocity traces.The quantitative analysis is described in Chapter 7, ’Quantitative Analysis’ on page 304.

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Accessing QTVI Stress analysis toolsThe three QTVI Stress analysis tools are entered by pressing a dedicated button on the scoring diagram (see Figure 4-11) of the selected view. Only views with TVI data acquired will display QTVI Stress tools buttons on the respective diagrams.

Figure 4-11: QTVI Stress tools buttons

Vpeak measurementThis tool enables the user to generate a tissue velocity profile for a given wall segment through the entire heart cycle and display color-coded Vpeak in tissue.

From the velocity trace, the user can determine whether the systolic Vpeak is over or under a clinically determined velocity threshold (see reference 1 on page 180) to confirm the wall motion scoring.

1. Vpeak measurement (V-peak measurement is displayed in views from peak levels and only after scoring.)

2. Tissue Tracking3. Quantitative analysis

CAUTION

QTVI Stress can be used only in conjunction with wall motion scoring analysis, as a guiding tool.

When activating QTVI Stress, the measurement applies only to the currently highlighted segment for the current level and projection view.

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To display a Vpeak measurement1. Perform segment scoring as described on page 170.

When performing scoring i a view from a peak level, the Vpeak measurement button (V) is displayed in the corresponding diagram.

2. In the Scoring diagram, press V.The trackball cursor is changed to sampling area and the scored peak views are updated showing:• A diagram with the current segment highlighted (scoring

bullet with a ring) and the segment's velocity cutoff (see Figure 4-12).

See page 178 for further information on Vpeak measure-ment interpreta-tion.

• Color-coded velocity in tissue. The color-coding convention is as follow:- Green: Velocities above threshold value + 5%- Yellow: Velocities near threshold (+/- 5% interval)- White: Velocities below threshold value - 5%

• A result window to display tissue velocity profile, shown when moving the sampling area in the view.

3. In the 2D sector, trackball the sampling point over the wall area corresponding to the current segment (shown as the highlighted segment in the diagram).A tissue velocity profile for the actual segment is generated in the Result window (see Figure 4-12).

4. Use SEGMENT SELECT assignable to analyze the other segments in the peak view,OrSelect another scoring bullet in the diagram in one of the peak views.

Turn-off the Vpeak measurement tool1. Trackball to one of the V button in the peak view scoring

diagrams.2. press SELECT in the trackball area.

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Figure 4-12: Vpeak QTVI Stress display

1. Threshold for current segment (green)2. Sampling point3. Current segment4. Vpeak threshold for current segment

5. Color-coded tissue velocity:6. Result window with tissue velocity profile

Color-coding (velocity thresholds and tissue):• Green: velocities above threshold value• Yellow: velocities near threshold (0 to -10% interval)• White: velocities below threshold value - 10%

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V-peak measurement interpretation

The systolic Vpeak in the tissue velocity profile is automatically detected and highlighted by a vertical bar (see Figure 4-12). The automatically detected Vpeak should be visually verified by the user. In addition Vpeak thresholds are displayed as color-coded horizontal lines (see Figure 4-12). These thresholds represent statistical guideline values for peak velocity at peak stress level (Dobutamine stress procedure) for the three apical views. Only threshold values for basal and mid-segments for each apical view are defined (see reference 1 on page 180). The result is highlighted by a color-coding of the thresholds lines, the color-coding in the 2D image and the scoring bullet (see Figure 4-12).

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Tissue TrackingTissue Tracking calculates and color-codes the displacement in tissue over a given time interval. The displacement is found as the time integral (sum) of the tissue velocities during the given time interval. The color-coded displacements calculated in the myocardium are displayed as color overlay in the respective acquisition window.

By studying the color patterns generated in the different segments, the user can confirm the standard segmental wall motion scoring at peak levels.

To display Tissue Tracking1. Trackball to a loop with TVI data (usually an apical view at

peak level).2. Press SELECT on the control panel.3. Trackball to the corresponding Wall segment diagram.4. Press T on the Wall segment diagram field (see

Figure 4-11, page 175).The Tissue Tracking color overlay is displayed in the Acquisition window.

Figure 4-13: Tissue Tracking display

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Quantitative analysisQuantitative analysis enables further analysis based on multiple tissue velocity traces. Quantitative analysis is performed using the Quantitative analysis package described in Chapter 7, ’Quantitative Analysis’ on page 304.

To start quantitative analysis1. Trackball to a loop with TVI data (usually an apical view at

peak level).2. Press SELECT on the control panel.3. Trackball to the corresponding Wall segment diagram.4. Press Q on the Wall segment diagram field to launch the

Quantitative analysis package (see page 304).

References1. Application of Tissue Doppler to Interpretation of

Dubotamine Echocardiography and Comparison With Quantitative Coronary Angiography. Cain P, Baglin T, Case C, Spicer D, Short L. and Marwick T H. Am. J. Cardiol. 2001; 87: 525-531

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Editing/creating a templateThe stress package provides protocol templates for exercise as well as pharmacological stress examinations. The user can create new templates or modify existing templates to suit the individual needs. Up to ten projections and fourteen stress levels can be created in a template.

Templates created may be temporary, used only during the current examination, or saved as new templates, for future use and reference. The editions that may be performed include:• Adding/deleting levels and projections, page 185• Assigning new labels to levels and projections, page 186• Defining level options, page 186• Defining new groups, page 187

Templates are edited/created from the Template editor screen.

Entering the Template editor screen1. Press PROTOCOL to enter the stress echo mode.2. Press the assignable TEMPLATE.

The Template pop-up menu is displayed.3. Trackball to Template Editor.4. Press SELECT.

The Template editor screen is displayed (see Figure 4-14).

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Template editor screen overview

Figure 4-14: The Template editor screen

Template

Parameter Description

Template:• select a pre-defined template from the

pop-up menu. The Protocol template preview (see below) is updated accordingly.

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Protocol template preview

Template settings


Protocol template preview:• displays an updated preview of the

template accordingly to the settings applied.

• To change Projection and Stress level labels, select a pre-defined label from the pop-up menu or press SELECT in the actual label field and type a new name.

Q Stress acquisition: enables TVI data acquisition for QTVI Stress analysis.


Template settings:• Cycles: select the number of cineloop

heart cycles to store for each level from the drop-down menu.

• Continuous capture:

: enables continuous image acquisition throughout the level. The images acquired are temporarily stored in the unit's storage buffer.

• Preview of store:

: enables review and adjustment of cineloops before storage (see page 345 for further information).

• Show reference:

: displays a dual screen with the reference level (first or previous level) on the left and the live image on the right.

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Other options


Grid size:• Enter the number of levels and projections

for the selected template.

Timers:

• : starts T1 and T2 timers automaticallyAuto-start analysis:

• : displays the Stress Echo Analysis screen when the last acquisition is performed.

Smart Stress:

• : stores a subset of the image acquisition settings (geometry incl. zoom, gain, compress, reject, power...etc) for each view in the protocol. Smart Stress enables to set image acquisition settings for each view at baseline level and automatically get the same image settings in the corresponding views in the next levels.In Continuous capture acquisition at peak stress, the active cell must be moved manually through the views using the arrow buttons (or foot pedal).

Reference image:• When Show Reference is selected (see

page 183), selects either corresponding baseline loop or corresponding loop from the previous level to be displayed as reference image during acquisition.

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Pre-defined groups

Editing/Creating a template

Selecting a base template to edit1. Trackball to the Template pop-up menu on the upper left

corner of the Template editor screen.2. Press SELECT on the arrow.

The Template pop-up menu is displayed.Determine the re-quired number of projections and lev-els you need and se-lect the most appropriate founda-tion template.

3. Trackball to the base template to edit.4. Press SELECT.

The selected template is displayed in the Protocol template preview field, showing the levels and projections and their labels.

Adding/deleting levels and projections1. Enter the number of levels and projections in the Grid size

field (see Figure 4-14).The new grid size is displayed in the Protocol template preview field.

2. Press New Template to create a new template.


Pre-defined groups:• Shows the image groups created.• New group: creates a new image group.

Select the desired images on the template preview (see page 187).

• Update group: edits a selected group after new loop selection on the template preview (see page 187).

• Delete group: deletes selected group (see page 187).

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OrPress Save Template to update the base template.

The timers can also be started or stopped at any time during stress exam-ination using the assignables T1 and T2 on the control panel.

Display timer(s)1. Check the box(es) to display timer(s) as specified (see

Figure 4-14).

Start analysis automatically1. Check Auto start analysis to display the Stress Echo

Analysis screen when the last acquisition is performed.

Assigning new labels to levels and projections1. In the Protocol template preview field, Trackball to the Label

field that is to be changed.2. Select the Label pop-up menu and press SELECT on the

desired pre-defined label.Or• If the Label field is empty:

Press SELECT and enter the label or projection name.• If the Label field has a name to be changed:

Press SELECT twice (double-click) to highlight the text to be replaced and enter the new label or projection name.

Configuring levels

The following options can be set up for each level:

Number of cycles to be stored in the cineloop:1. Enter the desired number in the Cycles field.

Up to four cycles/cineloop can be stored.

Continuous capture1. Check Continuous capture if continuous image

acquisition throughout the level is desired.When Continuous capture is selected, preview of cineloop and reference display (see below) during acquisition are not possible.

Preview of store1. Check Preview of store if review and adjustment of

cineloops before storage is desired.

Show reference1. Check Show reference if the display of the corresponding

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reference loop is desired during acquisition (dual screen mode).

Adding a group1. In the Protocol template preview field select the cells to be

part of the group.2. In the Pre-defined group field, press New group.

A dialogue box is displayed asking the user to enter a name for the new group.

3. Enter the group name.4. Press OK.

The new group is displayed in the Pre-defined group field.

Updating an existing groupA selected group is highlighted by a yellow frame.

1. In the Pre-defined group field, select the group to edit.The selected cell are highlighted in the Protocol template preview field.

2. Either select (a) new cell(s) to add to the group or deselect (an) existing cell(s) to remove from the group.

3. Press Update group in the Pre-defined group field.The display in the Protocol template preview field is updated accordingly.

Deleting a groupA selected group is highlighted by a yellow frame.

1. In the Pre-defined group field, select the group to delete.2. Press Delete group.

The group is removed from the list in the Pre-defined group field.

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Chapter 5 Contrast Imaging

• Introduction ................................................................................... ... 189• Data acquisition ........................................................................189• Quantification ............................................................................190

• Data acquisition ............................................................................ ... 192• Left Ventricular Contrast Imaging .............................................192• Myocardial Contrast Imaging ....................................................197• Real-Time Coded Phase Inversion (RTCPI) .............................205• Vascular Contrast Imaging .......................................................213• Abdominal Contrast Imaging ....................................................217• Rodent Contrast Imaging ..........................................................221

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IntroductionThe two basic steps of contrast imaging are data acquisition and quantification. Data acquisition is described in this chapter. Quantification is described in Chapter 7, ’Quantitative Analysis’ on page 304.

Data acquisition

Note: This system is designed for compatibility with commercially available contrast agents. Because the availability of these agents is subject to government regulation and approval, product features intended for use with these agents may not be commercially marketed nor made available before the contrast agent is approved for use. Advanced contrast features are only enabled on systems for delivery in countries or regions where the agents are approved for use or for investigational or research use.

Cardiac imaging

Three main contrast acquisition applications are available for cardiac imaging:• Left Ventricular Contrast imaging: The LV Contrast and

LVO Stress applications are optimized for endocardial border detection and assessment of wall motion and wall thickening. LVO Stress is optimized for higher heart rate. Both applications require the LVO Contrast option enabled.

• Myocardial Contrast imaging: optimized for assessment of myocardial perfusion. The MC Contrast application is pre-configured to give access to high power settings of the Coded Harmonic Angio technique, which combines the strength of harmonic imaging and power Doppler. MC Contrast application shall be used in intermittent mode. The

WARNING

Appropriate training

Only physicians or echo technicians who have received appropriate training can use the Contrast applications.

WARNING

Always read and follow carefully the manufacturer instructions on the contrast agent label.

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application is intended for clinical research and requires the Advanced Contrast option enabled.

• Real-time Coded Phase Inversion (RTCPI): is intended for visualization of myocardial perfusion by the use of ultrasound contrast agents. As opposed to MC Contrast, RTCPI will perform myocardial contrast imaging in a non-triggered mode. The application is intended for clinical research and requires the Advanced Contrast option enabled.

Non-cardiac imaging

The following non-cardiac contrast acquisition applications are available.• Abdominal Contrast imaging: optimized to visualize

contrast in non-beating organs, e.g. liver and kidneys. Requires the Vascular/Abdominal Contrast option enabled.

• Vascular Contrast imaging: optimized to visualize contrast in larger vessels, e.g. carotid artery. Requires the Vascular/Abdominal Contrast option enabled.

• Rodent Contrast imaging: optimized to visualize contrast in rodents, e.g. rat heart or rat liver. This application is intended for pre-clinical research only. Requires the Advanced Contrast option enabled.

QuantificationRefer to Chapter 7, �’Quantitative Analysis�’ on page 304.

Quantification enables the user to perform the following analysis:• Time-Intensity analysis: allows instant time-intensity

calculation from up to eight regions of interest (Angio power or tissue intensity display).

• Curve fitting analysis: for research studies of myocardial

WARNING

MC Contrast and RTCPI applications are for research purposes only. Diagnosis must not be based on results achieved by contrast analysis alone.

WARNING

Abdominal and Vascular Contrast applications are for research purposes only. Diagnosis must not be based on results achieved by contrast analysis alone.

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perfusion rates using contrast agents.• Arbitrary Anatomical M-Mode (Curved and Straight):

M-Mode applied to intensity data calculates and color-codes tissue and Angio intensity along a path drawn by the operator vs. time.

WARNING

Misdiagnosis based on image artifacts

Misdiagnosis in ultrasound contrast images may be caused by several artifacts, most importantly:

Motion artifacts: gives rise to signals independently of contrast presence. This may be caused by patient movement; including respiration, or by probe movement influenced by the operator.

Regional drop outs: caused by unintentional destruction of the contrast agent, too low concentration of contrast agent, poor acoustic penetration due to rib/lung shadows or system failing to detect the contrast agent due to erroneous settings induced by the operator.

Tissue harmonics: gives contrast-like signals independently of the presence of contrast agent.

The field of myocardial perfusion using contrast agents is still a research field. The myocardial applications RTCPI and MC Contrast are research tools for the development of this field. Default machine settings are set to minimize the amount these artifacts, but the operator has to take these artifacts into account while analyzing the data and confirm the results using other techniques.

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Data acquisition

Left Ventricular Contrast ImagingThe Left Ventricular (LV) Contrast application has an optimized system preset for optimal resolution of endocardial borders and for optimal assessment of wall motion and wall thickening.

The LV Contrast application may help to identify LV thrombus and evaluate wall motion.

LV Contrast overview

Figure 5-1: The LV Contrast acquisition screen

1. Status window2. Soft menu

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Figure 5-2: The LV Contrast controls on the front panel


1. Application2. Probe3. Gain R4. Assignable keys:

• Width• Frequency• Focus• Frame rate• Up/Down R• Left/Right R• T1• Cineloop (in Freeze, only)• B color maps RMORE menu• T2

5. Soft menu• Power• Compress R• Reject R• DDP R• Dynamic Range• Tilt• Edge Enhance• Diff On/Off

4

5

3

1

2

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LV Contrast controls

LV Contrast assignable controlsWidth

Controls the size and angular width of the image sector. A smaller angle generally produces a scan with a higher frame rate.

FrequencyEnables the adjustment of the probe's operating frequency. A higher frequency gives better resolution. Frequency is also used to switch between Octave (single-pulse) and CPI (multi-pulse).

FocusChanges the location of the focal point. A triangular marker on the depth scale along the image sector indicates the position of the focal point.

Two triangular markers pointing towards each other (><) indicate that Coded Phase Inversion (CPI) is being used. CPI is a multi-pulse technique with focus at the indicated depth.

Frame rateLower frame rate gives better resolu-tion.

Controls the line density.

Up/DownEnables the 2D image to be flipped 180 degrees.

Left/RightEnables the display of a mirrored image. When applied, the reference marker V moves to the other side of the image.

T1/T2 (Timers)Contrast timer: press T1 once to start the timer, press again to stop the timer. A second timer (T2) is available from the More menu.

B Color mapsDisplays a 2D maps menu to optimize the grey scale presentation. The menu enables an option from a list of non-linear grey-curves or different 2D-colorized curves to be selected.

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LV Contrast Soft menu controlsPower

Too high Power lev-el will destroy the contrast agent.

Controls the amount of acoustic power applied to the transmitted pulse.

CompressControls the degree of image contrast.

RejectControls the Echo rejection level. When increased, low level echoes are rejected and appear darker in the 2D image.

DDP (Data Dependant Processing)Performs temporal processing, which reduces random noise without affecting the motion of significant tissue structures.

Dynamic RangeControls the image contrast. A high dynamic range setting gives a softer image.

TiltEnables the axis of the 2D image to be tilted to the left or to the right. By default the axis of the 2D image is vertical.

Edge EnhanceControls the image processing related to the extent of edge enhancement applied.

The Diff control de-creases the frame rate and the number of focal zones when turned on.

Diff on/offAffects the level of reverberation in the image. The reverberation in the image is reduced when Diff control is turned on.

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Running LV Contrast

The LV Contrast application works with the M3S, 3S, M4S, 5S, 3V and 6T probes.

To select LV Con-trast application without changing the current probe, press APPL. on the control panel.

1. Press PROBE on the control panel.A list of the connected probes is displayed.

2. Trackball to the desired probe supporting the LV Contrast application.The Application menu for the selected probe is listed.

3. Trackball to LV Contrast application.4. Press SELECT to launch the application.5. Perform the acquisition.

Optimizing LV Contrast

The default setting for the LV contrast application is optimized for contrast detection and not tissue imaging. Therefore, with some patients it may be difficult to orient the probe before the contrast agent arrives. In this case we recommend to stay in the Cardiac application until the contrast agent is observed in the right ventricle and quickly switch to the LV Contrast or LVO Stress application.

If a swirling pattern is observed and persists after the LV cavity has been filled with contrast, the power should be reduced until homogenous opacification is obtained.

WARNING

Always read and follow carefully the manufacturer instructions on the contrast agent label.

CAUTION

Too high Power setting will destroy the contrast agent in the LV cavity.

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Myocardial Contrast ImagingThe main goal of the Myocardial (MC) Contrast application is in the assessment of myocardial perfusion.

Note: the MC Contrast application requires the Advanced Contrast option enabled.

The MC Contrast application is pre-configured to give access to high power settings of the Coded Harmonic Angio technique, which combines the strength of harmonic imaging and power Doppler. MC Contrast application shall be used in intermittent mode.

WARNING

This application is intended for clinical research only. Diagnosis must not be based on results achieved by contrast analysis alone.

CAUTION

This application may not be available on your system. Contrast agent for this application are undergoing clinical trial and therefore, not yet available in the United States.

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MC imaging overview

Figure 5-3: The MC Contrast acquisition screen


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Figure 5-4: The MC Contrast controls on the front panel



• 2D Width• ECG Trig 1• Dual Trig Delay• ECG Trig interval• Simultaneous R• ECG Trig• Dual Trig• Cineloop (in Freeze, only)• T1• Color maps R• Cineloop (in Freeze)MORE menu• Horizontal sweep• Frequency• Focus• T2

5. Soft menu 2D Live:• Tilt• Power• Sample volume• Frame rate• Color threshold R• PRF• Low velocity reject• Radial average• Lateral average

6. Trackball• ROI position• ROI size

4

5

3

1

2

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MC Contrast controls

MC Contrast assignable controls2D Width

Changes the width of the tissue sector while in Angio. This control may be used to control the frame rate. A narrow sector sector produces a scan with higher frame rate. The color sector width is adjusted with the trackball (see description below).

ECG Trig 1Specifies the delay (ms) from R-wave to the triggered frame.

Dual Trig DelaySpecifies the delay (ms) from the first triggered frame (ECG Trig 1) to the second triggered frame. Only active when Dual Trig is turned on.

ECG Trig IntervalControls the number of cardiac cycles between triggered images.

SimultaneousEnables simultaneous display of 2D B-mode and 2D Angio Color mode.


Dual TrigEnables intermittent imaging with two ECG triggered frames (primary and secondary). In this mode the scanner also activates a dual display, where the primary frames are displayed on the left side, whereas all frames (both primary and secondary) are displayed on the right side.


Color MapsDisplays a Color map menu to optimized the color presentation.

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Horizontal sweepAdjusts the refresh on the ECG.

FrequencyEnables the adjustment of the probe's operating frequency. A higher frequency gives better resolution.


MC Contrast Soft menu controls (2D Angio mode)Tilt

Enables the axis of the 2D image to be tilted to the left or to the right. By default the axis of the 2D image is vertical.

PowerControls the amount of acoustic power applied to the transmitted pulse.

Color thresholdToo high a Power level will destroy the contrast agent.

Controls the level of greyscale intensity that is used as a threshold for color overlay.

PRF (Pulse Repetition Frequency)Adjusts the repetition rate of the Doppler pulses transmitted to acquire the data for color mapping.

Lower frame rates give better resolu-tion.

Frame rateControls the line density.

Low Velocity RejectControls the extend of low velocity removal.

Sample volumeControls the size of the color angio area. Adjustment of the Sample volume may affect the PRF setting.

Radial AveragingSmooths the image by averaging the data collected along the same radial line.

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Lateral AveragingSmooths the image by averaging data collected along the same lateral line. An increase of the lateral averaging will reduce noise, but will also reduce the lateral resolution.

Trackball controlsROI (Region Of Interest) size

When the trackball command Size is selected (see also ’Trackball operation’ on page 57), the height and width of the color area is adjusted by rolling the trackball (up/down, right/left).

ROI (Region Of Interest) positionWhen the trackball command Pos (position) is selected (see also ’Trackball operation’ on page 57), the position of the color area is adjusted by rolling the trackball.

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Running MC Contrast

The MC Contrast application works with the M3S, 3S, M4S and 5S probes.

To select MC Con-trast application without changing the current probe, press APPL. on the control panel.


2. Trackball to the desired probe supporting the MC Contrast application.The Application menu for the selected probe is listed.

3. Trackball to MC Contrast application.4. Press SELECT to launch the application.5. Press COLOR to start color angio.6. Press the assignable ECG TRIG.7. Adjust the assignable TRIG 1.

The delay (ms) is displayed in the Status window (see Figure 5-3, page 198).

8. Adjust the assignable ECG TRIG INTERVAL.The number of heart cycles between the frame acquisition is displayed in the MC Contrast Status window under Trigger (Every (HB)).

9. Adjust ACTIVE GAIN from the Control Panel.10. If desired, press the SIMULTANEOUS assignable to prompt a

dual screen for side by side display of 2D B-mode and 2D Angio mode.

11. Press DUAL TRIG if dual triggering is desired, and adjust DUAL TRIG DELAY.

12. Acquire the baseline images.13. Press IMAGE STORE to save the baseline acquisition.

WARNING

Premature ventricular contractions (PVC's) have been reported in patients with the combination of end-systolic high MI triggered ultrasound and a contrast agent. Precautionary actions are built into the system, not allowing MI above 1.0 for contrast imaging. However, caution should be taken in this situation.

Literature: Van der Wouw P.A., Brauns A.C., Bailey S.E., Powers J.E., Wilde A.A.A. “Premature ventricular contractions during triggered imaging with ultrasound contrast” J. Am. Soc. Echocardiography, 13 (4), pp. 288-294, 2000

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The contrast solu-tion should be pre-pared just before injection.

14. Prepare the Contrast agent as described by the manufacturer.

15. Administrate the Contrast agent.16. Acquire the contrast images.17. Press FREEZE.18. Press CINELOOP.

See also page 58 about cineloop oper-ation.

19. Adjust LEFT MARKER and RIGHT MARKER to define the cineloop to transfer.

20. Press IMAGE STORE to save the contrast acquisition.

Optimizing MC Contrast• A good baseline image is the key for successful myocardial

contrast imaging. Using Coded Harmonic Angio, no colors should be found in the myocardium at baseline.

• The ECG triggering position should be adjusted to avoid wall motion artifacts.

• At rest a triggering interval from 1:3 to 1:5 should be used to allow for adequate contrast filling in normal regions. At peak stress a triggering interval of 1:1 is recommended.

• If there is poor contrast in a particular region adjust the focus to this depth.

• If there is too much filling or blooming, decrease the contrast dose or concentration (if attenuation appears) or decrease the sample volume size.

• In dual triggering, minimum distance between the primary and the secondary frame is given by 1/(frame rate). To get the secondary frame closer to the primary frame, increase frame rate by reducing the 2D width.

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Real-Time Coded Phase Inversion (RTCPI)RTCPI is intended for visualization of myocardial perfusion by use of ultrasound contrast agents. As opposed to MC Contrast, RTCPI performs myocardial contrast imaging in a non-triggered mode.

Note: the RTCPI application requires the Advanced Contrast option enabled.

WARNING


CAUTION


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RTCPI overview

Figure 5-5: The RTCPI Contrast acquisition screen


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Figure 5-6: The RTCPI controls on the front panel



• Width• Frequency• Focus• Flash frames• Flash• ECG Trig• T1• Cineloop (in Freeze)• B color maps RMORE menu• Flash gain• Flash power• Up/Down R• Left/Right R• T2

5. Soft menu:• Power• Frame rate• Compress R• Reject R• DDP R• Dynamic Range• Tilt

6. Trackball

4

5

3

1

2

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RTCPI controls

RTCPI assignable controlsWidth

Controls the size and angular width of the image sector. A smaller angle generally produces a scan with a higher frame rate.

FrequencyEnables the adjustment of the probe's operating frequency. A higher frequency gives better resolution. A lower frequency gives better penetration and contrast detection. Frequency is also used to switch between Octave (single-pulse) and CPI (multi-pulse).


Two triangular markers pointing towards each other (><) indicate that Coded Phase Inversion (CPI) is being used. CPI is a multi-pulse technique with focus at the indicated depth.

FlashEnables the transmission of a pulse with the maximum allowed power over a given time. The purpose of the Flash function is to destroy all contrast agent in the scan plane to create an “artificial” baseline image. The actual MI during Flash is displayed in the Status bar at the bottom of the screen.

Flash framesControls the length of the Flash specified in number of frames. The duration of the Flash depends on the actual frame rate.



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B Color mapsDisplays a 2D maps menu to optimize the grey scale presentation. The menu enables an option from a list of non-linear grey-curves or different 2D-colorized curves to be selected.

Up/DownEnables the 2D image to be flipped 180 degrees.

Left/RightEnables the display of a mirrored image. When applied, the reference marker V moves to the other side of the image.

Flash gainControls the (receive) gain of the Flash separately.

Flash powerControls the power (amplitude) of the Flash. The maximum allowed power is default.

RTCPI Soft menu controlsPower

Too high a Power level will destroy the contrast agent.

Controls the amount of acoustic power applied to the transmitted pulse.

Frame rateLower frame rates give better resolu-tion.

Controls the line density.

CompressControls the degree of image contrast.

RejectControls the Echo rejection level. When increased, low level echoes are rejected and appear darker in the 2D image.

DDP (Data Dependant Processing)Performs temporal processing, which reduces random noise without affecting the motion of significant tissue structures.

Dynamic RangeControls the image contrast. A high dynamic range setting gives a softer image.

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TiltEnables the axis of the 2D image to be tilted to the left or to the right. By default the axis of the 2D image is vertical.

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Running RTCPI

The RTCPI application works with the M3S and M4S probes.To select RTCPI ap-plication without changing the cur-rent probe, press APPL. on the control panel.


2. Trackball to the desired probe supporting the RTCPI application.The Application menu for the selected probe is listed.

3. Trackball to Real Time CPI application.4. Press SELECT to launch the application.5. Adjust the ACTIVE GAIN from the Control Panel.6. Acquire the baseline images.7. Press STORE to save the baseline acquisition.

The contrast solu-tion should be pre-pared just before injection.

8. Prepare and administer the contrast agent as described by the manufacturer.

9. Press FLASH when the contrast agent has reached a stable level (infusion) or just after peak (bolus injection).The contrast agent is destroyed in the myocardium.

10. Wait approximately ten heartbeats observing contrast wash-in.

11. Press FREEZE.12. Press CINELOOP.

Note: the application can be preset to automatically save N cardiac cycles in Config (F2)/Imaging/application.

See also page 58 about cineloop oper-ation.

13. Adjust CYCLE SELECT and NUMBER OF CYCLES to define the cineloop to transfer.

Storage of real time data takes consider-able space digitally. Be aware of this when selecting more than one cineloop for storage.

14. Press STORE to save the contrast acquisition.

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Optimizing RTCPI

RTCPI is by default scanning in low power mode to avoid destruction of slow moving contrast in the myocardium. This setting is required for real time contrast imaging, but is sub-optimal for tissue imaging.• To obtain good baseline images, the power may be

increased prior to contrast injection, but must be reset to its default value before contrast injection or infusion to avoid destruction of the contrast agent.

• If the patient is difficult to image, the power may be slightly increased to get sufficient signal from the contrast agent.

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Vascular Contrast ImagingVascular Contrast is intended for visualization of ultrasound contrast agents in large vessels (e.g. carotid artery and femoral artery).

The Vascular Contrast application works with the 7L, 10L and M12L probes. Probes with lower frequency gives better contrast detection.

The application uses Coded Phase Inversion (CPI) (greyscale) to maximize the contrast detection and visualization.


Note: The Vascular Contrast application requires the Vascular/Abdominal Contrast option enabled.

WARNING


CAUTION


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Vascular Contrast overview

Figure 5-7: The Vascular Contrast acquisition screen


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Figure 5-8: The Vascular Contrast controls on the front panel



• Width• Frequency• Focus• Flash frames• Logiq View• Flash• PRF• T1• Cineloop (in Freeze)• B color maps RMORE menu• Flash gain• Flash power• Up/Down R• Left/Right R• T2

5. Soft menu:• Power• Dynamic Range R• Reject R• Persistence R• Speckle reduction R• Edge Enhance

6. Trackball

4

5

3

1

2

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Vascular Contrast controls

Vascular Contrast assignable controlsThe Vascular contrast assignable controls are similar to the RTCPI controls. See ’RTCPI assignable controls’ on page 208 for more information on each controls.

Vascular Contrast Soft menu controlsPower, Dynamic Range and Reject

See ’RTCPI Soft menu controls’ on page 209 for more information about these controls.

PersistenceEnables the adjustment of color images, so that the current frame retains some color information from previous frames, in order to minimize noise.

Speckle ReductionSee ’UD Clarity’ on page 94 for more information.

Edge EnhanceSee ’Edge Enhance’ on page 195 for more information.

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Abdominal Contrast ImagingAbdominal Contrast is intended for visualization of ultrasound contrast agents in abdominal organs (e.g. liver or kidney).

The Abdominal Contrast application works with the 3.5C and 4C probes.



Note: The Abdominal Contrast application requires the Vascular/Abdominal Contrast option enabled.

WARNING


CAUTION


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Abdominal Contrast overview

Figure 5-9: The Abdominal Contrast acquisition screen


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Figure 5-10: The Abdominal Contrast controls on the front panel



• Width• Frequency• Focus• Flash frames• Flash• ECG Trig• T1• Cineloop (in Freeze)• B color maps RMORE menu• Flash gain• Flash power• Up/Down R• Left/Right R• T2

5. Soft menu:• Power• Dynamic Range R• Reject R• Persistence R• Speckle reduction R• Edge Enhance

6. Trackball

4

5

3

1

2

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Abdominal Contrast controls

Abdominal Contrast assignable controlsThe Abdominal contrast assignable controls are similar to the RTCPI controls. See ’RTCPI assignable controls’ on page 208 for more information on each control.

Abdominal Contrast Soft menu controlsThe Abdominal contrast assignable controls are similar to the RTMC controls. See ’RTCPI Soft menu controls’ on page 209 for more information on each control.

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Rodent Contrast ImagingRodent Contrast Imaging is intended for visualization of ultrasound contrast agents in rodents (e.g. rat heart or rat liver).

The Rodent Contrast application works with the i13L probe.


Note: the Rodent Contrast application requires the Advanced Contrast option enabled.

WARNING

This application is intended for pre-clinical research only.

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Chapter 6 Measurement and Analysis

• Introduction ................................................................................... ... 224• About Measurement results display ..........................................224

• The Assign and Measure modality ............................................. ... 226• Starting the Assign and Measure modality ...............................226• Entering a study and performing measurements ......................228

• Measure and Assign modality ..................................................... ... 230• Starting the Measure and Assign modality ...............................230• Post-measurement assignment labels ......................................231

• Cardiac Measurements ................................................................ ... 234• 2D Measurements ....................................................................234• M-Mode Measurements ............................................................238• Doppler Measurements ............................................................242• TSI Measurements ...................................................................245• Automated Function Imaging ....................................................251

• Vascular measurements .............................................................. ... 269• B-Mode measurements ............................................................269• M-Mode Measurements ............................................................273• Doppler measurements ............................................................274

• OB measurements ........................................................................ ... 280• OB graphs .................................................................................280

• Measurement package configuration ......................................... ... 285• Measurement package configuration - example .......................285• Normal values ...........................................................................287

• User-defined formulas ................................................................. ... 290• User-defined formula - example ...............................................290• About units ................................................................................296

• Measurement result table ............................................................ ... 299

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• Minimizing the Measurement result table .................................299• Moving the Measurement result table .......................................299• Deleting measurements ............................................................299

• Worksheet ..................................................................................... ... 301• Overview ...................................................................................301• Using Worksheet ......................................................................301

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IntroductionThe Vivid 7 Ultrasound unit provides functionality for two measurement conventions:

A study is a set of related measure-ments, or measure-ments that are logically grouped together. The mea-surements in a study are some-times used in a for-mula to calculate new parameters (e.g. biplane volume with EF, SV and CO).

• Assign and Measure (Measure Protocols): the user selects a study consisting in a set of pre-labeled measurements related to the active scanning mode and clinical application. The user is prompted through the measurements in the order of the measurement labels. This convention is started from the MEASURE button on the control panel. A set of tools is implemented to make the measurement process as fast and easy as possible for the user:• The user is guided through the study: an auto-sequence

functionality automatically selects the next measurement in a study.

• The selected measurement is highlighted in the Measurement menu.

• The performed measurement is indicated in the Measurement menu.

• The MENU key on the control panel enables quick access to the Measurement menu.

The studies and their parameters are user-configurable. The user can create its own studies containing the relevant measurements only (see page 530).• Measure and Assign (Free style): the user performs a

measurement and assigns a label. This convention is started either from MEASURE or CALIPER button on the Control panel.

About Measurement results displayBe aware of the following:• Measurement results display

By default the system always displays absolute values for parameters measured in Doppler. This means that values

CAUTION

Only assigned measurements are saved when ending the examination.

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from above and below baseline will all be displayed as positive results.For Cardiac this behavior cannot be changed. For non-Cardiac the Absolute Value setting can be turned off in Config -> Meas/Text -> Advanced, by setting the attribute Absolute Value to Off.

• Calculated parametersFor calculated parameters the system uses signed values in calculation formulas, and displays the absolute value of the result.

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The Assign and Measure modalityIn this measurement modality, the user selects a study consisting in a set of related pre-labelled measurements.

Starting the Assign and Measure modality1. Press MEASURE on the control panel.

The Measurement Menu is displayed in the Parameters window (see example Figure 6-3).The trackball cursor is in the scanning window, ready for starting measurement.

In Freeze mode, the UPDATE MENU key on the trackball area has the same func-tion as the MENU key.

2. For fast access to the Measurement menu, press MENU.The cursor is moved to the Measurement menu. After selection of a measurement the cursor is automatically moved back to the scanning window, ready for measurement.

Figure 6-1: Launching the Measurement conventions

1. Menu: fast access to the Measurement menu (when in measure mode)

2. Measure: assign and measure3. Caliper: measure and assign (see

page 230)

227Figure 6-2: Example of a measurement study

1. Active application2. Study3. Selected study4. Opened study5. Measurements related to the

area study for the cardiac application

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Entering a study and performing measurements1. Press MEASURE on the front panel to enter the Assign and

Measure modality.The Measurement menu with a list of studies is displayed in the Parameters window (see example Figure 6-3).When entering the Measurement mode for the first time, the Caliper tool is selected by default. When re-entering the Measurement mode, the first measurement in the actual study that has not been performed is selected by default.

To perform a measurement from another studyAlternative: Press MENU to access to the Measurement menu and track-ball to the actual study

1. Trackball to the required study.2. Press SELECT on the trackball area.

The study folder is opened displaying the measurements related to this study. Other related studies may also be available from within the study.

3. Trackball to the measurement to perform.4. Press SELECT on the trackball area to activate the

measurement tool.The cursor is moved back to the scanning window.

5. Perform the measurement.Completed measurements are marked with a check mark (Figure 6-3).When the measurement operation is completed the next measurement on the list is automatically selected.

To skip a measurement in a studyAlternative: Press MENU to access to the Measurement menu and track-ball to the actual study

1. Trackball to the desired measurement2. Press SELECT to activate the measurement tool.

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Figure 6-3: Display of a performed measurement (example)

1. Performed measurement2. Next measurement is

automatically selected

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Measure and Assign modalityIn this measurement modality, the user performs a measurement and assign a label.

Starting the Measure and Assign modality

Alternative: Press CALIPER on the con-trol panel and select the measurement tool from the as-signables.

1. Press MEASURE on the control panel.The Measurement Menu is displayed in the Parameters window (see example Figure 6-4).

2. If not selected, trackball to the actual measurement tool.3. Press SELECT on the trackball area to activate the

measurement tool.The cursor is moved back to the scanning window, ready for measurement.

Figure 6-4: The 2D Mode Measurement tools (Cardiac application)

CAUTION

Only assigned measurements will be saved.

1. Measurement tools

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Post-measurement assignment labelsEach type of measurement, within each mode, can be associated with a set of pre-defined parameter labels. Parameter labels can be assigned to the highlighted measurement by the user.

To assign a parameter label to a measurement:1. Trackball to the actual measurement in the Measurement

result table (see Figure 6-5).The selection of a measurement with-out pre-defined la-bels will not display the Parameter la-bel menu.

2. Press SELECT.A Parameter label menu is displayed.

3. Trackball through the Parameter label menu to highlight the required label.

4. Press SELECT to assign the highlighted parameter label to the measurement.

The assigned measurements may be reviewed in the Worksheet (see page 301). Up to five assigned measurements with the same label can be stored in the patient archive.

CAUTION

Only assigned measurements will be saved. Measurements without assignment will be lost when scanning is resumed.

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Figure 6-5: Measurement assignment

To assign a user-defined parameter label1. Trackball to the actual measurement in the Measurement

result table (see Figure 6-5).2. Press SELECT.

A Parameter label menu is displayed.3. Trackball to User and press SELECT.

The Enter new parameter window is displayed.

1. Parameter Label menu2. Selected label

Assignment

3. Assigned measurement

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Figure 6-6: The Enter new parameter window

4. Type a name for the parameter label.5. Press OK.

The user defined parameter label is assigned to the selected measurement.

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Cardiac Measurements

2D Measurements

2D Length measurements1. Generate the 2D image.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER on the con-trol panel and press CALIPER assignable.

3. Press MEASURE on the Control Panel.4. Select Caliper in the Measurement Menu (see Figure 6-2).5. Trackball the cursor to the start point of the measurement.6. Press SELECT to anchor the start point of the measurement.

See the Status bar to get the next step to perform.

7. Trackball the cursor to the measurement end point.The current distance value is displayed in the Measurement result table and is instantaneously updated when moving the cursor.

The measurement display color on the 2D image changes from green to red af-ter completion of the measurement.

8. Press SELECT to anchor the end point of the measurement.The measurement result is displayed in the Measurement result table.

9. To assign a label to the measurement, see page 231.10. Repeat steps 5 through 8 to make additional length

measurements.The measurements displayed on the 2D image and the cor-responding results are numbered.

2D length measurement ratio1. Generate the 2D image.2. Press FREEZE to stop the cineloop.3. Press MEASURE on the Control Panel.

Alternative: Press CALIPER and DIST RATIO assignable.

4. Select Dist. ratio in the Measurement Menu (see Figure 6-2).

5. Perform two length measurements as described in steps 5 through 8 in the above section.The measurement results including the ratio (%) of the two measured lengths are displayed in the Measurement result table.

Editing 2D Length measurements1. Trackball the cursor to one of the anchor points of the

measurement to modify.2. Double-click the SELECT key to select the anchor point.

The selected marker turns green and is unanchored.

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3. With the Trackball, reposition the marker.4. Press SELECT to anchor.

2D Area measurements1. Generate the 2D image.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER and AREA assignable.

3. Press MEASURE on the Control Panel.4. Select Area (trace) in the Measurement Menu (see

Figure 6-2).5. Trackball the cursor to the start point of the measurement.


6. Press SELECT to anchor the start point of the measurement.7. Trace the area (planetary) with the Trackball.

The measurement display color on the 2D image changes from green to red af-ter completion of the measurement.

The current area and circumference values are displayed in the Measurement result table and are instantaneously updated when moving the cursor.

8. Press SELECT to complete the measurement.The measurement result is displayed in the Measurement result table.

9. To assign a label to the measurement, see page 231.The measurements displayed on the 2D image and the cor-responding results are numbered.

10. Repeat steps 5 through 8 to make additional area measurements.

2D area measurement ratio1. Generate the 2D image.2. Press FREEZEto stop the cineloop.

Alternative: Press CALIPER, MORE as-signable and AREA RATIO.

3. Press MEASURE on the Control Panel.4. Select Area ratio in the Measurement Menu (see

Figure 6-2).5. Perform two area measurements as described in steps 5

through 8 in the above section.See the Status bar to get the next step to perform.

The measurement results including the ratio (%) of the two measured areas are displayed in the Measurement result table.

Editing 2D Area measurements1. Trackball the cursor to the anchor point of the area

measurement to modify.2. Press SELECT twice (Double-click) to select the anchor

point.

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The selected marker turns green and is unanchored.3. With the Trackball, reposition the marker.4. Press the SELECT to anchor.

2D Volume measurements

The measurements described in this section enable volume measurement in a defined zone. The measurements tool generates results by two methods:

For measurement formulae, refer to the Reference Manual.

• Method of Disk (displayed as Vmod in the Measurement result table), known as Simpson's method.

• Area/Length method (displayed as Va-l in the Measurement result table).

To perform a volume measurement:1. Generate the 2D image.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER and VOLUME assignable.

3. Press MEASURE on the Control Panel.4. Select Volume in the Measurement Menu (see Figure 6-2).5. Trackball the cursor to the start point where a volume is to

be measured.See the Status bar to get the next step to perform.

6. Press SELECT to anchor the start point of the measurement.7. Trackball the cursor to draw the length.8. Press SELECT to anchor the second point.9. Drag the cursor with the Trackball to outline the area of

interest.The measurement display color on the 2D image changes from green to red af-ter completion of the measurement.

The current area, circumference and Area/Length Volume (Va-l) values are displayed in the Measurement result table (see Figure 6-2) and are instantaneously updated when moving the cursor.

10. Press SELECT to complete the measurement.The measurement results including Vmod (Simpson) are displayed in the Measurement result table (see Figure 6-2).

The measurements displayed on the 2D image and the cor-responding results are numbered.

11. To assign a label to the measurement, see page 231.12. Repeat steps 5 through 10 to make additional volume

measurements.

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2D Depth measurements

The measurements described in this section enable depth measurement from the probe to a selected point.

To perform a depth measurement:1. Generate the 2D image.2. Press FREEZE to stop the cineloop.3. Press MEASURE on the Control Panel.


4. Press the assignable POINT to select the depth measurement function.

5. Trackball the cursor to the position to measure.The current distance from the probe is displayed in the Measurement result table and is instantaneously updated when moving the cursor.

The measurements displayed on the 2D image and the cor-responding results are numbered.

6. Press SELECT to anchor the point.The depth value (cm) is displayed in the Measurement result table.

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M-Mode MeasurementsIn M-Mode, the user can perform distance and time measurements. This measurement package has also the following pre-defined measurement studies: • LA/Ao• LV• RV

M-Mode Length measurements1. Generate the M-Mode image.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER on the con-trol panel and press CALIPER assignable.

3. Press MEASURE on the Control Panel.4. Select caliper in the Measurement Menu.5. Trackball the cursor to the start point of the measurement.6. Press SELECT to anchor the start point of the measurement.


7. Trackball the cursor to the measurement end point.The current distance value is displayed in the Measurement result table and is instantaneously updated when moving the cursor.

8. Press SELECT to anchor the end point of the measurement.The measurement display color on the M-Mode changes from green to red af-ter completion of the measurement.

The measurement result is displayed in the Measurement result table.

9. To assign a label to the measurement, see page 231.10. Repeat steps 5 through 8 to make additional length

measurements.The measurements displayed on the M-Mode image and the corresponding results are num-bered.

Editing M-Mode Length measurements1. Trackball the cursor to one of the anchor points of the

measurement to modify.2. Press SELECT twice (double-click).

The selected marker turns green and is unanchored.3. With the Trackball, reposition the marker to a new position.4. Press SELECT.

Ao/LA study1. Generate the M-Mode image.2. Press FREEZE to stop the cineloop.

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Alternative: Press CALIPER on the con-trol panel and press the AO/LA assign-able.

3. Press MEASURE on the Control Panel.4. Select Ao/LA in the Measurement Menu.5. Trackball the cursor along the time axis to the required point

to start measurement of Aorta root diameter.See the Status bar to get the next step to perform.

6. Press SELECT.The starting point for the measurement is anchored.

7. Trackball to the end point of the measurement.The current value is updated while mov-ing the cursor.

8. Press SELECT.The measurement end point is anchored and the value is displayed in the Measurement result table.A new free-moving cursor is displayed on the image, ready for the next measurement.

9. Repeat steps 5, through 8 to measure Left Atrium.The LA value is displayed in the Measurement result table. The Ao/LA ratio is displayed in the Measurement result table.

LV study

The LV study consists of measurements in fixed-time mode in both systole and diastole of:• Interventricular septum thickness (IVS)• Left ventricular internal dimension (LVID)• Left ventricular posterior wall thickness (LVPW)

The following parameters are also calculated:• EDV (End diastole volume)• ESV (End systole volume)• SV (Stroke volume)• EF (Ejection Fraction)

To perform LV study1. Generate the M-Mode image.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER on the con-trol panel and press the LV STUDY as-signable.

3. Press MEASURE on the Control Panel.4. Select LV study in the Measurement Menu.5. Trackball the cursor along the time axis to the required point

to start measurement of IVSd.6. Press SELECT.

The starting point for the measurement is anchored.

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7. Trackball to the end point of the measurement.8. Press SELECT.

The IVSd measurement end point is anchored and the value is displayed in the Measurement result table.

The end point of the IVSd is also the start point for the LVIDd.1. Trackball to the end point of the LVIDd measurement.2. Press SELECT.

The LVIDd measurement end point is anchored and the value is displayed in the Measurement result table.

The end point of the LVIDd is also the start point for the LVPWd.1. Trackball to the end point of the LVPWd measurement.2. Press SELECT.

The LVPWd measurement end point is anchored and the value is displayed in the Measurement result table.

3. Repeat steps 5, through 2 to measure IVS, LVID and LVPW in systole.

RV study

The RV study consists of measurement in fixed-time mode of Right ventricular internal dimension (RVID) in both diastole and systole.

To perform RV study1. Generate the M-Mode image.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER on the con-trol panel and press the RV STUDY as-signable.

3. Press MEASURE on the Control Panel.4. Select RV study in the Measurement Menu.5. Trackball the cursor along the time axis to the required point

to start measurement of RVIDd.6. Press SELECT.

The starting point for the measurement is anchored.The current value is updated while mov-ing the cursor.

7. Trackball to the end point of the measurement.8. Press SELECT.

The measurement end point is anchored and the RVIDs measurement value is displayed in the Measurement result table.A new free-moving cursor is displayed on the image, ready for the next measurement.

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9. Repeat steps 5, through 8 to measure RVIDs.The RVIDs value is displayed in the Measurement result table.

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Doppler MeasurementsThe following measurements may be calculated on Doppler mode spectra:

For measurement formulae, refer to the Reference Manual.

• Maximum (peak) and mean velocity• Maximum and mean pressure gradient• Pressure half-time (PHT)• Velocity time integral (VTI)• Mitral valve area (MVA), derived from PHT

Velocity and Pressure point measurements1. Generate the spectrum to be measured.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER on the con-trol panel and press the POINT CALIPER assignable.

3. Press MEASURE on the Control Panel.4. Select Point Caliper in the Measurement Menu.5. Trackball the cursor to the position to measure.

The current velocity is displayed in the Measurement result table and is instantaneously updated when moving the cursor.

The measurement display on the spec-trum and the corre-sponding results are numbered.

6. Press SELECT to anchor the point.The velocity (m/s) and pressure (mm Hg) values are displayed in the Measurement result table.

Velocity and Pressure caliper measurements1. Generate the spectrum to be measured.2. Press FREEZE to stop the cineloop.

Alternative: Press CALIPER on the con-trol panel and press the CALIPER assign-able.

3. Press MEASURE on the Control Panel.4. Select Caliper in the Measurement Menu.5. Trackball the cursor to the start point of the measurement.6. Press SELECT to anchor the start point of the measurement.7. Trackball the cursor to the measurement end point.

The current velocity and pressure values are displayed in the Measurement result table and are instantaneously updated when moving the cursor.

The measurement display color on the spectrum changes from green to red af-ter completion of the measurement.

8. Press SELECT to anchor the end point of the measurement.The following measurement results are displayed in the Measurement result table:• Velocity and pressure at anchor point positions• Velocity (V3) and pressure (p3) differences between

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anchor point position• Time difference (dT) between anchored points position

The measurement display on the spec-trum and the corre-sponding result are numbered.

9. To assign a label to the measurement, see page 231.10. Repeat steps 5 through 8 to make additional

measurements.

Manual Doppler trace measurementsAdjust Compress and reject controls to optimize the Doppler signal.

1. Generate the spectrum to be measured.2. Press FREEZE to stop the cineloop.3. Press MEASURE on the Control Panel.

Alternative: Press CALIPER on the con-trol panel and press the MANUAL TRACE assignable

4. Select Manual trace in the Measurement Menu.A vertical green cursor is displayed on the spectrum.

5. Trackball the cursor to the start point on the left side of the trace.

6. Press SELECT to anchor the start point of the measurement.7. With the trackball, trace the Doppler envelope.

The trace can be adjusted, while tracing, by moving the cursor backward to erase portion of the trace (or the entire trace) and then create the trace again.

The measurement display color on spectrum changes from green to red af-ter completion of the measurement.

8. Press SELECT to complete the trace.The following measurement results are displayed in the Measurement result table:• Maximum and mean Velocities• Maximum and mean pressures• Env. Ti • Velocity time integral (VTI)

9. Trackball the cursor to the start point of the next heart beat.10. Press the SELECT to anchor the next heart beat starting

point.The heart rate (BPM) is displayed in the Measurement result table.

Automatic Doppler trace measurementsAdjust Compress and reject controls to optimize the Doppler signal.


244

Alternative: Press CALIPER on the con-trol panel and press the AUTO TRACE as-signable.

4. Select Auto Trace in the Measurement Menu.A vertical green cursor is displayed on the spectrum.

5. Trackball the cursor to the starting point.6. Press SELECT to anchor the start point of the measurement.7. Trackball to the end trace position.8. Press SELECT to anchor the end point of the trace.

The trace is automatically generated and the following measurements are displayed in the Measurement result table:• Maximum and mean Velocities• Maximum and mean pressures• Env. Ti • Velocity time integral (VTI)

9. Trackball the cursor to the next heart beat.10. Press SELECT to anchor the next heart beat starting point.

The heart rate (BPM) is displayed in the Measurement result table.

MV E/A ratioAdjust Compress and reject controls to optimize the Doppler signal.


Alternative: Press CALIPER on the con-trol panel and press the MV E/A RATIO as-signable.

4. Select MV E/A ratio in the Measurement Menu.5. Trackball the cursor to the peak of the E wave.6. Press SELECT to anchor the point.7. Drag cursor to baseline to mark dT.8. Press SELECT on the trackball area to anchor the second

point.9. Trackball the cursor to the peak of A wave.10. Press SELECT to anchor the point.

the velocity at peak for E and A waves and the calculated E/A ratio are displayed in the Measurement result table.

Event timing measurements

Event timing enables the time measurement for opening and closure of the Aortic and Mitral valves, as referred to the automatically detected QRS marker, which normally is on the rising slope of the R-wave.

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Event timing can be performed on a Doppler spectrum or an M-Mode acquisition showing the corresponding valves. The procedure is similar on both modes. In addition event timing can be done on curved anatomical M-Mode traces in Q Analysis. The measurements are shown as dashed lines in the Analysis window and Anatomical M-Mode window in Q Analysis.1. Generate the spectrum to be measured.2. Press FREEZE to stop the cineloop.3. Press MEASURE on the Control Panel.4. Select Event Timing in the Measurement menu.

The following event timing measurements are available (with the first measurement on the list selected):• AVO: Aortic Valve Opening• AVC: Aortic Valve Closure• MVO: Mitral Valve Opening• MVC: Mitral Valve Closure

5. Trackball the cursor to the corresponding point on the spectrum for the selected measurement.

6. Press SELECT to anchor the point.The event timing measurement (ms) is displayed in the Measurement result table.

TSI MeasurementsEach sample in the TSI image represents the time to the maximum velocity within the chosen TSI search interval from TSI Start to TSI End. (See page 146 on how to set the TSI search interval.)

There are two automatic TSI time to peak measurement tools:• Generic TSI Time to peak measurement: displays the TSI

value at the location point set by the user.• Segment TSI Time to peak measurement: measures the

time to peak velocity in specific wall segments and gets automatically calculated TSI indexes based on these measurements. The measurements may be presented in a color coded Bull's eye diagram.

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Alternatively, TSI time to peak measurement can be done in Q Analysis by manually measuring the time between the QRS marker and the peak velocity on the velocity trace.

Generic Time to peak measurement1. Acquire a TSI apical loop.2. Press MEASURE.3. In the Measurement menu, select Generic and Time to

peak (see Figure 6-7).The TSI loop freezes at the TSI end frame.

4. Place a point in the middle of a basal or mid-level myocardial segment in the TSI image.

5. The Time to peak value for the segment is displayed in the Measurement result window.Note: to judge the quality of your data at the measuring point in the 2D image see the Caution text on page 251.

Figure 6-7: TSI Generic Time to peak measurement screen

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Segment Time to peak measurements1. Acquire TSI loops from all three apical views.2. Press MEASURE and select TSI time study.

The TSI loop freezes at the TSI end frame.The first measurement in the study is automatically selected (see Figure 6-8).

3. Place a point in the middle of the corresponding segment in the TSI image.The Time to peak and the Peak velocity for the segment are displayed in the Measurement result window.

4. Perform a measurement for all basal and mid-level segments in all three apical views.In addition to the Time to peak and the Peak velocity for each segment, the following TSI indexes are calculated:• Septal lateral delay: difference in Time to peak velocity

in the basal lateral wall and basal septum.• Septal posterior delay: difference in Time to peak

velocity in the basal posterior wall and the basal antero-septum.

• Basal max delay: difference between the maximum and minimum time to peak measurements in the six basal segments. Requires at least four of the six basal segment measurements.

• Basal standard deviation: the standard deviation of the time to peak measurements in the six basal segments. Requires at least four of the six basal segment measurements.

• All segments max delay: difference between the maximum and minimum time to peak measurements in all the measured basal and mid level segments. Requires at least eight of the twelve segmental measurements.

• All segments standard deviation: the standard deviation of the time to peak measurements in all measured basal and mid level segments. Requires at least eight of the twelve segmental measurements.

The TSI indexes indicate degrees of asynchrony in time to peak velocity

5. Select TSI Bull’s eye report in the Measurement menu.

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The measurements are displayed in a color coded bull’s eye diagram together with a list of the calculated TSI indexes.

Figure 6-8: Segment Time to peak measurements screen

TSI trace

The TSI Time to peak measurement can be verified and eventually manually changed from the TSI trace.1. Double click on the measurement point.

The ROI and the corresponding TSI curve are displayed (see Figure 6-9).

2. Press SELECT to anchor the ROI and trace.3. If required, select a new peak location in the trace.4. Click in the acquisition window to exit the TSI trace.

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Figure 6-9: TSI trace

Time to peak measurement in Q Analysis1. From a TSI apical loop, press Q ANALYSIS.2. Place a sample area in a myocardial segment.

A velocity trace is displayed in the Analysis window (see Figure 6-10).

3. Press MEASURE.4. In the Measurement menu, select Generic and Time.

Note: if Time is not available in the Generic folder, Press ACTIVE MODE on the Control panel.

5. In the Analysis window, measure the time from the yellow QRS marker to the peak velocity of the velocity trace.

1. TSI ROI2. TSI trace3. TSI Time to peak marker

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Figure 6-10: Manual TSI Time to peak measurement in Q Analysis

Note: it is possible to do a Generic or a Segment Time to peak measurement from within Q Analysis and compare the result with a manual Time to peak measurement. To access to the corresponding measurement tool in Q Analysis you may have to press ACTIVE MODE to display the relevant Measurement menu.

1. Time measurement tool2. Sample area3. QRS marker4. Time to peak measurement

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Automated Function ImagingAutomated Function Imaging (AFI) is a decision support tool for regional assessment of the LV systolic function. AFI is a tool derived from 2D Stain, which calculates the myocardial tissue deformation based on feature tracking on 2D grey scale loops.

AFI is performed on apical views in the following order: apical long-axis, 4-chamber and 2-chamber view, following an on screen guided workflow (see also Figure 6-11).

The result is presented as a Bull’s eye display showing color coded and numerical values for peak systolic longitudinal strain. All values are stored to the worksheet. In addition, global strain for each view and average global strain for the whole LV are stored to the worksheet.

CAUTION

The Time to peak measurement in Q Analysis may differ from the Generic and Segment Time to peak measurements due to the following considerations:• The Generic and Segment Time to peak measurements find the

maximum velocity only within the TSI search interval. If the desired peak on the velocity trace is outside the TSI search interval, the Generic and Segment Time to peak measurements will return a different result than the manual Time to peak measurement.

• If the maximum velocity is at one of the ends of the TSI search interval, the Generic and Segment time to peak measurements return the time of the end of the TSI search interval. In some cases the falling flank of an iso-volumic contraction peak at the time of TSI Start or the rising flank of a post-systolic contraction peak at the time of TSI End may be detected. In a manual measurement the time to a peak within the TSI search interval with a lower velocity than the velocity at the end of the interval may be measured instead.

• If there are two or more peaks of comparable velocity within the TSI search interval, or a poor signal quality, the Generic and Segment Time to peak measurements may return the time to a different peak than what a manual method would do. Typically in these situations, the TSI image will show a wide range of colors over a small spatial region.

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Figure 6-11: AFI workflow

APLAX 4-Ch 2-Ch Step

Acquired views

Defining a ROI

Tracking validation

AVC timing adjustment

Parametric image result

Trace and Bull’s eye result

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Acquisition1. Create an exam, connect the ECG device and make sure

to obtain a stable ECG trace.2. Acquire 2D grey scale cineloops of an Apical long axis

(APLAX) view, an Apical 4 chamber view and an Apical 2 chamber view.Note: it is recommended to acquire all three apical views sequentially in order to get similar heart rate in all views.• The frame rate should be between 37 and 80 frames per

second. A higher frame rate is recommended for high heart rate.

• The scanner should be configured to store 100 ms before and after each heart cycle.

• If the acquisition has more than one heart cycle, the analysis will be done on the second last heart cycle.

• The entire myocardium should be visible.• A depth range that includes the entire left ventricle

should be used.

Starting AFI1. Open an APLAX view and press MEASURE.2. In the Measurement menu, select AFI.

The View selection menu is displayed (see Figure 6-12).

Figure 6-12: Measurement and View selection menus

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3. Select APLAX.The AFI application is started. A ROI can be defined.

AFI on the APLAX view

Defining a ROIWhen selecting the view to analyze the system automatically displays a frame where the endocardial border is usually clearly visible. To use another frame, adjust SELECT FRAME. The ROI is defined by placing two annular points and one at the apex following the order shown on screen.

To define a ROI, place three points at the endocardial border; two annular points and one at the apex (see Figure 6-13). Follow the indications displayed on the screen when placing the three points.

Note: the Yo-yo function is turned on to help finding correct location for the points.

CAUTION

When performing AFI on all three apical views, the user is asked to start with the APLAX view. This allows manual adjustment of the Aortic Valve Closure (AVC) event timing that is used in the calculation of the longitudinal systolic strain in all apical views.

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Figure 6-13: Defining a ROI

After placing the apex point the ROI is displayed.

Note: Correct ROI definition is important for an accurate strain measurement. The system has an adaptive ROI function: using the endocardial three points as a guide, the system will analyze the image and automatically adapt the ROI to an optimal position.

You may adjust the shape of the ROI by moving the cursor over the inner ROI border, select an anchor point and move it to a new location (Figure 6-14). The shape of the ROI is updated accordingly.

Figure 6-14: Selected anchor point on the inner ROI border

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Note: Data processing is started automatically if the cursor is not moved for a few seconds. If the ROI needs to be adjusted make sure to make the changes immediately after the ROI is displayed.

Note: The auto processing function is configurable (from Config/Meas-Text/Advanced/AFI auto processing).

Figure 6-15: AFI auto processing configuration

Quick tipsCorrect ROI definition is crucial to get good tracking. Refer to the example displayed in the Tip window for correct point placements. To display additional guidelines, select the Tip button on the Tip window. Make sure to follow the recommendations when placing the three points (see below).

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Base Correct Wrong

1. Correct position of the base points.

2. The ROI extends into the aortic tract.

Apex Correct Wrong

1. Correct position of the Apex point.

2. The apex point is placed too high. The ROI is extending beyond the epicardium.

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1. Correct position of the Apex point.

2. The upper right border of the ROI is way too much into the chamber cavity.

Bulges Correct Wrong

1. Correct ROI.2. ROI should not be

bulging or follow the papillary muscle. To edit the ROI, see ’ROI adjustment’ on page 261.

Apex Correct Wrong

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The data is processed and the Tracking validation screen is displayed.

General Correct Wrong

The left ventricle must be visible through the entire cycle.1. End systole frame:

the entire left ventricle is displayed.

2. End diastole frame: the annulus is not displayed.

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Figure 6-16: Tracking validation screen

The ROI is divided into segments. The tracking quality for each segment is automatically evaluated and summarized in the Scoring table (see Figure 6-16).

Tracking validationThe tracking for each segment must be visually controlled and validated. Poor tracking quality could result from a variety of causes. Select Quick tips (see Figure 6-16) to get tips on the most common causes for bad tracking. The common causes for bad tracking are:• Erroneous placement of the basal points when defining the

ROI. If the basal points are placed too far from the annular region, the ROI segments at the annular base will not move together with the underlying 2D image throughout the entire heart beat (see example cineloops in the Quick tips).

1. Display Quick Tips on tracking quality assessment2. The ROI divided in segments3. The Scoring table

• : acceptable tracking

• : not acceptable tracking4. Bull’s eye icon:

• Segments with yellow border: segments being analyzed.• Green segments: segments already analyzed.• Black segments: segments not analyzed.

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• Erroneous placement of the apex point when defining the ROI. The point should be placed so that the resulting ROI covers mainly the endocardium. If the apex point is placed too high, the ROI will mainly cover the epicardium resulting in poor tracking (see example cineloops in the Quick tips).

• Too small ROI width. Narrowing the ROI too much will result in poor tracking due to lack of tissue data in the ROI (see example cineloops in the Quick tips).

• Too much clutter. Images with too much static clutter will result in poor tracking (see example cineloops in the Quick tips).

1. Inspect each segment and make sure that the center line is moving together with the underlying 2D image. Note: To get a better visualization you may press Show/Hide ROI to show or hide the ROI borders.The tracking quality is automatically evaluated for each segment and displayed in the Scoring table. The tracking in each segment is scored as either Acceptable ( ) or Not acceptable ( ).If the tracking needs to be improved for some segments, the user can modify the ROI as described in ’ROI adjustment’ on page 261.The user may override the tracking quality evaluation done by the system by clicking on the evaluation result in the Scoring table.

2. Once the tracking quality has been validated for all segments, press Approve in the Scoring table.The user is asked to confirm or adjust the AVC timing setting (see ’Timing validation’ on page 262).

ROI adjustment1. Press RECALC.2. The following adjustments can be done:

• Adjust ROI WIDTH. • Press DRAW CURVE to re-define the ROI.• Adjust the shape of the existing ROI: move the cursor

over the inner ROI border, select an anchor point and move it to a new location. The shape of the ROI is updated accordingly.

Data processing is started automatically if the cursor is not moved for a few seconds.

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The Tracking validation screen is displayed for tracking validation.

Timing validationTiming information may be crucial to accurate diagnosis. The most important event timing is the aortic valve closure (AVC), since it is part of the definition of the peak systolic strain parameter.

Determination of the AVC timing by the system is as follow, depending on the situation:• If AVC timing has been measured by the operator (through

an event timing measurement, see page 244) prior to running AFI, the system is using this data.

• If event timing is not available, an automatic AVC estimate is used, determined by the temporal contraction of all LV segments (Strain curves).

• From the APLAX view, the user can adjust the estimated AVC timing. The adjusted AVC timing will then be used in the other apical views when running AFI on these views. This option is only available from the APLAX view.

AVC timing adjustmentThis procedure is available in the APLAX view only.1. After validation of the tracking quality, the frame for the

current AVC setting (automatic or event timing measurement) is displayed and highlighted on the ECG.

2. To keep the current AVC setting, press SELECT. To change the AVC setting, use the trackball to display another frame and press SELECT.If the AVC setting was changed, a Confirmation window is displayed. Select one of the following options:• Manual to accept the manual AVC setting.• Event timing to discard the manual AVC setting (if for

example the AVC setting was not possible to assess from the APLAX view). The AVC event timing measurement will then be used.Note: This choice is only visible if AVC event timing measurement has been done.

• Auto to discard the manual AVC setting and use the automatic AVC timing.

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The Parametric systolic strain APLAX view is displayed (see Figure 6-17).

Figure 6-17: Parametric systolic strain APLAX view

Note: The image will not be saved unless IMG. STORE is pressed.

Peak detectionThe peak systolic strain detection for each segment can be verified and eventually manually changed.

To adjust the peak detection:1. Press QUAD SCREEN.

A quad screen is displayed (see Figure 6-18) showing:• 2D image with the ROI• 2D image with Peak systolic strain parametric data• Segmental curves with peak marker• M-Mode image with strain parametric dataNote: the Quad screen will not be saved unless IMG. STORE is pressed.

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Figure 6-18: Quad screen for the APLAX view

2. To change the peak marker position on a curve:• Press SELECT on the peak marker (white square point)

on one of the curves, hold down the SELECT key and move the peak marker to a new position. Release the SELECT key.OR

• Place the cursor on a segment in one of the 2D images. The corresponding curve is highlighted.Click on the segment to select the corresponding peak marker and move it to a new position.

AFI on A4-Ch and A2-Ch views

The procedure for AFI on Apical 4-chamber and 2-chamber views is similar to the one used in the APLAX view:• Open the apical view from the clipboard.• Select the corresponding view in the View selection menu

(see Figure 6-12, page 253).• Define a ROI (see page 254).

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• Validate tracking (see page 260).

Note: the AVC timing setting defined in the APLAX view is used by the system when running AFI on the other apical views.

Results

For the APLAX and apical 4-chamber views the following results are available:• Single screen (see Figure 6-17) displaying a 2D image with

strain parametric data.• Quad screen (see Figure 6-18) displaying:

• 2D image with the ROI• 2D image with Peak systolic strain parametric data• M-Mode image with strain data• Segmental curves

When performing AFI on all three apical views the following results are also available:• Quad curve screen (Figure 6-19) displaying:

• Segmental curves for each three Apical views • Bull’s eye presentation with segmental Peak systolic

strain color coding and segmental Peak systolic strain values

• Single Bull’s eye screen (see Figure 6-20) displaying:• Bull’s eye presentation with segmental Peak systolic

strain color coding and segmental Peak systolic strain values

CAUTION

If auto-AVC is used as AVC timing calculation method when running AFI (see page 262), the strain values displayed in the Quad screen for the APLAX and 4 Chamber views may differ from the strain values obtained after the system has performed the final calculation from all three views. The reason for this is that the Auto-AVC calculation derived from all three views is most accurate and may be different from the intermediate AVC calculations used for each view. The strain values displayed in the Quad screen on APLAX and 4 Chamber views are therefor preliminary values. Only final strain values should be reported. Note: If you enter Quad screen again after all three loops have been processed, the strain values will be correct.

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Note: The Bull’s eye can be configured to display either 18 or 17 segments (from Config/Meas-Text/Advanced/AFI Segment model). Note: The system can be configured so that the user can also choose to display Post systolic index (PSI) color coding and segmental PSI values in the Bull’s eye (from Config/Meas-Text/Advanced/AFI).

• Global Peak strain values for all three apical views.• Averaged global Peak strain value from all three apical

view data.• AVC measurement (either automatic, event timing

measurement or manual, see page 262)

Getting the resultsWhen approving the tracking in the Apical 2-chamber the Quad curve screen with segmental curves and Bull’s eye is displayed (Figure 6-19). Select Bull’s eye only to display the Single Bull’s eye screen (Figure 6-20).

Figure 6-19: Quad screen

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Figure 6-20: Single Bull’s eye screen

To save the results, press Img. store. Once the results are saved, the measurements are available in the Worksheet and can be used in the report.

If the tracking quality of a segment was scored as Not acceptable ( ), the colorimetric display on the Bull’s eye is greyed. (see Figure 6-21).

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Figure 6-21: Colorimetric display

About the resultsBe aware of the following:• Clinical assessments should be made based on both color

and segmental Peak systolic strain values.• The Save As function is intended for research purposes

and should not be used to archive diagnostic data.• To populate the worksheet and the report the Single Bull’s

eye screen must be saved.• All results shown (curves, colors and values) are based on

drift compensated values. Any strain drifting is linearly compensated throughout the cycle. If the drift compensation in a given segment is too high, the tracking quality is automatically set to Not acceptable (X).

• If the tracking quality was scored as Not acceptable (X) in more than one segment, the Global peak strain value is not calculated.

Reprocessing dataThe data from one or several views from a saved AFI analysis may be reprocessed. When reprocessing an AFI analysis new result screens are created.1. Double-click on the Bull’s eye thumbnail.

A quad screen is displayed showing the three apical views and the Bull’s eye diagram.

2. Select the view to reprocess and perform the analysis as described on page 254.

1. Segment with tracking quality scored as Not acceptable ( ).

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Vascular measurements

B-Mode measurementsThe following instructions assume that you first scan the patient and press FREEZE.

% Stenosis

% Stenosis by diameter1. Press MEASURE on the control panel.2. Open % Stenosis in the Measurement menu.3. Select % Sten (Diam).4. Make a distance measurement of the inner area of the

blood vessel.5. Make a distance measurement of the outer area of the

blood vessel.The distance measurements and the % Stenosis are displayed in the Measurement result table.

% Stenosis by area1. Press MEASURE on the control panel.2. Open % Stenosis in the Measurement menu.3. Select % Sten (Area).4. Make a trace measurement of the inner area of the blood

vessel.5. Make a trace measurement of the outer area of the blood

vessel.The area measurements and the% Stenosis are displayed in the Measurement result table.

Volume

The volume calculation can be made from one, two or three distance measurements.1. Press MEASURE on the control panel.2. Select Volume in the Measurement menu.3. When doing volume calculation from three distance

measurements (i. e. biplane volume), the measurements should be done in dual mode displaying a sagittal and an axial view. One measurement is usually made in the sagittal plane and two measurements in the axial plane.

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When doing volume calculation from one or two distance measurements, make one or two distance measurements and press MENU or CLEAR.The distance measurement(s) and the volume calculation are displayed in the Measurement result table.

A/B Ratio

In B-Mode, A/B Ratio can be measured by diameter or area.

A/B Ratio by diameter1. Press MEASURE on the control panel.2. Open A/B Ratio in the Measurement menu.3. Select between:

• Ratio (Diam)• Ratio (Area)

4. Make the corresponding two measurements.The measurements and the corresponding A/B Ratio are displayed in the Measurement result table.

Intima-Media Thickness

The Intima-Media Thickness (IMT) is calculated based on automatic contour detection of the Intima and Media layers on a user-defined search region along the vessel wall. Multiple IMT measurements are made between pairs of intima and adventitia points along the wall (Figure 6-22). IMT can be measured both on the posterior and the anterior walls of the vessel.

The IMT measurement is available with linear probes only.

Note: due to the physical properties of ultrasound imaging, the posterior IMT measurement is generally more accurate than the anterior IMT measurement.

The following parameters are calculated:• Average IMT• Maximum IMT• Minimum IMT• Standard deviation of IMT measurements• Number of successful IMT measurements

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Figure 6-22: IMT measurement (Posterior wall)

IMT Measurement procedureThe following procedure describes the posterior IMT measurement.1. Acquire a longitudinal scan of the carotid artery and

optimize the image.2. Press FREEZE.3. Scroll to an end-diastolic frame where the intima layer is

clearly visible.4. Press MEASURE.5. Select the appropriate IMT measurement. If measuring the

IMT of the posterior wall of the right common carotid select Rt and CCA IMT Post (Figure 6-23).

1. Vessel lumen2. Vessel wall

3. Lumen-Intima boundary4. Media-Adventitia boundary5. Multiple IMT measurements

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Figure 6-23: IMT Measurement menu (Right Common Carotid Posterior IMT measurement tool)

6. Place the cursor in the artery closer to the posterior wall and press SELECT to anchor the start of the search region (Figure 6-24, left).

7. Move the cursor parallel to the artery to define the end point of the search region. Make sure the Intima and Media layers are within the search region (indicated by the lower dotted line in Figure 6-24, left).Press SELECT to anchor the point. For the posterior wall the contour detector searches for the leading of the edges of the intima and adventitia layers. The detected contours are drawn in the image (Figure 6-24, right).The measurement calculations are displayed in the Measurement result Table.Note: if the Intima and Media layers are not within the search region, the contour is not drawn. Select (double click) and move the anchored points closer to the Intima layer.

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Figure 6-24: IMT Measurement segment and traces

8. If the contour is not optimal, the following assigned control may be adjusted to improve border detection:• TRACE FIT: the traces are modified according to different

threshold values.If the contour is still not optimal, try to perform the IMT measurement on another frame, preferably close to the end diastole.

IMT trace approvalSince the IMT measurements are done semi-automatically, the operator has to approve the detection by visual inspection before storing the results in worksheet and report.1. If the traces fit both layers of the posterior wall, approve the

measurement by selecting Transfer in the Measurement menu.Once transferred, the calculations can be viewed in the worksheet and report.Note: measurements that are not approved will not be saved.Note: any image adjustments (e.g Gain or zoom) on approved (transferred) measurements will unassign the measurements. Press Transfer to approve the measurements again.

M-Mode MeasurementsThe following instructions assume that you first scan the patient and press FREEZE.

1. Measurement segment 2. IMT trace

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% Stenosis1. Press MEASURE on the control panel.2. Select % Stenosis in the Measurement menu.3. Make a distance measurement of the inner area of the

blood vessel.4. Make a distance measurement of the outer area of the

blood vessel.The distance measurements and the % Stenosis are displayed in the Measurement result table.

A/B Ratio

In M-Mode, A/B Ratio can be measured by diameter, time or velocity.1. Press MEASURE on the control panel.2. Open A/B Ratio in the Measurement menu.3. Select between:

• Ratio (Diam• Ratio (Time)• Ratio (Velocity)

4. Make the corresponding two measurements.The measurements and the corresponding A/B Ratio are displayed in the Measurement result table.

Doppler measurementsThe system can detect the trace automatically or the user can draw the trace manually.

Auto vascular calculation

The system performs calculation automatically on the spectrum trace.

The auto vascular calculation can operate in live, freeze or be turned off (Live, Frozen and Off commands in the Measurements menu).

From the Modify Calcs menu, the user can:• select the calculations to be displayed in the Measurement

result table.• set the calculations that should be default when an exam is

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started (Save as default command).• turn on the automatically detected trace to display max

and/or mean trace (Max and Mean commands).• display forward flow, reverse flow or both flows (Above,

Below and Both commands).

Setting up auto vascular calculation1. Press MEASURE.

The Vascular measurement menu is displayed (Figure 6-25).

2. Press Auto and select between:• Live: calculation displayed on the real-time image.• Freeze: calculation displayed on the frozen image.• Off: auto vascular calculation is turned off.

3. Press Modify Calcs.The Modify Calcs menu is displayed (Figure 6-25).

4. Select: • Above, Below or Both to select the spectrum to perform

the calculations on, i. e. above or below the baseline or both.

• Max and/or Mean to display max and/or mean velocities.5. In the Modify Calcs menu, select the measurements and

calculations to be displayed in the Measurement result table.

6. Press Save as default to set the selected calculations to be default when a new study or exam is started.

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Figure 6-25: Vascular measurement menu (example)

Using Auto vascular calculation1. Perform the scan and press FREEZE.

The system performs the calculation automatically and the pre-defined measurements and calculation are displayed in the Measurement result table.

2. The following controls may be adjusted from the control panel:• CYCLE SELECT: change the selected cycle.

1. Selected vessel2. Vessel location parameters3. Manual/auto calculation controls4. Other vessels

5. Trace parameters6. Selected measurements and calculation to

appear in the Measurement result table.7. Assign measurement and calculation

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• TRACE SENSITIVITY: optimize the trace contour.• CURSOR SELECT: select Peak systolic or End diastolic

marker. The selected marker can be moved to a new location. Press SELECT to anchor the marker to its new location.

Assigning auto calculations1. In the Vascular Measurement menu (Figure 6-25), select:

• The actual vessel name• Prox, Mid or Dist: the location of the vessel (Proximal,

Middle or Distal).• Rt or Lt: right or left side of the patient.

2. Press Transfer to assign the measurements and calculations.

To undo the assign-ment, press Cancel transfer.

The Measurement result table is updated accordingly and the measurements and calculations are added to the worksheet and report.

Manual vascular calculation

When doing manual measurements, the system can detect the trace automatically or it can be drawn by the user. This is controlled by the Auto and Manual commands is the Measurement menu.

The following instructions assume that you first scan the patient and press FREEZE.1. Adjust the vessel location parameters in the Vascular

measurement menu (Figure 6-25).2. Select the measurement to be performed from the

Measurement menu or from the Show All menu for additional measurements.

3. Perform the measurement as described below.

Acceleration, Acceleration time (AT)1. Select Accel or AT.2. Position the caliper at the start point and press SELECT to

anchor the caliper.3. Position the second caliper at the end point and press

SELECT to anchor the caliper and complete the measurement.

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The acceleration and/or the acceleration time is displayed in the Measurement result table.

Heart rateHeart rate is calculated by selecting two identical points over four heart cycles.1. Select HR.2. Position the caliper at a recognizable point in the first cycle

and press SELECT to anchor the caliper.3. Position the second caliper at the identical point in the

fourth cycle and press SELECT to anchor the caliper and complete the measurement.The Heart rate is displayed in the Measurement result table.

Peak systole (PS), End diastole (ED) and Mid diastole (MD)1. Select PS, ED or MD.2. Position the caliper at the corresponding measurement

point and press SELECT to complete the measurement.The selected measurement is displayed in the Measurement result table.

Pulsatility index (PI) With Auto trace on

1. Select PI.2. Position the caliper at the beginning of the wave form and

press SELECT to anchor the caliper.3. Position the second caliper at end diastole and press

SELECT.A trace is displayed between the two calipers and PS, MD, ED, TAMAX and PI are displayed in the Measurement result table.

With Manual trace on1. Select PI.2. Position the caliper at the beginning of the wave form and

press SELECT to anchor the caliper.3. Using the trackball, draw the trace to the end diastole and

press SELECT.The trace is displayed and PS, MD, ED, TAMAX and PI are displayed in the Measurement result table.

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Peak systole/End diastole (PS/ED) and End diastole/Peak systole (ED/PS) ratio1. Select PS/ED or ED/PS.2. Position the caliper at Peak systole or End systole and

press SELECT to anchor the caliper.3. Position the second caliper at End diastole or Peak systole

and press SELECT to anchor the caliper and complete the measurement.The Peak systole, End diastole and PS/ED or ED/PS ratio are displayed in the Measurement result table.

Resistive index (RI)1. Select RI.2. Position the caliper at Peak systole and press SELECT to

anchor the caliper.3. Position the second caliper at end diastole and press

SELECT.The Peak systole, End diastole and RI are displayed in the Measurement result table.

TAMAX/TAMEAN/Volume Flow With Auto trace on

1. Select TAMAX, TAMEAN or Volume Flow.2. Position the caliper at the start point and press SELECT to

anchor the caliper.3. Position the second caliper at the end point and press

SELECT to anchor the caliper and complete the measurement.A trace is displayed between the two calipers and corresponding measurements are displayed in the Measurement result table.

With Manual trace on1. Select TAMAX, TAMEAN or Volume Flow.2. Position the caliper at the start point and press SELECT to

anchor the caliper.3. Using the trackball, draw the trace to the end point and

press SELECT.The trace is displayed and the corresponding measurements are displayed in the Measurement result table.

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OB measurements1. From an obstetric exam on a scan in Freeze, press

MEASURE.2. Select the desired study.3. Perform the required measurements from the selected

study.Follow the on-screen indications when performing measurements.

OB graphsOB Graphs allow you to assess fetal growth compared to a normal growth curve. When a patient has completed two or more ultrasound exams, you can also use the graphs to look at fetal trending. For multi-gestational patients you can show curves for all fetuses and compare the growth on the graphs. The Vivid 7 provides the following two basic types of graphs:• Fetal Growth Curve graphs – show one measurement per

graph. These graphs show the normal growth curve, positive and negative standard deviations or applicable percentiles, and ultrasound age of the fetus using the current measurement. For multi-gestational pregnancies, you can show curves for all fetuses. If previous exam data is available, the graph can show fetal trending.

• Fetal Growth Bar graph – shows the ultrasound age and the gestational age based on patient data. Plots all measurements on one graph.

To view OB graphs1. Press WORKSHEET.2. Press Graph.

The Fetal growth curve graph is displayed (Figure 6-26). The horizontal axis shows the fetal age in weeks. The system determines this age from the data entered in the Patient information window. Depending on the measurement selected the vertical axis displays measurements (mm or cm), ratios (%) or fetal weight (g).The Fetal growth curve graph shows the following information for the selected measurement:• The normal growth curve• The standard deviations or relevant percentiles

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• The gestational age of the fetus, using patient data (vertical dotted line)

• Using the current ultrasound measurement data, where the fetus is on the growth curve

From the OB graphs screen, the user can enter relevant information in the Fetus position and Placenta fields.

Figure 6-26: Fetal growth curve graph

To select the measurement1. Select the measurement in the Measurement type field.

A list of available measurements is displayed.2. Select the measurement to display.

To scroll through all Fetal growth curve graphs, adjust GRAPH CHANGE.

To select the age to use1. Adjust SELECT GA.

The plot displays either gestational age (GA) from the LMP, or the composite ultrasound age (CUA).

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When selected, the gestational age may be changed by the user.1. Select the GA (LMP) value.

An editing window is displayed.2. Enter a new value and select OK.

The GA (LMP) label is changed to GA(GA) showing the new value entered. This information is also updated in the Patient information window. In addition the EDD (LMP) is updated to EDD (GA) with new calculated value.

To view single or quad screen1. Press QUAD to display four graphs simultaneously.2. To select the measurements to display in the quad screen,

select the drop-down button on the left of each graph and select the desired measurement.

3. Press SINGLE to display single graph screen again.

Figure 6-27: Fetal growth curve graph: quad screen

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Fetal trending

When you have ultrasound data for more than one exam for a patient, you can use the data to look at fetal trending on the Fetal growth curve graphs. Fetal trending requires that a LMP value is entered in the Patient information screen.1. Press WORKSHEET.2. Press GRAPHS and select the desired measurement to

display.3. Press MORE and PLOT BOTH.

The system automatically finds the data from previous ultrasound exams, and displays it on the graph with the present data.

Figure 6-28: Fetal trending graph

Fetal growth bar graph

The fetal growth bar graph shows current exam measurements and the normal growth range based on the gestational age. It shows all measurements on one graph.1. Press WORKSHEET.2. Press GRAPH.3. Press BAR.

The fetal growth bar graph is displayed.

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Figure 6-29: Fetal growth bar graph

• The horizontal axis shows the gestational weeks.• The red vertical line shows the gestational age using the

patient data.• The blue dotted vertical line shows the ultrasound age

using the current measurements.• The yellow x shows the ultrasound age for each

measurement.• The green rectangle shows the normal age range for the

measurement.

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Measurement package configurationA list of all cardiac calculations with needed measurements and location in the Measurement package can be found in the Reference manual.

There are many more measurements and parameters in the measurement package than shown in the default Measurement menu. Use the configuration system to set up the measurements that should be available in the Measurement menu and which parameters should be calculated.

The following example based on calculation of AV CO (Cardiac Output by Aortic Flow) describes how to configure the measurement package so that necessary measurements and the resulting calculations are displayed on screen.

Measurement package configuration - exampleCalculation of Cardiac Output by Aortic Flow requires measurement of:• AV diameter located in the folder Dimension (2D mode)• AV VTI located in the folder Aortic (Doppler AV Trace).• Heart rate

If a calculated parameter (e.g. AV CO in AV Trace measurement) requires another parameter to be calculated (e.g. AV Diam) the user must first measure the required parameter (e.g. AV Diam) before the dependent parameter (e.g AV CO in AV Trace) gets calculated.

Configuration of the Measurement menu

If the AV diameter measurement is not present in the folder Dimension in the Measurement menu, follow the following procedure:1. Press CONFIG (F2) and select the category Measure.

The Measurement menu sheet is displayed (see Figure 6-30).

2. AV Diam is a 2D measurement, make sure that 2D is checked in the Measurement sheet.

3. Select folder Dimension in the Measurement menu.

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A list of all available measurements for the selected folder is displayed in the Measurement menu sheet.

4. Check the box in front of AV Diam.The AV Diam measurement is displayed in the folder Dimension in the Measurement menu.

5. For the AV VTI measurement, check Doppler in the Measurement menu sheet and select the folder Aortic in the Measurement menu.

6. Check the box in front of AV Trace.The AV Trace measurement is displayed in the folder Aortic in the Measurement menu.

Figure 6-30: Configuration of the Measurement menu

1. Select the scanning mode for the measurement to add to the Measurement menu.2. Select the folder for the measurement to add.3. Select the measurement to add.

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Configuration of the Measurement result table

If AV CO calculation is not displayed in the Measurement result table, follow the following procedure:1. Press CONFIG (F2) and select the Config category

Measure/Text.The Measurement menu sheet is displayed.

2. The AV CO calculation is based on Doppler AV Trace measurement in the folder Aortic, check Doppler in the Measurement menu sheet and select the folder Aortic.A list of all available measurements and calculations for the selected folder is displayed in the Measurement menu sheet.Note: Entries in green are calculated measurements.

3. In the Measurement menu sheet, double-click on the AV Trace measurement.A list of all available measurements and calculations for the AV Trace measurement is displayed in the Measurement menu sheet.

4. Check the box in front of AV CO.The AV CO calculation will be displayed in the Measurement result table.

Normal valuesNormal values can be defined by the user for all parameters. A normal value can be either a range or a threshold. Normal values entered are grouped by measurement category (e.g. Cardiac, Pediatrics...etc).

Normal values can be displayed in the report.

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To define a Normal value

Figure 6-31: Adding Normal value

1. Press CONFIG (F2) and select the Config category Measure/Text.The Measurement menu sheet is displayed (Figure 6-31).

2. In the Measurement menu, browse to the measurement of interest.The parameters for the selected measurements are displayed in the Measurement menu sheet.Note: to change Measurement category, press the Heading in the Measurement menu and select another Measurement category.

3. Select in the Normal value column.The Normal value window is displayed.

1. Measurement category2. Selected measurement3. Parameters4. Press to define Normal value

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Figure 6-32: The Normal value window

4. In the Normal value window:• Select the Normal value type (Range, Above or Below).• Type in the Normal value.• Optionally enter a reference for the Normal value.

5. Select OK.The Normal value is displayed in the Measurement menu sheet.

To display normal values and references in the Report, the Report template must be configured to show Normal values (see page 461). Measurements outside the Normal value are highlighted with an “!” in the report.

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User-defined formulasUser-defined formulas can be created using existing measurements or by defining new measurements. The following example describes the creation of a formula based on existing measurements.

User-defined formula - exampleThe workflow for user-defined formula is:• If the user-defined formula is based on several

measurements of different types, create a user-defined folder in the Measurement menu so that all measurements and the formula are grouped together. If the formula is based on a single measurement you may select an existing appropriate folder.

• Add the measurement(s) needed for the formula to the user-defined (or existing) folder.

• Create the formula based on the added measurements.

The following procedure describes the creation of user-defined LIMP formula as follow: My LIMP = (MCO-AV ET)/AV ET.

CAUTION

GE Ultrasound does not take any responsibility for the correctness of the user-defined functions.

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Creation of a user-defined folder

Figure 6-33: The Measurement menu sheet

1. Press CONFIG (F2) and select the category Measure.2. MCO and AV ET are Doppler measurements, select

Doppler in the Measurement menu sheet.3. Select Add folder.4. Give the folder a name (e.g. “My Folder”).

Adding measurements


1. Select the user-defined folder (e.g. “My Folder”) in the

1. Select the appropriate scanning mode.2. Create a folder in the Measurement menu.

1. Select the user-defined folder.2. Press Add measurement.

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Measurement menu.2. Press Add Measurement in the Measurement menu

sheet.The Add measure window is displayed.

Figure 6-35: The Add measure window

3. MCO and AV ET are measurements that already exist on the system, check Use copy of and select MCO from the drop down menu.

4. Select OK to add the MCO measurement.5. Repeat steps 2 to 4 to add the AV ET measurement.

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Creation of the formula


The formula for this example is as follow: My LIMP = (MCO-AV ET)/AV ET1. In the user-defined folder (e.g.”My folder”), select the last

measurement created (e.g. AV ET).2. Double-click (Name) in the last line in the Parameter list in

the Measurement menu sheet.3. Enter the name for the formula (e.g. My LIMP).

4. Select .The Edit formula window is displayed.

1. Select the last measurement.2. Double click and enter the formula name.3. Select “=” to create the formula.

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Figure 6-37: The Edit formula window

5. Select “(“from the Operators drop-down menu.6. In the Doppler drop-down list, select

MCO [My Folder, MCO].Make sure to select the measurement located in the user defined folder (e.g. “My Folder”).

7. Select “-“from the Operators drop-down menu.8. In the Doppler drop-down list, select

AV ET [My Folder, AVET].9. Select “)“from the Operators drop-down menu.10. Select “/“from the Operators drop-down menu.11. In the Doppler drop-down list, select

AV ET [My Folder, AVET].The Formula line should display: ({MCO}-{AVET})/{AVET}.No units are necessary since the formula is a ratio (see also ’About units’ on page 296).

12. Press Check to make sure that the syntax for the formula is correct.

User-defined measurements

Some user-defined formula may require measurements that do not exist on the system. The following example based on a generic distance measurement illustrates how to create user-defined measurements.

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1. Press CONFIG (F2) and select the category Measure.2. In the Measurement menu sheet, select the appropriate

scanning mode for the measurement to be created (e.g. 2D).

3. Select the appropriate folder in the Measurement menu (e.g. Dimension).

4. Press Add Measurement in the Measurement menu sheet.The Add measure window is displayed.

Figure 6-39: The Add measure window

5. Check Blank and press OK.The Measurement menu sheet is updated.

1. Select the appropriate scanning mode.2. Select the appropriate folder.3. Press Add measurement.

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6. In the Measurement menu sheet, enter the name for the measurement (e.g. My Distance).

7. Select the appropriate measurement tool in the drop-down menu, next to Tool (e.g. 2D Caliper).

8. Double-click (Name) in the appropriate parameter (e.g Distance) and enter a name for the parameter (e.g. My Length).If desired change the unit and the number of decimals for the measurement by double clicking the values under Unit and Precision (see also ’About units’ on page 296).

About unitsBe aware of the following:• All formulas are calculated in SI units (see table below).• If no unit is specified in the Edit formula window when

defining a formula, the displayed value will be in SI unit.

1. Enter a name for the measurement.2. Select the appropriate measurement tool.3. Double click and enter the formula name.

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To define a different unit1. When creating a formula, enter the unit to use when

displaying the formula output. E.g. if Y in the formula Y=f(x) is to be displayed in cm, enter cm in the Unit field.The Unit field is case sensitive, make sure to enter the exact unit as shown in the table below (Alternative unit column).

2. The output of a formula must always be in an SI unit (see table below). Conversion to the specified display unit is then done automatically.Example: an user wants to add a regression formula for estimating a length B from a measured length A, both in cm.The formula is: B = 2.4 + 1.1*A.• As A is a measurement value the system will enter the

formula in the SI unit for length (m). The formula expects A in cm, and to get that, A must be multiplied by 100:B = 2.4 + 1.1*A*100

• The formula now gives B in cm. Converting the output from cm to the SI unit (m), is done by dividing by 100:B = (2.4 + 1.1*A*100)/100

The output is now in m, and by entering this formula into the system the user gets the expected result. Measuring an A of 2 cm gives: B = (2.4 + 1.1*0.02*100)/100 = 0.046 m.Before display of the value it is converted according to the specified display unit (cm), and the system displays 4.6 cm. If the selected display unit was set to mm the formula would give the exact same output, 0.046 m, but the automatic unit conversion would now instead give a displayed value of 46 mm.

Calculation SI Alternative unit

Time s

Ratio %

Frequency bpm

Angle rad

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Distance m

Velocity m/s

Acceleration m/s2

Area m2

Volume m3

Volume flow m3/s

Pressure mm Hg*

Pressure/time mm Hg/s

Mass kg

Other

* The correct SI unit for pressure is Pa, but here mm Hg was used as base unit as it is a standard pressure unit to use in medicine.

Calculation SI Alternative unit

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Measurement result tableThe display of the Measurement result table can be minimized and moved to prevent the table obscuring parts of the ultrasound image.

Minimizing the Measurement result table

1. Trackball to the symbol on the heading of the Measurement result table (see Figure 6-41).

2. Press SELECT.Repeat step 1 to en-large the Measure-ment result table.

The Measurement result table is minimized to the heading bar.

Moving the Measurement result tableAlternative: Rotate the assignable RESULT WINDOW to move the Measure-ment result table from corner to cor-ner on the Acquisi-tion window.

1. Trackball to the symbol on the heading of the Measurement result table (see Figure 6-41).

2. Press SELECT to grab the table.3. Trackball the Measurement result table to a new position.4. Press SELECT to anchor the table.

Figure 6-41: Measurement result table display tools

Deleting measurements1. Trackball to the measurement to delete in the

1. Minimize/maximize table2. Move table

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Measurement result table and press SELECT.A menu is displayed.

2. Select Delete Measurement.

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WorksheetThe worksheet function enables the user to review, edit, delete or print data independently of a report. All measurements and calculations taken during the examination can be viewed at any time using the worksheet.

Overview

Figure 6-42: The Worksheet screen (Cardiac)

Using Worksheet1. Press WORKSHEET on the control panel and select the

1. Measurement type2. Measurement parameter 3. Value: Averaging, Max, Min or Last

4. Measured / calculated values5. Value type6. Measurement type selection

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measurement type (see Figure 6-42).

To scroll through pages1. Select PAGE DOWN or PAGE UP.

To select the type of value1. Trackball to the relevant cell in the Method column.2. Press SELECT.

A pop-up menu is displayed showing the different options available (Figure 6-43).

Figure 6-43: The Calculation method options list.

3. Trackball to the required option.4. Press SELECT.

The value is updated accordingly.

Excluding or including measurements

One or more measurement values from a set of measurements for a parameter can be excluded when doing average calculation.

To exclude a measurement1. Trackball to the measurement value to exclude.2. Press UPDATE MENU.

The Worksheet menu is displayed.When excluded the measurement dis-play turns grey.

3. Trackball to Exclude Value.4. Press SELECT.

To include a measurement1. Trackball to the measurement value to include.2. Press UPDATE MENU.

The Worksheet menu is displayed.3. Trackball to Include Value.

1. Average of the measurements taken2. Maximum measurement3. Minimum measurement.4. Last measurement that was taken

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4. Press SELECT.

Manually changing a value

Individual measured values can be manually changed using the alphanumeric keyboard.

To manually change a value1. Trackball to the value that is to be changed.2. Press SELECT.

An asterisk indi-cates that the value has been manually altered. The calcula-tion type is changed to Edit.

3. Use the alphanumeric keyboard to enter the required value.

To restore automatic calculation1. Trackball to the relevant cell in the Method column.2. Press SELECT.

A pop-up menu is displayed showing the different calculation options available (Figure 6-43).

3. Press SELECT.The value is re-calculated according the method selected.

Deleting measurement parameter1. Trackball to the measurement parameter to delete.2. Press UPDATE MENU.

The Worksheet menu is displayed.3. Trackball to Delete Value.4. Press SELECT.

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Chapter 7 Quantitative Analysis

• Introduction ................................................................................... ... 306• Accessing the Quantitative analysis package ........................... ... 307• Quantitative Analysis window ..................................................... ... 308

• Overview ...................................................................................308• Generation of a trace .................................................................... ... 315

• About the sample area ..............................................................315• To generate a trace ..................................................................315• Manual tracking of the sample area (dynamic anchored sample

area) ..........................................................................................316• Zooming in the Analysis window ...............................................317

• Deletion of a trace ........................................................................ ... 318• To delete all traces ...................................................................318• To delete one specific trace ......................................................318

• Saving/retrieving Quantitative analysis ..................................... ... 318• Frame disabling ............................................................................ ... 319

• Disabling frames .......................................................................319• Re-enabling all frames ..............................................................319

• Optimizing sample area ............................................................... ... 321• Reshaping a sample area .........................................................321• Labelling a sample area ............................................................322

• Optimizing the trace display ........................................................ ... 323• Optimizing the Y-axis ................................................................323• Trace smoothing .......................................................................324

• Switching modes or traces .......................................................... ... 326• To switch mode .........................................................................326• To switch trace ..........................................................................326

• Cine compound ............................................................................ ... 327

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• Curve fitting analysis ................................................................... ... 328• Anatomical M-Mode ...................................................................... ... 337

• Introduction ...............................................................................337• Using Anatomical M-Mode ........................................................337

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IntroductionThe quantitative analysis software package is designed for analysis of TVI, Tissue Tracking, Strain, Strain rate and Contrast related raw data.

The main features of these options are:

For TVI:• Multiple Time -motion trace display from selected points in

the myocardium.• Arbitrary Curved anatomical M-Mode

For Tissue Tracking:• Multiple tissue displacement trace display from selected

segments in the myocardium.• Arbitrary Curved anatomical M-Mode

For Strain rate:• Multiple Strain rate (Rate of deformation (s-1)) trace display

from selected segments in the myocardium.• Arbitrary Curved anatomical M-Mode

For Strain:• Multiple Strain (extend of tissue deformation (%)) trace

display from selected segments in the myocardium.• Arbitrary Curved anatomical M-Mode

For Contrast:• Time-Intensity analysis from multiple region of interest• Curve fitting• Arbitrary Curved anatomical M-Mode

If not otherwise specified, the topics described in this chapter are applicable for both TVI and contrast data.

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Accessing the Quantitative analysis package

In replay mode:1. Open an examination and recall a TVI or contrast loop.2. Press the assignable Q ANALYSIS.

The Quantitative Analysis screen is displayed (see Figure 7-1).

In live1. Press FREEZE.

Note: if in 2D mode outside a contrast application, press ALT and MORE assignable.

2. Press the assignable Q ANALYSIS.The Quantitative Analysis screen is displayed (see Figure 7-1).

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Quantitative Analysis window

Overview

Figure 7-1: The Quantitative analysis window (here with TVI data)

The color cineloop window

1. Color cineloop window2. Tissue cineloop window3. Analysis window4. Sample Area

5. Time at cursor position and velocity at cursor position

6. Trackball Assignments7. Sample area tools

7

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Displays TVI, Tissue Tracking, Strain, Strain rate or Angio color-coded data.Sample area (1):Indicates sampling position of the velocity (TVI), displacement (Tissue Tracking), percent deformation (Strain), deformation rate (Strain rate) or intensity (Contrast) trace. The sample area is color-coded: the first sample area is yellow, the second green...etc.

a) Shown only when a sample area is selected (pointed at).b) With Contrast data only.c) Shown only when pointing at an anchored sample area.

The cineloop windows system menuThis menu is entered by pressing UPDATE MENU when the QA trackball cursor is within one of the Cineloop windows.• Delete all Sample areas: removes all traces

at once.• Disable frameb: the current frame is

excluded from the cineloop display.• Set Sample area Shapea: enables resizing

of a selected sample area by setting height, width and tilt angle. The trackball marker must be pointed at an anchored sample area.

• Label Sample area...a: set a descriptive name to the sample area. The label is useful for identification of the sample area when exporting data.

• Delete anchorc: remove anchoring from a dynamic sample area (see also page 315 and page 316).

• Delete Sample areaa: removes selected sample area from the Cineloop window and belonging trace in the Analysis window. The trackball marker must be pointed at an anchored sample area.

• Cancel: exits the System menu.

1

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The Tissue cineloop window

Displays 2D dataSample area (1):Indicates sampling position of the velocity (TVI), displacement (Tissue Tracking), percent deformation (Strain), deformation rate (Strain rate) or intensity (Contrast) trace. The sample area is color-coded: the first sample area is yellow, the second green...etc.

Sample area tools:

• : creates a sample area based on freehand drawing.

• : creates a sample area with a pre-defined circular/elliptic shape (configurable, see page 321)

1

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The analysis window

TVI:Displays velocity trace1. Y axis: velocity scale (cm/s)2. X axis: Time (s)3. ECG4. Time at cursor position5. Velocity at cursor position6. Velocity at frame marker position

(color coded)Tissue Tracking:Displays tissue displacement trace1. Y axis: displacement scale (mm)2. X axis: time (s)3. ECG with Tracking start and Tracking

end markers4. Time at cursor position5. Displacement at cursor position6. Displacement at frame marker

position (color coded)Strain rate:Displays Strain rate trace (rate of deformation (s-1))

1. Y axis: s-1

2. X axis: time (s)3. ECG4. Time at cursor position5. Strain rate at cursor position6. Strain rate at frame marker position

1

2

3

45

-2.3

6

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Strain:Displays Strain trace (extent of tissue deformation (%))1. Y axis: percent displacement2. X axis: time (s)3. ECG with Strain start and Strain end

markers4. Time at cursor position5. % deformation at cursor position6. % deformation at frame marker

position (color coded)Contrast:Displays time-intensity curve1. Y axis: Intensity scale (logarithmic)

(dB) or linear acoustic units (AU).2. X axis: Time (s) or dT (s), elapsed

time from previous frame.3. ECG: displays ECG trace, the current

frame marker and the start and stop markers for the cineloop.

4. Time at cursor position5. Intensity (dB or AU) at cursor position6. Intensity (dB or AU) at frame marker

position (color coded)

1

2

3

45

-2.3

6

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a) With contrast data only.b) Shown only in zoom mode.

The analysis window system menu:This menu is entered by pressing UPDATE MENU when the QA cursor is within one of the analysis window.• Delete all Sample areas: removes all traces

at once.• Analysis signal: toggles trace display

between velocity, displacement, strain rate, stain or greyscale intensity curves.

• Drift compensation: compensates drifting of strain or Tissue Tracking curves by either resetting the curve to zero at the tracking start point (cycle resetting) or by linear compensation throughout the cycle (linear compensation)

• Horizontal scale: set horizontal unit as time (s) or time interval (dt) between frames.

• Vertical auto-scaling: selects between full unit range or a range according to the maximum and minimum values of the displayed trace(s).

• Vertical unita: toggles between logarithmic (dB) and linear acoustical units (AU).

• Line style: selects between solid line only or solid line with square markers at each data point.

• Smoothing: smooths the trace displayed by applying a filter over a defined time window. Both the filter type and time window are user-selectable. The type of filter available is depending on the analysis signal displayed.

• Export traces: saves trace data in ASCII format, readable in spreadsheet programs. If present, trace data for physiological traces are also exported.

• Curve fittinga: toggles between Wash-in, Wash-out and off.

• Unzoomb: restores full analysis window display when in zoom mode.

• Cancel: exits the System menu.

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The Trackball assignments

QA:Pointing tool in Quantitative analysis mode.Scroll/Speed:• When the cineloop is stopped, enables

scrolling through the cineloop.• When the cineloop is running, enables

control of the cine replay speed.

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Generation of a traceUp to eight traces can be generated.

About the sample areaThe sample area can be in three different states:• Free sample area: freely moving sample area (QA cursor)

before anchoring.The free sample area disappears when the QA cursor is moved over a static an-chored frame.

• Static sample area: the free sample area is anchored by pressing SELECT on the Trackball area.

• Dynamic anchored sample area: the sample area is anchored in two or more frames (see Manual tracking below). In these particular frames, the sample area is displayed with an anchor. The sample area moves smoothly between the anchored positions when playing/scrolling the cineloop.

To generate a trace

Trace from a pre-defined sample area

The shape of the pre-defined sample area is configurable (see page 321).1. If the Trackball assignment is not on QA, press TRACKBALL

until QA is highlighted.The trace and sam-ple area are col-or-coded. First generated trace is yellow, second green...etc.

2. If necessary, select the sample area Shape button . 3. Trackball to one of the Cineloop windows.

The trackball cursor is changed to a sample area (white circle).A preview of the trace is displayed in the Analysis window.

4. Press SELECT to anchor the sample area.In this frame the sample are is marked with an anchor.If the cineloop has more than one heart cycle a sample area will also be anchored in the corresponding frame in the next heart cycles.The trace is updated accordingly in the Analysis window.

The Strain cursorIn Strain and Strain rate modes, the sample area displays a Strain cursor showing the segment along the beam direction that is used for Strain and Strain rate calculations. Make sure

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that the Strain cursor is within the myocardium when anchoring the sample area.

Trace from a freehand sample area1. Select the Pencil button .2. Trackball to one of the Cineloop windows.

The trackball cursor is changed to a cross.3. Press and hold down the SELECT button while drawing a

sample area with the trackball.4. Release the SELECT button.

The sample area is automatically closed.The trace is updated accordingly in the Analysis window.

Manual tracking of the sample area (dynamic anchored sample area)The sample area can be moved within the loop to ensure that data in the trace are generated from the same anatomical location during the cyclic motion of the heart.1. Place a sample area over a region of interest.

Note the anatomical location of the sample area.2. Using the trackball, scroll to a new frame.3. Press TRACKBALL until the QA trackball assignment is

selected.4. Trackball to the sample area.5. Press SELECT.

The sample area is unanchored.6. Drag the sample area to the corresponding anatomical

location in the new frame.In the original frame and this par-ticular frame the sample area is marked with an an-chor.

When the sample area is anchored in more than one frame, linear interpolation is performed, so that the sample area is smoothly moved between the anchored positions in the selected frames when running the cineloop.

7. Press TRACKBALL until the Scroll trackball assignment is selected.

8. Using the Trackball, scroll through the cineloop and control that the sample area follows the moving anatomical structure.

9. Add anchored sample areas in several frames to obtain a more accurate displacement of the sample area.

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To move a dynamic anchored sample area1. Press TRACKBALL until the Scroll trackball assignment is

selected.In these frames the sample area is marked with an an-chor.

2. Using the trackball, browse through the cineloop to display one of the frames where the sample area was anchored.

3. Press TRACKBALL until the QA trackball assignment is selected.

4. Trackball to the sample area to move, in one of the Cineloop windows.

5. Press SELECT.The sample area is unanchored.

6. Drag the sample area to a new location.7. Press SELECT to anchor the sample area to the new

location.

Zooming in the Analysis window1. In the Analysis window, press and hold down the SELECT

key while dragging the trackball cursor to define the zooming area.

2. Release the SELECT key.The selected area is displayed in the Analysis window.

To unzoom1. Press UPDATE MENU in the trackball area on the control

panel.The System menu is displayed.

2. Trackball to Unzoom.3. Press SELECT.

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Deletion of a traceThe user can delete all traces at once or one at a time.

To delete all traces1. If necessary, press TRACKBALL until the QA trackball

assignment is selected.2. Press UPDATE MENU in the trackball area on the control


3. Trackball to Delete all traces.4. Press SELECT.

To delete one specific trace1. If necessary, press TRACKBALL until the QA trackball

assignment is selected.2. Trackball to the sample area to delete.3. Press UPDATE MENU in the trackball area on the control


4. Trackball to Delete trace.5. Press SELECT to perform deletion.

Saving/retrieving Quantitative analysis1. Press IMAGE STORE to save the quantitative analysis

session.2. To recall the Quantitative analysis session, select the icon

on the clipboard, and press the assigned key Q ANALYSIS.

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Frame disablingFrame disabling excludes the actual frame from the cineloop display. Frame disabling is available only with contrast data.

Disabling framesTo re-enable a frame: Press SELECT on the cor-responding frame marker.

1. Trackball to the frame marker of the frame to disable beneath the Analysis window (see Figure 7-2).

2. Press SELECT to disable the frame. The frame marker turns red.

disabling successive frames at a timeTo re-enable succes-sive frames: press and hold down the SELECT key while dragging the cursor over the frame markers.

1. Press and hold down SELECT while dragging the cursor over the frame markers of the frames to disable.The frame markers turn red.

ECG triggered frame disabling

In a multi-cycle acquisition, the user may deselect all frames in all heart cycles but a selected one. This function can be used for example to select a particular systolic frame for each heart cycle.1. Scroll through the cineloop to identify the cardiac phase to

analyze or identify the cardiac phase on the ECG trace.2. Trackball to the frame marker of the frame of interest in one

of the heart cycles (see Figure 7-2).3. Press UPDATE MENU.

The System menu is displayed.4. Trackball to ECG triggering.5. Press SELECT.

All frames in all heart cycles are disabled except for the selected and corresponding frames in the other heart cycles.

Re-enabling all frames1. Trackball the cursor to the Frame marker axis.2. Press UPDATE MENU in the trackball area on the control


3. Trackball to Enable all frames.4. Press SELECT.

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All previously disabled frames are re-enabled.

Figure 7-2: Frame disabling

1. Analysis window2. Frame marker axis3. Enabled frame (green marker)4. Disabled frame (red marker)5. ECG6. Current frame

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Optimizing sample areaThe sample area can be reshaped and labelled.

Reshaping a sample areaThere are two ways of modifying a sample area: either from the Update menu or by selecting the SAMPLE SHAPE assignable.

Reshaping a sample area from the Update menu1. If necessary, press TRACKBALL until the QA trackball

assignment is selected.2. Trackball to the sample area to reshape.3. Press UPDATE MENU in the trackball area on the control


4. Trackball to Set Sample area shape.5. Press SELECT.

A Dialogue window is displayed where the user can adjust the height, the width and the angle of the sample area (see Figure 7-3).

Figure 7-3: The sample area reshaping window

6. Drag the sliders to adjust the shape of the sample area as desired.

7. Press OK to return to the Quantitative analysis window and use the settings for the current analysis only.ORPress Set as default to return to the Quantitative analysis screen and keep the settings as default.

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Reshaping a sample area from the assignables

This procedure allows to reshape either a free sample area or a specific anchored sample area providing that the QA cursor is pointing at the actual sample area.1. Press the SAMPLE SHAPE assignable.

The Sample shape assignable controls are displayed.2. Adjust the size and angle of the sample area using the

assignable rotaries.3. If desired press the assignable SET DEFAULT to keep the

settings as default.

Labelling a sample areaThe sample area label is used to identify data associated to the sample area when exporting to a spreadsheet program.1. If necessary, press TRACKBALL until the QA trackball

assignment is selected.2. Trackball to the sample area to label.3. Press UPDATE MENU in the trackball area on the control


4. Trackball to Label Sample area....5. Press SELECT.

A Dialogue window with a free text field is displayed (see Figure 7-4).

6. Type a name for the sample area.7. Press OK to return to the Quantitative analysis screen.

Figure 7-4: The sample area labelling window

1. Free text

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Optimizing the trace display

Optimizing the Y-axis

Auto-scaling

The system can be configured to display the full unit range or a range according to the maximum and minimum values of the displayed trace(s) (auto-scaling function). In addition, the auto-scaling function can be set to be live update (updates while the sample area is moved) or delayed (updated when the sample area is anchored).

Setting the auto-scaling function1. If necessary, press TRACKBALL until the QA trackball

assignment is selected.2. Trackball to the Analysis window.3. Press UPDATE MENU in the trackball area on the control


4. Trackball to Vertical auto-scaling.5. Press SELECT.

The Vertical autoscaling menu is displayed.

Figure 7-5: The Vertical Auto-scaling menu

6. Trackball to the desired option:• Delayed: autoscaling takes place after anchoring the

sample area.• On: autoscaling while moving the sample area.• Off: displays full scale.

7. Press SELECT.

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Vertical units

Applicable with contrast data only.

When analyzing contrast data, the Y-axis can be set to display either logarithmic scale (dB) or linear, acoustical units (AU) for both tissue intensity (2D) or Angio intensity data.

Selecting the Y-axis unit1. If necessary, press TRACKBALL until the QA trackball



4. Trackball to Vertical unit.5. Press SELECT.

The Vertical unit menu is displayed.

Figure 7-6: The Vertical unit menu

6. Trackball to the desired option.7. Press SELECT.

Trace smoothingThe system can smooth the traces displayed by applying a filter over a defined time window. The type of filter available is depending on the analysis signal displayed.

Smoothing trace(s)1. If necessary, press TRACKBALL until the QA trackball



325

4. Select Smoothing.The Smoothing menu is displayed.

5. Select a smoothing filter.The trace display is updated.

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Switching modes or tracesThe user can toggle between TVI, Tissue Tracking, Strain rate or Strain modes to access to the mode specific controls (soft menu and assignable) or display alternative traces from within a selected mode.

To switch mode1. Press MORE.2. Select the desired mode (TVI, Tissue Tracking, Strain rate

or Strain.The Soft menu and assignables are updated accordingly.

To switch trace1. If necessary, press TRACKBALL until the QA trackball



4. Trackball to Analysis signal.5. Press SELECT.

The Analysis signal menu is displayed.

Figure 7-7: The Analysis signal menu

6. Trackball to the desired trace.7. Press SELECT.

The Analysis window is updated with the selected trace.

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Cine compoundCine compound calculates and displays cineloops generated from a temporal averaging of multiple consecutive heart cycles. The number of averaged cycles is displayed on the top left corner.

To apply cine compound:1. Using the Soft menu rocker, adjust the number of heart

cycles to average.The traces are updated showing averaged data. The number of heart cycles averaged is displayed on the top left corner.

2. Press the assigned key CC Zoom to display the last recorded heart cycle.

3. Press CC Zoom again to unzoom.

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Curve fitting analysisCurve fitting analysis is used to estimate local myocardial perfusion rate using ultrasound contrast agents.

The analysis is based on two algorithms:• Wash-in curve fitting: find and estimate local perfusion

rate using contrast agent.Exponential wash-in is described by the function:y(t)=A[1-e-kt]+B, where:• A (dB or AU) is the intensity from the contrast agent.

Note that A+B = contrast + tissue = plateau level.

• B (dB or AU) is the intensity at time t = 0 (defined as the time of left marker). This corresponds to the tissue (baseline) signal if no contrast is present at the selected starting point.

• k (1/s) is a time constant.• Wash-out curve fitting: find and estimate the wash-out

rate of contrast agent locally (e.g. LV or myocardium).Exponential wash-out is described by the function:y(t)=Ae-kt+B, where:• A (dB or AU) is the intensity from the contrast agent.

Note that A+B is the initial intensity level.

• B (dB or AU) is the intensity from the tissue = baseline signal.

• k (1/s) is a time constant.

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Figure 7-8: Curve fitting examples, A) wash-in, B) wash-out A=900 AU, B=300 AU for all curves

1. Intensity (AU)2. Time (s)

0

1200

900

600

300

1 2 3 4 5 6 7 8 9 10

k=0.15k=0.3k=0.7

0

1200

900

600

300

1 2 3 4 5 6 7 8 9 10

k=0.15

k=0.7

A B

330

Wash-in curve fitting analysis

Overview

The purpose of wash-in curve fitting analysis is to find and estimate local perfusion rate using contrast agent. There are two methods to obtain this information:• Use the Real-time CPI application (see page 205) with low

transmit power (MI 0.1). Applying Flash will destroy most or all contrast within the imaging plane. The period of low power imaging immediately following the flash will contain the information on how fast contrast agent washes into different segments of the myocardium. By storing data 5 to 10 seconds after Flash and performing curve fitting to this data set, the user can explore myocardial perfusion.

• Use the myocardial Contrast application in triggered mode (page 197). This imaging mode is destructive for the contrast agent, and the interval between each frame determines the image intensity. Vary the triggering interval to obtain information regarding how fast the contrast agent washes into the myocardium after destruction.

Performing wash-in curve fit

From a contrast examination in Quantitative analysis:1. Disable frames that are significantly different (i.e. because

of respiration or probe movements), see page 319.Up to eight different sample areas may be generated in the myocardium.

2. Trackball the sample area over the myocardium in one of the Cineloop windows.

3. Press SELECT to anchor a sample area in the myocardium.4. If desired, reshape the sample area as described on

page 321.Refer to �’Manual tracking of the sam-ple area (dynamic anchored sample ar-ea)�’ on page 316 for further details

5. Because of heart motion, the sample area in each frame has to be adjusted manually to be located inside the myocardium (Manual tracking of the sample area).The signals originating from the heart cavities are typically 10 to 20 times stronger than the signals from the myocardium, and will have a major effect on the averaging of signals in the sample area.

6. Browse through the cineloop to ensure that the sample area is in the same anatomical position in all frames.

331

7. Rotate the HORIZONTAL SWEEP assignable and scroll through the cineloop to visualize a specific part of the data, typically the region immediately after Flash.

8. Rotate the LEFT MARKER and RIGHT MARKER assignables to apply curve fitting to a specific region.

9. Trackball to the Analysis window.10. Press UPDATE MENU in the trackball area on the control


11. Trackball to Curve fitting.12. Press SELECT.

The Curve fitting menu is displayed.

Figure 7-9: The Curve fitting menu

13. Trackball to Wash-in.14. Press SELECT.

The Wash-in curve is displayed in the Analysis window (see Figure 7-10).

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Figure 7-10: Wash-in curve fit of Real Time CPI data

Wash-in curve fitting using varying triggering intervals

If the data set contains frames with uneven time intervals, e.g. triggered images with increasing triggering intervals, it is possible to plot the data using the time interval (dt) on the X-axis.1. Disable unwanted frames. Curve fitting will be performed

using all enabled frames.The frame disabling procedure is ex-plained on page 319.

2. Trackball the sample area over the myocardium in one of the Cineloop windows.

1. Parameter window

333

Up to eight different sample areas may be generated in the myocardium.

3. Press SELECT to anchor a sample area in the myocardium.4. Repeat steps 2 and 3 if other sample areas are desired.5. If desired, reshape the sample area as described on

page 321.See page 316 for more information on sample area manual tracking.

6. Perform manual tracking of the sample areas on all frames to ensure that the sample area is inside the myocardium.



9. Trackball to Horizontal scale.10. Press SELECT.

The Horizontal scale menu is displayed.11. Trackball to dT scaling.12. Press SELECT.

The X-axis in the Analysis window is updated accordingly.13. Press UPDATE MENU again.14. Trackball to Curve fitting.15. Press SELECT.



16. Trackball to Wash-in.17. Press SELECT.

The Wash-in curve is displayed in the Analysis window.

334

Figure 7-12: Wash-in curve fitting after varying triggering interval

1. Parameter window

Angio (dB)

(s)

1 2 1

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Wash-out curve fitting analysis

Overview

The purpose of wash-out curve fitting analysis is to find and estimate a local wash-out rate. The analysis may be used for wash-out of contrast from LV or myocardium.

Performing wash-out curve fitting

From a contrast examination in Quantitative analysis:1. Disable frames that are significantly different (i.e. because

of respiration or probe movements), see page 319.2. Trackball the sample area over the myocardium in one of

the Cineloop windows.Up to eight different sample areas may be generated in the myocardium.

3. Press SELECT to anchor a sample area in the myocardium.4. If desired, reshape the sample area as described on

page 321.Refer to �’Manual tracking of the sam-ple area (dynamic anchored sample ar-ea)�’ on page 316 for further details.

5. Because of heart motion, the sample area in each frame has to be adjusted manually to be located inside the myocardium (Manual tracking of the sample area).The signals originating from the heart cavities are typically 10 to 20 times stronger than the signals from the myocardium, and will have a major effect on the averaging of signals in the sample area.

6. Browse through the cineloop to ensure that the sample area is in the same anatomical position in all frames.

7. Rotate the HORIZONTAL SWEEP assignable and scroll through the cineloop to visualize a specific part of the data.

8. Rotate the LEFT MARKER and RIGHT MARKER assignables to apply curve fitting to a specific region.



11. Trackball to Curve fitting.12. Press SELECT.


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13. Trackball to Wash-out.14. Press SELECT.

The Wash-out curve is displayed in the Analysis window (see Figure 7-14).

Figure 7-14: Wash-out curve fit of two sample regions in an in-vitro experiment

Angio (dB)

(s)

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Anatomical M-Mode

IntroductionM-Mode applied to TVI, Tissue Tracking, Strain rate, Strain or intensity data (Contrast) calculates and color/codes data accordingly along a path drawn by the operator.

Using Anatomical M-Mode1. Press the CAMM assignable.2. In one of the Cineloop windows, trackball to the region from

where to start the sampling path.3. Press SELECT to anchor the first point of the path.4. Trackball to the location for the next anchoring point of the

path.To edit a path under construction, trackball back-ward and retrace the path.

5. Press SELECT to anchor the point.A path with two anchor points will give a straight anatomical M-Mode profile. By creating more than two anchor points, the user can bend the path and obtain a curved anatomical M-Mode profile.

6. To end the trace press SELECT twice (double clicking).Rotate HORIZ. SWEEP and scroll through the cineloop to optimize the display to the portion of interest.

The color-coded display of the corresponding data calculated along the path is shown in the Analysis window (see Figure 7-15).

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Figure 7-15: The anatomical M-Mode display (here TVI data)

1. Cineloop window2. Analysis window

3. Path anchor point4. Time scale

2

3

4

1

3

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Optimizing Anatomical M-Mode

Edition of the curve

The drawn Anatomical M-Mode path can be edited by moving the anchor points.

To move an anchor point1. Trackball to anchor point to move.2. Press SELECT.3. Trackball the anchor point to a new position.4. Press SELECT to anchor the point to its new location.

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Chapter 8 Archiving

• Introduction ................................................................................... ... 342• Storing images and cineloops .................................................... ... 343

• Storing an image .......................................................................345• Storing a cineloop .....................................................................345• Saving stored images and cineloops to a standard format .......346• MPEGVue/eVue .......................................................................348

• Retrieving and editing archived information ............................. ... 351• Locating a patient record ..........................................................351• Selecting a patient record and editing data in the archive ........355• Deleting archived information ...................................................361• Moving examinations ................................................................363

• Review images in archive ............................................................ ... 366• Review the images from a selected examination .....................366• Select images from the Image list screen .................................367

• Connectivity .................................................................................. ... 371• The dataflow concept ................................................................371• Stand-alone scanner scenario ..................................................375• A stand-alone scanner and a stand-alone EchoPAC PC

environment ..............................................................................376• A stand-alone scanner and a stand-alone DICOM workstation 378• A scanner and EchoPAC PC in a direct connect environment .379• A scanner and EchoPAC PC in a network environment ...........383• A scanner and a DICOM server in a network ...........................385

• Export/Import patient records/examinations ............................. ... 395• Exporting patient records/examinations ....................................395• Importing patient records/examinations ....................................404

• Disk management ......................................................................... ... 408

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• Configuring the Disk management function ..............................409• Running the Disk management function ...................................411

• Data Backup and restore ............................................................. ... 416• Backup procedure .....................................................................417• Restore procedure ....................................................................421

• DICOM spooler .............................................................................. ... 423• Starting the DICOM spooler ......................................................423

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IntroductionDuring an examination, the operator stores data, images and cineloops for immediate purposes. The Vivid 7 ultrasound unit includes an integrated patient archiving system for data and image storage.

The Vivid 7 ultrasound unit enables also storing of data and images to external databases (EchoServer, Magneto Optical (MO) disk or CD-R). The patient and image archives are set by the selected dataflow (see page 551 about available dataflows and default dataflow selection).

CAUTION

Do not use the internal harddrive for long-term image storage.

343

Storing images and cineloopsDICOM images are stored to formatted Magneto Optical disks separately from patient data.

Images and cineloops that are stored during a current examination are displayed as thumbnails on the clipboard (see Figure 8-1). When an image is stored, all the additional information that is displayed is saved with it (e.i. probe and application selected, image setting, annotations or measurements...).

The image archive is set by the dataflow selected (see page 551 about available dataflows and default dataflow selection).

In addition, stored images and cineloops can be saved to a removable media in the standard formats JPEG, MPEG, AVI and DICOM (see page 346).

CAUTION

Do not use the internal harddrive for long-term image storage.

A formatted (see page 562) Magneto Optical Disk is recommended for image archive.

CAUTION

If working off-line with a dataflow pointing to a DICOM server, the images stored during the examination will have to be manually resent in the DICOM spooler (page 423) when reconnecting the unit. Resend all jobs that are failed or on hold (See page 423 for more information on DICOM spooler.).

344

Figure 8-1: The Clipboard on the scanning screen

1. Single image stored2. Cineloop stored Scrolling tool3. Scrolling tool

345

Storing an imageImages are displayed chronologically on the clipboard.1. While scanning in any mode, press FREEZE.2. Trackball to scroll through the cineloop and select the

required image.3. Press STORE.

The image is stored and a thumbnail is displayed on the clipboard. The number “1” on the thumbnail image indicates that the image stored is a single frame (see Figure 8-1, page 344).

Storing a cineloopA cineloop is a sequence of images recorded over a certain time frame. The time frame can be adjusted to cover one or more heart cycles. The stored cineloops are displayed chronologically on the clipboard. Cineloops can be stored at any time during the scanning session. The user can choose to preview the cineloop before storage or save the cineloop directly as described below.

Preview and storage of a cineloop1. While scanning in any mode, press FREEZE.2. Press the Assignable CINELOOP.3. Determine the best cineloop to store using the assignables

(see page 58 for further information on cineloop operation).4. Press STORE.

The cineloop is stored and a thumbnail is displayed on the clipboard (Figure 8-1, page 344).

Direct storage of a cineloop

Depending on whether the system has been configured to enable or disable the Preview Loop before store function (see page 521), the following procedures enable the cineloop to be stored directly.

346

Storing cineloop without previewThe function Preview Loop before store is disabled (see page 521).1. While scanning, press STORE.

The last valid cineloop is stored in the archive and a thumbnail is displayed on the clipboard (Figure 8-1, page 344).Scanning resumes immediately.

Storing cineloop with previewThe function Preview Loop before store is enabled (see page 521).1. While scanning, press STORE.

The last valid cineloop is previewed on the screen (but not stored).

2. If desired, press CINELOOP and adjust the cineloop to be stored using the assignables (see page 58).

3. Press STORE to save the cineloop.A thumbnail is displayed on the clipboard (Figure 8-1, page 344).

Saving stored images and cineloops to a standard formatStored images and cineloops can be saved to a removable media in the following standard formats:• Still images: JPEG, MPEG, DICOM and RawDICOM (Raw

data + DICOM)• Cineloops: AVI, MPEG, DICOM and RawDICOM (Raw

data + DICOM)

Images can also be stored as MPEG format on a CD-R using the Export function as described on page 348.

Procedure:1. Trackball to the required image or loop icon on the

clipboard.2. Press SELECT.

The selected image is displayed.3. Press MENU on the control panel.

The System menu is displayed.

347

Figure 8-2: The System menu

4. Trackball to Save as.5. Press SELECT.

The Save as menu is displayed.

Figure 8-3: The Save as menu

6. Select the desired removable media from the Save in archive pull-down menu.

7. Enter a file name in the File name field.

348

If the image or cineloop is saved as DICOM or RawDICOM the file name is automatically generated to follow the DICOM standard.

8. Select between:• Store image only: saves the image or cineloop only.• Store secondary capture: creates a still image of the

image area and the Title bar.The secondary capture is not available when saving images as DICOM or RawDICOM.

9. Select the image compression type (JPEG or RIe) or no compression.

10. Enter in the desired Image quality (between 10 and 100).A high quality setting will give a lower compression.

11. In the Save as type field select one of the following formats:• RawDICOM: saves the still image or cineloop in both GE

raw format and DICOM format.• DICOM: saves the still image or cineloop in pure DICOM

format.• JPEG: saves a still image in JPEG format.• MPEG: saves the still image or cineloop in MPEG

format.• AVI: saves the cineloop in AVI format.

12. Press Save.A file is saved in the selected archive.

MPEGVue/eVueMPEGVue/eVue enables the user to export or save an exam (images, measurements and reports) into MPEG format readable from a regular Windows computer together with a special MPEG viewer. The measurements performed during the exams are stored as an Excel file, the saved report as Compiled HTML format.

MPEG exams can be created using the Export function (MPEGVue) or by using the dataflow Local Archive - Int. HD/eVue (eVue).

The MPEGVue option is used to create MPEG exams on finished exams. The eVue option is used to create MPEG exams when performing the exam, upon saving the images.

349

Creating a MPEG exam using the Export function (MPEGVue)

Refer to ’Exporting patient records/examinations’ on page 395.

Creating a MPEGVue exam using the dataflow Local Archive - Int. HD/eVue (eVue)

The dataflow must be configured before first time use as follow:1. Press CONFIG (F2) and log on as administrator.2. Select the Connectivity category and Dataflow subgroup.

The Dataflow sheet is displayed.3. Select the dataflow Local Archive - Int. HD/eVue in the

Name pull-down menu.

Figure 8-4: The Dataflow sheet

4. Select the eVue device in the Selected devices pane and press Properties.The eVue properties window is displayed.

350

Figure 8-5: The eVue properties window

5. Select a removable media or a network volume remote path as the destination in the Destination Pull-down menu.Note: Remote paths of network volumes must be entered once in the Remote path field before they can be selected from the Destination Pull-down menu.

6. Check the options as required.7. Select OK and press CONFIG (F2).

To create an MPEG exam using the dataflow Local Archive - Int. HD/eVue1. Press ARCHIVE.

The Search/Create patient window is displayed.2. Select the dataflow Local Archive - Int. HD/eVue.3. Perform an exam.

When saving an image, it is stored as raw data to the local archive, a MPEG copy is created and stored to the destination set during the configuration of the dataflow.

Reading a MPEG exam

A MPEG exam can be read from any computer with Windows 98/2000/XP, provided that DirectX 8.1 or later and Windows Media Player 7.1 or later are installed.

Refer to the MPEGvue User Manual for details on readings MPEG exams on a computer.

351

Retrieving and editing archived information

Locating a patient recordTo create an opera-tor ID, see page 575.

1. Press ARCHIVE on control panel.If the unit is password protected a Log In window (Figure 8-6) will appear asking for user ID, and password.


The unit can be con-figured to automati-cally generate a patient ID (see page 563)

2. Press Log on when completed.The Search/Create patient window is displayed (Figure 8-7).

3. Type the patient Last Name, and/or ID.

The automatic searching tool dis-playing matching patient information in the Patient list can be turned off (see page 563)

When default configured, the system automatically searches to see if the patient is already in the database. The result of this search is displayed in the Patient list field.

4. Trackball to the actual patient and press the Trackball SELECT key.The patient record is highlighted.

5. Press SELECT PATIENTOrPress [+] in front of the actual patient record and select the desired examination.The Examination List window for the actual patient is displayed (refer to Figure 8-9).

1. Select the operator

CAUTION


352

Figure 8-7: The Search/Create Patient window


2. Select new archive and other pre-defined services

3. Extended menu

4. Select the column heading border and drag to adjust column width


The Search/Create patient window may be slightly different depending on the Dataflow selected

353

Advanced search

The list of searching filters may vary de-pending on the Dataflow selected

To restrain the search to a specific patient group, one or more filters may be applied to the search. The table below shows the filters applicable to a patient search:

Searching with filter:The unit can be con-figured to display the Advanced search tool as de-fault (see page 563)

1. Trackball to the More button in the Search/Create Patient window.

2. Press SELECT on the control panel.The Search/Create Patient window is extended displaying the searching filters (see Figure 8-8).

3. Type the information in the required searching filter field.4. Type the patient Last Name, and/or ID.

The matching data is displayed in the Patient list when the automatic search function is turned on.

Sorting data

The search result can be sorted according to the fields displayed in the patient list, in ascending or descending order.

To sort data:1. In the Patient list field, Trackball to the field header by which

the sort is to be performed (Figure 8-8, page 354).2. Press SELECT on the control panel.

The patient list is sorted in ascending order according to the field selected.

Searching filter

Echolab

Diag. code

Date of birth (time span)

Examination date (time span)

Current date

Images

Stress examinations

Report

354

3. Press SELECT once more.The patient list is sorted in descending order according to the field selected.

Figure 8-8: The extended Search/Create Patient window

Printing patient list1. In the Search/Create patient window, select More to display

the additional menu.2. Select Print Patients.

The displayed patient list is printed.


2. Select new archive and other pre-defined services

3. The system can be configured to display the Advanced search tool as default (see page 563)

4. Select the column heading border and drag to adjust column width


The Search/Create patient window may be slightly different depending on the Dataflow selected.

355

Selecting a patient record and editing data in the archiveAfter locating the patient in the database (see page 351 page 354), the user must select the patient record, to be able to review and edit archived data.

Selecting a patient record from the patient list1. In the Search/Create patient window, trackball to the actual

patient and press the Trackball SELECT key.The patient record is highlighted.

2. Press SELECT PATIENT.The Examination List window is displayed showing previous examinations and diagnosis information related to the selected patient (see Figure 8-9).

356

Figure 8-9: The Examination list window

1. The information displayed in the Patient list is configurable (see page 563).

2. Go to Search/Create Patient window (see page 352)

3. Insert pre-defined text in the Comment field 4. Select the column heading border and drag to

adjust column width

357

Editing Referral Reasons, Comments and Diagnosis

The user can edit the actual text in the Examination List window using the alphanumeric keyboard and by inserting pre-defined text input.

Text edition1. In the Examination list window (Figure 8-9), trackball to the

required field.2. Press SELECT.

Use the Arrow keys to move text mark-er.

3. Using the alphanumeric keyboard, edit the information.4. Press ARCHIVE on the control panel to quit the archive.

Inserting pre-defined text input1. In the Examination list window, trackball to Insert Text over

the actual field.2. Press SELECT.

The Insert text window is displayed (see Figure 8-10).The pre-defined text list is organized in a three level hierarchy. Selecting one item in the first column displays pre-defined text entries related to the selected text in the second and third column.

3. Navigate through the pre-defined text list by selecting items in the columns and double-click on the desired pre-defined text to be inserted. If an entry in the third column is inserted, the selected text in the second column is also inserted.Press More>> to display the full text for the selected entry.

CAUTION

The user is responsible for patient demographic data, diagnostic information or any other patient related information entered in the database.

358

Figure 8-10: The Insert text window

Creating, editing and deleting text inputThese features are described in ’The Comment texts sheet’ on page 547.

Diagnosis code

Entering a Diagnosis code1. In the Examination list window, select Code (see

Figure 8-9).The Entered Code window is displayed.

2. Select Add.The Code list window is displayed.

3. Double-click the code to enter.The Code selected is displayed in the Examination list window.

Figure 8-11: Entering Diagnosis codes

Deleting an entered Diagnosis code1. In the Examination list window, select Code (see

Figure 8-9).The Entered code window is displayed.

2. In the Entered code window, select the code to delete and press Delete.

1. The Entered code window2. The Code list window

359

Creating a Diagnosis code1. In the Examination list window, select Code (see

Figure 8-9).The Entered code window is displayed.

2. Select Add.The Code list window is displayed.

3. Select New.4. Enter the new code.5. Select Done to exit.

See also ’The diagnostic codes sheet’ on page 545.

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Editing Demographic details

1. Press PATIENT INFO.The Patient information window is displayed.

2. Trackball to the field to edit.3. Press SELECT on the control panel.4. Using the alphanumeric keyboard, edit the information.

Alternative: Press any active scanning mode key.

5. Press the EXAM LIST assignable to go back to the Examination list window. ORPress ARCHIVE on the control panel to quit the archive.

WARNING

If you modify the Patient ID, Last name, First name or Date of birth on a patient in the archive, be aware that the contents of the archived images for that patient is not updated. If the images are still in the buffer and not yet archived, the image files are updated if you modify any patient information, but not if the images are archived. So if any of these images are later on exported to DICOM media or DICOM server, they will still contain the original patient information, as it was before you did the modification in the archive. The system does not alter the contents of the image files at all when doing DICOM export.**

CAUTION


361

Deleting archived informationOnly user logged in with full operator rights can delete pa-tient records (see page 575 for further information).

To delete a patient record1. Press ARCHIVE on the Front panel.

The Search/Create Patient window is displayed (Figure 8-7, page 352).

2. Type the patient Last Name, and/or ID.3. Trackball to the actual patient record.4. Press SELECT to highlight the patient record to delete.5. Press Delete in the Search/Create Patient window.

A dialogue box is displayed asking for confirmation of the deletion (Figure 8-12).

6. Trackball to OK and press SELECT on the control panel.

Figure 8-12: Delete patient record confirmation prompt

To delete an examination1. Press ARCHIVE on the Front panel.


2. Type the patient Last Name, and/or ID depending on system configuration.

3. Trackball to the actual patient record and double-click the Trackball SELECT key (or press SELECT once and SELECT PATIENT) to select the patient.The Examination list window is displayed.

4. Trackball to the examination to delete.

362

5. Press the trackball SELECT key.6. Press More in the Examination list window (see Figure 8-9,

page 356).7. Press Del Exam to delete the examination.

A warning message is displayed asking the user to confirm the action to perform (see Figure 8-13).

8. Trackball to OK and press SELECT to delete the selected examination.Trackball to Cancel and press SELECT to abort deletion.

Figure 8-13: Delete Examination prompt

To delete an image1. Press ARCHIVE on the Front panel.

The Search/Create Patient window is displayed.2. Type the patient Last Name, and/or ID. 3. Trackball to the required patient to highlight the record.4. Press the SELECT assignable.

The Examination list window is displayed.5. Trackball to the actual examination in the Examination list

window.6. Press the SELECT assignable.7. Press REVIEW.

The images for the selected examination are displayed on the Review screen (Figure 8-16, page 367).

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Repeat steps 8 and 9 to delete several im-ages.

8. Trackball to the image to delete.9. Press SELECT on the control panel.10. Press Delete.

A pop-up dialog box is displayed asking for confirmation of the deletion.

11. Trackball to OK and press SELECT on the control panel.The image is deleted.

To delete an image from the clipboard1. If in live, press FREEZE.2. Press TRACKBALL until the Pointer tool is selected.3. Move the pointer over the image to delete in the clipboard.4. Press Update menu.5. Select Delete clipboard cell from the Update menu.

A pop-up dialog box is displayed asking for confirmation of the deletion.

6. Trackball to OK and press SELECT on the control panel.The image is deleted.

Moving examinationsAn examination can be moved from one patient record to another. This feature should only be used if an examination was performed and stored to a wrong patient record.

1. In the Search/Create Patient window press [+] in front of the patient record containing the examination(s) to move (see Figure 8-7, page 352).

2. Select the examination to move.3. Press More in the lower, right-hand corner of the

Search/Create Patient window. 4. Press Move Exam.

The Move exam window is displayed.

CAUTION

When moving an examination, verify that the target patient record is correct.

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Figure 8-14: The Move exam window

5. Search and select the target patient record.6. Press Move Exam.

A warning message is displayed asking the user to confirm the action to perform (see Figure 8-15).

CAUTION

Make sure that the patient record selected is correct.

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Figure 8-15: Moving examination prompt

7. Trackball to OK and press SELECT.An information window is displayed to confirm the operation.

8. Press OK.

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Review images in archiveThere are two ways to access to archived images:• Review the images from a selected examination.• Select images from the Image list screen displaying all the

images sorted by examination sessions for the actual patient.

Review the images from a selected examination1. In the Examination list window (see Figure 8-9, page 356),

trackball to the actual examination.2. Press SELECT on the control panel to highlight the

examination.3. Press REVIEW on the control panel.

The stored images for the selected examination are displayed in the Review screen (see Figure 8-16).

To analyze images:1. Press SELECT on the images to analyze.2. Press ANALYZE.

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Figure 8-16: The Review screen

Select images from the Image list screenThe procedure described below enables the analysis of images belonging to different examinations for a selected patient record. If images are stored on multiple removable media, they have to be restored to the local hard drive prior to review as described below.1. In the Examination list window (see Figure 8-9, page 356),

press Image list.The Image list screen is displayed (see Figure 8-19) showing thumbnails of stored images for the actual patient sorted by examination.

1. Page number2. Selected image (bold frame)

3. Selection tools

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If the images are stored on a removable media that is not mounted, the image thumbnail is replaced by a symbol.

2. Press SELECT on the images to review or press ANALYSE to review all images.• If all images are available the images are displayed for

review.• If some of the images are not available locally the

Restore images window is displayed.

Figure 8-17: The Restore images window

3. Select between:• Restore only the selected images: only selected

images that are not available locally are restored.• Restore all images of the selected exam: all images

that are not available locally in the exams where an image was selected are restored.

• Restore current patient: restores all images in all examinations.

4. Press OK.The Insert media window is displayed.

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Figure 8-18: The Insert media window

5. Insert the required media.6. Select between:

• OK: the images on the mounted media are restored on the local hard drive. If not all the required images are on the inserted media, the user is prompted to insert another media until all required images are restored on the hard drive.

• Skip media: the images stored on the media required are not restored. If not all the required images are on the inserted media, the user is prompted to insert another media until all required images are restored on the hard drive.

• Cancel: no images are restored.The selected images are displayed for review.

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Figure 8-19: The Image list screen

1. Examination2. Examination date and archive location3. Selected image4. Preview of selected image5. Missing images

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ConnectivityThis section describes the communication and connection options for the Vivid 7 ultrasound unit with other devices in the hospital information system. This section covers the procedures for configuration and optimal data management from a Vivid 7 in the following scenarios:• A stand-alone Vivid 7 (page 375).• A Vivid 7 and one or several EchoPAC PC workstations in

a sneaker net environment (page 376).• A Vivid 7 and an EchoPAC PC workstations in a direct

connect environment (page 379).• A Vivid 7 and a DICOM server in a network (page 385).

The dataflow conceptCommunication between the Vivid 7 ultrasound unit and other information providers on the network takes the form of dataflows. Selecting a dataflow will automatically customize the ultrasound unit to work according to the services associated with this dataflow. Each dataflow defines the location and format of patient information. Patient information can include demographic data and images, as well as reports, measurement and analysis data. By utilizing dataflows, the user can configure the Vivid 7 ultrasound unit to optimally meet the connectivity needs of the facility, while keeping the user interface unchanged. The dataflow concept allows the flexibility of data to be obtained from various sources and allows data to flow to various output sources.

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Dataflow examples

Refer to Chapter 12, ’Presets and System setup’ on page 514 for a complete list and description of supported dataflows.

Stand-alone scannerThe figure below illustrates two different dataflows for a stand-alone scanner.

Figure 8-20: Stand-alone scanner dataflows

A: LocalArchive-Int.HD dataflow:The local database is used for patient archiving. Images are stored to internal harddrive.

B: LocalArchive-MOD dataflow:The local database is used for patient archiving. Images are stored to a MOD

AVivid 7

B Vivid 7

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Scanner in a networkThe figure below illustrates two different dataflows for a scanner connected to a network.

Figure 8-21: Scanner in a network dataflows (example)

Dataflow selection

Select a dataflow from the Search/Create Patient window (see ’Creating a new Patient record or starting an examination from an existing patient record’ on page 48) or configure the system with a default dataflow from the Configuration management package as described below.

Default dataflow selection1. Press CONFIG (F2) and log on as administrator if required.2. Select the Connectivity category and Dataflow subgroup.

The Dataflow sheet is displayed (see Figure 8-22).3. Select the desired dataflow in the Name pull-down menu

and check the option Default.4. Press CONFIG (F2) to exit the Configuration management

package.

C: RemoteArch-Remote HD dataflow:A remote database (here EchoPAC PC) is used for patient archiving. Images are stored to a remote archive (here EchoPAC PC).

D: Worklist/LocalArchive-DICOM Server/Int.HD dataflow:Search in the DICOM Modality Worklist, the patient found is copied into the local database. Images are stored to a DICOM server and to the internal harddrive.

CEchoPAC PC

DDICOM Server

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Figure 8-22: Default dataflow setting

1. Select Connectivity category2. Select Dataflow subgroup3. Select a dataflow4. Default option for the selected dataflow

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Stand-alone scanner scenarioIn this scenario images will most likely be reviewed from VCR tape. If digital images are stored, they should be stored on the scanner’s internal harddrive.

Figure 8-23: Stand-alone scanner with LocalArchive-Int.HD dataflow

Data management

Data acquisition1. Select the LocalArchive-Int.HD dataflow as default

dataflow.In this configuration the local database is used for patient archiving. Images are stored to internal harddrive.

Image reviewThe same dataflow is used for review on the system.

Vivid 7

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A stand-alone scanner and a stand-alone EchoPAC PC environmentIn this scenario the EchoPAC PC (one or several) is used for review of studies acquired on one or more Vivid 7 without being connected via a private or a local area network.

Images can be stored on the scanner’s internal harddrive (recommended) or on a dedicated MOD.

Images stored on the internal harddrive

Figure 8-24: A stand alone scanner and a stand alone EchoPAC PC environment with images stored on the scanner’s harddrive

In this configuration images are first stored on the scanner’s harddrive and then exported from the scanner’s harddrive to a MOD and finally imported from the MOD to the EchoPAC PC’s internal harddrive.

Data managementScanner’s dataflow configuration

1. Select the LocalArchive-Int.HD dataflow as default dataflow.The local database is used for patient archiving. Images are stored to internal harddrive.

Export from Vivid 71. Export the data (images, demographics, measurements

and report) for the patient(s) to be reviewed on a blank dedicated formatted MOD as described in ’Export/Import

Vivid 7: dataflow LocalArchive-IntHDEXP: export from LocalArchive-Int.HD to Removable MOD ArchiveIMP: import from Removable MOD Archive to LocalArchive-Int.HDEchoPAC PC: dataflow LocalArchive-Int.HD

Vivid 7

MODEchoPAC PC

EXPEEXPE IMPIMP

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patient records/examinations’ on page 395.Export from LocalArchive-Int.HD to Removable MOD Archive.Make sure that the option Copy images is checked.

Import on EchoPAC PC1. Select the LocalArchive-Int.HD dataflow on the

EchoPAC PC (can be configured as default dataflow).The MOD dedicat-ed to Export/Import can be reformatted and reused.

2. Import the data from the Export/import MOD to EchoPAC PC internal harddrive using the Import function as described in the workstation user manual.Import from Removable MOD Archive to LocalArchive-Int.HDMake sure that the option Copy images is checked.

3. Press Archive and select the patient to be reviewed.

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A stand-alone scanner and a stand-alone DICOM workstationIn this scenario a DICOM workstation is used for review of studies acquired on one a Vivid 7 without being connected via a private or a local area network.

Figure 8-25: A stand-alone scanner stand-alone DICOM workstation

Data management

Scanner’s dataflow configuration1. Select the LocalArchive-Int.HD dataflow as default

dataflow.The local database is used for patient archiving. Images are stored to internal harddrive.

2. Export the data to the DICOM MOD using the following settings: export from LocalArchive-Int.HD to Pure DICOM MOD (see ’Export/Import patient records/examinations’ on page 395).

Vivid 7: dataflow: LocalArchive-Int.HDEXP: export from LocalArchive-Int.HD to DICOM MODIMP: import from the MOD to the DICOM workstation

Vivid 7

DICOM-MODDICOM Workstation

EXPEEXPE IMPIMP

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A scanner and EchoPAC PC in a direct connect environmentIn this scenario the data is transferred from the Vivid 7 to a dedicated EchoPAC PC workstation over the Ethernet (either in a peer-to-peer connection with a crossover cable, or in a network). The database from the EchoPAC PC is used as the master and images are stored directly to the EchoPAC PC internal harddrive. In this configuration the scanner is just an intermediate acquisition unit which after completion of a study, will not contain any patient information, measurements or images.

Up to three scanners can be connected to one EchoPAC PC if the workstation has the EchoPAC Share option enabled.

Figure 8-26: A scanner and EchoPAC PC in a direct connect environment (peer to peer or network)

The acquisition can be done online or offline. Both situations are described below.

Scanner’s connectivity configuration

If working in a peer-to-peer connection with a crossover cable between a Vivid 7 and an EchoPac PC, the default delivery TCP/IP settings should be used.

If working in a network, follow the procedure described below to configure the scanner.

Vivid 7: dataflow RemoteArch-RemoteHDEchoPAC PC: dataflow LocalArchive-Int.HD

EchoPAC PC

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Scanner’s TCP/IP settingsTo be able to use the network functions when connected to a hospital network, the scanner must have a proper network address. Typically source for this information in the network administrator.1. Press CONFIG (F2) and log on as administrator.2. Select the Connectivity category and TCP/IP subgroup.

The TCPIP subgroup is displayed.

Figure 8-27: TCP/IP setting

3. In the IP settings area enter:• The IP address for the scanner• The subnet mask for the scanner• The IP address for the Default Gateway

1. Computer name: device’s name of type VIVID7-00nnnn or ECHOPAC7-00nnnn, where “nnnn” is the system’s serial number. Do not change the computer name.

2. IP settings: system IP settings

3. Remote archive setup: remote archive IP address and name (EchoPAC PC or EchoServer)

4. Save TCP/IP settings. The changes will be effective after the system is rebooted.

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4. In the Remote archive setup area enter:• The IP address for the remote archive• The name of the remote archive

5. Press Save settings and reboot the system.

Direct connect with online acquisition


1. Select the RemoteArch-RemoteHD dataflow as default dataflow.When saving the study on the scanner, the images are transferred from the scanner’s image buffer to the harddrive of the EchoPAC PC. Patient demographics, measurements and reports are transferred on the fly when entering the information on the Vivid 7.

Review on the EchoPAC PC workstation1. Select the LocalArchive-Int.HD dataflow on the

EchoPAC PC (can be configured as default dataflow).


Direct connect with offline acquisition

Data managementScanner’s dataflow configuration for offline acquisition

1. When offline, select the LocalArchive-IntHD dataflow.The local database is used for patient archiving. Images are stored to internal harddrive.

Export examinations done offline from the scanner to EchoPAC PC

1. When reconnected, export the data (images, demographics, measurements and report) for the examination(s) done offline to EchoPAC PC as describes in

CAUTION

Do NOT open a study on the EchoPAC PC workstation before the study is closed on the scanner.

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’Export/Import patient records/examinations’ on page 395.Press Today to dis-play today�’s exams to ease the search.

Export from LocalArchive-Int.HD to RemoteArch-RemoteHD.Make sure that the option Copy images is checked.

The examination done offline can now be reviewed on the workstation.

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A scanner and EchoPAC PC in a network environmentIn this scenario the Vivid 7 is configured to work with an ImageVault 3 or an EchoServer 7 patient demographics and image server in a network environment. Images are first saved on the local image buffer on the scanner and transferred to the server when saving the examination.

The acquisition can be done online or offline. Both situations are described below.

Network environment with online acquisition


1. Select the RemoteArch-RemoteHD dataflow as default dataflow in the sublevel Dataflow in the subgroup Connectivity of the Configuration management package (see page 551 and following pages).When saving the study on the scanner, the images are transferred from the scanner’s image buffer to the server. Patient demographics, measurements and reports are transferred on the fly when entering the information on the Vivid 7.

Review on the EchoPAC PC workstation1. Select the RemoteArch-RemoteHD dataflow on the

EchoPAC PC (can be configured as default dataflow).


Network environment with offline acquisition

Data managementScanner’s dataflow configuration for offline acquisition

1. When offline, select the LocalArchive-IntHD dataflow.The local database is used for patient archiving. Images are stored to internal harddrive.

CAUTION

Do NOT open a study on the EchoPAC PC workstation before the study is closed on the scanner.

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Export examinations done offline from the scanner to the server

1. When reconnected, export the data (images, demographics, measurements and report) for the examination(s) done offline to the server as described in ’Export/Import patient records/examinations’ on page 395.

Press Today to dis-play today�’s exams to ease the search.

Export from LocalArchive-Int.HD to RemoteArch-RemoteHD.Make sure that the option Copy images is checked.To free space in the internal harddrive on the scanner, check the command Delete selected patient(s) after copy in the Export patient window (see Figure 8-38, page 399).

The examination done offline can now be reviewed on the workstation.

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A scanner and a DICOM server in a networkIn this scenario the Vivid 7 is configured to work with a DICOM server in a network environment. Images are first saved on the local image buffer on the scanner. At the end of the examination the images are sent to the DICOM server via a DICOM spooler.

The DICOM server dataflows supported are:• DICOM server: images are stored to a DICOM server.• Local Archive - Int HD/DICOM Server: the local archive is

used for patient archiving. Images are stored to the internal harddrive and to a DICOM server.

• Remote Archive - Remote HD/DICOM Server: a remote database is used for patient archiving. Images are stored to a network image volume and to a DICOM server.

• Worklist/Local Archive - DICOM Server/Int HD: search in a DICOM Modality Worklist, the patient found is copied into local database. The patient information and the examination results are stored to the local database. Images are stored to a DICOM server and to an image volume on the local harddrive.

• Worklist/Remote Archive - DICOM Server/Remote HD: search in a DICOM Modality Worklist, the patient found is copied into a remote database. The patient information and the examination results are stored to a remote database. Images are stored to a DICOM server and to an image network volume as pure DICOM in both locations.

• Query/Retrieve: retrieve images from a DICOM server based on query parameters.

This scenario requires that the scanner is configured to be connected to the DICOM server as described below.

Scanner’s connectivity configuration

The scanner’s TCP/IP settings must be configured as described in ’Scanner’s TCP/IP settings’ on page 380.

In addition, to work against the DICOM server the following information has to be entered in the scanner:• The DICOM server IP address

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• The DICOM server port number• The DICOM server AE title (the server’s name)

Typically source for this information in the network administrator.

Setup of the DICOM server in the scanner’s configuration management package

DICOM dataflow selection1. Press CONFIG (F2) and log on as administrator.2. Select the Connectivity category and Dataflow subgroup.

The Dataflow sheet is displayed.3. Select the DICOM dataflow to configure in the Name

pull-down menu (see Figure 8-28).


DICOM devices configurationDepending on the DICOM dataflow selected, one or several DICOM devices may have to be configured.1. Select a DICOM device in the Selected devices pane and

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press Properties (see Figure 8-29).

Figure 8-29: Display of the DICOM device Properties window

The Properties window for the selected DICOM device is displayed (Figure 8-30).

1. Select the DICOM device. 2. Press Properties.

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Figure 8-30: DICOM worklist properties window

2. Select the DICOM server from the IP-address pull-down menu.Follow the steps below if the IP address settings for the DICOM server need to be modified or created:• Select <Modify> from the IP-address pull-down menu.

The IPs window is displayed.• Select the DICOM server and press Modify in the IPs

window (or press Add if creating a new IP address). The Enter name and IP window is displayed.

• Enter the name and/or IP address of the server and press OK to return to the Properties window.

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Figure 8-31: Modifying/Creating the IP address

3. In the Properties window, enter:• The DICOM server AE title. This entry is case sensitive

and must match exactly.• The DICOM server portFor some DICOM servers, the default Timeout setting may be too low.When configuring the DICOM storage device, the following image settings should be entered in the Properties window:• Check DICOM SR if required (see below).• Keep Reopen per image unchecked.• Keep Allow raw data unchecked.• Set Max Frame rate to 30.• Keep Only Black and White unchecked.• Set Compression to JPEG.• Set Quality to 95.• Check Allow multiframe.

DICOM SRDICOM Structured Reporting (SR) is a standardized format for medical results. Vivid 7 and EchoPAC PC support the specialized form for Adult Echo Ultrasound (“Supplement 72") for M&A results.

With the DICOM SR support, M&A for an exam can be sent at the end of the exam or when exported from local archive. The destination can be either a server on the network (Storage

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SCP) or a removable media (DICOM Media) depending on the DICOM dataflow selected.

“Supplement 72" does not support all M&A results from Vivid 7 and EchoPAC PC. “Supplement 72" limits the information that is possible to send to the following:• Publicly coded parameters, no pediatric or fetal cardiac or

unassigned measurement.Refer to the Vivid 7 Reference manual for a complete list of supported parameters.

• Basic modes: 2D, M-mode, Color Flow, PW and CW Doppler.

• Publicly coded methods, not Modified Simpson or Bullet.Refer to the Vivid 7 Reference manual for a complete list of supported methods.

• Basic derivations (Average, Last), no references between the derived measurements and the ones they were made from.

• Wall Motion Scoring: individual segment scores only according to 16-segment model, no graded Hypokinesis (only Hypokinesis is used).

Activating DICOM SRDICOM SR must be activated for each DICOM device.1. Press CONFIG (F2) and log on as administrator.2. Select the Connectivity category and Dataflow subgroup.

The Dataflow sheet is displayed.3. Select the DICOM dataflow to configure in the Name

pull-down menu (see Figure 8-28).4. Select a DICOM storage device in the Selected devices

pane and press Properties.The Properties window for the selected DICOM storage device is displayed.

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Figure 8-32: DICOM storage properties window

5. Check the option DICOM SR.6. Select OK.7. Press CONFIG (F2).

Adjusting the Search criteriaWhen selecting a DICOM Worklist dataflow or Query/Retrieve, search criteria can be set for the system to use when searching the database.1. Press CONFIG (F2) and log on as administrator.2. Select the Connectivity category and Dataflow subgroup.

The Dataflow sheet is displayed (see Figure 8-33).3. Select a DICOM Worklist dataflow or the Query/Retrieve

dataflow.4. Select the Worklist or Query/Retrieve device in the

Selected devices pane and press Properties.The Properties window for the selected DICOM device is displayed.

5. Press Search criteria.The Search criteria window is displayed.

6. Select a Search criteria from the Select tag pull-down menu.

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7. Enter a value if required or leave blank if not to be used. This entry is case sensitive and must match exactly.

8. Press Add to list.9. Press OK to close the Search criteria window.

Figure 8-33: Adjusting the Search criteria

1. The dataflow sheet2. The Properties window for the Worklist device.3. The Search criteria window

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Checking the connection to the DICOM server1. In the Dataflow sheet, select the DICOM device to verify the

connection to.2. Press Check.

The verification process may takes several seconds.• A green check mark is displayed in front of the DICOM

device if the verification is successful.• A red cross is displayed in front of the DICOM device if

the verification failed.

Data management (DICOM dataflows)

Performing a studyOnline scanner

1. In the Search/Create patient window, select a DICOM dataflow.

2. If a DICOM worklist dataflow is selected, enter a search criteria and press Query.The patient list is updated.

3. Select or create a new patient and perform the examination in a usual manner.During the examination images are temporarily stored in the local buffer on the system.

4. At the end of the study press END EXAM on the Control panel.The save images dialogue window is displayed.

5. Press All to save all images on the DICOM server or press Select to display the Image review screen where to select specific images to be saved.The images are transferred to the server via the DICOM spooler.

6. Press F4 or ALT+S to display the DICOM spooler (see ’DICOM spooler’ on page 423 for further details).

Offline scannerWhen working offline the images are stored in the DICOM spooler. Images are sent to the DICOM server when re-connecting the system to the network.1. If a DICOM worklist dataflow is selected, the patient list

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must be queried before the system is disconnected.2. After offline acquisition, the images stored on the DICOM

spooler are automatically sent to the DICOM server when connecting the system.Press F4 or ALT+S to display the DICOM spooler (see ’DICOM spooler’ on page 423 for further details).

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Export/Import patient records/examinationsPatient records/examinations from the local archive on one system (Vivid 7 or EchoPAC PC) can be exported to the local archive on another system via a removable media. Patient records/examinations from the local archive can also be exported directly to a remote archive (Echo server, DICOM server or EchoPAC PC depending on the environment). In addition patient records/examinations from a remote archive (Echo server or EchoPAC PC depending on the environment) can be exported to a removable media or to a DICOM server. Database information (patient and report archives) can be exported with or without images. No data is deleted from the source archive when exporting data unless the command Delete selected patient(s) after copy is checked in the Export patient window (see Figure 8-38, page 399).

Similarly, patient records/examinations from the local archive on one system can be imported to the local archive on another system via a removable media. Database information can be imported with or without images. No data is deleted from the source archive when importing data. In addition patient records from a removable archive can be imported to a remote archive (Echo server).

Exporting patient records/examinations1. Insert a removable media in the drive.2. Press ARCHIVE on the Front panel.


3. Select the source archive in the Dataflow field:• LocalArchive-Int.HD: exports data from the local

archive.• RemoteArch-RemoteHD: exports data from an Echo

server.4. Press Export in the Search/Create Patient window.

The Export dialogue window is displayed.

CAUTION

If an examination is opened, it must be closed before performing Export/Import of patient records/examinations to guarantee that all data is included in the transfer.

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Figure 8-34: The Export Dialogue window

5. Select one of the following available destinations from the Destination drop-down menu:• MOD Archive: exports raw and DICOM (if present) data

to a removable MOD.• DICOM MOD 5.25: export DICOM data only to a

removable MOD.• CD/DVD Archive: exports raw and DICOM (if present)

data to a CD/DVD.• DICOM CD/DVD: export DICOM data only to a

CD/DVD-R/W.• Remote Import/Export Archive: exports raw and

DICOM (if present) data to an Echo server (network) or EchoPAC PC (direct connect or network).

• DICOM Server: exports DICOM data only to a DICOM server.

• Excel file: exports data to a spreadsheet. The export destination must be configured (see page 401).

• DICOM Print: prints images to a DICOM printer via DICOM spooler.

• MPEGVue: exports examinations to MPEGVue format readable from a regular computer. Ultrasound images are stored as MPEG, measurements as an Excel file and saved reports as CHM-files. The export destination must be configured (see page 401).

6. Press OK.

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The following situations may occur:• The system is checking that the removable media is

inserted. If not, a dialogue window is displayed prompting the user to insert a media.

Figure 8-35: Insert media window

Insert the media and select Retry.• The system is checking if the destination media is empty

and needs to be formatted. If yes an Information window is displayed asking the user whether or not to format the media.

Figure 8-36: Media formatting window

If desired enter a new label and select OK.Note: only the following characters and signs can be used when labelling a media: A - Z, a - z, 0 - 9, “_” and

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“-”. Do not use more than 11 characters or signs. Do not use space.

• If the media is not empty, the Add files window is displayed.

Figure 8-37: Add files windows

Select Yes.The system is preparing the media to allow addition of new files.

The Export patient window is displayed (see Figure 8-38).

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Figure 8-38: The Export patient window

7. Search and select the patient records/examinations to export in the Patient list.The following selection methods can be used: • Press and hold down SHIFT while selecting patient

records/examinations to select several consecutive items at a time.

• Press and hold down CTRL while selecting patient records/examinations to select several discrete items.

• Press Select all in the Export patient window to export all patient records.

Press More to dis-play the extended Export patient window if neces-sary.

• Press Today to display today's examinations and select the actual examinations.

• Fill in the Exam between field to display the patient records done during a specific time period and select the actual records.

• Fill in the Born between field to display the patient

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records of patients born during a specific time period and select the actual records.

8. Adjust the following settings (if available) as desired:• Delete selected patient(s) after copy• Copy images

9. Press Copy.If one or more patient examination is already present in the destination archive the Export/Import conflict window is displayed (see Figure 8-39). For each conflicting item, select:Keep: to keep the existing examination in the destination archive.Replace: to replace the existing examination with the corresponding item in the source archive.

Figure 8-39: The Export/Import conflict window

Press OK to resume export.

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A progress indicator is displayed. When done a status window is displayed showing the number of patient records that have been successfully exported.

10. Press OK.A check mark is displayed in the Copied field in the Export patient window for each item exported.A status message is displayed for each item exported. Make sure that the operation was successful for each item exported.

11. Press Done in the Export patient window to complete the process.

Do not eject the CD using the button on the CD drive

12. Press ALT+E to eject the media.The Eject device menu is displayed.

Figure 8-40: The Eject device menu

13. Select the relevant media.The selected removable media is ejected.

Export configuration

The destination for Export of patient records to Excel and MPEG must be configured prior to use. This is done from the Dataflow sheet in the Configuration package.

To display the Dataflow sheet:1. Press CONFIG (F2) and log on as administrator.2. Select the Connectivity category and Dataflow subgroup.

The Dataflow sheet is displayed (Figure 8-41).3. Select the dataflow Misc. Export in the Name pull-down

menu.

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Export to Excel configuration1. Select the Excel storage device in the Selected devices

pane and press Properties.The Excel properties window is displayed.

Figure 8-42: The Excel properties window

2. Select a removable media or a network volume remote path as the destination in the Destination Pull-down menu.

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Note: Remote paths of network volumes must be entered once in the Remote path field before they can be selected from the Destination Pull-down menu.

3. Select OK and press CONFIG (F2).

Export to MPEGVue configuration1. Select the eVue device in the Selected devices pane and

press Properties.The eVue properties window is displayed.

Figure 8-43: The MPEGVue properties window

2. Select a removable media or a network volume remote path as the destination in the Destination Pull-down menu.Note: Remote paths of network volumes must be entered once in the Remote path field before they can be selected from the Destination Pull-down menu.

3. Check the options as required.4. Select OK and press CONFIG (F2).

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Importing patient records/examinations1. Insert the removable media of the source archive in the

corresponding drive (MO drive or CD-ROM).2. Press ARCHIVE on the Front panel.


3. Select destination archive in the Dataflow field: • LocalArchive-Int.HD: imports data to the local archive.• RemoteArch-RemoteHD: imports data to an Echo

server (network) or an EchoPAC PC (direct connect).4. Press Import in the Search/Create Patient window.

The Import dialogue window is displayed (see Figure 8-44).

Figure 8-44: The Import Dialogue window

5. Select one of the following available source archive from the Source drop-down menu:• MOD Archive: imports raw and DICOM data (if present)

from a MOD.• DICOM MOD 5.25: imports DICOM data only from a

MOD.• CD/DVD Archive: imports raw and DICOM data (if

present) from a CD/VDV-R.• DICOM CD/DVD: imports DICOM data only from a

CD/DVD-R.• Remote Import/Export Archive: imports raw and

DICOM (if present) data from an Echo server (network) or EchoPAC PC (direct connect or network).

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• Query retrieve: imports data from a DICOM server.6. Press OK.

The Import patient window is displayed (see Figure 8-45).

Figure 8-45: The Import patient window

7. Search and select the patient records to import in the Patient list.The following selection methods can be used: • Press and hold down SHIFT while selecting patient

records/examinations to select several consecutive items at a time.

• Press and hold down CTRL while selecting patient records/examinations to select several discrete items.

• Press Select all in the Import patient window to export all patient records.

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Press More to dis-play the extended Import patient window if neces-sary.

• Press Today to display today's examinations and select the actual examinations.

• Fill out the Exam between field to display the patient records done during a specific time period and select the actual records.

• Fill out the Born between field to display the patient records of patients born during a specific time period and select the actual records.

8. Adjust the following settings (if available) as desired:• Copy images

9. Press Copy.If one or more patient examination is already present in the destination archive the Export/Import conflict window is displayed (see Figure 8-39). For each conflicting item, select:Keep: to keep the existing examination in the destination archive.Replace: to replace the existing examination with the corresponding item in the source archive.

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Figure 8-46: The Export/Import conflict window

Press OK to resume import.A progress indicator is displayed. When done a status window is displayed showing the number of patient records that have been successfully imported.

10. Press OK.A check mark is displayed in the Copied field in the Import patient window for each item imported.A status message is displayed for each item imported. Make sure that the operation was successful for each item imported.

11. Press Done in the Import patient window to complete the process.

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Disk managementThe Disk management function allows the user to manage hard disk space while maintaining the patient database on the system. The Disk management function can be used to move, copy or delete images and reports from the oldest patient records (configurable). The Disk management function has also an auto-purge feature that will automatically delete images and reports that have already been copied if the local hard disk is getting full.

Three different disk management scenarios are possible depending on the system configuration:

When moving or copying files a copy of the patient ar-chive is also created on the media.

• Disk management is set to move files: the user runs the Disk management function on a regular basis to move images and reports from older patient records to removable media or to a network volume. Using this setting, moved images and reports are deleted from the local hard drive and copied to the specified destination. This scenario prevents the local disk to fill up and keeps images and reports from the most recent patient records on the local disk. Using this scenario, the user can control what should remain on the system while keeping the disk free space at an operational level.

• Disk management is set to copy files: the user runs the Disk management function on a regular basis to copy images and reports from older patient records to removable media or to a network volume. To prevent the local disk to fill up, the auto-purge function automatically deletes files that were previously copied when the disk free space has reached the minimum allowed limit. This scenario lets the system automatically manage the disk space on the system.Note: when using this setting, the images location displayed in the Examination list screen will be the selected destination for the copy operation, even if the images are still present on the local hard drive. When reviewing the exam, the original images will be retrieved from the local hard drive as long as they are available there. When the images are deleted from the local hard drive by the auto-purge function, the copied images will be retrieved.

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• Disk management is set to delete files: the user runs the Disk management function on a regular basis to delete images and reports from older patient records.

Ensure that you have established a data management protocol for your office/institution. The user MUST manage the removable media used when running Disk management by keeping a log and by creating a media filing system.

A person should be in charge of performing the process. The Disk management system can be set up so that a reminder is displayed at a regular time span.

Configuring the Disk management functionConfiguration of the Disk management system can only be done by user with administration rights.1. Press CONFIG (F2).

If required log on as administrator.2. Select the category Admin.3. In the Admin category, select the sheet Disk management.

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Figure 8-47: The Disk management sheet

Disk management schedule setting1. Next to Reminder interval, specify the number of

days/weeks you want the system to prompt you to perform disk management.This setting should be set based on the activity of your office/institution. If None is selected, no reminder will be displayed.

Data management settings1. Select a number of days, weeks or months or a specific

date next to Manage files older than. Only files older than the specified setting will be copied or moved.If none is selected, all files will be copied or moved.

1. Sets the reminder time interval for running Disk management.2. Sets the files to be managed based on the examination dates.3. Sets the Disk management to copy, move or delete images.4. Sets the destination device.

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2. Next to Operation check:• Copy: the images and reports from the examinations

older than the specified setting defined in step 1 are copied to the specified destination. Using this setting, the files will exist in two locations, the local hard drive and the media used to copy to.

• Move: the images and reports from the examinations older than the specified setting defined in step 1 are copied to the specified destination, verified and then deleted from the local hard drive. Using this setting, the files will exist in one location, the media used to move the files to. They are removed from the local hard drive.

• Delete: the images and reports from the examinations older than the specified setting defined in step 1 are deleted from the hard drive.

Destination device setting1. Next to Destination device, select a removable media or a

network shared folder.Note: to be able to select a network shared folder in the Destination device field, its path must have been entered once in the field next to Remote path.

Running the Disk management functionThe Disk management function can be run at any time. In addition, the user may be prompted to run Disk management if the time since the last Disk management operation performed has reached the setting for the Reminder interval (see page 410), or if the local hard drive is about to be full.

Manual start of Disk management1. Press ARCHIVE on the control panel.

The Search/Create patient window is displayed.2. Press More in the Search/Create patient window to display

additional menu options and select Disk management.

CAUTION

If using removable media, it is recommended to use dedicated media to the Disk management process. Removable media used for data backup must not be used when performing Disk management.

Do not use the same removable media on several systems.

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The Disk management welcome screen is displayed (Figure 8-48).

Figure 8-48: The Disk management welcome screen

The Disk management operation will either copy, remove or delete files from the local archives depending on the Disk management configuration (see page 409). Make sure that the correct configuration is set.

3. Press Next.The Storage size information window is displayed (Figure 8-49).Verify the information displayed. If using removable media, the operation may require several media as specified on the screen. Make sure to gather the necessary number of disks.

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Figure 8-49: The Storage size information window

4. Insert a removable media in the specified drive.The disk does not need to be formatted.

5. Press Next.The Copying files window is displayed (Figure 8-50).

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Figure 8-50: The Copying files window

The system automatically formats and labels new disks. If the media contains backup or export data, a Warning window is displayed.Select between:• Cancel: the Disk management process is stopped.• Eject: the media is ejected, a new media must be

inserted to resume the Disk management process. • OK: (Export disk only) the export data on the disk is

deleted and the Disk management process is resumed. This choice is not available if the disk contains backup data.

The information displayed on the Copying files window is updated while the files are being copied.

6. If more than one media is necessary the filled media is ejected and a dialogue window is displayed asking the user to label the ejected disk and insert a new media.Press OK after the new media is inserted.The operation is resumed.When all the files are copied, the media is automatically ejected.

7. Press Next to continue.

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The Summary window is displayed (Figure 8-51), showing a list of the disks used.• Select Print summary to print the list for archiving

purpose.• Select Detailed summary to display the list of the

patient records copied.

Figure 8-51: The Summary window

8. Make sure that all media are physically labelled according to the list displayed in the Summary window. The media label should also have an identification of the system the Disk management was run from.

9. Press Done to complete the Disk management operation and file the media.

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Data Backup and restoreThe Backup/Restore function enables the user to:• Copy/Restore the patient archive.• Copy/Restore the system configuration. The Copy/Restore

system configuration feature enables the user to configure several units with identical presets, providing that the units have the same software version.

To minimize accidental loss of data, perform backup of the patient archive stored on the local harddrive at least once a week.

There is no backup function for the images or reports (no creation of a safety copy). For long-term storage, images and reports should be moved to removable MOD or to a network shared folder using the Disk management procedure (see page 408).

The backup of the patient archive on the harddrive and the system configuration is done from the configuration management package as described on page 417.

Data from Backup/Restore disks may be restored to the local harddrive using the Restore procedure as described on page 421.

Only users with administration rights have access to the backup/Restore function.

WARNING

GE Medical Systems is not responsible for lost data if the suggested backup procedures are not followed and will not aid in the recovery of lost data.

CAUTION

DO NOT use the local harddrive for long-term image storage.

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Backup procedure1. Press ARCHIVE.

The Operator login window is displayed.2. Select the operator with administration rights, enter the

password and press Log on.The Search/Create patient window is displayed.

3. In the Search/Create patient window, select the dataflow Local Archive - Int. HD.

Figure 8-52: Dataflow selection for backup

4. Press CONFIG (F2).5. Select the category Admin.6. Select the Backup sheet.

Figure 8-53: The Backup sheet

7. In the Backup sheet select as needed:

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• Patient archive to backup the patient records.• System configuration to copy system settings and

user presets.8. Select a removable media or a shared network folder as

destination.Note: to be able to select a shared network folder, the path (of type: \\server-name\share-name) must be entered once in the Remote path field.

9. If the backup is done to a removable media, insert a dedicated media in the drive.

10. Select Start backup.The following situations may occur:• The system is checking that the removable media is

inserted. If not, a dialogue window is displayed prompting the user to insert a media.

Figure 8-54: The Insert media window

Insert the media and select OK.• The system is checking if the media needs to be

formatted. If yes, the media is automatically formatted. An Information window is displayed showing the media label.

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Figure 8-55: The Information window

Write down the label and select OK.• The system is checking if there is already a backup or a

Disk management copy on the media. If the following error message is displayed, the disk is ejected and the user is asked to use a new media that does not contain any backup or Disk management data.

Figure 8-56: The Replace current media window

Insert a new media and select OK.Note: to reuse a Backup media when performing a new archive backup, the media has to be re-formatted first.

11. During backup, Progress windows are displayed showing the current operation being performed.

Figure 8-57: The Backup progress windows

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12. At the end of the process, the media is ejected and the Backup completed window is displayed.

Figure 8-58: The Backup completed window

Select OK.The Backup result is displayed on the Backup sheet.

Figure 8-59: The Backup result

13. Make sure to physically label the media. An identification of the system should also be noted on the media and a backup log should be kept.File the media in a safe place.

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Restore procedure1. Press CONFIG (F2).2. Select the category Admin.3. Select the Restore sheet.

Figure 8-60: The Restore sheet

4. In the Restore sheet select as needed:• Patient archive to restore the patient archive.• System configuration to restore all system settings

and user presets.OR

• One or several system configuration items to restore parts of the system settings and user presets (see Figure 8-60).

5. Make sure that Restore from Source Device is selected.6. Select the appropriate Source device.

CAUTION

The Restore procedure will OVERWRITE the existing data on the local harddrive. Make sure to select the correct source device.

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7. If restore is done from a backup on a removable media, insert the media in the drive.

8. Select Restore now.Depending on the selection, one or two Restore confirmation windows are displayed:

Figure 8-61: The Restore confirmation window

9. Ensure that the correct source is selected an select OK.The selected items are copied to the systems. If items from the system configuration are restored the system needs to be rebooted. The Reboot system window is displayed.

Figure 8-62: The Reboot system window

10. Select OK to reboot the system.

CAUTION

The Restore procedure will OVERWRITE the existing data on the local harddrive. Make sure to insert the correct media.

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DICOM spoolerDICOM spooler displays the current DICOM output jobs. The jobs may be Storage, Print, Modality Performed Procedure Step or Storage Commitment. The DICOM spooler is used for checking the current job's status when a job is saved or when the total spooler status on the right of the Archive windows displays an error.

From the DICOM spooler the user can also:• Delete non-active jobs• Resend a job that has failed or is in hold• Send a job that has failed or is in hold, to a new destination.• Hold a job that is not active.

The job's status displayed in the DICOM spooler window can be:• Pending: the job is complete, waiting to be active.• Hold: the job is complete, but suspended, waiting for an

user action.• Append: the job is incomplete, waiting for more images

(Direct store function).• Active: the job is complete and connected to the

destination device.• Failed: the job is complete but one or more images failed to

transmit to the destination device.• Done: the job is saved to the destination device. The jobs

that are done are removed from the spooler after a while.

Starting the DICOM spoolerAlternative: Press F4.

1. On the alphanumeric keyboard, press and hold down the ALT key and press S.The DICOM spooler window is displayed (see Figure 8-63).

The DICOM spooler window is automatically updated. Press Refresh to update the information displayed at any time.

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Figure 8-63: The DICOM job spooler window

Deleting a jobOnly non-active jobs can be deleted.

1. Trackball to the job to delete in the DICOM job spooler window.Note: several jobs can be selected.

2. Press SELECT.3. Trackball to Delete.4. Press SELECT.

Resending a jobOnly jobs that failed or are in hold can be resent.

1. Trackball to the job to re-send in the DICOM job spooler window.Note: several jobs can be selected.

2. Press SELECT.3. Trackball to Resend.4. Press SELECT.

Sending a job to a new destinationOnly jobs that failed or are in hold can be sent to a new destination.

1. Trackball to the job to send in the DICOM job spooler window.

2. Press SELECT.3. Trackball to Send to....

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4. Press SELECT.A dialogue window is displayed.

5. Select the new destination from the Destination popup menu.

6. Trackball to Send.7. Press SELECT.

Holding a job1. Trackball to the job to hold in the DICOM job spooler

window.Note: several jobs can be selected. Only inactive jobs can be set on hold.

2. Press SELECT.3. Trackball to Hold.4. Press SELECT.

To undo hold, press Resend.

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Chapter 9 Report

• Introduction ................................................................................... ... 427• Creating a report ........................................................................... ... 428

• Working with the report function ...............................................428• To print a report ........................................................................431• To store a report .......................................................................431• Retrieving an archived report ....................................................432• Deleting an archived report .......................................................432

• Structured Findings ..................................................................... ... 433• Prerequisite ...............................................................................433• Starting Structured Findings .....................................................434• Structured Findings structure ....................................................434• Using Structured Findings ........................................................436• Structured Findings configuration .............................................439

• Direct report .................................................................................. ... 450• Creating comments ...................................................................450• Creating pre-defined text inputs ................................................452

• Report designer ............................................................................ ... 453• Accessing the Report designer .................................................453• Report designer overview .........................................................454• Designing a report template ......................................................457• Saving the report template ........................................................467• To exit the Report designer ......................................................468

• Report templates management ................................................... ... 469• Configuration of the Template selection menu .........................469• Export/Import of Report templates ............................................471

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IntroductionThe Vivid 7 system enables the creation of patient and examination reports containing measurements, images and analysis that were made during the examination. The layout of the reports is defined by generic templates delivered with the system. Custom templates can also be made.

Saved reports are read-only. Therefore it is recommended that the data is carefully reviewed before the report is saved. Use the worksheet (see page 301) to facilitate the review and adjustment of data before generating a report. The final report can be printed on a regular laser printer.

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Creating a reportReports summarize data obtained in the examination. They can contain data and images.

Once generated, the report can be viewed, images can be added, wall segment diagrams can be assigned and text can be entered in the free text fields. All other information must be changed from the Patient information window and the Worksheet screen.

Working with the report function1. Press REPORT.

The default template for the current examination is displayed (see Figure 9-1). The information entered during the examination is automatically filled in (e.g. demographic, Diagnosis, Comments...etc.).

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Figure 9-1: The Report screen and assigned keys

1. Assigned keys• Print• Store• Retrieve• Template• Insert textMORE menu• Save as• Delete• Designer• Findings

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To choose another report template1. Press the assignable TEMPLATE.

The Template selection menu is displayed showing the available report templates organized by application.Note: The Template selection menu can be configured to display only the templates of interest (see page 469).

2. Do one of the following:• Select a template from the current application template

list.• Select another application and select the desired

template from the sub-menu displayed.Note: From a sub-menu, select Back to return to the current application template list.

The selected template is displayed on the screen.

To change patient information1. Trackball to heading of the information to change.

The trackball marker is changed to a hand with pointing finger .

2. Press SELECT on the Trackball area.The original location of the data is displayed.

3. Change the information entered if required.4. Press REPORT when completed.

To add an image to the report

Images are inserted in the report by dragging a selected image from the clipboard into an Image container in the report.1. Trackball to the Image of interest in the Image clipboard.2. Press and hold down the SELECT key and using the

trackball, drag the selected image in the Image container in the report.

3. To move images between image containers, press and hold down the SELECT key and using the trackball, drag the selected image to the new location.

4. To remove an image from the report, press and hold down the SELECT key and using the trackball, drag the selected image back to the clipboard.

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To print a reportOnly members of the user group “Cardiologist” are allowed to print a report (see page 575).1. Press PRINT.

The report is printed on the default printer. A status window is displayed showing the printing process.For printer configuration, see page 511.

To store a reportOnly members of the user group “Cardiologist” are allowed to store a report (see page 575).1. Press STORE.

The report is stored in the Report archive.A confirmation window is displayed when completed.

2. Press OK.

Alternative storage

Reports can also be saved in a user-defined locations in the following formats:• Compiled HTML (.CHM) files: readable from any web

browser.• Portable Document Format (.PDF) files: readable with

Adobe Acrobat reader.1. Press MORE.

The additional controls are displayed (Figure 9-1).2. Press SAVE AS.

The Save as dialogue window is displayed.3. Select the destination folder from the Save in pull down

menu. The default location is the Export folder.The Report archive folder is selected by default.The default name for the report is of type: <exam DICOM UID>.

4. Select PDF or CHM format from the Save as type pull down menu.

5. Press SAVE.

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Retrieving an archived report1. Press RETRIEVE.

A list of the available reports for the actual examination is displayed.The default name for a report is of type: <template type>_<store date>_<store time>.To display the current report, select Show active exam.

2. Trackball to the report to retrieve.3. Press SELECT.

Deleting an archived reportOnly members of the user group “Cardiologist” are allowed to delete a report (see page 575).1. Press MORE.

The additional controls are displayed (Figure 9-1).2. Press DELETE.

A list of the available reports for the actual examination is displayed.The default name for a report is of type: <template type>_<store date>_<store time>.

3. Trackball to the report to delete.4. Press SELECT.

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Structured FindingsStructured Findings is a feature that enables the user to insert pre-configured structured diagnostic statements and codes (e.g Billing, Accreditation) in the patient report and create a conclusion based on the inserted statements.

PrerequisiteTo be able to insert structured diagnostic statements and create a conclusion in a patient record, the report template used must have assigned fields for the structured findings, the codes and the conclusion.

To create the assigned fields in a report template:1. Press REPORT.2. Press TEMPLATE and select the desired report template.3. Press MORE and DESIGNER.

The Report designer screen is displayed.4. Select the location in the report template where to insert the

Structured findings fields.5. Select Insert and Archive Information.

The Archive information box is displayed (Figure 9-2).6. Double-click on Select All under all three parameter fields

in the Archive information box to deselect all parameters.7. Select Structured findings, Findings conclusion

Indication codes and Billing codes in the Exam Information field (Figure 9-2).

8. Select OK.9. Save the Report template and exit the Report designer.

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Figure 9-2: The Archive information box

Starting Structured Findings1. Press REPORT.

Make sure the current template has a Structured Findings field and a Conclusion field defined or select another template if necessary.

2. Press MORE and FINDINGS.The Structured Findings window is displayed (Figure 9-5).

Structured Findings structureThe diagnostic statements are organized in tab folders (see Figure 9-3). Each tab folder may contain:• Underlying tab folders that contain Tab sheets.• Tab sheets that contain diagnostic statements.

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Figure 9-3: Structured findings structure

There are three types of diagnostic statements (see Figure 9-4):• Check box statement: when selected the statement is

included in the report.• Combo box statement: create a statement by selecting one

alternative text among several choices.• Statement group: create several statements by selecting

multiple check box statements.

1. Tab folder with underlying tab sheets2. Tab sheet

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Figure 9-4: Diagnostic statement types

Using Structured Findings1. Start Structured Findings (see page 434).2. Browse to the tab sheet containing the statements of

interest.3. To insert a statement in the report (Findings field):

• Check box statement: select the statement.• Combo box statement: select an alternative text in the

combo box next to the statement.• Statement group: select the statements of interest within

the group.A preview of the selected statement(s) is displayed in the Findings preview field (see Figure 9-5). The statement text in the preview field can be edited. This will apply only for the current report.Once a statement is selected an asterisk is displayed on the tab of the current sheet and folder.Note: select Normal to select only normal statements from the current tab sheet (see page 443 for more information on how to define normal statements).

1. Check box statement2. Combo box statement3. Statement group

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Note: select Clear to deselect all statements from the current tab sheet.

To insert a conclusion statement in the report:• Press the Conclusion button in front of the statement of

interest.A preview of the selected conclusion statement is displayed in the Conclusion preview field (see Figure 9-5). Conclusion statements are displayed in a numbered list.The list can be reordered: triple-click on the conclusion statement to move in the Conclusion preview field and use the ARROW UP or ARROW DOWN key to move the statement up or down.The conclusion text in the preview field can be edited. This will apply only for the current report.To display the changes in the report, select Refresh report.Note: pressing the Conclusion button in front of a statement that was not previously selected results in simultaneously inserting the finding statement and create the conclusion.

4. Press OK.The report for the current patient is displayed with the selected findings, conclusion statement(s) and associated codes (if any).Note: Some diagnostic statements have measurements values in the body text referred by a tag (e.g the {EF} tag refers to EF measurement). These statements require that the actual measurement is done to display correctly in the report.

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Figure 9-5: Structured Findings window

Global selection of normal statements

It is possible to select all normal statements from all tab sheets. 1. Place the cursor in the Statement field, press UPDATE MENU

1. Statement inserted in the Conclusion and Findings field.2. Statement inserted in the Findings field only.3. Findings preview field4. Conclusion preview field5. Remove all selections.6. Insert normal findings for the current tab sheet.

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on the control panel and select All normal.All statements defined as normal are selected from all the tab sheets. An asterisk is displayed on the tab of all the tab sheets that contain normal statements.Note: this operation will remove any other “non-normal” previously selected statements.

2. To remove all statements at once, place the cursor in the Statement field, press UPDATE MENU and select Clear all.

Structured Findings configurationStructured Findings configuration is used to:• Create, edit or delete finding statements, conclusion

statements and codes.• Organize the diagnostic statements in the Structured

Findings screen.• Define the normal diagnostic statements.

Accessing the Structured Findings configuration screen1. Press CONFIG (F2) and select the Report category.2. Select the Structured Findings tab.

The Structured Findings configuration screen is displayed (Figure 9-6).

Or from within Structured Findings:1. Press UPDATE MENU on the control panel and select Config.

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Figure 9-6: Structured Findings configuration screen

1. Structured Findings structure tree:• tab folder• tab sheet• Check box statement• Combo box statement• Statement group

2. Tab or statement label3. Findings text4. Conclusion text5. Codes for the selected statement6. Create, move, copy or delete statement7. Create folder, Combo box or statement groups8. Enter a variable in statement or conclusion text9. Hide selected tab or statement from the Structured Finding window10. Set the selected statement as normal11. Rest factory default findings12. Export/import findings.

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Creation of a tab folder

The following procedure describes how to create a new top level tab folder.

Figure 9-7: New tab folder

1. In the Structured Findings configuration window (Figure 9-6), select the Structured Findings tab folder.

2. Select Add.A new entry is created in the Structured Findings tab folder. The new entry is by default a tab sheet ( ).

3. Select Enable one more tab level to change the new entry to a tab folder ( ).A warning message is displayed. Select OK.

4. With the new entry selected, follow the following steps:• Enter a name in the Label field (tab name).• Enter a description in the Findings text field. The

description will be displayed in the report as a heading when selecting a statement from the underlying tab sheets. The system is always using the Findings text from the highest item in the structure as a heading for the selected underlying statements.

• Enter the appropriate codes.

1. Configuration window2. Structured findings window

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Note: to enter several codes separate each code by a space.

5. Press Up or Down to move the tab in the structure tree (or do drag and drop).

Creation of a tab sheet

The following procedure described how to create a tab sheet in a tab folder.

Figure 9-8: New tab sheet

1. Make sure that the tab folder is selected and press Add.A new entry is created in the tab folder. The new entry is by default a tab sheet ( ).

2. With the new entry selected, follow the following steps:• Enter a name in the Label field (tab name).• Enter a description in the Findings text field.If required:• Enter the appropriate codes.



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Adding statements in the tab sheet

Check box statementThe following procedure describes how to create a check box statement.

Figure 9-9: New check box statement

1. Make sure that the tab sheet is selected and press Add.A new entry is created in the tab sheet. The new entry is by default a check box statement ( ).

2. With the new entry selected, follow the following steps:• Enter a name in the Label field (statement name).• Enter the full statement in the Findings text field.• Enter a conclusion in the Conclusion text field (optional).

Note: if the Conclusion text field is left empty, the statement text will be used as conclusion when selected.


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If required:• Enter the appropriate codes.


• Check Include findings in normal report to define the statement as normal.All statements within the selected tab sheet that have this option checked will be included in the report when Normal is selected in the Structured Findings window (see ’Using Structured Findings’ on page 436).

Combo box statementThe following procedure describes how to create a combo box statement.

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Figure 9-10: New combo box statement

1. Create a new statement as described above. A check box statement is created by default.

2. With the new statement selected, press Add.A new underlying entry is created and the parent statement is changed to a Combo box statement ( ).

3. With the new underlying entry selected, follow the following steps:• Enter a name in the Label field.• Enter a text in the Findings text field.


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• Enter a conclusion in the Conclusion text field (optional).4. Repeat the procedure from step 2 to create as many

underlying statements as necessary. Each underlying statement will be a selectable entry in the combo box.

Statement groupStatement groups are created by changing a combo statement to a statement group.1. Create a combo box statement as described above.2. Make sure the combo box statement is selected and

deselect the option Enable pull-downs.The combo box statement is changed to a statement group ( ). Each underlaying entries are changed to check box statements.

Editing a statement

Tab label, statements and statement alternative texts can be edited.1. In the Structured Findings configuration window

(Figure 9-6), select the item to edit.2. Make the required changes.

Inserting variable parameters in a statement

Variable parameters such as patient name, institution name, measurement values...etc can be inserted in a statement as tagged information.

To insert variable parameters in a statement:1. Place the cursor at the required position in the Findings text

field (or Conclusion text field).2. Press Insert parameter.

The Insert parameter window is displayed (see Figure 9-11).

3. Browse and select the actual parameter to insert.Note: for measurement values, select first the scanning mode.

4. Press OK.The selected parameter is inserted in the statement as a tag (e.g the {EF} tag refers to EF measurement)

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Note: to display correctly in the report, the actual parameter value must exist, e.g. if a measurement value is included in a statement as a variable parameter, a measurement value must exist for the current patient, otherwise the parameter name is displayed.

Figure 9-11: Insert parameter window

Copy of a statement

Tab folders, tab sheets and statements can be copied from one location to another. The word “Copied” is added to the copied item name.1. In the Structured Findings configuration window

(Figure 9-6), select the item to copy.2. Select Copy.3. Select the item to contain the copy.4. Select Paste.

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Note: if the item to copy cannot be copied in the selected location, the operation is ignored.Note: copy can be done by drag-and-drop, while holding CTRL depressed.

Deletion of a statement

Tab folders, tab sheets and statements can be deleted.

1. In the Structured Findings configuration window (Figure 9-6), select the item to delete.

2. Select Delete.The selected item is deleted.

Factory reset

All statements can be reset back to the factory default.

1. Select Reset.The Reset statements window is displayed.

2. Select:• Yes to reset all statement to the factory default (No

undo).• No to cancel the operation.

Exporting/Importing statements

Diagnostic statements can be exported from one system and imported on another system.

Exporting statements1. In the Structured Findings configuration window

(Figure 9-6), select Export.A browsing window is displayed.

2. Browse to a destination and select Save.

CAUTION

Deletion cannot be undone.

CAUTION

Factory reset cannot be undone.

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Importing statements

1. In the Structured Findings configuration window (Figure 9-6), select Import.A browsing window is displayed.

2. Browse to a destination and select Open.

CAUTION

Importing statements will replace the current statements. If necessary, backup the current statements by exporting them before performing import.

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Direct reportDirect report enables the user to insert comments at any time during the examination that will be part of the final report.

Direct report provides also an overview over the measurements completed.

Creating comments1. Press UPDATE MENU.2. Select Direct report (see Figure 9-12).3. In the Direct report screen, select the comment type.4. Type your comments in the Text field.5. To add a measurement in the comment, double-click a

measurement in the Measurement overview field.

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Figure 9-12: The Direct report

1. Open Direct report2. Select the type of information3. Create/insert pre-defined text4. Text field5. List of measurements completed6. Exits the Direct report

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Inserting pre-defined text input1. Select the insertion point in the Text field.2. Select Insert text.

The Insert text window is displayed (see Figure 9-13).

Figure 9-13: The Insert text window

The pre-defined text list is organized in a three level hierarchy. Selecting one item in the first column displays pre-defined text entries related to the selected text in the second and third column.

3. Navigate through the pre-defined text list by selecting items in the columns and double-click on the desired pre-defined text to be inserted. If an entry in the third column is inserted, the selected text in the second column is also inserted.Press More>> to display the full text for the selected entry.

Creating pre-defined text inputsThis feature is described in ’The Comment texts sheet’ on page 547.

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Report designerThe Report designer software package enables the user to create report templates that best suit its needs.

Designing a report template consists of choosing the information to display in the report (e.g. header, footer, logo, patient information, images, measurements...etc.) and arrange it in the report viewer.

The Report designer function is based on the information container concept: each type of information is included within a container with parameters that can be configured (size, color, font properties, information to display...etc.).

Accessing the Report designer1. Press REPORT on the Control panel.

The Report screen is displayed.2. Press DESIGNER.

The Report designer screen is displayed with the selected template in the Report template design area (see Figure 9-14).

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Report designer overview

The Report designer screen

Figure 9-14: The Report designer screen

1. Menu bar2. Report template design area

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The menu bar

Menu Description

File • New: start working on an new template.• Save: save the template using the same name. Factory

report templates cannot be overwritten.• Save as: save the template using a new name.• Page setup: define printing orientation and

header/footer for the printed report.• Print Preview: display a print preview of the report

template.• Exit: exit the Report designer and returns to the report

function. The user can choose whether to save the updates or restore the original template.

Menu Description

Edit • Delete: remove the selected object from the report template.

• Undo: restore the previous state of the report template.

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Menu Description

Insert • Page Break: insert a new page in the report template.• Table: configure and insert a table in the report

template.• Logo: select and insert a logo to the report template.• Archive info: select and insert data from the following

categories:Patient informationExam informationSite information

• Anatomical graphics: select and insert an anatomical graphic (cardiac, vascular or TEE).

• Image: create a container for the display of ultrasound images.

• Wall motion analysis: insert a container for the display of Stress Echo analysis results (cut planes Bull’s eye and scoring table).

• OB/GYN: insert OB graph.• Measurements: insert a container for the display of

measurements and calculations. When creating a measurement container, the user is prompted through a configuration procedure enabling the selection of mode specific measurements and/or calculations.

• Text field: insert a container where the user can write in the report.

• Fixed text: insert a container with static text. The text typed during the creation of the container will be displayed in the report.

Menu Description

Preferences • Page Color: sets the default background color for the template page.

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Designing a report template

Starting template designing1. Start the Report designer (see page 453).2. Press File and select New to display a blank page or use

the current report template as basis template.

Setting the layout preferences

Adjusting the report page color background1. Press Customize and select Page Color.

The Color selection window is displayed.2. Select the desired color.3. Press OK.

Header and footer in the printed reportThis function is described on page 466.

Inserting an information container in the report template body

The different type of information to be included in a report are grouped in information containers. Designing a report template consists in inserting and configuring the different information containers in the template page in an ordered manner.

Information containers can be inserted either: • Directly into the report template body: this procedure does

not allow side-by-side insertion, the information container will normally cover the width of the report template page.

• Within a table: this procedure allows side-by-side insertion of several information containers.

Inserting a table1. Press the Left mouse button at the desired insertion point

in the Report template design area.2. Press Insert and select Table.

The Container properties window is displayed (see Figure 9-15).

3. Adjust the parameters as desired.4. Press OK.

The table is displayed in the template.

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Note: To modify an inserted table, double-click in an empty area in the table. A selection menu is displayed where the user can add, delete a row or a column or open the Table properties window.

Figure 9-15: The Table properties window

Inserting a logo1. Provide the hospital logo in JPEG or Bitmap format onto a

CD or MO disk.2. Select the location where to insert the logo (a table cell or

directly in the report template).3. Select Insert and Logo.

The Logo box is displayed.

Figure 9-16: The logo box

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4. Select a logo, or if not available, select Import logo.Browse and select the logo and select OK.

5. Specify the appearance.6. Select OK.

Inserting fixed text

Fixed text is an entry that cannot be changed in the report (e.g. hospital information).1. Select the location where to insert the fixed text (a table cell

or directly in the report template).2. Select Insert and Fixed text.

The Fixed text box is displayed.

Figure 9-17: The Fixed text box

3. Enter the text and specify the appearance.4. Select OK.

Inserting archive information

Archive information contains all the objects of the different information menus (Patient, Exam, Study and Site Information).

You may display the archive information over two columns using a table container as described below.1. Insert a table for the archive information to the desired

location (a table cell or directly in the report template).2. Select the first table cell.

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3. Select Insert and Archive information.The Archive information box is displayed.

Figure 9-18: The Archive information box

4. If desired, enter a heading and select a heading link from the pull-down menu.

5. Select the Information parameters to be displayed in the first cell.Select Box properties to change the font, alignment, appearance, etc.

6. Select OK.7. Select the next table cell and repeat steps 3 to 6 to enter the

remaining archive information.

Inserting an Image container• Select the location where to insert the fixed text (a table cell

or directly in the report template).• Select Insert and Image.

The Ultrasound image box is displayed.

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Figure 9-19: The Ultrasound image box

• If desired, enter a heading, set the container size and specify the text appearance.

• Select OK.

Inserting measurement containers

You may display the measurements over several columns using a table container as described below.1. Insert a table for the measurements to the desired location.2. Select the first table cell.3. Select Insert and Measurements.

The Measurements box is displayed.

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Figure 9-20: The Measurements box

4. Enter a heading (e.g. 2D).5. Using the Filter criteria, define the type of measurements to

be displayed (e.g. Cardiac, 2D, measured and calculated).Select Show normal value to display user-defined Normal value next to the measurements in the Report (see ’Normal values’ on page 287 for more information).Note: References for the normal values can be displayed in the report by checking Normal value references from Insert -> Archive Info (see page 459).The Measurement list on the left side is updated.

6. From the measurement list, select the measurement to insert and press Add. Both single measurements or a folder may be added.

7. The list of the inserted measurements is displayed in the Selected measurement list on the right side.

8. Press OK.9. Select the next table cell and repeat steps 3 to 8 to insert

several measurements.

Inserting Text fields

Text fields are:

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• Containers for Referral reasons, Comments and Diagnosis information.

• Containers for free text, where the user can type information in the report.

1. Select the location where to insert the text field container (a table cell or directly in the report template).

2. Select Insert and Text field.The Text field box is displayed.

Figure 9-21: The Text field box

3. Enter a heading.4. From the Display field, select between:

• Referral reasons: displays the information entered in the Direct report (see page 450) or in the Examination list window.

• Comments: displays the information entered in the Direct report (see page 450) or in the Examination list window.

• Diagnosis: displays the information entered in the

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Direct report (see page 450) or in the Examination list window.

• Free text 1-8: creates an empty free text container.5. If desired, adjust the font settings for the header and data.

Inserting Wall motion scoring analysis containers

Two different containers must be inserted for the Wall motion scoring analysis:• A Wall motion scoring diagrams container (Cut planes or

Bull’s eyes)• A Wall motion scoring table

Inserting Wall motion scoring diagrams container1. Select the location where to insert the free text container (a

table cell or directly in the report template).2. Select Insert, Wall motion analysis and select between

Cut planes and Bull’s eye.The corresponding Wall motion scoring box is displayed.

Figure 9-22: The Wall motion scoring box (Cut planes)

3. Adjust the parameters and select OK:The scoring diagrams are inserted in the report template

Inserting Wall motion scoring table container1. Place the cursor right below the Wall motion scoring

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diagrams container.2. Select Insert, Wall motion analysis and select Score

table box.The Score table box is displayed.

Figure 9-23: The Score table box

3. Adjust the layout parameters in the Score table box and select OK.The Score table is inserted in the report template.

Editing the information container

Resizing the information container1. Move the Mouse cursor over the border of the container to

resize.The mouse cursor is changed to a cross .

2. Press Left mouse button once.The container is displayed with anchor squares on the sides and at the corners.

3. Resize the container by dragging from the anchor points.

Editing the information container propertiesModifying the container’s specific properties

1. Move the Mouse cursor over the border of the container to edit.The mouse cursor is changed to a cross .

2. Double-click on the Left mouse button.The Container box is displayed.

3. Adjust the parameters specific to the selected container.

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Note: Some information containers have additional parameters that may be adjusted by selecting Box properties.

Inserting a new page1. In the template, position the Mouse cursor at the insertion

point.2. Press the Left mouse button.3. Press Insert and select Page Break.

Inserting header and footer

Header and footer may be defined to be displayed in the printed report. The header and footer are not visible in the on screen report.

To insert header and footer in the printed report:1. Select File and Page setup.

The Page setup box is displayed.

Figure 9-24: The Page setup box

2. Adjust the printing orientation.3. Define the header and footer for the printed report, by

typing text and entering the required variables listed in the table below.Check Different on first page and create a specific header/footer for the first page.

4. Select OK.

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To check the display of the header and footer, select File and Print preview.

Saving the report template

Replace an existing template

Factory templates cannot be overwritten.1. Press File and select Save.

A dialogue window is displayed asking for confirmation.2. Select:

• Yes to save the report template• No to discard the report template• Cancel to go back to the Report designer without saving

the report template.

Save existing template with a new name1. Press File and select Save as.

The Save as template window is displayed.

Variable Description

{pid} Patient ID

{pnm} Patient name

{pdb} Patient date of birth

{exd} Examination date

{prd} Current date (printing date)

{prt} Current time (printing time)

{cp} Current page

{tp} Page count

{c} Subsequent entries are centered

{r} Subsequent entries are right aligned

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Figure 9-25: The Save as template window

2. Enter a name for the template.3. Press OK.

The template is saved.

To exit the Report designer1. Select File and Exit.

The Exit window is displayed.2. In the Exit window, select:

• Yes: to save the report template and exit the application.• No: to exit the application without saving the changes

made in the report template.• Cancel: to return to the application.

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Report templates managementThis section describes:• Configuration of the Template selection menu.• Deletion of user-defined report templates.• Export/import of user-defined report templates.

The report templates management is done from the Report templates sheet in the system configuration package.

To access to the Report templates sheet:1. Press CONFIG (F2) and select the Report category.

The Report category sheet is displayed.

Figure 9-26: The Report template sheet

Configuration of the Template selection menuThe Template selection menu displays the application specific report templates that can be selected when creating a report. The Template selection menu can be configured to display only the templates of interest.

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Inserting a template in the Templates selection menu1. Press CONFIG (F2) and select Report.

The Report template sheet is displayed (Figure 9-26)2. In the Available templates field (left field), select the

template to insert in the Template selection menu.3. Next to Section, select the appropriate application.4. Press the Right arrow button .

The selected template is inserted in the Template selection menu.Note: Double-clicking on a template in the Available template field will also insert the template in the Template menu.

Removing a template from the Template selection menu1. In the Report template menu field (right field), select the

template to remove.2. Press the Left arrow button .

The selected template is removed from the Template selection menu.Note: Double-clicking on a template in the Report template menu field will also remove the template from the Template menu.

Sorting the templates in the Template selection menu1. In the Report template menu field, select the template to

move. 2. Press the Up or Down arrow buttons .

The selected template is moved accordingly in the Template selection menu.

Deleting a report template from the system

Only user-defined report templates can be deleted from the system.1. In the Available templates field (left field), select the report

to delete (Figure 9-26).2. Press Delete.

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A Confirmation window is displayed.3. Select Yes to delete the report template.

Export/Import of Report templatesUser-defined report templates can be exported to a removable media and imported from the removable media into another system (Vivid 7/EchoPAC PC).

Export of Report templates1. Insert a removable media in the in the drive.2. Press CONFIG (F2) and select Report.

The Report template sheet is displayed (Figure 9-26, page 469).

3. Select Export Templates.The available user-defined templates are displayed in the Export templates window.

Figure 9-27: The Export templates window

4. Select the templates(s) to export. Multiple selection can be done using SHIFT or CTR key.

5. Select the desired removable media under Select target device.

6. Press OK.A Confirmation window is displayed.

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7. Press OK.The selected template(s) are exported to the removable media.

8. Press ALT + E and select the media to eject.

Import of Report templates1. Insert the removable media with the report template(s) to

import.2. Press CONFIG (F2) and select Report.

The Report template sheet is displayed (Figure 9-26, page 469).

3. Select Import Templates.The Import template window is displayed.

Figure 9-28: The Import template window

4. Select the source device from the pull-down menu.5. Press OK.

A Confirmation window is displayed.6. Press OK.

The templates are imported into the system.7. Press ALT + E and select the media to eject.

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Chapter 10 Probes

• Probe overview ............................................................................. ... 474• Supported probes .....................................................................474• Probe orientation ......................................................................479• Probe labelling ..........................................................................479• Maximum probe temperature ....................................................481

• Probe Integration .......................................................................... ... 483• Connecting the probe ...............................................................483• Activating the probe ..................................................................486• Disconnecting the probe ...........................................................487

• Care and Maintenance ................................................................. ... 488• Planned maintenance ...............................................................488• Inspecting the probe .................................................................489• Cleaning and disinfecting probes ..............................................490

• Probe safety .................................................................................. ... 493• Electrical hazards .....................................................................493• Mechanical hazards ..................................................................493• Biological hazards .....................................................................494

• Biopsy ............................................................................................ ... 495• Precaution concerning the use of biopsy procedures ...............495• Preparing the Biopsy guide attachment ....................................496• Displaying the Guide zone ........................................................500• Biopsy needle path verification .................................................501• Starting the biopsy procedure ...................................................501• Cleaning, disinfection and disposal ..........................................501

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Probe overviewThe Vivid 7/Vivid 7 PRO ultrasound unit supports four types of probes:• Phased Array Sector• Linear Array• Curved Array (Convex)• Continuous Wave Doppler

Supported probes

Phased Array Sector probes

Probe Mode Intended use Technical data

3S 2D modeM-ModeColor FlowCW DopplerPW Doppler

CardiologyCoronaryTranscranialAbdomenPediatric

Frequency:Foot print:

1.5–3.8 MHz18 x 24 mm

M3S 2D modeM-ModeColor FlowCW DopplerPW Doppler



1.5–4.3 MHz20 x 28 mm

M4S 2D modeM-ModeColor FlowCW DopplerPW Doppler



1.5–4.3 MHz20 x 28 mm


CardiologyCoronaryPediatric


2.2–5.0 MHz18 x 24 mm

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Linear Array probes




2.7–8.0 MHz15 x 22 mm




2.9–8.0 MHz15 x 21 mm




3.7–11.5 MHz10 x 14 mm

3Va 2D modeM-ModeColor FlowCW DopplerPW Doppler

Cardiology4D and Multi-plane imaging


1.5–4.0 MHz21 x 26 mm

a) Vivid 7 Dimension only



7L 2D modeM-ModeColor FlowPW Doppler

Peripheral vascularSmall parts


2.2–8.0 MHz17 x 58 mm

9L 2DM-ModeColor FlowPW Doppler

Peripheral vascularSmall parts


3.0–10.0 MHz14 x 52 mm

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Curved Array (Convex) probes


Small partsperipheral vascular


4.0–10.0 MHz17 x 49 mm


Small partsperipheral vascular


4.9–13.0 MHz17 x 49 mm

M12L 2D modeM-ModeColor FlowPW Doppler

CarotidSuperficial


4.9–14.0 MHz10 x 45 mm

i8L 2D modeM-ModeColor FlowPW Doppler

Cardiac intraoperative Frequency:Foot print:

3.9–10.0 MHz16 x 44 mm

i13L 2D modeM-ModeColor FlowPW Doppler

Cardiac intraoperative Frequency:Foot print:

5.3–14.0 MHz10 x 28 mm



3.5C 2D modeM-ModeColor FlowPW Doppler

AbdomenFetal HeartObstetricsPelvicRenal

Frequency:Foot print:FOV:

2.0–5.0 MHz18 x 64 mm70 degrees

4C 2D modeM-ModeColor FlowPW Doppler




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Doppler probe

Multiplane Transesophageal Phased Array probe





M7C 2D modeM-ModeColor FlowPW Doppler





AbdomenCarotidNeo Head



E8C 2D modeColor FlowPW Doppler

Fetal HeartObstetricsPelvic


3.7–8.0MHz23 x 10 mm128 degrees



2D (P2D) CW DopplerPW Doppler

Cardiology Frequency: 2.0 MHz

6D (P6D) CW DopplerPW Doppler

Carotid Frequency: 5.0 MHz5.8 MHz

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6T/6T-RS 2D modeM-ModeColor FlowCW DopplerPW Doppler

Transesophageal Cardiology

Frequency: 2.7–7.0 MHz

6Tc 2D modeM-ModeColor FlowCW DopplerPW Doppler



9T/9T-RS 2D modeM-ModeColor FlowCW DopplerPW Doppler

Transesophageal pediatric Cardiology


5T PAMPTE

2D modeM-ModeColor FlowCW DopplerPW Doppler



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Probe orientationSome probes are provided with a green light (LED) orientation marking near their head (see Figure 10-1). Probes which do not have a LED have an indentation (notch) for orientation on the probe housing. This LED, or notch, corresponds with the V mark on the scanning screen. The V mark indicates the orientation of the probe to the scan.

Figure 10-1: Orientation marking on probe and on screen

Probe labellingEach probe is labelled with the following information:• Name of distributor and manufacturer• Operating frequency• Model number• Probe serial number• Year of manufacture

1. LED2. Notch

3. V-mark on screen: indicates the orientation of the probe to the scan.

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The probe name displayed on both the probe housing and the connector can be read when the probe is connected.

Figure 10-2: Probe labelling (examples)

1. CE mark2. Probe name

M12L

MODEL 2250695SERIAL

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Maximum probe temperature

Notes: Lens temperature measured under following conditions per IEC 60601-2-37 Amd.1:1. Thermocouple was placed at the geometric center of the

lens.Thermal phantom made with tis-sue-mimicking ma-terial as referenced in IEC60601-2-37 Amd 1: Annex II.2

2. a: Thermal phantom at 37 °C for non-external probes.b: Thermal phantom at 33 °C (or 23 °C) for external probes. (Temperature rise is measured and added to 33 °C if the phantom is at 23 °C).c: P2D and P6D with probe transmitting in air, no phantom.

3. Probe placed upright in contact with above thermal phantom.

4. Auto-freeze capability is disabled.5. Lens temperature is monitored for 30 minutes.6. 6T/6Tc/5T/PAMPTE, 9T, M4S and 3V probes are equipped

with internal temperature sensor and mechanism to monitor and limit temperature.

Probe Max Temp Probe Max Temp

3S 41.1 i8L 37.6

M3S 40.7 i13L 36.2

3V 42.6 3.5C 40.4

M4S 42.2 4C 41.1

5S 39.8 5C 40.9

6S 40.8 M7C 41.0

7S 38.2 8C 40.5

10S 40.1 E8C 37.1

7L 38.7 6T/5T/PAMPTE 40.7

9L 40.6 6Tc 41.9

10L 39.9 9T 37.6

12L 38.2 P2D 37.1

M12L 40.8 P6D 38.9

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7. a: Measurement uncertainty for probes with temperature sensor: 0.3 °Cb: Measurement uncertainty and probe variation for other probes: 2 °C

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Probe IntegrationThis section covers:• Connecting the probe• Activating the probe• Disconnecting the probe

Connecting the probeProbes can be connected at any time, whether the unit is on or off.

Systems with the 4D Imaging option installed have one probe port of a new type (Figure 10-3).

Figure 10-3: Probe ports

To connect a probe1. Hold the probe connector vertically with the cable pointing

A: system without 4D Imaging option1. Standard probe ports2. Park probe port

B: system with 4D Imaging option1. Standard probe ports2. Probe port for 4D Imaging option

A B

CAUTION

Do not allow the probe head to hang freely. Impact to the probe head may result in irreparable damage.

WARNING

Do NOT touch the patient and any of the connectors on the ultrasound unit simultaneously, including ultrasound probe connectors.

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upward.2. Turn the connector locking handle counterclockwise.3. Align the connector with the probe port and carefully push

into place.4. Turn the locking handle clockwise to the full vertical position

to lock in place.5. Position the probe cable so that it is not resting on the floor.

Connecting the PAMPTE or the 6Tv probe

The PAMPTE and the 6Tv probes are equipped with a Vivid Five connector. To connect the these probes on the Vivid 7/Vivid 7 PRO, an adaptor must be used (see Figure 10-4).

To connect the PAMPTE or 6Tv probe:1. Turn the probe connector locking handle to the horizontal

position.2. Align the connector with the adaptor port and carefully push

into place.3. Rotate the probe connector locking handle to the full

vertical position to lock the probe connector and the adaptor together.

4. Ensure that the locking handle on the adaptor is in up position (see Figure 10-4).

5. Align the adaptor with the probe port and carefully push into place.

6. Move the locking handle to the down position to lock in place (see Figure 10-4).

7. Position the probe cable so that it is not resting on the floor.

CAUTION

Take the following precautions with the probe cables:• Keep free from the wheels.• Do not bend.• Do not cross cables between probes.

CAUTION

Transesophageal probes require a special handling. Refer to the user documentation enclosed with these probes.

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Figure 10-4: The PAMPTE probe adaptor

Connecting the 6T-RS or the 9T-RS probe

The 6T-RS and the 9T-RS probes are equipped with a Vivid i connector. To connect these probes on the Vivid 7, an adaptor must be used (see Figure 10-5).

1. PAMPTE or 6Tv probe connector in2. To the system probe port3. Unlocked position4. Locked position

CAUTION


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Figure 10-5: The RS probe adaptor

Activating the probeWhen a probe is connected to the unit it is automatically detected.

To select a probe and an application:To change applica-tion without chang-ing the current probe, press APPL. on the control pan-el.

1. Press PROBE on the control panel. A list of the connected probes will pop up.

2. Trackball to the desired probe. An application menu for the desired probe is then listed.

3. Trackball to the desired application4. Press SELECT to launch the application.

1. Insert the RS adaptor in the system probe port.2. Lock the adaptor.3. Insert the RS type probe connector in the adaptor.4. Lock the probe connector

CAUTION

Make sure that the probe and application names displayed on the screen correspond to the actual probe and application selection.

Check that the correct TI category is displayed (see ’Thermal Index’ on page 597). TIB must be displayed when a fetal application is selected.

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Disconnecting the probe

To disconnect probes:1. Rotate the lock handle counter-clockwise to the horizontal

position to unlock the connector.The probes that are not connected to the unit should be stored in their stor-age case.

2. Remove the connector from the port.3. Ensure that the probe head is clean before placing the

probe in its storage case.

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Care and MaintenanceThis section covers:• Planned maintenance• Probe inspection• Probe cleaning• Probe disinfection

Planned maintenance

It is recommended to keep a maintenance log and note all probe malfunctions. Follow the maintenance schedule below to ensure optimum operation and safety:

After each use:• Inspect the probe• Clean the probe• If required disinfect the probe

Before each use:• Inspect the probe

CAUTION

Improper handling can lead to early probe failure and electric shock hazards.

DO follow the specific cleaning and disinfection procedures provided in this chapter and the germicide manufacturers instructions.

Failure to do so will void probe warranty.

CAUTION

Transesophageal and intraoperative probes require a special handling. Refer to the user documentation enclosed with these probes.

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Inspecting the probe

After each use:1. Inspect the lens, the probe housing and the cable

(Figure 10-6.2. Look for damage that might allow liquid into the probe.

Before each use:1. Inspect the lens, the probe housing and the cable

(Figure 10-6).2. Look for damage that might allow liquid into the probe.3. Test the functionality of the probe.

Figure 10-6: Probe parts

CAUTION

If any damage is found, DO NOT use the probe until it has been inspected and released for further use by a GE service representative.

1. Housing2. Strain relief3. Seal4. Lens

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Cleaning and disinfecting probes

Cleaning probes

Cleaning procedure1. Disconnect the probe from the unit.2. Remove the coupling gel by wiping the probe lens with a

soft cloth.3. Wipe the probe and cable with a soft cloth moisten in a

warm soap and water solution (<80 oF/27 oC).4. Wipe the probe and cable with a soft cloth moisten in clean

water (<80 oF/27 oC) until all soap is removed.5. Wipe dry with a soft towel.

Disinfecting probes

In order to provide users with options in choosing a germicide, GE Medical Systems routinely reviews new medical germicides for compatibility with the materials used in the transducer housing, cable and lens. Although a necessary step in protecting patients and employees from disease transmission, liquid chemical germicides must also be selected to minimize potential damage to the transducer.

Refer to the Probe Care Card enclosed in the probe case or to http://www.gehealthcare.com/usen/ultrasound/products/probe_care.html for the latest list of compatible cleaning solutions and disinfectants.

Low-level disinfection1. After cleaning, the probe and cable may be wiped with a

tissue sprayed with a recommended disinfectant.

Use additional precautions (e.g. gloves and gown) when decontaminating an infected probe.

High-level disinfectionHigh-level Disinfection destroys vegetative bacteria; lipid & non-lipid viruses, fungi and, depending highly on time of contact, is effective on bacterial spores. This is required for

CAUTION

Transesophageal and intraoperative probes require a special handling. Refer to the user documentation enclosed with these probes.

491

endocavity (TV,TR,TE) probes after contact with mucosal membrane.

High-level disinfection procedureFollow the manu-facturer's instruc-tions for storage, use and disposal of the disinfection so-lution.

1. Prepare the germicide solution according to the manufacturer's instructions.

2. Place the cleaned dried probe in contact with the germicide for the time duration specified by the manufacturer.

3. Rinse the part of the probe which was in contact with the germicide according to the germicide manufacturer's instructions.

4. Wipe dry with a soft towel or air dry the probe.

WARNING

Use only germicides that are listed in the Probe Care Card enclosed with the probe. In addition, refer to the local / national regulations.

Do not steam autoclave or subject the probe to Ethylene Oxide (ETO).

WARNING

Do not immerse the probe in liquid beyond the level specified for that probe (see Figure 10-7).

Never immerse the probe connector or probe adapters in liquid.

The probe should not be exposed to the germicide longer than specified to achieve the desired effect.

DO NOT soak or saturate probes with solutions containing alcohol, bleach, ammonium chloride compounds. In addition TE probes must not be immersed in solutions containing hydrogen peroxide.

WARNING

CREUTZFELD-JACOB DISEASE

Neurological use on patients with this disease must be avoided. If a probe becomes contaminated, there is no adequate disinfecting means.

492

Figure 10-7: Probe immersion levels

1. Fluid level2. Contact face with patient

environment

7L / 9L10L / 12L

M12L3.5C / 4C5C / M7C 8C

3S / M3SM4S / 5S

6S / 7S / 3V

2D (P2D) 6D (P6D)

E8C

493

Probe safetyThis section includes information on hazards to both the user and the equipment, as follow:• Electrical hazards• Mechanical hazards• Biological hazards

Electrical hazardsProbes are driven by electricity, which can injure the patient or user when exposed to contact with conductive solution.

Mechanical hazardsTake precaution to avoid mechanical hazards.

WARNING

Do not immerse the probe into any liquid beyond the level shown in Figure 10-7. Never immerse the probe connector or adaptors into any liquid.

Do not subject the probe to mechanical shock or impact, which may result in cracks or chips in the housing and degrade performance.

Inspect the probe before and after each use, as described on page 489, for damage or degradation to the housing, strain relief, lens and seal.

DO NOT apply excessive force to the probe cable, to prevent insulation failure.

Electrical leakage checks should be performed regularly by a GE service representative or qualified hospital personnel, according to the procedures described in EN 60601-1/IEC 60601-1 §19.

WARNING

Observe immersion levels as displayed in Figure 10-7, page 492.

Inspect probes for sharp edges or rough surfaces that could injure sensitive tissue.

DO NOT bend or pull the cable forcefully, to avoid mechanical shock or impact to the probe.

494

Biological hazards

To minimize disease transmission, legally marketed and sterile pyrogen-free sheaths should be used for each probe recommended for intra-cavity procedures.

Adequate cleaning and disinfection are essential to prevent disease transmission. It is the responsibility of the user to verify and maintain the effectiveness of the infection control procedures in use.

CAUTION


495

BiopsyThe Vivid 7 supports biopsy capability for the 3.5C, 4C, M7C, 7L, 9L, 10L, 12L, M12L, 3S, M4S, M3S and E8C probes. The biopsy option is intended for use by a duly licensed physician who has received the appropriate training in biopsy techniques as dictated by current relevant practices, as well as in proper operation of the Vivid 7 ultrasound unit.

Precaution concerning the use of biopsy procedures

WARNING

Do not freeze the image during a biopsy procedure. The image must be live to avoid a positioning error.

CAUTION

The use of biopsy devices and accessories that have not been evaluated for use with the equipment may not be compatible and could result in injury.

CAUTION

The invasive nature of biopsy procedures requires proper preparation and technique to control infection and disease transmission. Equipment must be cleaned as appropriate for the procedure prior to use.• Follow the probe cleaning and disinfection procedures and

precautions to properly prepare the probe.• Follow the manufacturer’s instructions for the cleaning of biopsy

devices and accessories.• After use, follow proper procedures for decontamination, cleaning,

and waste disposal.

Improper cleaning methods and the use of certain cleaning and disinfecting agents can cause damage to the plastic components that will degrade imaging performance or increase the risk of electric shock.

496

Preparing the Biopsy guide attachmentThe 3.5C, 4C, M7C, 7L, 9L, 10L, 12L, M12L, 3S, M4S, M3S and E8C probes have an optional biopsy kit specific for each probe. The biopsy kit consists of:• One reusable non-sterile bracket• Five disposable sterile Ultra-Pro IITM Needle guide kits

(Civco Medical Instruments Co, Inc.) consisting of:• Two sets with needle inserts covering gauge

size 14 through 23 (2.1 mm to 0.6 mm)• One sterile sheath• Two rubber bands• gel

• One reusable needle guide• Instructions

In addition sterile Ultra-Pro IITM Needle guide kits can be ordered as replacement kit.

WARNING

Read the following instructions and the user’s guide for the Ultra-Pro IITM Needle Guide kit before using the biopsy equipment.

497

Bracket attachment procedure1. Identify the appropriate biopsy guide bracket as shown in

Figure 10-8 and Figure 10-9.

Figure 10-8: The biopsy brackets

Probe Biopsy

3.5C

4C

M7C

7L

9L

10L

498

Figure 10-9: The biopsy brackets

2. Orient the bracket so that the needle clip attachment is on the same side as the probe orientation mark (notch or LED), see Figure 10-10.

3. Attach the biopsy bracket to the probe by sliding the bracket over the end of the probe until it clicks or lock into place.Make sure the bracket is firmly attached to the probe.

Probe Biopsy

12L/M12L

M3S/M4S/3S

E8C

499

Figure 10-10: Probe/bracket alignment

4. M3S, M4S and 3S probes: tighten the biopsy bracket to the probe by locking the lever lock.

Placing the probe and bracket into the sterile sheath

Refer to the Ultra-Pro IITM Needle Guide user manual.

Attaching the needle guide to the bracket

Refer to the Ultra-Pro IITM Needle Guide user manual.

1. Needle clip attachment on the bracket2. Bracket label3. Probe label4. Probe orientation mark (notch or LED)5. Lever lock

500

Displaying the Guide zone1. Select the desired probe with biopsy support.2. Press F5 (Biopsy) on the alphanumeric keyboard.3. If the needle multi-angle is supported, select the correct

angle from the Biopsy menu.

Figure 10-11: The Biopsy menu

The biopsy guide zone is displayed on the screen.

Figure 10-12: Biopsy guide zone

1. Biopsy guide zone• 5 cm between the red marks• 1 cm between the large yellow marks• 0.5 cm between two consecutive marks

The first red mark is at 5 cm from the top of the needle guide.

501

Biopsy needle path verificationPerform the Needle path verification once a year or whenever there is a suspicion of malfunction.

To verify that the path of the needle is accurately indicated within the guide zone on the system monitor, perform the following:1. Properly install the bracket and biopsy guide (see

page 497).2. Scan in a container filled with a glycerol solution (6% in

water).3. Display the biopsy guide zone on the monitor (see

page 500).4. Ensure that the needle echo falls within the guide zone

markers.

Starting the biopsy procedure1. Press F5.

Enabling color flow would allow for vi-sualization of the vascular structure around the area to be biopsied.

2. Place sterile coupling gel on the scanning surface of the probe/sheath.

3. Perform the biopsy.

Cleaning, disinfection and disposal1. Refer to the Ultra-Pro IITM Needle Guide user manual for

cleaning and disinfection of the bracket.2. Perform cleaning and disinfection of the probe as described

in page 490.3. Dispose the sheath, bands and needle guide after use,

according to medical regulations for biohazardious waste.

502

Chapter 11 Peripherals

• Introduction ................................................................................... ... 503• VCR/DVD operation ...................................................................... ... 505

• VCR/DVD Overview ..................................................................505• Using VCR/DVD .......................................................................506

• Printing .......................................................................................... ... 510• To print an image ......................................................................510• Printer configuration ..................................................................511

• Specifications for peripherals ..................................................... ... 513

503

IntroductionThis chapter provides information on peripherals that can operate with the Vivid 7 ultrasound unit, as follows:• VCR• DVD recorder (DVD-R and DVD-RW only)• Color Thermal Video Printer• Black & White Thermal Video Printer

CAUTION

Use only GE Medical Systems approved internal equipment when replacing an internal peripheral.

External peripheral equipment must be CE marked and in compliance with related standards (EN 60601-1 or EN 60950). Conformance to EN 60601-1-1 (2000) must be verified.

All devices meeting IEC60950 must be kept outside of the patient environment, as defined in IEC60601-1-1 (2000), unless it, according to IEC60601-1-1 (2000), is equipped with additional protective earth or extra isolating transformer. Commercial devices such as laser cameras, printers, VCRs and external monitors, usually exceed allowable leakage current limits and, when plugged into separate AC outlets, are in violation of patient safety standards. Suitable electrical isolation of such external AC outlets, or providing the device with extra protective earth, will be required in order to meet UL2601-1 and IEC60601-1 standards for electrical leakage.

504

Figure 11-1: Peripheral locations on the Vivid 7.

1. Color Video Printer (side)2. B&W Video Printer3. VCR or DVD

WARNING

When using peripheral device, observe all warnings and cautions given in peripheral operator manuals.

505

VCR/DVD operation

VCR/DVD OverviewThe VCR/DVD is operated from the ultrasound unit control panel. The VCR/DVD status displayed on the screen indicates the current VCR/DVD function (see Figure 11-2).

Figure 11-2: The Video status area on the Title bar

1. Recording (red)2. Stop3. Play4. Pause (red while recording)5. Fast Forward6. Rewind

7. Eject8. Search9. Shuttle Forward10. Shuttle Rewind11. Date and time12. Video counter

1 2 3 4 5 6 7 8 9 10

11

12

506

Figure 11-3: The Video controls on the Control panel

Using VCR/DVD

Adjustment of the Video Counter (VCR only)

To start the video counter at a different point:1. Press VIDEO on the Control Panel.2. Press UPDATE MENU in the Trackball area.3. Trackball to Video Counter/Search.4. Press SELECT.

The Video Counter/Search window is displayed (Figure 11-4).

1. Video: enter video playback mode. Displays the video assignable controls.2. Assignable keys3. Record/Pause4. Shuttle speed

507

5. Use the alphanumeric keyboard to enter the counter number in the counter field.ORPress Search Blank to set the counter number to a blank (unrecorded) section on the tape (works in a the forward direction only).

Selecting Cancel will undo the cur-rent changes to the counter.

6. Press Set Counter to save the change.7. Press VIDEO on the Control Panel to return to the scanning

mode.

Figure 11-4: The Video set counter / Search window

Start Recording1. VCR: Ensure that the VCR counter is set correctly.2. Press REC/PAUSE on the Control panel.

A red dot is displayed in the VCR/DVD status area on the Title bar to indicate that recording has begun (see Figure 11-2).Note: DVD: a record start to a record stop is treated as one title. Up to 49 titles can be recorded.

Pause recording1. Press REC/PAUSE on the Control panel.

The video status icon is changed to (Pause) .Note: DVD: each time Pause is used a new chapter is created.

The Video Set Counter/Search Window is also displayed when inserting the tape in the VHS.

508

Play back an examination1. Press VIDEO on the Control Panel.2. Use the Assignable keys on the Control panel to perform

actions on the recorded session, such as stop, pause, rewind or fast forward (see Figure 11-3).The video status icon is updated accordingly (see Figure 11-2).DVD: press MORE to access to the controls: Previous/Next Chapter and Previous/Next Title.

Searching in the video tape/DVD 1. Press VIDEO on the Control Panel.2. Press UPDATE MENU and select Video Counter/Search or

press MORE and GO TO/SEARCH.The Video Counter/Search window is displayed (Figure 11-4).

3. DVD: select a title from the Recording title drop-down menu and enter a counter value if desired.VCR: Enter a counter value.

4. Select Search.

Additional playback features

When playing back an examination, part of it can be stored on the computer’s memory as a cineloop. The cineloop enables the user to perform further operations on the stored section (see page 58 for further information on cineloop operation).

To store a recorded sequence as a cineloop1. Press FREEZE while playing back a recorded session.

The last few seconds are stored as a cineloop.

Refer to ’Cineloop operation’ on page 58 for further details on working with cineloops.

Ejecting DVD1. Press STOP/EJECT.

The Finalize window is displayed.2. Select:

• Yes: the DVD is finalized and ejected. Finalized DVD cannot be reused for recording.

• No: the DVD is ejected without being finalized. The DVD

509

can be reused for recording additional titles, but it will not be playable on other DVD players without being finalized.

510

PrintingThe Vivid 7 ultrasound unit can support a color and a black & white thermal video printer. The printer devices are controlled from the PRINT keys on the control panel (see Figure 11-5).

The PRINT keys can also be configured to perform alternative storage (i.e. storage to DICOM media or secondary capture). See page 560 for configuration of the PRINT keys.

Figure 11-5: The printer controls on the Control panel

To print an imageFor details on the Thermal video printers operation, consult the manu-facturer operator manual provided with the printer.

1. Press PRINT or ALT. on the Control panel (see Figure 11-5).The image displayed on the screen is printed on B&W or Color printer, depending on the key assignment configuration (see page 560).

1. Alt. Print2. Print

511

Printer configurationThe following procedure describes how to configure and select a printer as the default printer.1. Press CONFIG (F2).2. Select Connectivity and Additional output.

The Additional output screen is displayed (see Figure 11-6).

3. In the Additional output screen select Advanced in the Printer setup field.The Standard printer properties window is displayed.

4. Press Configure.The Print setup window is displayed.

5. In the Print setup window, select the printer and adjust the parameters for the printer. Additional settings may be adjusted by selecting Properties.

6. Select OK to close the Print setup window.The Standard printer properties window is displayed.

To choose the configured printer as the default printer:1. Select Open in the Standard printer properties window.

The Printer status window for the opened printer is displayed.

2. Select Printer and Set as default printer.3. Close the Printer status window and select OK in the

Standard printer properties window.

512

Figure 11-6: Printer configuration

513

Specifications for peripheralsPlease refer to the documentation accompanying the peripherals.

514

Chapter 12 Presets and System setup

• Introduction ................................................................................... ... 516• Starting the Configuration package ............................................ ... 519

• To open the Configuration package ..........................................519• Overview ........................................................................................ ... 520• Imaging .......................................................................................... ... 521

• The Global setup sheet .............................................................521• Application ................................................................................524• Application menu ......................................................................528

• Measure/Text ................................................................................. ... 530• The Measurement menu sheet .................................................531• The Advanced sheet .................................................................536• The Modify calculations sheet ..................................................537• The OB table sheet ...................................................................538

• Report ............................................................................................ ... 544• The diagnostic codes sheet ......................................................545• The Comment texts sheet .........................................................547

• Connectivity .................................................................................. ... 550• Dataflow ....................................................................................551• Additional outputs .....................................................................560• Tools .........................................................................................562• Formats .....................................................................................563• TCP/IP ......................................................................................568

• System ........................................................................................... ... 569• The system settings ..................................................................569

• About ............................................................................................. ... 573• Administration .............................................................................. ... 574

• Users ........................................................................................575

515

• Unlock Patient ...........................................................................578

516

IntroductionThis chapter describes the configuration management package of the Vivid 7 ultrasound unit. The Vivid 7 configuration package enables users to customize the global configuration for the unit and the application-specific settings.

In addition, users with administration rights have access to the local archive backup function, local archive restore function and creation of users.

Note: the default factory password for the “ADM” user is ulsadm (case sensitive).

The configuration management package consists of a Setup dialogue window divided in different setup categories with sublevels.

The table below summarizes the contents and access rights of the different categories and sublevels of the Vivid 7 configuration package:

Category and sublevel Description access Refer to

Imaging page 521

• Global Sets the cineloop controls and display.Sets the patient information display.Sets the scan information displayed on the video record.

All

• Application Configures the probe and application specific settings.

All

• Application menu Configures the Application menu.

All

Measure/Text page 530

517

• Measurement menu• Advanced• Modify calculations

Configures the Measurement menu by selecting and defining the sequence of the measurements and calculation to perform.Creates user-defined measurementsConfigures vascular Doppler calculations to be performed.

All

• OB table Create user-defined OB tables. All

• Annotation• Customize

Configures the Annotation menu and create pre-defined annotation.

All

Report page 544

• Templates • Configures the Report templates menu by selecting and ordering the templates to show in the menu.

All

• Diagnostic codes Create or delete pre-defined text input for the referral reasons and diagnosis.

All

• Comment texts Create or delete pre-defined text input for the comments.

All

Connectivity page 550

• Dataflow Create new dataflows or configure existing dataflows.

Admin

• Additional outputs Configure the PRINT and ALT keys.

All

• Tools Formats removable media. All

• Formats Configures the Examination list window display and other options related to the patient management.

All

• TCPIP Sets the Transmission Protocol/Internet Protocol.

Admin


518

System page 569

• Settings Sets the date and time format, language and units.

Admin

• Test Enables testing of the different parts of the unit.

Admin

About Displays information about the software, hardware and probes.

All page 573

Administration page 574

• Backup Local archive and system configuration backup.

Admin

• Restore Restore local archive and system configuration from a backup.

Admin

• Users Operator and referring staff registration, operator's rights settings.

Admin

• Unlock patient Unlock patient records that were not properly finished.

Admin

Service This sheet is for service staff only. Deals with video selection, LCD light setting, printer definition and keyboard configuration.

Admin


519

Starting the Configuration packageTo access the Configuration package the user has to log on as a specific user (see page 575). This ensures user-specific and user-defined settings and presets to be used.

The access to the entire configuration package is user configuration dependent (see page 575).

To open the Configuration package1. Press CONFIG on the alphanumeric keyboard.

The Log In window is displayed asking for operator ID and password (see Figure 12-1).

2. Select Log on when completed.The Setup dialogue window is displayed (see Figure 12-2).


1. Select the operator2. Type password

520

OverviewThe configuration management package consists of a Setup dialogue window divided in different setup categories with sublevels (sheets labelled with tab).

The functionality of each configuration category and associated sublevels are described on the following pages.

Figure 12-2: The Setup dialogue window structure

1. Sublevel tabs for the selected Setup category.

2. Setup categories3. Selected Setup category

521

Imaging• Global: enables the user to configure display-related

settings.• Application: enables configuration of the probe and

application specific settings.• Application menu: enables configuration of the

Measurement menu.

The Global setup sheet

Figure 12-3: The Global setup sheet

522

Cineloop store

Crop images

Doppler


Cineloop store:• Time before/after heart cycle: sets the total

storage time span of the cineloop in ECG mode.

• Time span (no ECG): sets the total storage time span of the cineloop with no ECG.

• Preview loop before store: when selected enable review of cineloops before storage.


Crop images:: In the Analysis screen, removes top and

bottom of the image when more than two images have been selected.


Doppler:• Show KHz scale: when selected, displays

the KHz scale on the left side of the Doppler spectrum (see page 110).

523

Patient Info

Scan Info


Patient Info:• Title bar Line 1 & 2: selects from the

pop-up menu the patient information to display on the scanning screen's Title bar (see page 51).

• Anonymous patient: when checked, no patient information is displayed on the scanning screen's Title bar.


Scan Info:• : displays scan information on the

video record.

524

ApplicationThe Application category enables the configuration of probe/application specific settings (presets). The application-specific settings can be stored and used as default presets with this probe.

Figure 12-4: The Application setup sheet (example)

525

The Probe/application configuration parameters


Image Store settings:• Single frame (live store):

: Store cineloop.: Store single frame image only.

• Number of heart cycles:Select the number of heart cycles to store (Single frame must be unchecked).

Auto freeze:• Freeze 2D image in Doppler: the last

2D or color flow image is displayed when entering in Doppler mode.

• Auto freeze after: sets the time after which the system enters in freeze when not in use.

Footswitch functionality:Configures the footswitch pedal for the selected application.Select the operation to perform for each pedal from the associated Pedal pop-up menu.

Templates and Packages:Defines the default stress protocol associated to the application.Select the default Protocol to be associated to the selected application from the pop-up menu.

Auto invert on steer:In Color flow, the color bar is inverted when steering the color flow sector angle.

526

Create a new Application

The application created is probe dependant. Select the desired probe before configuring a new application.1. Press APPLICATION on the Control panel.2. Trackball to Preset... in the Application pop-up menu.

The Application setup sheet (see Figure 12-4) is displayed.3. Adjust the parameters as desired (see page 525).4. Press New.

A Dialogue window is displayed.5. Enter a name for the new application.6. Press OK

To edit an application1. Press APPLICATION and select the application to edit.2. Press APPLICATION again.3. Trackball to Preset... in the Application pop-up menu.

The Application setup sheet (see Figure 12-4) is displayed.4. Change the parameters as desired (see page 525).5. Press Save to store the changes.

Applicable only on user-defined applications.

Create new application:Press New to create a new Application. A dialogue window is displayed where the operator is asked to give a name to the new application.Remove current application:Press Delete to remove the current application. Factory Application settings cannot be deleted.Save image/appl. settingsPress Save to store the changes applied to the current setting. Not applicable on factory application settings.


527

Deletion of an Application1. Press APPLICATION and select the application to delete.2. Press APPLICATION again.3. Trackball to Preset... in the Application pop-up menu.

The Application setup sheet (see Figure 12-4) is displayed.4. Press Delete to remove the selected application.

528

Application menuThe Application menu category enables rearrangement of the the Application menu to best suit the user's requirements.

The Application menu is a two-levels pop-up menu. The first level called Application, displays the most frequently used applications in any desired order. The second level called More... displays the less frequently used applications.

Figure 12-5: The Application menu setup sheet (example)

1. First menu level2. Second menu level

3. Moving tools

529

Configuration of the Application menu

The Application menu can be configured by moving the applications up and down inside the pop-up menu and from one level to the other.

To move an application inside one level1. Trackball to the application to move.2. Press SELECT.

3. Press .The application is moved one step up.

Press Default to get factory setting.

4. Press .The application is moved one step down.

To move an application from one level to the other1. Trackball to the application to move.2. Press SELECT.3. Press as many times as necessary:

• if the application to move is in the More menu

• if the application to move is in the Applications menu

till the application has moved to the other menu.

530

Measure/TextThe Measure/Text category deals with:• Configuration of the Measurement menu (see page 531)• Creation of user-defined measurements (see page 290)• Configuration of Measurement tools (see page 536)• Configuration of the vascular Doppler calculation (see

page 537)• Creation of user-defined OB tables (see page 538)• Configuration of the Annotation function (see page 83)

531

The Measurement menu sheetThe Measurement sheet enables the organization of the Factory default Measurement menu and the creation of user-defined Measurements.

Figure 12-6: The Measurement menu setup sheet

1. Configuration window (see next pages for details)

2. The measurement menu (displays updated configuration)

532


Add measurement:Create or select from the pop-up list a measurement to be added to a folder (see page 290).

Add folder:Enables the user to create its own folder with the desired measurements. The folder is displayed the Measurement menu.

M&A Categories:Enables selection of the measurement categories to display in the Measurement menu. Only checked items will be displayed.• Create Copy: Enables copy of a

selected measurement category (selection is done by selecting the category name).

• Delete: enables deletion of user-defined measurement categories.

• Factory Default: restores factory display.

2D, MM and Dop. radio buttons:Enables the display of mode related Measurement menu in the configuration window.

Configuration tools:Deletes selected entry (folder or measurement) in the Measurement menu. The factory entries cannot be

deleted.Moves selected measurement or folder up or down inside the Measurement menu.

533

Folder:Displayed when a folder is selected in the Measurement Menu.Shows the entire contents of a selected folder.• : The items is displayed in the

Measurement menu.• : The item is hidden from the

Measurement menu.

Measurement:Displayed when a measurement is selected in the Measurement Menu.Shows all the parameters related to the selected measurement.• : The items is displayed in the

Measurement menu.• : The item is hidden from the

Measurement menu.Only checked parameters will be displayed in the Measurement result window, the worksheet and the report.

Auto sequence:: Prompts the next measurement in the

folder.


534

Configuration of the Measurement menu

There are many more measurements and parameters in the measurement package than shown in the default Measurement menu. Use the configuration system to set up the measurements that should be available in the Measurement menu and which parameters should be calculated (see also ’Measurement package configuration’ on page 285).

Display of the Measurement categories1. Press M&A categories in the Configuration window.

The M&A categories are displayed in a pop-up window (see page 532).

2. Check the categories to be displayed.Uncheck the categories to hide.

To copy a Measurement category1. Press M&A categories in the Configuration window.

The M&A categories are displayed in a pop-up window (see page 532).

2. Move the trackball marker over the M&A category name.3. Press SELECT to highlight the category.4. Press Create copy.

A copy of the selected measurement category is displayed in the Measurement menu.

Factory Measure-ment categories cannot be renamed.

To rename the Measurement category:1. Select the Measurement category in the Measurement

menu.2. Enter a new name in the Measurement field.

Selection of a Measurement category1. Trackball to the Measurement menu heading.2. Press SELECT.

The measurement categories are displayed in a sub-menu.

3. Trackball to the measurement category of interest.4. Press SELECT.

The measurement category is displayed.

Moving an item in the Measurement menu1. Trackball to the entry to move into the Measurement menu.2. Press SELECT.

535

3. Press or to move the selection up or down inside the Measurement menu.

Deleting an item in the Measurement menuOnly user created items can be delet-ed.

1. Trackball to the entry to delete in the Measurement menu.2. Press SELECT.

3. Press to delete the item.

Display/hide a folder or a measurement in the Measurement menuThe Measurement menu (Folders and Measurements) can be configured to display only the entries (folders and measurements) of interest.

To hide a folder or a measurement:1. Uncheck the actual folder or measurement in the Folder or

Measurement field in the Configuration window.

To display a hidden folder or measurement:1. Check the actual folder or measurement in the Folder or

Measurement field in the Configuration window.

Creating a user-defined folder1. If the folder is to be inside another folder, select the actual

folder in the Measurement menu.2. Press Add folder.

The Measurement menu is updated.3. Select the new folder and Enter the folder name in the

Name text field.

Adding a measurement to a folderThe user can either add a pre-defined measurement or create a new measurement with user-defined parameters to a folder (see page 290 for more information).

536

The Advanced sheetThe Advanced sheet enables further configuration of the Measurement function. The settings are divided into application specific parameters and global parameters.

Figure 12-7: The Advanced sheet

Parameter configuration:1. If configuring application specific parameters, select an

application from the M&A category pull-down menu.When pointing at a parameter an expla-nation label is dis-played.

2. Select the configuration value next to the parameter to configure.A pull-down menu is displayed (see Figure 12-7).

3. Select a new value from the pull-down menu.

537

The Modify calculations sheetThe Modify calculation sheet is used to configure the calculations to be performed when doing a Doppler vascular measurements.

Figure 12-8: The Modify calculations sheet

The following example describes how to configure the Carotid Doppler calculations.1. In the Modify calculations sheet, select Vascular next to

M&A Categories.The Vascular measurement category is displayed.

2. Select Carotid.The available calculations are displayed.

3. Check the desired calculations to be performed.4. Select Save.

538

The OB table sheetThe OB table sheet enables the creation and edition of user-defined OB tables.

Figure 12-9: The OB table sheet

The following example describes how to create a fetal age OB-2/3 table based on Bi Parietal Diameter measurements.1. In the Measure/Text category, select the Measurement

menu sheet.2. In the Measurement menu sheet, select 2D mode.3. Select the OB table sheet.4. In the Measurement menu, select the category Obstetrics

(Measurement menu heading) and the OB-2/3 measurement study.

5. In the OB table sheet, check New table.6. Enter or select the following:

• OB Table Template: when creating a new OB table, select Template (1 - 7) which you want to use as the basis of the user programmable OB Table (see page 540).

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When editing an existing user OB table, select the desired OB table to edit.

• Tool type: Select the type of measurement (e.g. Distance)

• Measure Name: type the name of measurement that will display in the Measurement menu (e.g. My BPD Measure).

• Author Name: Type the author’s name (e.g. My Name).• Table Type: If necessary, select the table type (e.g.

Fetal Age).• Measure type: select the desired measurement (e.g.

BPD).7. Select Edit table.

The OB Table spreadsheet is displayed, showing the table template selected.

Figure 12-10: The Edit table spreadsheet

8. Enter the Min, Max and Interval values in the Parameters field.The system automatically fills in the MEAS column.

9. Enter the input values for the MEAN and SD columns.10. Select Exit to save.

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The OB table templates

Template 1 (based on Hadlock)

Fetal age format: MEAS MEAN SD

Unit: mm week week

Table range: 1 SD

Graph range: 1 SD

Measurement result

Value: [cm]

GA: [#w#d]

Min: [#w#d]

Max: [#w#d]

Fetal growth Format: AGE MEAN SD

Unit: week mm week

Others are same as above

Template 2 (based on Tokyo)

Fetal age Format: MEAS MEAN SD

Unit: mm day day

Table range: 1 SD

Graph range: 1 SD

Measurement result

Value: [cm]

GA: [#w#d]

SD: [day (+/-)]


Unit: day mm day


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Template 3 (based on Osaka)


Unit: mm day mm

Table range: 1 SD

Graph range: 1 SD

Measurement result

Value: [cm]

GA: [#w#d]

SD: [(mv-pv)/sd]


Unit: day mm day


Template 4 (based on several European tables)


Unit: mm weekday mm

Table range: 5%–95%

Graph range: 5%–95%

Measurement result

Value: [cm]

GA: [#w#d]

GP: [%] Calculated by Fetal growth table. If Fetal growth table is not edited, GP is not calculated.


Unit: weekday mm day


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Unit: mm weekday mm

Table range: 1 SD


Measurement result

Value: [cm]

GA: [#w#d]



Unit: weekday mm day



Fetal age Format: MEAS MIN MEAN SD

Unit: mm weekday weekday weekday

Table range:

10%–90%

Graph range:

10%–90%

Measurement result

Value: [cm]

GA: [#w#d]


Fetal growth Format: AGE MIN MEAN SD

Unit: weekday mm mm mm


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Unit: mm weekday mm

Table range: 1 SD


Measurement result

Value: [cm]

GA: [#w#d]



Unit: weekday mm mm


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ReportThe Report configuration category is divided in three sheets:• Templates: enables the configuration of the Template

selection menu and the export/import of user-defined templates. See ’Report templates management’ on page 469 for more information.

• Diagnostic codes: enables the creation of pre-defined text inputs to be used in the Diagnosis information field in the Examination list window (see Figure 8-10, page 358).

• Comment texts: enables the creation of pre-defined text inputs to be used in the Comment information field in the Examination list window (see Figure 8-10, page 358).

• Structured findings: enables the insertion of pre-configured structured diagnosis statements and Billing/Accreditation codes in the patient report (see ’Structured Findings’ on page 433).

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The diagnostic codes sheetThis sheet enables the creation (and deletion) of text inputs that can be used when entering diagnostic codes in the Examination list window (see Figure 8-10, page 358).

Figure 12-11: The Diagnostic codes sheet

Creating a diagnostic codes1. Select New text to create a new diagnostic code (see

Figure 12-11).2. In the Code field enter a name for the diagnostic code.3. Trackball to the Text input display area.

1. List of text inputs2. Text input name

3. Text input display area (free text area)4. Create a text input

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4. Press SELECT.5. Enter the text.

To add a diagnostic code to an examination refer to ’Diagnosis code’ on page 358

Deleting a diagnostic code1. In the Code list field, trackball to the diagnostic code to

delete (see Figure 12-11).2. Press SELECT.3. Trackball to Delete.4. Press SELECT.

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The Comment texts sheetThis sheet enables the creation (and deletion) of text inputs that can be used when entering comments in the Examination list window (see Figure 8-10, page 358) or in the Direct report.

Figure 12-12: The Comment texts sheet

The pre-defined text list is organized in a three level hierarchy. Selecting one item in the first column displays pre-defined text entries related to the selected text in the second and third column.

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Creating pre-defined text input

First level1. Select the first level.2. Press New.

The Enter new text window is displayed.

Figure 12-13: The Enter new text window

3. Enter a title in the Text field.Enter the pre-defined text in the Full text field.

4. Press OK.

Second and third level1. Select an item in the first column.

The pre-defined text input to be created in the second and third column will be related to this selection only.

2. Select the second or third column.3. Press New.

The Enter new text window is displayed (Figure 12-13).4. Enter a title in the Text field.

Enter the pre-defined text in the Full text field.5. Press OK.

Editing a pre-defined text input1. Select the term to edit in one of the columns.2. Press Edit.

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3. The Edit text window is displayed.

Figure 12-14: The Edit text window

4. Edit the text in both the Text and Full text fields.5. Press OK.

Deleting a pre-defined text input1. Select the item to delete in one of the columns.2. Press Delete.3. A Confirmation window is displayed.4. Press Yes.

The selected text input is deleted including the belonging text inputs.

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ConnectivityThis configuration setup category deals with: • Dataflow: connection and communication setup of the

ultrasound unit with other devices.• Additional output: configuration of the PRINT and ALT keys

on the control panel.• Tools: formatting of removable media• Formats: configuration of the Examination list window and

other tools related to patient management.• TCPIP: internet protocol configuration

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DataflowCommunication between the Vivid 7 ultrasound unit and other information providers on the network takes the form of dataflows. Each dataflow defines the transfer of patient information and images from an input source to the unit, and from the unit to one or several output sources.

A dataflow is a set of pre-configured settings. Selecting a dataflow will automatically customize the unit to work according to the settings associated with this dataflow.

Dataflows are configured in the Dataflow sublevel sheet in the Connectivity setup category as described below. The Dataflow sublevel sheet is only available to users with administration rights.

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Figure 12-15: The sublevel Dataflow (example)

Dataflows available

A set of pre-defined dataflows is available on the unit as listed in the table below. Input/output devices cannot be

1. Select a dataflow to configure2. Use selected dataflow as default3. Store data directly to archive4. Hide selected dataflow from the list of available

dataflow5. Option for the search function. In the

Search/Create patient window select between None, All patients and Today’s patient

6. Add/Remove a user-defined dataflow (available with Service Dongle only)

7. Available input/output devices that can be assigned to the current dataflow

8. Input/output devices assigned to the current dataflow

9. Add/remove selected device to/from the current dataflow (user-defined dataflows only)

10. Adjust the settings for the selected assigned device

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added/removed to/from the pre-defined dataflows. However the settings for the devices can be adjusted (see page 558).

Dataflow Description

No Archive Enables to perform an examination without storing the data to the archive.

LocalArchive-Int.HD Local archive internal harddriveThe local database is used for patient archiving. Images are stored to internal harddrive.

LocalArchive-MOD Local archive Magneto Optical Disk (MOD)The local database is used for patient archiving. Images are stored to a MOD. The stored image files will consist of raw data only, together with a single-frame DICOM preview image (no DICOM multi-frame is stored).

LocalArchive-Int.HD/MOD Local archive internal harddrive and Magneto Optical DiskThe local database is used for patient archiving. Images are stored to the internal harddrive and to a MOD as DICOM Media. The stored image files, both to internal harddrive and to the MOD, will consist of both DICOM (multi-frame if cineloop) and raw data.

Local Archive - Int HD/DICOM Server

The local archive is used for patient archiving. Images are stored to the internal hard drive and to a DICOM server.Some of the measurements are stored if DICOM SR is turned on (see page 389).

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RemoteArch-RemoteHD Remote archive remote harddriveA remote database (either on EchoPAC workstation or on EchoServer) is used for patient archiving. Images are stored to a network image volume (either internal HD on EchoPAC workstation or EchoServer volume).

Remote Archive - Remote HD/DICOM Server

A remote database is used for patient archiving. Images are stored to a network image volume and to a DICOM server.Some of the measurements are stored if DICOM SR is turned on (see page 389).

This dataflow cannot be used with an ImageVault 3.0 server.

RemoteArchive-MOD Remote archive Magneto Optical DiskA remote database (either on EchoPAC workstation or on EchoServer) is used for patient archiving. Images are stored to a MOD.

WL-LA-DServ: the local database is not searched, only the DICOM Modality Worklist.

Worklist/LocalArchive-DICOMServer/Int.HD

Modality Worklist local archive DICOM server and local harddriveSearch in the DICOM Modality Worklist, the patient found is copied into local database. The patient information and the examination results are stored to the local the database. Images are stored to a DICOM Server and to an image volume on the local harddrive.Some of the measurements are stored if DICOM SR is turned on (see page 389).


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Worklist/RemoteArchive-DICOMServer/RemoteHD

Modality Worklist remote archive DICOM server and remote harddriveSearch in the DICOM Modality Worklist, the patient found is copied into a remote database. The patient information and examination results are stored to a remote database. Images are stored to a DICOM Server and to an image network volume as pure DICOM in both locations.Some of the measurements are stored if DICOM SR is turned on (see page 389).

Worklist/Remote Archive - Remote Storage

This dataflow is used in a network environment that includes Vivid HL7 Gateway. The patient list in the Search/Create Patient window is coming from Vivid HL7 Gateway through DICOM Modality Worklist. All patient data and images are stored to EchoServer.

Raw DICOM MOD Raw image format to/from a DICOM Magneto Optical DiskRead/Write images in raw format from/to a DICOM formatted 5.25'' MO-disk.Some of the measurements are stored if DICOM SR is turned on (see page 389).

DICOM MOD Pure DICOM image format to/from a DICOM Magneto Optical DiskRead/Write images in “pure” DICOM format from/to a DICOM formatted 5.25'' MO-disk.Some of the measurements are stored if DICOM SR is turned on (see page 389).


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DICOM CD/DVD read DICOM CD/DVD readRead DICOM Media from the CD/DVD-drive.Read only dataflow, no data can be stored.

EP MAC MOD: the MOD must be PC-formatted.Only images can be read.

EchoPAC Mac MOD read EchoPAC Macintosh Magneto Optical Disk readRead MOD from EchoPAC (Macintosh).Read only dataflow, no data can be stored.

DICOM Server DICOM serverStore pure DICOM images to a DICOM device.Some of the measurements are stored if DICOM SR is turned on (see page 389).

Query Retrieve Retrieve images from a DICOM server

LocalArchive-Int.HD/eVue The local database is used for patient archiving. Images are stored to internal harddrive and a MPEG exam is created to the configured destination.

RemoteArch-RemoteHD/eVue

A remote database (either on EchoPAC workstation or on EchoServer) is used for patient archiving. Images are stored to a network image volume (either internal HD on EchoPAC workstation or EchoServer volume) and a MPEG exam is created to the configured destination.


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To select the default dataflow1. Select the dataflow in the Name drop-down menu. (see

Figure 12-15).2. Check the Default box.

The dataflow will be selected by default when restarting the unit.

3. Check the Direct Store box to have data stored automatically to the archive (no buffer storage).

To create a new dataflow1. Press Add.

The Add dataflow window is displayed.

Figure 12-16: The Add dataflow window

2. Enter a name for the new dataflow.3. Press OK.4. Select an Input device in the Available inputs/outputs field

and press the Right arrow button to assign the service to the dataflow.

5. Repeat step 4 to assign input/output devices as desired.Most dataflows consist of one input device and one or several output devices. However in two cases it is possible to have two input devices, when defining a dataflow with DICOM Worklist or DICOM Query/Retrieve in combination with a database.

6. Adjust the device’s parameters as described below.7. To remove a device from the dataflow, select the device in

the Selected devices field and press the Left arrow button.

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Adjusting the assigned devices1. Select the device in the Selected devices field.2. Press Properties.

The Properties window is displayed.3. Adjust the device specific parameters as desired (see table

below). Not all the settings listed below apply to all devices.

General settings Definition

Name Free text: give a descriptive name for the device.

IP address Select from drop-down menu

Database Name Automatically selected according to the IP address

File destination Automatically selected according to the IP address

Removable Check the entry is the media is removable.

MPPS Modality Perform Procedure Step: send information (typically to a HIS) that a scheduled exam has been started, performed or interrupted.

Image settings Definition

Allow raw data : Save data in both raw and DICOM format.: Save data in DICOM format only.

Raw Compression Enables compression of raw data images upon storage and export. Raw compression is active only if the setting Allow raw data is checked.

Max Frame rate Select 25, 30 or Full (original acquisition) from the pop-up menu.

Compression Select compression type or no compression.

Quality Set picture quality from 1 to 100%. A low picture quality level allows high data compression, while a high picture quality restrains the compression.

Allow Multiframe : Allow cineloop storage.

Connection settings Definition

Retry Set maximum number of connection tentative, time interval between tentative and time-out.

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DICOM settings Definition

AE Title The Application Entity Title is set during DICOM configuration. Refer to the network specifications.

Port The Port no. is allocated during DICOM configuration. Refer to your network specifications.

Verification Verify the connection to another DICOM application

Storage commitment Send a request to a PACS, asking it to permanently archive image(s)

MPPS Modality Perform Procedure Step: send information (typically to a HIS) that a scheduled exam has been started, performed or interrupted.

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Additional outputsThe Additional outputs sheet deals with configuration of the PRINT and ALT keys on the control panel. Several outputs (e.g. Video Print, Laser print, DICOM storage...etc.) can be associated to the keys (i.e. hitting PRINT can result in printing a Color video print and storage to a DICOM media).

Figure 12-17: The sublevel Additional outputs (example)

Print / Alt. Print key configuration1. In Button field select Print or Alt. Print.2. Select an output device in the available outputs field and

press the Right arrow button to assign the service to the dataflow.

1. Select between PRINT and ALT keys.2. Available output devices that can be assigned

to the current button.3. Output devices assigned to the current button.4. Add or remove selected device to/from the

current button.

5. Adjust the device settings for the selected assigned device

6. Select the type of images to produce and adjust image settings.

7. Printer configuration (see page 511)

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The Properties window for the selected device is displayed.

3. Adjust the device specific parameters and select OK.4. Adjust the image specific parameters (see table below).

To remove a device, select the device in the Selected devices field and press the Left arrow button.

Configuration parameter

Format Select between:• Raw DICOM• DICOM

Image compression Select compression mode from the pop-up menu.

Quality When JPEG compression is selected, adjust the picture quality between 1 and 100%. A low picture quality level allows high data compression, while a high picture quality restrains the compression.

Image frames Select between:• Single: stores single frame only• Multiple: stores cineloop• Secondary Capture: screen shot

Capture Area Select between:

• Video Area (1)• Whole Screen (2)

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ToolsThe Tools sublevel sheet deals with: • formatting of removable media (MO disk, CD-R, DVD-R or

ZIP disk), see page 63.• Creation or re-creation of a DICOM directory on a

removable media containing DICOM images.• Enter a remote path of a network shared folder

(\\server-name\share-name) for:• Export traces function in Q-Analysis• Export of system error log file• Save as function for images

Figure 12-18: The sublevel Tools

Creation of a DICOM directory1. Insert the media in the drive.2. Select Repair DICOM DIR.

Wait for the display of the Information window indicating that the process is completed.

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FormatsThe Formats sublevel enables configuration of the Examination list window (see page 356) and other tools related to patient management, as described below.

Figure 12-19: The sublevel Formats

Configuration of the Examination list window

The user can configure the examination list displayed in the Examination list window (see page 356) by deleting, adding columns and change the information type displayed in each column.

Column configuration1. Trackball to the column to edit.

To adjust column width, select and drag column head-ing border.

2. Press the SELECT key in the trackball area.A sub-menu is displayed (see Figure 12-20).

3. Select the action to perform:• Insert: creates a new column• Delete: removes selected column• select the desired information to be displayed in the

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selected column.

Figure 12-20: Configuration of the Examination list window

1. Insert new column to the left of the selected column

2. Delete selected column3. Select column heading

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Other configuration settings


Use free text addresses:In the Patient information window (see page 51),

: The address information (e.g. street, city...etc.) is entered in type-specific fields.

: The address information is entered in a single field (free text).

Use Date of birth:In the Patient information window (see page 51), enter either the patient age or the birth date:

: Enter age (Date of birth field not available)

: Enter Date of birth, the age is calculated.

Use extended patient dialog:In the Patient information window (see page 51),

: The entire patient information data is displayed.

: Patient information data displayed is restricted to a minimum (e.g. name and Patient ID). When unchecked, press More to display the entire patient information data.

Use extended search dialog:In the Search/Create Patient window (see page 50, page 352 and page 354),

: All the searching filters are displayed as default.

: The searching criteria are restricted to a minimum. When unchecked, press More to display all the searching filters.

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Auto search for patient:In the Search/Create Patient window (see page 50, page 352 and page 354),

: The system searches automatically through the patient archive selected while entering patient information.

: The system searches through the patient archive after pressing SELECT.

Pre-defined text directly:In the Examination list window (see page 356),

: The Insert text key launches pre-defined text input.

: The Insert text key open the extended text field.

Examination list on Archive buttonWhen a patient is selected, pressing ARCHIVE will:

: Open the Examination list window for the selected patient.

: Open the Patient Information window for the selected patient.

Automatic generation of patient ID:In the Search/Create Patient window (page 50),

: Patient ID is not required when entering a new patient in the archive. The system generates automatically an ID number.

: Patient ID is required when entering a new patient in the archive.

Request acknowledge of End Exam action:

: The user is asked to confirm action when ending an examination.


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Go directly to scanning from search:: The unit goes directly to the Scanning

screen after selecting/creating patient record.

: The unit displays the Patient information window after selecting/creating patient record for further information entry. The user must press Begin Exam to enter the Scanning screen.

Save all images on end exam:: All images on the clipboard are

automatically saved when ending an examination.

: A dialogue window is displayed when ending an exam where the user can select between:• Store all images• Select images to store• Store no images

Exam screen/Report headings:Enter user-defined headings for Comments, Diagnosis and Referral reasons fields.

DICOM images:Select between:• No extra info• Add visible patient info in the DICOM

images: displays patient information (name, date of birth and ID) on DICOM images.

• Add titlebar: adds the Titlebar to the DICOM images.


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TCP/IPThis configuration category enables the user with administration rights to set the Transmission Protocol/Internet Protocol for the system and connected remote archive.

Figure 12-21: The sublevel TCP/IP

1. Computer name: device’s name of type VIVID7-00nnnn or ECHOPAC7-00nnnn, where “nnnn” is the system’s serial number. Do not change the computer name.

2. IP settings: system IP settings3. Remote archive setup: remote archive IP address and name (EchoPAC PC

or EchoServer)4. Save TCP/IP settings. The changes will be effective after the system is

rebooted.5. Advanced DICOM log: creates a detailed DICOM related report log. Should

be used only if DICOM issues are registered (see page 584 about report log generation).

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SystemThis configuration category is divided in two sheets:• System Settings: enables the user to set the date and

time, choose the measurement unit and language for the system and enter basic information about the organization, such as the institution name and department.

• Test: enables testing of the different parts of the unit.

This sheet is accessible to users with administration rights only.

The system settings

Figure 12-22: The System settings setup sheet

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Location


Location:• Hospital: Enter the hospital name (up to 64

characters). This information is displayed on the scanning screen's Title bar (up to 24 characters) and on the image properties of all saved images.

• Department: Enter the department name (up to 64 characters). This information is displayed on the image properties of all saved images.

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Date and Time

Languages

Units


Changes done on the date or time format will be effective only after rebooting the system.

Date and Time:• Date: sets the date. Select the correct

date from the pop-up window.• Time: sets the time. Press the arrow head

buttons to set the time (hour minute and second).

• Time Format: select the desired format (24 or 12 AM/PM) from the pop-up menu.

• Date Format: select the desired format (EU or US) from the pop-up menu.

• Default Century: select the desired format (1900, 2000 or None) from the pop-up menu.1900: the number 19 is automatically displayed when entering the year in the patient date of birth (to edit century, press BACKSPACE twice).2000: the number 20 is automatically displayed when entering the year in the patient date of birth (to edit century, press BACKSPACE twice).None: the four digits have to be typed when entering the year in the patient date of birth.


Changes apply after rebooting the system.

Language:Select the desired language for the system from the pop-up menu.Manual language:Select the desired language for the Online manual. If not available the English manual will be displayed as default.

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Units:Select the desired units (Metric or US) from the pop-up menu.

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AboutThe About sheet gives informations about the ultrasound unit concerning:• software• hardware• Probes

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AdministrationOnly users with ad-ministration rights have access to this setup category (see page 575).

The Admin. category deals with:• Disk management: enables the management of the hard

disk space while maintaining the patient database on the system (see page 408).

• Backup: enables the backup procedures for local patient, and report archives as well as system and user-defined configuration (see page 416).

• Restore: enables data retrieving of patient and report archives as well as system and user-defined configuration (presets) from a backup (see page 416).

• Users: deals with operators registration, operator's rights setting and registration of staff related to an examination (e.g. referral doctors, sonographers...etc.).

• System Administration: keeps track of all the options implemented in the unit.

• Unlock patient: enables to unlock patient records that were not properly terminated.

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UsersThe Users sheet deals with operators registration, operator's rights setting and registration of referring members related to examinations (e.g. referring and diagnosing physicians).

Figure 12-23: The Users setup sheet

Users are divided in groups with different rights. There are two types of groups:• User groups: members of these groups (see table below)

are allowed to login on the system when selected together with the group Operator. They have group specific rights.

• Referring groups: members of these groups (Diagnosing physician and Referring doctor) are not allowed to login on the system. They are registered as references that can be associated to a patient record.

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The rights associated to the user groups are:

Creating a user or a referring member1. Press New2. Enter the user’s information.

Table 12-1: The User groups

Right (see definition below)

Group

Create

Print report

Store report

Adm

in

Service

Cardiologist + + + Activated with a DonglePhysician + +

Sonographer + +

Fellow + +

Sys Admin + + +

Hosp admin +

GE admin + + +

Right Definition

Create and delete • Create, update and delete a patient record• Create, update and delete an examination• Create, update and delete an user or a referring member• Import/Export patient records, examinations• Move examinations

Print report • Print a report

Store report • Store a report

Admin • System administration

Service • Access to the service platform

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3. Select the type of user/referring member in Member of Group(s).

Editing an user configuration1. Select the actual user in the User list.2. Make the desired changes.3. Press CONFIG or any active scanning key to exit the

Configuration management package.

Deleting a user1. Select the actual user in the User list.2. Press Delete.

The user is removed from the User list.

Auto logon and Auto screenlock

Auto logon1. Select the desired logon setup from the pull down menu:

• Disabled: no default user is selected when logging on.• Last user: the last user is selected automatically when

logging on.• A specific user: select one of the users to be the default

user when logging on.

Auto screenlock1. Set the time span (from 10 min) for the system to

automatically get locked when not in use. When the system is locked, the current user may either log on again or the system may be restarted by a different user.

CAUTION

To be able to login on the system, the group Operator MUST be selected.

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Unlock PatientIf for any reason an examination is not properly finished, the patient record is locked and cannot be opened again unless it is unlocked.

Figure 12-24: The Unlock patient sheet

To unlock patient records:1. Press CONFIG (F3).2. Select the category Admin.3. In the Admin category, select the sheet Unlock Patient.4. In the Unlock Patient sheet, select the patient record(s) to

unlock.You can search for a specific patient record or a group of patient record using the searching filters.

5. Select Unlock to unlock the selected patient record(s) or select Unlock all to unlock all patient records.A Confirmation window is displayed.

6. Select OK.

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Chapter 13 User maintenance

• System Care and Maintenance .................................................... ... 580• Inspecting the system ...............................................................580• Cleaning the unit .......................................................................581• Air filter ......................................................................................581• Prevention of static electricity interference ...............................583

• System self-test ............................................................................ ... 584• System malfunction ..................................................................584

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System Care and Maintenance

To ensure that the Vivid 7 unit constantly operates at maximum efficiency we recommend that the following procedures be observed as part of the customer’s internal routine maintenance program.

Inspecting the system

Monthly

Examine the following on a monthly basis (or whenever there is a reason to assume that any issue may have occurred):• Connectors on cables, for any mechanical defects• Entire length of electrical and power cables, for cuts or

abrasions• Equipment, for loose or missing hardware• Control panel for defects• Brakes

CAUTION

The user must ensure that safety inspections are performed at least every 12 months according to the requirements of the patient safety standard IEC 60601-1 (1988).

Only trained persons are allowed to perform the safety inspections mentioned above.

Technical descriptions are available on request.

CAUTION

If any defects are observed or malfunctions occur, DO NOT operate the equipment, and inform a qualified service person.

WARNING

To avoid electrical shock hazard, do not remove panels or covers from the unit.

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Cleaning the unit

Weekly

The Vivid 7 ultrasound unit requires weekly care and maintenance to function safely and properly. The following components should be cleaned:

System cabinet1. Moisten a soft, non-abrasive folded cloth with a mild,

general purpose, non-abrasive soap and water solution or a general purpose disinfectant.

2. Wipe down the top, front, back and both sides of the cabinet. Do not spray any liquid directly into the unit.

Monitor1. Apply a glass cleaner to a soft non-abrasive folded cloth. 2. Gently wipe the monitor face.

Diligent cleaning of the Vivid 7 console reduces the risk of spreading infection from person to per-son, and also helps to maintain a clean working environ-ment.

Control panel1. Turn off the power to the system.2. Moisten a soft, non-abrasive folded cloth with water or a

mild, non-abrasive soap and water solution.3. Gently wipe the surface of the console.

For difficult spots or general cleaning, an all-purpose cleaner may also be used.

Air filter

Every three months

Clean the unit’s air filter to ensure that a clogged filter does not cause the unit to overheat and reduce system performance and reliability.

The air filter is situated in the back of the system.

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Figure 13-1: The air filter location

To remove the filter1. Grab the filter cover by the handle and pull away the cover

from the unit (see Figure 13-1).2. Pull away the four clips holding the filter.3. Remove the filter from the air duct.

To clean the filter1. Shake the filter in an area away from the unit.2. Wash the filter with a mild soapy solution.3. Rinse and dry the filter.

1. Filter cover2. Air intake locations3. Handle

WARNING

DO NOT operate the unit without filter.

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Prevention of static electricity interferenceInterference from static electricity can damage electronic components in the system. The following measures help to reduce the likelihood of electrostatic discharge:• Wipe the alphanumeric keyboard and monitor with lint-free

tissue or a soft cloth dampened with anti-static spray on a monthly basis.

• Spray carpets with anti-static spray because constant walking on carpets in or near the scanning room may be a source of static electricity.

WARNING

Allow the filter to dry thoroughly before re-installing it in the unit.

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System self-testThe Vivid 7 ultrasound unit is designed for reliable operation and consistent, high-quality performance. Automatic self-testing facilities are provided to monitor system operation and to detect malfunction as soon as possible, thereby eliminating unnecessary downtime. The detection of any serious malfunction may result in immediate interruption of scanner operation.

System malfunctionIn the event of error or system malfunction the user may generate and export a log file to a removable media as described below and contact authorized service personnel.

Generating a logfile1. Press ALT - D on the alphanumeric keyboard.

The Problem description dialogue window is displayed (see Figure 13-2).

2. Type in a description of the problem. Notes should be made regarding the selected probe, the imaging mode and the application that was being used at the time of malfunction. If applicable, try to describe the button or key pushing sequence that immediately preceded the problem.Check the mention System lockup if applicable.

3. Press Save to create a logfile.

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Figure 13-2: The Problem description dialogue window

Exporting the logfile1. Press ALT - D on the alphanumeric keyboard to display the

Problem description dialogue window again.2. Select the destination where to export the logfile (MOD or

CD-R).3. Press Export.

A Zip file (named “logfile_<date>_<time>.zip”) is copied on to the selected removable media.

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Chapter 14 Safety

• Introduction ................................................................................... ... 588• Owner responsibility .................................................................... ... 589• Important safety considerations ................................................. ... 590

• Notice against user modification ...............................................590• Regulatory information ................................................................ ... 591

• Standards used .........................................................................591• Device labels ................................................................................. ... 592

• Classifications ...........................................................................596• Acoustic output ............................................................................ ... 597

• Definition of the acoustic output parameters ............................597• Acoustic output and display on the Vivid 7 ...............................598• ALARA ......................................................................................599• Safety statement .......................................................................599• System controls affecting acoustic output ................................599

• Patient safety ................................................................................ ... 601• Patient identification ..................................................................601• Diagnostic information ..............................................................601• Mechanical hazards ..................................................................601• Transesophageal probe safety .................................................602• Electrical Hazard .......................................................................602

• Personnel and equipment safety ................................................ ... 603• Explosion hazard ......................................................................603• Implosion hazard ......................................................................603• Electrical hazard .......................................................................603• Moving hazard ..........................................................................604• Biological hazard ......................................................................604• Pacemaker hazard ....................................................................605

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• Electrical safety ............................................................................ ... 606• Device classifications ................................................................606• Internally connected peripheral devices ...................................606• External Connection of other peripheral devices ......................606

• Allergic reactions to latex-containing medical devices ............ ... 607• Electromagnetic Compatibility (EMC) ......................................... ... 608• Environmental protection ............................................................ ... 610

• System disposal ........................................................................610

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IntroductionThis section describes the important safety measures which should be taken before operating the Vivid 7 ultrasound unit. Procedures for simple care and maintenance of the unit are also described.

Various levels of safety precautions may be found on the equipment, and different levels of severity are identified by one of the following icons that precede precautionary statements in the text.

The following icons are used to indicate precautions:

Other precautions or prudent-use recommendations are indicated in the note sections in the left column. These are:• Use of the Vivid 7 ultrasound unit as a prescription device,

under the order of a physician.• Maintaining an optimum unit environment.• Reference to the User's Manual.

DANGER


WARNING


CAUTION


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Owner responsibility

It is the responsibility of the owner to ensure that anyone operating the system reads and understands this section of the manual. However, there is no representation that the act of reading this manual renders the reader qualified to operate, inspect, test, align, calibrate, troubleshoot, repair or modify the system. The owner should make certain that only properly trained, fully-qualified service personnel undertake the installation, maintenance, troubleshooting, calibration and repair of the equipment.

The owner of the Vivid 7 ultrasound unit should ensure that only properly trained, fully qualified personnel are authorized to operate the system. Before authorizing anyone to operate the system, it should be verified that the person has read, and fully understands, the operating instructions contained in this manual. It is advisable to maintain a list of authorized operators.

Should the system fail to operate correctly, or if the unit does not respond to the commands described in this manual, the operator should contact the nearest field GE Ultrasound Service Office.

For information about specific requirements and regulations applicable to the use of electronic medical equipment, consult the local, state and federal agencies.

CAUTION

For USA only:

Federal law restricts this device to use by, or on the orders of, a physician.

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Important safety considerations

Notice against user modificationNever modify this product, including system components, software, cables, and so on. User modification may cause safety hazards and degradation in system performance. All modification must be done by a GE qualified person.

This section includes considerations for the following:• Patient safety• Personnel and equipment safety

The information contained in this section is intended to familiarize the user with the hazards associated with the use of the unit, and to alert them to the extent to which injury and damage may occur if the precautions are not observed.

Users are obligated to familiarize themselves with these safety considerations and to avoid conditions that could result in injury or damage.

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Regulatory informationThe GE Vingmed Ultrasound product families are tested to meet all applicable requirements in relevant EU Directives and European/International standards. (See “Standards used” below.) Any changes to accessories, peripheral units or any other part of the system must be approved by the manufacturer: GE Vingmed Ultrasound. Ignoring this advice may compromise the regulatory approvals obtained for the product.

Please consult your local GE Vingmed Ultrasound representative for further details.

Standards usedThe Vivid 7 ultrasound unit is a Class I device, type CF, according to Clause 14 of IEC 60601-1 (1988). To fulfill the requirements of relevant EC directives and/or European Harmonized/International standards, the following documents/standards have been used:

Standard/Directive Scope

93/42/EEC Medical Devices Directive (MDD)

EN55011: 1998+A1 :1999+A2: 2002 Emitted noise according to Class B requirements + Electromagnetic Susceptibility

IEC60601-1: 1988+A1: 1991+A2: 1995EN60601-1: 1990+A1: 1993+A2: 1995UL60601-1: 2003CAN/CSA-C22.2 No 601.1-M90

Medical Electrical Equipment, Part 1; General Requirements for Safety

IEC60601-2-37: 2001+A1: 2004

IEC1157/ EN61157/ (1994)

Medical electrical equipment - Part 2-37. Particular requirements for the safety of ultrasonic medical diagnostic and monitoring equipmentRequirements for the declaration of the acoustic output of medical diagnostic ultrasonic equipment.

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Device labelsThe following table describes the purpose and location of safety labels and other important information provided on the equipment.

EN60601-1-2: 2001 Medical Electrical Equipment - part 1-2. Collateral standard: Electromagnetic compatibility - Requirements and tests.

EN60601-1-4: 1996+A1: 1999 Medical Electrical Equipment - part 1-4. Collateral standard: Programmable electrical medical systems

IEC60601-1-6: 2004 General requirements for safety - Usability NEMA/AIUM Acoustic Output Display Standard (NEMA UD-3, 2004)

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Label Purpose Location

Identification Plate Manufacturer's name and addressModelDevice Listing/Certification Labels

Rear

Equipment Type BF, in which protection against electric shock does not rely on basic insulation only. Provides additional safety precautions such as double insulation or reinforced insulation, because there is no provision for protective earthing or reliance upon installation conditions.

Probe connectors.

Equipment Type CF, indicates equipment having a floating applied part having a degree of protection suitable for direct cardiac contact.

ECG connector

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Defibrillator-proof Type CF equipment.

ECG connector

Rear of unit.

Alternating current Various

Protective earth (ground) Internal

Earth (ground) Internal

Equipotentiality: indicates terminal to be used for connecting equipotential conductors when interconnecting (grounding) with other equipment as described in IEC60601-1.

Rear of unit

Attention - Consult accompanying documents: alerts the user to refer to the user documentation when complete information cannot be provided on the label.

Various

CAUTION - Dangerous voltage: used to indicate electric shock hazards.

Various

ATTENTION - Observe precaution for handling electrostatic sensitive device.

Rear of unit (External I/O)

The system is not designed for use with flammable anesthetic gases.

Rear of unit (Identification plate)


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AP

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The disassembly and parts disposition procedure is located on the card cage front cover.To access to the procedure, remove the right side panel by unscrewing the two screws on the lower part.


This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately. Please contact the manufacturer or other authorized disposal company to decommission your equipment.


This product consists of devices that may contain mercury, which must be recycled or disposed of in accordance with local, state, or country laws. (Within this system, the backlight lamps in the monitor display contain mercury.)

Rear of the LCD monitor(USA only)

This precaution is intended to prevent injury that may result if one person attempts to move the unit over considerable distances or on an incline due to the weight of the unit.


CAUTION - Do not move the unit if the keyboard console is in the free position

Keyboard console


190 kg

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Apply a short push on the ON/OFF button to shut down the system.

Keyboard console


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ClassificationsType of protection against electric shock• Class I Equipment

Degree of protection against electric shock• Type BF Applied part (for Probes marked with BF symbol)• Type CF Applied part (for PCG, ECG and probes marked

with CF symbol)

Continuous Operation

System is Ordinary Equipment (IPX0)

Footswitch is IPX8

Class I Equipment

EQUIPMENT in which protection against electric shock not rely on BASIC INSULATION only, but includes an earth ground. This additional safety precaution prevents exposed metal parts from becoming LIVE in the event of an insulation failure.

Type BF Applied part

TYPE BF APPLIED PART providing a specified degree of protection against electric shock, with particular regard to allowable LEAKAGE CURRENT.

Type CF Applied part

TYPE CF APPLIED PART providing a degree of protection higher than that for Type BF Applied Part against electric shock particularly regarding allowable LEAKAGE CURRENT.

Normal mode Single fault condition

Patient leakage current < 100 microA < 500 microA

Normal mode Single fault condition

Patient leakage current < 10 microA < 50 microA

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Acoustic output

Definition of the acoustic output parameters

Thermal Index

TI is an estimate of the temperature increase of soft tissue or bone. There are three thermal index categories:• TIS: Soft tissue thermal index. The main TI category. Used

for applications that do not image bone.• TIB: Bone thermal index (bone located in a focal region).

Used for fetal application.• TIC: Cranial bone thermal index (bone located close to the

surface). Used for transcranial application.

Mechanical Index

MI is the estimated likelihood of tissue damage due to cavitation. The absolute maximum limits of the MI is 1.9 as set by the FDA 510(k) guidance of 1997.

Ispta

The Ispta is the Spatial Peak Temporal Average Intensity. The absolute maximum limit of Ispta is 720 MW/cm2 as set by the FDA 510(k) guidance of 1997.

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Acoustic output and display on the Vivid 7In the title bar, two fields are allocated for the display of power values as shown in Figure 14-1.

Figure 14-1: The display of MI and TI on the screen

The Vivid 7 chooses the correct category based on mode of operation and chosen application, and presents only one TI to the operator. It is therefore important that the operator chooses the right application.

The Vivid 7 has an internal limit of 3.0 on TI. IEC87 has suggested some time dependent thresholds that are partly implemented on the Vivid 7 as color-coding of the thermal index. The color-coding scheme together with the thermal exposure times in the table below are not meant as limits on TI or exposure time, but as an aid for the operator. Note that the Vivid 7 does not monitor the thermal exposure time. The displayed TI is coded as follow:

The maximum possible MI and Ispta on the Vivid 7 is within the limits set in Track 3 in the FDA 510(k) guide of 1997, MI < 1.9 and Ispta < 720 mW/cm2.

1. Title bar2. MI3. TI

TI Color Recommended thermal exposure time

0.0–0.4 Dimmed -

0.4–1.5 White -

1.5–2.0 White < 12 h

2.0–3.0 White < 1 h

3.0–4.0 Red < 15 min.

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ALARAUltrasound procedures should be performed using output levels and exposure times As Low As Reasonably Achievable (ALARA) while acquiring clinical information.

Training

During each ultrasound examination the user is expected to weigh the medical benefit of the diagnostic information that would be obtained against the risk of potential harmful effects. Once an optimal image is achieved, the need for increasing acoustic output or prolonging the exposure cannot be justified. It is recommended that all users receive proper training in applications before performing them in a clinical setting. Contact the GE Ultrasound sales representative for training assistance.

Safety statement

GE Vingmed Ultrasound safety statement

Although no harmful biological effects have been demonstrated for ultrasound frequencies, intensities and exposure times used in examination with the GE Vingmed Vivid 7 system, GE Vingmed Ultrasound recommends using the lowest acoustic output settings which will produce diagnostically acceptable information.

System controls affecting acoustic outputThe operator controls that directly affect the acoustic output are discussed in the Acoustic Output Data Tables in the Reference Manual. These tables show the highest possible acoustic intensity for a given mode, obtainable only when the maximum combination of control settings is selected. Most settings result in a much lower output. It is important to note the following:• The duration of an ultrasound examination is as important

as the acoustic output, since patient exposure to output is directly related to the exposure time.

• Better image quality yields faster clinical results, making it possible to complete the relevant ultrasound examination

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more rapidly. Therefore, any control that improves the quality of the examination can help to reduce patient exposure, even though it may not directly affect acoustic output.

Probe selection

As long as the appropriate application is available, any probe can be used with the knowledge that the intensities fall at, or below, those stated in the Acoustic Output Data Tables. The duration of patient exposure is most likely minimized with the use of a probe that is optimized to provide resolution and focal depth, appropriate to the examination.

Application selection

Selecting the probe and application preset appropriate to a particular ultrasound examination automatically provides acoustic output limits within FDA guidelines for that application. Other parameters which optimize performance for the selected application are also set automatically, and should assist in reducing the patient exposure time. See page 52, for information on selecting probes and application presets.

Changing imaging modes

Acoustic output depends on the imaging mode selected. The choice of mode (2D, M-Mode, Doppler or Color Flow) determines whether the ultrasound beam is stationary or in motion. This greatly affects the energy absorbed by the tissue.

See Chapter 3, ’Scanning Modes’ on page 87, for complete information on changing imaging modes.

When operating in a combined mode, such as 2D and M-Mode, the total acoustic output comprises contributions from each individual mode. Depending on the modes in use, either or both output indices may be affected.

The user can override the default settings, but care should be taken to observe the displayed MI and TI values.

Power

It is possible to change the power in all operating modes so that the operator can use the ALARA principle.

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Patient safety

Patient identification

Always include proper identification with all patient data and verify the accuracy of the patient's name and/or identity number when entering such data. Ensure that the correct patient ID is provided on all recorded data and hard copy prints. Identification errors could result in an incorrect diagnosis.

Diagnostic informationThe images and calculations provided by the system are intended for use by competent users, as a diagnostic tool. They are explicitly not to be regarded as the sole, irrefutable basis for clinical diagnosis. Users are encouraged to study the literature and reach their own professional conclusions regarding the clinical utility of the system.

The user should be aware of the product specifications and of the system accuracy and stability limitations. These limitations must be considered before making any decision based on quantitative values. If in doubt, the nearest GE Ultrasound Service Office should be consulted.

Equipment malfunction or incorrect settings can result in measurement errors or failure to detect details in the image. The user must become thoroughly familiar with the operation of the unit in order to optimize its performance and to recognize possible malfunctions. Application training is available through the sales representative.

Mechanical hazardsDamaged probes or improper use and manipulation of the transesophageal probe may result in injury or increased risk of

WARNING

The concerns listed in this section can seriously affect the safety of the patient undergoing a diagnostic ultrasound examination.

CAUTION

Be certain to ensure privacy data of patient information.

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infection. Inspect probes frequently for sharp, pointed or rough surface damage that could cause injury or tear protective barriers (gloves and sheaths).

Transesophageal probe safety Never use excessive force when manipulating the transesophageal probe. The detailed operator manual enclosed with the transesophageal probe must be read carefully.

Electrical Hazard A damaged probe may increase the risk of electric shock if conductive solutions come in contact with internal live pads. Inspect probes often for cracks or openings in the housing and holes in and around the acoustic lens, or other damage that could allow moisture to enter. Become familiar with the use and care precautions described in Chapter 10, ’Probes’ on page 473.

Vivid 7 and Electrosurgical units

WARNING

This equipment provides no special means of protection from high frequency (HF) burns that may result from using an electrosurgical unit (ESU). To reduce the risk of HF burns, avoid contact between the patient and ultrasound transducer or ECG electrodes while operating the ESU. Where contact cannot be avoided, as in the case of TEE monitoring during surgery, make sure the transducer or ECG electrodes are not located between the ESU active and dispersive electrodes and keep the ESU cables away from the transducer or ECG cables

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Personnel and equipment safety

Explosion hazardNever operate the equipment in the presence of flammable or explosive liquids, vapors or gases. Malfunctions in the unit, or sparks generated by fan motors, can electrically ignite these substances. Operators should be aware of the following points to prevent such explosion hazards.• If flammable substances are detected in the environment,

do not plug in or turn on the system. • If flammable substances are detected after the system has

been turned on, do not attempt to turn off the unit, or to unplug it.

• If flammable substances are detected, evacuate and ventilate the area before turning off the unit.

Implosion hazardDo not subject the unit to serious mechanical shocks because the cathode ray tube (CRT) may implode if struck or jarred. This may cause pieces of glass and/or phosphor coating to fly into the air and result in serious injury.

Electrical hazard

Note: Any rest energy within our scanners or their components will be below 60 V DC or 2 mJ.

To avoid injury• Do not remove the unit's protective covers. No

user-serviceable parts are inside. If servicing is required, contact qualified technical personnel.

• Connect the attachment plug to a hospital-grade grounding

DANGER

The hazards listed below can seriously affect the safety of personnel and equipment during a diagnostic ultrasound examination.

WARNING

The internal circuits of the unit use high voltages, capable of causing serious injury or death by electrical shock.

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outlet to ensure adequate grounding.• Do not place liquids on or above the unit. Conductive fluids

seeping into the active circuit components may cause short circuiting, which could result in an electrical fire.

• An electrical hazard may exist if any light, monitor or visual indicator remains on after the unit is turned off.

Fuses blown within 36 hours of being replaced may indicate a malfunctioning electrical circuit within the system. In this event, the unit must be checked by GE Ultrasound service personnel. No attempt should be made to replace the fuses with others of a higher rating.

Moving hazard

Special care must be used to avoid injury when moving or transporting the unit.• Always be sure the pathway is clear.• Limit the speed of movement to a careful walk.• Use at least two people when moving the unit on inclines.

Ensure that the unit is well prepared before transporting. Refer to ’Moving and transporting the unit’ on page 18 for more information.

Biological hazardFor patient and personnel safety, beware of biological hazards while performing transesophageal procedures. To avoid the risk of disease transmission:• Use protective barriers (gloves and probe sheaths)

whenever necessary. Follow sterile procedures as required.

• Thoroughly clean probes and reusable accessories after each patient examination and disinfect or sterilize as needed. Refer to Chapter 10, ’Probes’ on page 473, for probe use and care instructions.

• Follow all in-house infection control policies as they apply

CAUTION

The Vivid 7 unit weighs approximately 190 Kg (419 lb.).

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to personnel and equipment.

Pacemaker hazardThe possibility of the system interfering with pacemakers is minimal. However, as this system generates high frequency electrical signals, the operator should be aware of the potential hazard this could cause.

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Electrical safety

Device classificationsThe Vivid 7 ultrasound unit is a Class I device, type CF, according to Sub-clause 14 of IEC 60601-1 (1988).

Internally connected peripheral devicesThe system, together with peripheral devices, such as video tape recorders and printers, meets UL2601-1 and IEC 60601-1 (1988) standards for electrical isolation and safety. These standards are applicable only when the specified peripheral devices are plugged into the AC outlets provided in the unit.

External Connection of other peripheral devices

Other external devices, such as laser cameras, printers, VCRs and external monitors, usually exceed allowable leakage limits and, when plugged into separate AC outlets that are then connected to the unit, are in violation of patient safety standards. Suitable electrical isolation of such external AC outlets may be required in order to meet UL2601-1 and IEC 60601-1 (1988) standards for electrical leakage.

CAUTION

External devices can be used only if CE marked and in compliance with related standards (EN 60601-1 or EN 60950). Conformance to EN 60601-1-1 (2000) must be verified.

External devices meeting EN 60950 should be kept outside of the patient environment, as defined in IEC 60601-1-1 (2000).

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Allergic reactions to latex-containing medical devices

Due to reports of severe allergic reactions to medical devices containing latex (natural rubber), the FDA advises health-care professionals to identify latex-sensitive patients, and be prepared to treat allergic reactions promptly. Latex is a component of many medical devices, including surgical and examination gloves, catheters, incubation tubes, anesthesia masks and dental dams. Patient reaction to latex has ranged from contact urticaria, to systemic anaphylaxis.

For more details regarding allergic reaction to latex, refer to FDA Medical Alert MDA91-1, March 29.

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Electromagnetic Compatibility (EMC)This unit carries the CE mark. It com-plies with regulato-ry requirements of the European Di-rective 93/42/EEC concerning medical devices. It also com-plies with emission limits for a Group 1, Class B Medical Device as stated in EN 60601-1-2 (2001) (IEC 60601-1-2 (2001)).

AII types of electronic equipment may characteristically cause electromagnetic interference with other equipment, transmitted either through air or connecting cables. The term Electromagnetic Compatibility (EMC), indicates the capability of the equipment to curb electromagnetic influence from other equipment, while at the same time not affecting other equipment with similar electromagnetic radiation.

Radiated or conducted EMC can cause distortion, degradation, or artifacts in the ultrasound image which could potentially obscure diagnostic information.

There is no guarantee that interference will not occur in a particular installation. If this equipment is found to cause or respond to interference, which may be determined by turning equipment on and off, qualified service personnel should attempt to correct the problem by one or more of the following measures:• Re-orient or re-locate the affected device.• Increase the separation between the unit and the affected

device.• Power the equipment from a source other than that of the

affected device.• Consult the service representative for further suggestions.

The manufacturer is not responsible for any interference or responses caused by the use of interconnecting cables other than those recommended, or by unauthorized changes or modifications to this unit. Unauthorized changes or modifications could void the user's authority to operate the equipment.

To comply with the regulations on electromagnetic interference, all interconnecting cables to peripheral devices must be shielded and properly grounded. Use of cables not properly shielded and grounded may result in the equipment causing or responding to radio frequency interference, in violation of the European Union Medical Device Directive and FCC regulations.

Do not use devices which intentionally transmit RF signals, for example, cellular phones, transceivers, or radio controlled

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products, in the vicinity of this equipment as it may cause performance outside the published specifications. Keep the power to these types of devices turned off when near this equipment.

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Environmental protection

System disposalPlease follow the disassembly procedure and part disposition attached inside the unit. To access to the procedure, remove the right side panel by unscrewing the two screws on the lower part.

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Appendix

• Product description ...................................................................... ... 612• Probe/Application overview ........................................................ ... 631

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Product description

System Architecture• TruScan architecture unleashes powerful imaging

capabilities for the Vivid 7.• 3D Beamforming technology significantly improves

image quality with breakthrough performance in 2D, color and Doppler imaging

• QScan imaging helps to extract more definitive diagnostic information from cardiovascular images by bringing quantitative assessment tools out of the research lab and into your routine clinical exam.

• Total data management with true, raw data DICOM networking capabilities to communicate findings and to unlock data for future quantitative analysis.

• Unprecedented level of ergonomic design and comfort with productivity software that allows operators to personalize their workspace.

Data Acquisition• Cardiac, cardiovascular, abdominal, OB/GYN, peripheral

vascular and OR optimized application presets• High precision data acquisition • Programmable open-ended system architecture• Application-specific channel architecture• 12 bit A/D converters per physical channel• Digital data acquisition• In addition to standard Phased Array, Doppler Probes, Flat

and Curved Linear transducers, it supports Active Matrix Array Sector (M3S, M4S), Flat (M12L) and Curved Linear (M7C) probes as well as the new 3V for 4D and multi-dimensional imaging

• Parallel data processing on four channels• Receive focusing, aperture, apodization, and frequency

response are all continuously variable as a function of depth

Data Processing• TruScan architecture provides raw data management

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integrated into scan conversion processing• PipeLink Technology: high speed parallel data bus for pre-

and post-processing• Echo data processing of phase, amplitude and frequency

information• Upgradable for future needs• Raw data digital replay for retro and looping - allows for

adjustment of all major display parameters and M & A• Selectable data compression (including compression of

raw data)

Display• High resolution (up to 1024 x 768 pixels), flicker-free

17-inch computer graphics monitor, tilt and swivel• 16.7 Million simultaneous colors available• Scanner software supports 800 x 600 display resolution• VCR input is played back through digital replay, allowing

VCR images to be looped during review and M&A capability• Instant review screen displays 12 simultaneous

loops/images for quick study review• Scanplane position indicator and probe temperature are

displayed with all multiplane TEE probes• Image orientation marker• Selectable display configuration of duplex and triplex

modes: side-by-side or top-bottom, during live, digital replay and clipboard image recall

• Single, dual and quad-screen view• Split screen view

Ergonomics• Floating keyboard with lifting swivel and in/out keyboard

displacement• Monitor with independent swivel and tilt movement• Backlit keyboard

Display Annotations• On-screen display of Mechanical Index (MI)• On-screen display of Thermal Index

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• Patient name/ID• Hospital name• Time/date• Trackball driven annotation arrows• Scanning parameters• Active mode display• Stress protocol parameters• Parameter annotation follow ASE standard

Tissue Imaging

General• Variable transmit frequencies for resolution/penetration

optimization• Display zoom with zoom area control• High Resolution (HR) Zoom: concentrates all image

acquisition power into selected Region of Interest (ROI)• Variable Contour Filtering for edge enhancement• Depth range up to 30 cm - probe specific• Selectable greyscale parameters: Gain, Reject, DDP and

Compress - can be adjusted in live, digital replay and image clipboard recall.

• Automatically calculated TGC curves require minimal operator interaction

Multi-dimensional and Volume Imaging (option)

Vivid 7 Dimension only• 4D imaging allows real time acquisition and display of

volume data in gray scale• Multi-dimensional imaging is used to acquire parasternal

bi-plane and apical tri-plane views and supports 2D, color, as well as, Tissue Doppler modes (including Tissue Synchronization Imaging which is part of the Advanced QScan option)

• Full volume gray scale data acquired from 4 or 6 sequential heart cycles in real time

• Slice mode allows an anyplane gray scale display based on

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volume data• 9 Slice view: efficient access to 9 simultaneous slices, in

particular useful for 9 short axis views at different levels of LV

• Easy and fast optimization of rendered 4D image display• Enhanced 4D render representation quality• Comprehensive control set for optimizing rendered 4D

image display• Full M&A package can be applied to multi-dimensional and

slice mode images• The 3V probe which supports 4D and multi-dimensional

imaging allows also PW and CW Doppler examinations• Contrast specific presets for 4D and multi-dimensional

imaging• Colorized 4D data enhances representation of rendered

images• All data can be stored in raw data DICOM format and can

be recalled for post-processing• Data management is completely integrated in

EchoPAC PC archiving system• Multi-plane imaging improves workflow as well as the

quality of Tissue Synchronization Imaging and stress echo studies (separate options)

2D-Mode• Sector tilt and width control• Frame Rate in excess of 600 fps, depending on probe,

settings and applications• Coded Octave Imaging with Coded Phase Inversion - 3rd

generation harmonic tissue imaging providing improved lateral and contrast resolution over conventional imaging. Features reduce noise, improve wall definition, and axial resolution, making it the tissue modality of choice for all patient groups.

• Confocal Imaging - allows for multiple transmit focal zones over range of view and a high vector density - probes dependent.

• Automatic Tissue Optimization - single key stroke optimizes immediately and automatically different gray scale settings

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adjusted for the real time image• Speckle Reduce Imaging - an advanced image processing

technique to remove speckle in real time examining the relative difference between neighboring pixel values and determining whether the gray scale variations have a sharp difference, follow a trend, or are random in nature

• Variable image width: a reduction either increases frame rate or increases the number of focal zones while maintaining the frame rate - application dependent

• Multiple Angle Compound Imaging - Multiple co-planar images from different angles combined into a single image in real time improving border definition, contrast resolution, and reducing angular dependence of border or edge

• LOGIQView - provides the ability to construct and view a static 2D image with wider field of view of a given transducer. This allows viewing and measurements of anatomy that is larger than what would fit in a single image

• Dual Focus: a powerful tool giving additional focal zone for excellent spatial and contrast resolution from heart base to apical areas

• L/R and Up/Down invert, in live, digital replay or image clipboard recall

• Digital replay for retrospective review or automatic looping of images, allowing for adjustment of parameters such as gain, reject, Anatomical M-Mode, persistence and replay speed.

• Data Dependent Processing performs temporal processing which reduces random noise but leaves motion of significant tissue structures largely unaffected. Can be adjusted even in digital replay

• 256 shades of gray• Colorized 2D-Mode, user selectable in real-time, digital

replay

M-Mode• Trackball Steerable M-Mode line available with all imaging

probes, max steering angle is probe dependent.• Simultaneous Real Time 2D- and M-Mode.• M-Mode PRF 1 kHz, all image data acquired are combined

to give high quality recording regardless of display scroll

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speed.• Digital replay for retrospective review of spectral data• Several top-bottom formats, side-by-side format and

time-motion only format - can be adjusted in live and digital replay

• Selectable horizontal scroll speed: 1, 2, 3, 4, 6, 8, 12, 16 seconds across display.

• Horizontal scroll can be adjusted in live or digital replay.

Anatomical M-Mode• M-Mode cursor can be adjusted at any plane• Curved Anatomical M-Mode: free (curved) drawing of

M-Mode generated from the cursor independent from the axial plane

• Can be activated from live, digital replay or image clipboard recall

• Anatomical Color and Tissue Velocity M-Mode• M & A Capability

B-Flow• B-Flow is a new digital imaging technique that provides

real-time visualization of vascular hemodynamics by directly visualizing blood reflectors and presenting this information in a gray scale display

• Use of GE-patented techniques to boost blood echoes, and to preferentially suppress non-moving tissue signals

• B-Flow is available for most vascular and shared service applications

Blood Flow Imaging• Combines color Doppler with gray scale speckle imaging• Allows better delineation of blood flow without bleeding into

tissue or vessel wall

Color Doppler

General• Steerable Color Doppler available with all imaging probes -

max steering angle is probe dependent• Trackball-controlled ROI

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• Removal of color map from the tissue during digital replay • Digital replay for retrospective review of Color M-Mode data

allowing for adjustment of parameters such as Encoding Principle, Color Priority and Color Gain even on stored data

• PRF settings - user selectable• Advanced Regression Wall Filter gives efficient

suppression of wall clutter• For each encoding principle, multiple-color maps can be

selected in live and digital replay - variance maps available• More than 65,000 simultaneous colors processed,

providing a smooth display two-dimensional color maps containing a multitude of color hues

• Simultaneous display of greyscale 2D and 2D with Color Flow

• Color Invert, user selectable in live and digital replay • Variable Color Baseline, user selectable in live and digital

replay • Multivariate Color Priority function gives reliable delineation

of disturbed flows even across bright areas of the 2D-Mode image

• Color Doppler frequency can be changed independently from 2D for optimal flow

Color Doppler Imaging• TruSpeed Imaging allows either ultra-high frame rate or

increased lateral resolution• Very high digital signal processing power, maintaining high

frame rates with large ROIs even for very low PRF settings• Frame rate in excess of 100 fps, depending on probe and

settings• Variable ROI size in width and depth• User-selectable Radial and Lateral Averaging for reduction

of statistical uncertainty in the color velocity and variance estimates

• Data Dependent Processing (DDP) performs temporal processing and display smoothing with reduced possibility for loss of transient events of hemodynamic significance

• Digital replay for retrospective review or automatic looping of color images, allowing for adjustment of parameters such

619

as DDP, encoding principle, baseline shift, color maps, color priority and color gain even on frozen/recalled data

• Application dependent Multivariate Motion Discriminator reduces flash artifacts

• Dedicated coronary flow application

Color Angio (Color Intensity Imaging)• Angle independent mode for visualization of small vessels

with increased sensitivity compared to standard color flow

Color M-Mode• Variable ROI length and position - user selectable• User-selectable Radial Averaging for reduction of statistical

uncertainty in the color velocity and variance estimates• Selectable horizontal scroll speed • 1, 2, 3, 4, 6, 8, 12, 16 seconds across display - can be

adjusted during live, digital replay or image clipboard recall• Real-time 2D image while in color M-Mode• Same controls and functions available as in standard 2D

color Doppler

Anatomical Color M-Mode™• Vingmed-patented any plane Color M-Mode display

derived from Color Doppler cineloop.• Also applicable to Tissue Velocity Imaging• M&A capability

Spectral Doppler

General• Operates in PW, HPRF, and CW modes• Trackball Steerable Doppler available with all imaging

probes - max steering angle is probe dependent• Selectable Doppler frequency for better optimization• High-Quality Real-time duplex or triplex operation in all

Doppler Modes, CW and PW and for all velocity settings• Frame Rate Control for optimized use of acquisition power

between spectrum, 2D, and Color Doppler Modes in duplex or triplex modes

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• Very fast and flexible spectrum analysis with an equivalent DFT rate of 0.2 ms

• Dynamic Gain Compensation for display of flows with varying signal strengths over the cardiac cycle and improved ease of use

• Dynamic Reject gives consistent suppression of background - user selectable, in real-time, digital replay or image clipboard recall

• digital replay for retrospective review of spectral Doppler data

• Several top-bottom formats, side-by-side format and time-motion only format - can be adjusted in live or digital replay.

• Selectable horizontal scroll speed: 1, 2, 3, 4, 6, 8, 12, 16 seconds across display - can be adjusted in live or digital replay

• Adjustable spectral Doppler display parameters: Gain, Reject, Compress, Color Maps - can be adjusted in live or digital replay

• User-adjustable baseline shift - in live, digital replay and image clipboard recall

• Adjustable velocity scale• Wall filters with range 10 - 2000 Hz (velocity scale

dependent)• Angle correction with automatic adjustment of velocity

scale - in live, digital replay and image clipboard recall• Stereo speakers mounted in the front panel• Display annotations of frequency, mode, scales, Nyquist

limit, wall filter setting, angle correction, acoustic power indices

PW / HPRF Doppler• Automatic HPRF Doppler maintains its sensitivity even for

shallow depths and with the highest PRFs• Digital Velocity Tracking Doppler employs processing in

range and time for high-quality spectral displays• Adjustable sample volume size of 1-20 mm (probe

dependent)• Maximum sample volume depth 30 cm

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CW Doppler• Highly sensitive steerable CW available with all phased

array probes

Advanced Options

Tissue Velocity Imaging• Myocardial Doppler Imaging with color overlay on tissue

image• Tissue Doppler data can be acquired in background during

regular 2D imaging• Digital Velocity profile analysis allowing velocity and time

quantification at any point and at any time during the heart cycle from digital replay or image clipboard recall

• Quantitative Segmental Wall Motion Analysis can be obtained with use of Anatomical M-Mode, from digital replay or image clipboard recall

• The velocity of all myocardial segments after entire heart cycle can be displayed in one single image

• Tissue color overlay can be removed to show just the 2D image, still retaining the tissue velocity information

• Quantitative profiles for TVI, Tissue Tracking, Strain and Strain Rate can be derived

• Time markers for valve events derived from any TM mode simplify understanding of signals in velocity traces or curved Anatomical M-mode

Tissue Tracking• Real time display of the time integral of TVI for quantitative

display of myocardial systolic displacement• Myocardial displacement is calculated and displayed as a

color-coded overlay on the 2D image - different colors represent different displacement ranges

Tissue Synchronization Imaging (option)• Parametric imaging which gives information about

synchronicity of myocardial motion• Delayed myocardial segments produce red overlay

whereas segments moving in normal rhythm are green• Available in live scanning as well as an offline calculation

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derived from tissue Doppler data• Additional features in combination with multi-dimensional

imaging option:• Simultaneous acquisition of tri-plane TSI images

covering all standard segments in apical views with more than 100 fps

• Efficient segment specific TSI time measurements• Immediate Bull’s eye report• Automatic calculated TSI synchrony indexes• TSI surface mapping• LV synchronization report template

Strain rate/Strain imaging (option)

Research• Tissue deformation and rate of tissue deformation are

calculated and displayed as real time color-coded overlay on the 2D image

• Tissue deformation (Strain) is calculated and displayed as real time color-coded overlay on the 2D image

• Cine compound calculates and displays cineloops generated from a temporal averaging of multiple consecutive heart cycles

• Anatomical M-Mode and Curved Anatomical M-Mode displays (SI and SRI)

• Optimized strain presets for further 2D strain analysis on EchoPAC PC Dimension workstation (separate research option)

Intima Media Thickness (IMT) Measurement (option)• Automated measurement of IMT rather than the

conventional way of measuring the IMT manually• Results representative of a region rather than a single point

of a vessel wall• Reduction of examination time by providing a quick and

easy procedure in measuring the IMT

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Contrast Imaging

(All use of contrast agents should be used as described on the label by the contrast agent manufacturers.)

LVO Contrast (option)1 Enables contrast applications intended for clinical use:• LV Contrast (3V, M3S, 3S, M4S, 5S and 6T) enhances

delineation of the LV border in combination with ultrasound contrast agents. The new implementation of GE’s Coded Phase Inversion (CPI) provides high resolution detection of contrast in the LV cavity and excellent suppression of myocardial tissue signals. Furthermore, tri-plane imaging with 3V using LV Contrast enables acquisition of three simultaneous apical views within one cardiac cycle

• LVO Stress (M3S), same as LV Contrast but with slightly higher frame rate to account for the higher heart rates during stress

1) Harmonic Imaging for supporting contrast agent imaging was developed by Schering.

Vascular/Abdominal Contrast (option)2

Enables contrast applications intended for vascular and abdominal contrast imaging:• Vascular Contrast (7L, 10L and M12L) Coded Phase

Inversion enables excellent detection and resolution of vascular contrast imaging

• Abdominal Contrast (3.5C and 4C) – Coded Phase Inversion optimized for abdominal contrast imaging

Advanced Contrast (option)2

Enables contrast applications intended for research only. Diagnosis shall not be based on these applications alone.• Real Time CPI (M3S and M4S) – with improved resolution,

tissue suppression and higher contrast sensitivity is obtained by utilizing new Coded Phase Inversion mode (B-mode) intended for low power real time myocardial contrast imaging. Destruction: wash-in studies are possible online or offline using “flash” and Q-analysis features. Offline ECG triggering (acquire the full cineloop is yet another useful tool of the RTCPI application

624

• MC Contrast (M3S, 3S, M4S and 5S) – Harmonic Angio for high power triggered myocardial contrast imaging

• Rodent Contrast (i13L) – With the unique combination of high frequency of i13L and our newly developed CPI we provide superior tools for small animal ultrasound research

2) GE Healthcare’s Vivid 7 Dimension designed for compatibility with commercially available contrast agents. Because the availability of these agents is subject to government regulation and approval, product features intended for use with these agents may not be commercially marketed nor made available before the contrast agent is approved for use. Advanced contrast features are only enabled on systems for delivery in countries or regions where the agents are approved for use or for investigational or research use.

Physiological Traces• Up to five traces display simultaneously• ECG trigger• ECG lead selection• High-resolution display of the following traces: ECG,

Respiration, Phono, AUX1 and Pressure/AUX2

Analysis Program• Personalized measurement protocols allow individual set

and order of M&A items• Measurement can be labelled seamlessly by using

protocols or post assignments• Bodymark icons for location and position of probe• Cardiac calculation package including extensive

measurements and display of multiple repeated measurements

• Vascular measurements package• Measurements assignable to protocol capability• Parameter annotation follow ASE standard• Measurements assignable to report generator• Doppler auto trace function with automatic calculations in

both live and digital replay• Possibility of performing Measure and Analysis on video

625

playback• Seamless data storage and report creation• Measurements are summarized in worksheets - individual

results can be edited or deleted• User-assignable parameters

User Interface• Easy-to-learn user interface with intelligent keyboard• Front panel with application-specific rotaries and push

buttons for primary controls• Application-specific secondary controls available through

slidebars operated by a four-way rocker • Slide pot TGC curve with eight pots • Overall gain for 2D-Mode, Active mode, Depth and Zoom

Span on dedicated rotaries• Digital harvesting of images and loops into image clipboard• Patient Browser Screen for registration of demographic

data and quick review of Image Clipboard contents• Fully programmable user presets for probe/application

default settings

EchoPAC PC• EchoPAC PC adds connectivity and image analysis

capability to Vivid 7• Instant access to ultrasound raw data provided by the

system• Advanced Post-Processing Analysis• MO drive (option)• DVD writer (supports CD-R and DVD-R)• Three user levels help organizing data security

requirements

Image and Data Management• Ultimate workflow with instant access data management• Next generation of DICOM image format: raw image

DICOM incorporates raw image data information with all its data management flexibility into the image communication standard DICOM

626

• 2D, CFM or TVI data at maximum frame rate may be reviewed by scrolling or by running cine loops (can contain more than 1000 images for all imaging modes)

• Image Clipboard for stamp-size storage and review of stored images and loops

• Built-in patient archive with image/loops, patient information, measurements and reports

• Structured findings report tools support efficient text entries• User can enter normal values which are then compared to

actual measurements• Configurable HTML-based report function• Report Templates can be customized on board• ASE-based default text modules (English), user

customizable• Internal archive data can be exported to Removable Image

Storage through Magneto-Optical Disk and DICOM Media• Internal Hard Disk: for storing programs, application

defaults, ultrasound images and patient archive• All data storage is based on ultrasound raw data, allowing

to change gain, baseline, color maps, sweep speeds etc., for recalled images and loops

• DICOM media: read/write images on DICOM format• Alphanumeric patient data can be exported in MS Excel

compatible format• JPEG export for still frames• AVI and MPEG export for cineloops MPEGvue• Using MPEGvue, exams may be stored onto removable

media or on remote networked system together with integrated MPEGvue player for viewing on standard PC

• Smart e-mail feature allows transparent transmission of images via e-mail using resident Outlook e-mail client

eVue (option)• Allows interactive viewing of images, loops or full exams

from remote location

Wideband probes• Electronic selection between three solid state and one

stand-alone Doppler connectors

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• Biopsy support for 3.5C, 4C, M7C, E8C, 9L, 10L, 7L, 12L, M12L, 3S, M3S and M4S probes

Probe Freq. Range Cat. #

Phased Array Sector

M3S 1.5–4.3 MHz H45011SZ

M4S 1.5–4.3MHz H4000PA

3S 1.5–3.8 MHz H4550SZH4701SZ

5S 2.2–5.0 MHz H4901RAH40422LA

6S 2.7–8.0 MHz H45021RS

7S 2.9–8.0 MHz H4000PH40422LB

10S 3.7–11.5 MHz H4901PC

3Va 1.5–4.0 MHz H4900PC

Linear Array

7L 2.2–8.0 MHz H40412LF

9L 3.0–10.0 MHz H44112LT

10L 4.0–10.0 MHz H40212LG

12L 4.9–13.0 MHz H40412LH

M12L 4.9–14.0 MHz H40412LD

i8L 3.9–10.0 MHz H45511NW

i13L 5.3–14.0 MHz H45511NT

Curved Array (Convex)

3.5C 2.0–5.0 MHz H4901PE

4C 1.6–5.0 MHz H4904PC

5C 3.0–6.7 MHz H40412LA

M7C 2.9–7.0 MHz H40412LC

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Virus ProtectionTo minimize virus vulnerability Vivid 7 is configured with a minimal set of open ports and with all network services not actively used by the system closed down. This significantly reduces the risk of a virus attack on Vivid 7

GE is continuously judging the need for additional actions to reduce vulnerability of equipment, this includes vulnerability scanning of our products and evaluation of new security patches for the 3rd party technology used. Microsoft (and other) security patches that addresses serious issues with Vivid 7 will be made available to customers after GE verification of those patches.

Peripherals (options)

Internal peripherals• SVHS VCR

8C 3.7–8.0 MHz H40412LJ

E8C 3.7–8.0 MHz H40412LE

Doppler

2D (P2D) 2.0 MHz H4830JE

6D (P6D) 5.0 MHz5.8 MHz

H4830JG

Multiplane Transesophageal Phased Arrayb

6T 2.7–7.0 MHz H45001YDH45531HWH45521DX

6Tc 2.7–7.0 MHz H45551JA

9T 3.1–10.0 MHz H45521DY

a) Vivid 7 Dimension onlyb) TEE probe adapter allows using PAMPTE and 6Tv which are designed for System FiVe and Vivid FiVe scanners

Probe Freq. Range Cat. #

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• Full control from system panel• Frame grabber for playback• M&A package for video measurements

• B/W video printer with control from system panel• Color video printer with control from system panel• USB-2 interface

External• Ink-jet printer• Color laser printer

Physical Dimensions

Cart• Low rolling resistance casters • Brakes on front casters• Direction of casters can be locked for improved

maneuverability• Intelligent Fans: revolution speed is automatically adapted

to the system's internal operating temperature

Size Metric Imperial

Heighta 137.5 cm 157.5 cm 54.1 in 62 in

Width 64.0 cm 25.2 in

Depth 90.0 cm 35.4 in

Weightb 190 kg 419 lbs

a) with monitor

b) with monitor, without peripherals

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Electrical Specifications

Safety• Built to meet the requirements of:

• IEC60601-2-37/A1: 2004• IEC60601-1/A1/A2: 1995• IEC60601-1-2: 2001• IEC60601-1-4: 2000• UL60601-1: 2003• CAN/CSA C22.2 No 601.1-M90• The European Medical Devices Directive (MDD)

93/42/EEC (CE Mark)• The European Directive for Waste electrical and

electronic equipment (WEEE) 2002/96/EC• The Vivid 7 ultrasound unit is a Class I device, type CF,

according to Sub-clause 14 of IEC 60601-1 (1998).• The Vivid 7 ultrasound unit meets the EMC

requirements in EN 55011/A1/A2: 2002 for Group 1. Class B (10 meters)

Voltage(VAC)

Frequency(Hz)

Current(A)

100–120 50–60 10

230 50–60 5

CAUTION

Not all features or products described in this document may be available or cleared for sale in all markets. Please contact your local GE Medical Systems representative to get the latest information.

© 2001-2006 GE Medical Systems

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Probe/Application overview

Probe

Application

3S M3S

M4S

5S 6S7S 10S 3V7L 9L10L12LM

12Li8Li13L3.5C

4C

Abdominal + + + + +

Breast + +

Cardiac + + + + + + + + + +

Carotid + + + + +

Contrast + + + + + +

Coronary + + + + + + +

Exercise + + + +

Fetal Hearta + + + + + + + + +

LEA + + + + +

LEV + + + + +

LV Contrast + + + + +

LVO Stress + +

MC Contrast + + + +

Muscle Skeleton + +

Neo Head +

Octave SRI + +

Obstetricsa + +

Pediatric + + + + + + +

Pelvic + +

Pharm Stress + + +

Q-Stress + + +

Real Time CPI + +

Only the applications marked with a “a” are approved for fetal use when appropriate probe is selected.

632

Renal + + + + +

Scrotal + +

Small parts + + +

Small rodent + + + +

Transcranial + + +

Thyroid + +

UEA + + + + +

UEV + + + + +

Probe

Application

5CM

7C8C E8C2D 6D 6T/6Tc9T PA

MPTE

Abdominal + + +

Breast

Cardiac + + +

Carotid + +

Coronary +

Exercise

Fetal Hearta + + +

LEA +

LEV +


Probe

Application

3S M3S

M4S

5S 6S7S 10S 3V7L 9L10L12LM

12Li8Li13L3.5C

4C


633

LV Contrast +

LVO Stress

MC Contrast + +

Muscle Skeleton

Neo Head +

Octave SRI

Obstetricsa + + +

Pediatric +

Pelvic + + +

Pharm Stress

Q-Stress

Real Time CPI

Renal + +

Scrotal

Small parts

Small rodent

Transcranial

Thyroid

UEA +

UEV +

Probe

Application

5CM

7C8C E8C2D 6D 6T/6Tc9T PA

MPTE


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CAUTION

GE recommends dedicated probes for use on humans only or animals only. Mark probes dedicated for animals only with special labels.

If probes are interchanged between humans and animals, GE strongly recommends that the probes are sterilized between transitions humans / animals. Observe any national rules and regulations for handling equipment used on both animals and humans. Such national restrictions may prohibit transfer of probes used on animals to humans and vice-versa.

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Index

Numerics2D Soft menu controls ..........................................................................................................932D-Mode......................................................................................................................................90

Controls ..................................................................................................................................92Optimizing..............................................................................................................................95Overview ................................................................................................................................90Using .......................................................................................................................................95

AActive mode gain

Optimizing Color Mode....................................................................................................109Optimizing CW Doppler................................................................................................... 115Optimizing PW Doppler................................................................................................... 115

Air filter .......................................................................................................................................581Angle correction

CW Doppler......................................................................................................................... 113Optimizing CW Doppler................................................................................................... 116Optimizing PW Doppler................................................................................................... 116PW Doppler......................................................................................................................... 113

Annotations ................................................................................................................................79Configure ...............................................................................................................................83Editing .....................................................................................................................................82Erasing....................................................................................................................................82Inserting..................................................................................................................................79

Applicationselecting .................................................................................................................................52

Assignable keys .......................................................................................................................55Automated Function Imaging ..........................................................................................251Automatic Tissue Optimization (ATO)

2D.............................................................................................................................................93AVI ................................................................................................................................................346

BB Flow.........................................................................................................................................149Backup........................................................................................................................................416Baseline

636

Color Mode..........................................................................................................................105CW Doppler......................................................................................................................... 112Optimizing Color Mode....................................................................................................109PW Doppler......................................................................................................................... 112TVI.......................................................................................................................................... 119

Biopsy .........................................................................................................................................495Blood Flow Imaging..............................................................................................................149Bodymark ....................................................................................................................................85

CCare and Maintenance .......................................................................................................580Cine Compound

Strain .....................................................................................................................................140Strain rate ............................................................................................................................134Tissue Synchronization Imaging ..................................................................................145Tissue Tracking..................................................................................................................127

Cineloop.......................................................................................................................................58Controls ..................................................................................................................................60Overview ................................................................................................................................58Saving as AVI.....................................................................................................................346Using .......................................................................................................................................61

Classifications .........................................................................................................................596Cleaning

Air filter..................................................................................................................................581Ultrasound unit ...................................................................................................................581

Color 2DUsing .....................................................................................................................................108

Color maps2D Mode.................................................................................................................................92Color Mode..........................................................................................................................105CW Doppler......................................................................................................................... 113M-Mode ..................................................................................................................................98PW Doppler......................................................................................................................... 113Strain .....................................................................................................................................138Strain rate ............................................................................................................................132Tissue Synchronization Imaging ..................................................................................144Tissue tracking...................................................................................................................125TVI..........................................................................................................................................120

Color M-ModeOverview ..............................................................................................................................103Using .....................................................................................................................................108

637

Color Mode...............................................................................................................................102Controls ................................................................................................................................105Optimizing............................................................................................................................109Overview ..............................................................................................................................102using ......................................................................................................................................108

Color thresholdMC Contrast........................................................................................................................201

Comments.................................................................................................................................357Compound ................................................................................................................................148Compress

2D.............................................................................................................................................93CW Doppler......................................................................................................................... 113LV Contrast .........................................................................................................................195M-Mode ..................................................................................................................................98Optimizing CW Doppler................................................................................................... 115Optimizing M-Mode ..........................................................................................................101Optimizing PW Doppler................................................................................................... 115PW Doppler......................................................................................................................... 113RTCPI ...................................................................................................................................209Strain rate ............................................................................................................................133TVI..........................................................................................................................................120

Connecting peripherals ........................................................................................................12Connecting the unit ................................................................................................................10Connectivity..............................................................................................................................550

Buttons..................................................................................................................................560Dataflow ...............................................................................................................................551Overview ..............................................................................................................................550

Continuous capture ..............................................................................................................160Contour

2D.............................................................................................................................................94M-Mode ..................................................................................................................................98Optimizing M-Mode ..........................................................................................................101

Contrast ImagingAbdominal Contrast Imaging .........................................................................................217Data acquisition .................................................................................................................192LV Contrast Imaging ........................................................................................................192MC Contrast Imaging .......................................................................................................197Rodent Contrast Imaging................................................................................................221RTCPI ...................................................................................................................................205Vascular Contrast Imaging.............................................................................................213

Control panel .............................................................................................................................26CW Doppler.............................................................................................................................. 110

638

Controls ................................................................................................................................ 112Optimizing............................................................................................................................ 115Overview .............................................................................................................................. 110Using ..................................................................................................................................... 115

DDDP

2D.............................................................................................................................................94LV Contrast .........................................................................................................................195Optimizing 2D.......................................................................................................................95RTCPI ...................................................................................................................................209

DeleteExamination ........................................................................................................................361Image ....................................................................................................................................362Patient record .....................................................................................................................361

Depth2D.............................................................................................................................................93Optimizing 2D.......................................................................................................................95

Diagnosis code.......................................................................................................................358Diagnosis information..........................................................................................................357DICOM spooler.......................................................................................................................423DICOM SR................................................................................................................................389DICOM verification ...............................................................................................................562Diff On/Off

2D.............................................................................................................................................94LV Contrast .........................................................................................................................195

Direct report .............................................................................................................................450Disk space management...................................................................................................408Doppler see PW or CW DopplerDual focus

2D.............................................................................................................................................92Color Mode..........................................................................................................................105TVI.......................................................................................................................................... 119

Dynamic range2D.............................................................................................................................................93LV Contrast .........................................................................................................................195M-Mode ..................................................................................................................................99Optimizing M-Mode ..........................................................................................................101RTCPI ...................................................................................................................................209

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EECG

Adjusting trace .....................................................................................................................77Connecting ............................................................................................................................71Controls ..................................................................................................................................75Trigging...................................................................................................................................78

Edge EnhanceLV Contrast .........................................................................................................................195

Event timing .............................................................................................................................244Examination

Starting ...................................................................................................................................48Export

Patient records...................................................................................................................395

FFlash

RTCPI ...................................................................................................................................208Focus

2D.............................................................................................................................................92LV Contrast .........................................................................................................................194MC Contrast........................................................................................................................201M-Mode ..................................................................................................................................98Optimizing 2D.......................................................................................................................95Optimizing M-Mode ..........................................................................................................101RTCPI ...................................................................................................................................208

Footswitchoperation ................................................................................................................................42

Frame rate2D.............................................................................................................................................92CW Doppler......................................................................................................................... 114MC Contrast........................................................................................................................201Optimizing CW Doppler................................................................................................... 115Optimizing M-Mode ..........................................................................................................101Optimizing PW Doppler................................................................................................... 115PW Doppler......................................................................................................................... 114RTCPI ...................................................................................................................................209Strain .....................................................................................................................................138Strain rate ............................................................................................................................132Tissue Synchronization Imaging ..................................................................................144Tissue Tracking..................................................................................................................125TVI.......................................................................................................................................... 119

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Frequency2D.............................................................................................................................................92Color Mode..........................................................................................................................106CW Doppler......................................................................................................................... 114LV Contrast .........................................................................................................................194MC Contrast........................................................................................................................201M-Mode ..................................................................................................................................98Optimizing Color Mode....................................................................................................109Optimizing CW Doppler................................................................................................... 115Optimizing M-Mode ..........................................................................................................101Optimizing PW Doppler................................................................................................... 115PW Doppler......................................................................................................................... 114RTCPI ...................................................................................................................................208Strain .....................................................................................................................................139Strain rate ............................................................................................................................133Tissue Synchronization Imaging ..................................................................................145Tissue Tracking..................................................................................................................126TVI..........................................................................................................................................120

GGain

2D.............................................................................................................................................93Optimizing 2D.......................................................................................................................95Optimizing M-Mode ..........................................................................................................101

HHorizontal sweep

Color M-Mode.....................................................................................................................105CW Doppler......................................................................................................................... 112M-Mode ..................................................................................................................................98Optimizing CW Doppler................................................................................................... 116Optimizing M-Mode ..........................................................................................................101Optimizing PW Doppler................................................................................................... 116PW Doppler......................................................................................................................... 112

IImages

Saving as JPEG.................................................................................................................346Import

Patient records...................................................................................................................404Intima-Media Thickness .....................................................................................................270

641

Invert2D.............................................................................................................................................92Color Mode..........................................................................................................................105CW Doppler......................................................................................................................... 112Optimizing Color Mode....................................................................................................109Optimizing CW Doppler................................................................................................... 116Optimizing PW Doppler................................................................................................... 116PW Doppler......................................................................................................................... 112Strain rate ............................................................................................................................132Tissue Tracking..................................................................................................................125TVI.......................................................................................................................................... 119

JJPEG ...........................................................................................................................................346

LLanguage

Online manual ....................................................................................................................571System..................................................................................................................................571

Lateral AveragingColor Mode..........................................................................................................................106MC Contrast........................................................................................................................202Optimizing Color Mode....................................................................................................109Strain .....................................................................................................................................139Strain rate ............................................................................................................................133Tissue Tracking..................................................................................................................126TVI..........................................................................................................................................121

LogiqView..................................................................................................................................148Low Velocity Reject see LVRLPRF ........................................................................................................................................... 113LVR

Color Mode..........................................................................................................................106CW Doppler......................................................................................................................... 112MC Contrast........................................................................................................................201Optimizing Color Mode....................................................................................................109Optimizing CW Doppler................................................................................................... 115Optimizing PW Doppler................................................................................................... 115PW Doppler......................................................................................................................... 112TVI..........................................................................................................................................120

642

MMagneto Optical Disk

Formatting............................................................................................................................562Measurements ........................................................................................................................222

Configuration ......................................................................................................................285User-defined formulas .....................................................................................................290

Measurements (Cardiac)2D...........................................................................................................................................234Doppler .................................................................................................................................242M-Mode ................................................................................................................................238TSI..........................................................................................................................................245

Measurements (Vascular)B-Mode .................................................................................................................................269Doppler .................................................................................................................................274M-Mode ................................................................................................................................273

M-Mode ........................................................................................................................................96Anatomical M-Mode .........................................................................................................100Controls ..................................................................................................................................98Conventional M-Mode......................................................................................................100Curved Anatomical M-Mode ..........................................................................................100Optimizing............................................................................................................................101Overview ................................................................................................................................96Using .....................................................................................................................................100

MonitorBrightness..............................................................................................................................43Contrast ..................................................................................................................................43

Moving the unit .........................................................................................................................18MPEG..........................................................................................................................................348

OOn/Off............................................................................................................................................16

PPatient

Entering information ...........................................................................................................48Phono

Adjusting trace .....................................................................................................................77Connecting ............................................................................................................................73Controls ..................................................................................................................................75Display trace .........................................................................................................................77

Physiological traces ...............................................................................................................70

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Power2D.............................................................................................................................................94Color Mode..........................................................................................................................106CW Doppler......................................................................................................................... 114LV Contrast .........................................................................................................................195MC Contrast........................................................................................................................201M-Mode ..................................................................................................................................99Optimizing Color Mode....................................................................................................109PW Doppler......................................................................................................................... 114RTCPI ...................................................................................................................................209Strain rate ............................................................................................................................133Tissue Synchronization Imaging ..........................................................................140, 145Tissue Tracking..................................................................................................................126

PRFMC Contrast........................................................................................................................201

PrintPatient list ............................................................................................................................354

Printing .......................................................................................................................................510Printer configuration ......................................................................................................... 511

ProbesActivating .............................................................................................................................486Care and Maintenance ....................................................................................................488Cleaning ...............................................................................................................................490Connecting ....................................................................................................................43, 483Disconnecting...............................................................................................................43, 487Disinfecting..........................................................................................................................490Labelling...............................................................................................................................479Orientation markers..........................................................................................................479Safety ....................................................................................................................................493Selecting ................................................................................................................................52Types.....................................................................................................................................474

Pulse PressureAdjusting trace .....................................................................................................................77

Pulse Pressure transducerConnecting ............................................................................................................................73Controls ..................................................................................................................................75Display trace .........................................................................................................................77

PW Doppler.............................................................................................................................. 110Controls ................................................................................................................................ 112Optimizing............................................................................................................................ 115Overview .............................................................................................................................. 110Using ..................................................................................................................................... 115

644

QQuantitative Analysis...........................................................................................................304

Anatomical M-Mode .........................................................................................................337Deletion of a trace.............................................................................................................318Frame disabling .................................................................................................................319Labelling a sample area..................................................................................................322Manual tracking .................................................................................................................316Optimizing Anatomical M-Mode ...................................................................................339Optimizing sample area ..................................................................................................321Optimizing the trace display...........................................................................................323Overview ..............................................................................................................................308Sample area........................................................................................................................315Strain cursor........................................................................................................................315To generate a trace ..........................................................................................................315Trace smoothing................................................................................................................324Wash-in curve fitting.........................................................................................................330Wash-out curve fitting ......................................................................................................335

RRadial Averaging

Color Mode..........................................................................................................................106MC Contrast........................................................................................................................201Optimizing Color Mode....................................................................................................109Strain .....................................................................................................................................140Strain rate ............................................................................................................................133Tissue Tracking..................................................................................................................126TVI..........................................................................................................................................121

Referral reasons ....................................................................................................................357Reject

2D.............................................................................................................................................93LV Contrast .........................................................................................................................195M-Mode ..................................................................................................................................99Optimizing 2D.......................................................................................................................95Optimizing M-Mode ..........................................................................................................101RTCPI ...................................................................................................................................209Strain .....................................................................................................................................139Strain rate ............................................................................................................................133

Removable mediaEjecting...................................................................................................................................65Formatting..............................................................................................................................63

Report .........................................................................................................................................426Add an image to.................................................................................................................430

645

Configuration of the Template selection menu........................................................469Creating................................................................................................................................428Deleting ................................................................................................................................432Direct report ........................................................................................................................450Export/Import templates..................................................................................................471Print .......................................................................................................................................431Retrieving.............................................................................................................................432Save.......................................................................................................................................431

Report designer......................................................................................................................453Designing a template .......................................................................................................457

RespirationAdjusting trace .....................................................................................................................77Connecting ............................................................................................................................71Controls ..................................................................................................................................75Display trace .........................................................................................................................77

Restore data ............................................................................................................................416ROI size

Color Mode..........................................................................................................................107MC Contrast........................................................................................................................202

SSafety ..........................................................................................................................................586

Biological hazard ...............................................................................................................604Electrical hazard ................................................................................................................603Equipment safety...............................................................................................................603Explosion hazard...............................................................................................................603Implosion hazard ...............................................................................................................603Mechanical hazard............................................................................................................601Moving hazard....................................................................................................................604Pacemaker hazard............................................................................................................605Patient safety......................................................................................................................601Personnel safety................................................................................................................603

Sample volumeColor Mode..........................................................................................................................106CW Doppler......................................................................................................................... 113MC Contrast........................................................................................................................201Optimizing Color Mode....................................................................................................109Optimizing CW Doppler................................................................................................... 115Optimizing PW Doppler................................................................................................... 115PW Doppler......................................................................................................................... 113

ScaleColor Mode..........................................................................................................................105

646

Strain .....................................................................................................................................138TVI.......................................................................................................................................... 119

ScanningScreen layout........................................................................................................................39starting ....................................................................................................................................52

SimultaneousStrain .....................................................................................................................................138Strain rate ............................................................................................................................132Tissue Synchronization Imaging ..................................................................................144Tissue tracking...................................................................................................................125TVI.......................................................................................................................................... 119

Site requirements ......................................................................................................................9Soft Menu Rocker ...................................................................................................................55

using ........................................................................................................................................56Strain ...........................................................................................................................................136

Controls ................................................................................................................................138Optimizing............................................................................................................................141Overview ..............................................................................................................................136Using .....................................................................................................................................141

Strain cursor.............................................................................................................................315Strain rate..................................................................................................................................130

Controls ................................................................................................................................132Optimizing............................................................................................................................135Overview ..............................................................................................................................130Using .....................................................................................................................................135

Stress Echo..............................................................................................................................151Acquisition ...........................................................................................................................155Analysis ................................................................................................................................168Configuring levels..............................................................................................................186Creating an image group ................................................................................................187Deleting a group ................................................................................................................187Editing template .................................................................................................................181Labelling a level .................................................................................................................186Labelling a projection .......................................................................................................186Quantitative TVI Stress analysis ..................................................................................173Scoring..................................................................................................................................170Selecting a template.........................................................................................................153Timers ...........................................................................................................................159, 186Tissue Tracking..................................................................................................................179

SystemControls affecting acoustic output................................................................................599Switching On/Off..................................................................................................................16

647

System setup...........................................................................................................................514Application ...........................................................................................................................524Examination list window..................................................................................................563Imaging setup.....................................................................................................................521Language.............................................................................................................................569M&A.......................................................................................................................................530Patient information............................................................................................................523Starting system setup ......................................................................................................519Units.......................................................................................................................................569User configuration.............................................................................................................575

TTCPIP..........................................................................................................................................568TGC see Time Gain Compensation...............................................................................93Threshold

Strain .....................................................................................................................................139Strain rate ............................................................................................................................133Tissue Synchronization Imaging ..................................................................................145Tissue Tracking..................................................................................................................126TVI..........................................................................................................................................120

Tilt2D.............................................................................................................................................94LV Contrast .........................................................................................................................195MC Contrast........................................................................................................................201RTCPI ...................................................................................................................................210

Time Gain Compensation (TGC)2D.............................................................................................................................................93Optimizing 2D.......................................................................................................................95Optimizing M-Mode ..........................................................................................................101

Tissue priorityColor Mode..........................................................................................................................106Optimizing Color Mode....................................................................................................109

Tissue Synchronization Imaging....................................................................................142Controls ................................................................................................................................144Optimizing............................................................................................................................147Overview ..............................................................................................................................142Using .....................................................................................................................................146

Tissue Tracking......................................................................................................................123Controls ................................................................................................................................125Optimizing............................................................................................................................128Overview ..............................................................................................................................123Using .....................................................................................................................................128

648

Tissue Velocity Imaging see TVITrackball

Operation ...............................................................................................................................57Transcranial .............................................................................................................................632Transparency

Strain .....................................................................................................................................139Strain rate ............................................................................................................................133Tissue Synchronization Imaging ..................................................................................145Tissue Tracking..................................................................................................................126TVI..........................................................................................................................................120

TriggingMC Contrast........................................................................................................................200RTCPI ...................................................................................................................................208

TSI, see Tissue Synchronization ImagingTVI ................................................................................................................................................ 117

Controls ................................................................................................................................ 119Optimizing............................................................................................................................122Overview .............................................................................................................................. 117Using .....................................................................................................................................122

VVariance

Color Mode..........................................................................................................................105Optimizing Color Mode....................................................................................................109

Velocity rangeCW Doppler......................................................................................................................... 112Optimizing CW Doppler................................................................................................... 116Optimizing PW Doppler................................................................................................... 116PW Doppler......................................................................................................................... 112

WWheels..........................................................................................................................................18Width

2D.............................................................................................................................................92LV Contrast .........................................................................................................................194RTCPI ...................................................................................................................................208

Worksheet.................................................................................................................................301

XYZZoom .............................................................................................................................................67


Vivid 7/EchoPAC PCDimension - version 7.x.x

4D and Multi-plane Imaging

GEVU #: FD092081GEVU Rev. 01MHLW No: 21300BZY00416000

Operating Documentation

Copyright © 2007 By General Electric Co.

0470


© GE Medical Systems. All rights reserved. No part of this manual may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of GE Medical Systems.


1

Table of Contents

Table of ContentsIntroduction

4D imaging......................................................................................1Multi-plane Imaging .......................................................................2Measurement and analysis ...........................................................2Multi-plane stress echo .................................................................2Remark concerning the 3V probe.................................................2Important.........................................................................................3Conventions used in this manual.................................................4

Chapter 14D Imaging

Introduction ....................................................................................64D mode overview - Vivid 7...........................................................7

Volume rendering mode screen ............................................7Slice mode screen.................................................................84D mode controls ..................................................................9Assigned rotaries and keys .................................................104D mode assigned controls.................................................11Additional 4D mode assigned controls ................................14Soft menu controls ..............................................................16Trackball controls ................................................................17Display controls ...................................................................19

Using 4D mode - Vivid 7 ..............................................................21Parasternal view acquisition................................................21Apical view acquisition ........................................................22Full volume acquisition ........................................................23Rotating/Translating the 4D image......................................25Zooming ..............................................................................26Cropping..............................................................................269 Slice..................................................................................29

4D mode overview - EchoPAC PC..............................................32

2

Volume rendering mode screen ..........................................32Slice mode screen...............................................................334D mode control panel ........................................................34Display controls ...................................................................36Cropping..............................................................................37

Working with 4D acquisitions - EchoPAC PC ...........................399 Slice..................................................................................39

4D LV Volume application ...........................................................41Starting the 4D LV Volume application — Vivid 7 ...............41Starting the 4D LV Volume application — EchoPAC PC ....41

Chapter 24D Color Flow Imaging

Introduction ..................................................................................434D Color Flow mode overview - Vivid 7 .....................................44

Color Flow Volume rendering mode screen ........................44Color Flow Slice mode screen.............................................454D Color Flow mode controls ..............................................46Assigned rotaries and keys .................................................474D Color Flow mode assigned controls...............................48Additional 4D mode assigned controls ................................49Soft menu controls ..............................................................50Trackball controls ................................................................51Display controls ...................................................................51

Using 4D Color Flow mode - Vivid 7...........................................53Real time 4D Color flow acquisition.....................................53Full volume Color Flow acquisition......................................546 Slice..................................................................................56

4D Color Flow mode overview - EchoPAC PC ..........................59Volume rendering mode screen ..........................................59Slice mode screen...............................................................604D mode control panel ........................................................61

Chapter 3Multi-plane imaging

Introduction ..................................................................................64

3

Multi-plane mode overview - Vivid 7 ..........................................65Bi-plane mode screen .........................................................65Tri-plane mode screen ........................................................66Multi-plane mode controls ...................................................67

Using Multi-plane mode imaging - Vivid 7 .................................75Scan plane rotation .............................................................76Tilting scan plane 2 .............................................................76Zooming ..............................................................................77

Multi-plane mode overview - EchoPAC PC................................80Bi-plane mode screen .........................................................80Tri-plane mode screen ........................................................81The multi-plane control panel ..............................................82

Working with multi-plane acquisitions - EchoPAC PC.............83

Chapter 4Measurements and Analysis

Introduction ..................................................................................85Left ventricular volume measurements .....................................86

Tri-plane acquisition ............................................................86Full volume acquisition ........................................................89Rotation of the Volume reconstruction ................................90Bi-plane acquisition .............................................................91

TSI surface model ........................................................................93To edit the sampling path ....................................................94

Quantitative analysis ...................................................................95Starting Quantitative analysis from a multi-plane acquisition ...........................................................................95

Chapter 5Multi-plane Stress Echo

Introduction ..................................................................................98Creating a Multi-plane stress test template...............................99

Launching the Template editor..........................................100Stress Template setup ......................................................100

Stress test acquisition...............................................................102Baseline acquisitions.........................................................102

4

Low dose and Peak dose level acquisitions......................105Image analysis............................................................................108

Index

1

Introduction

This user manual describes the 4D and Multi-plane Imaging applications for the Vivid 7 Dimension and EchoPAC PC Dimension.

The 2D matrix probe 3V enables real time volume rendering, simultaneous bi-plane or tri-plane data acquisition (multi-plane acquisition).

4D imaging4D imaging enables real time acquisition and rendering of volume ultrasound data. Free rotation of the 3-dimensional image combined with the zoom function and 4D image optimization controls enhance spatial understanding of the anatomical structure and function of the heart.

4D imaging is available in combination with B-Mode only.

1. Real time Volume acquisition (4D imaging)2. Real time Bi-plane acquisition3. Real time Tri-plane acquisition

2

Multi-plane ImagingMulti-plane imaging displays two (Bi-plane) or three (Tri-plane) rotated scan planes acquired simultaneously. Free rotation, tilting (in Bi-plane) of the scan planes and zoom enable the investigation of anatomical structures from different angles.

Multi-plane imaging is available from B-Mode, Color flow mode and TVI related modes.

If not otherwise specified, the term multi-plane means either Bi-plane or Tri-plane.

Measurement and analysisAll cardiac measurements available in B mode are also available in 4D and Multi-plane.

The 4D and Multi-plane modes enable the creation of a left ventricular volume reconstruction based on contours drawn from three cross sections at both end-systole and end-diastole with calculation of end-systolic and end-diastolic volumes and ejection fraction.

Multi-plane stress echoCombined with specially designed Stress echo protocols, Multi-plane mode enables faster stress tests as several views can be acquired simultaneously.

Remark concerning the 3V probeThe 3V probe temperature will increase during extensive use, due to heating from the probe electronics. If the probe reaches its temperature limit, this will be detected by the system and scanning will stop. Currently, this limit is set to 42.3 degrees Celsius, which complies with regulatory instructions relating to patient comfort and safety. This is reported with a dialog box and the user has to wait until the temperature is below acceptable limits before scanning can continue. This does not in any way indicate probe malfunction. The user has to unfreeze to start scanning again.

In order to reduce the chance for full freeze due to heating, the system will reduce power slightly in a temperature interval just

3

below the full freeze limit. Changes to the power level are reported in the status bar as Setting power level down and Setting power level up.

The recommended use of this probe for live 4D and full volume 4D scanning is to enter full freeze whenever the probe is not used for imaging. For other modalities no special actions are required.

ImportantRead and understand all instructions in the Vivid 7 and EchoPAC PC User manuals before attempting to use the devices.

4

Conventions used in this manualKeys and button, on the control panel or alphanumeric keyboard are indicated by over and underlined text (ex. 2D refers to the 2D mode key)

Bold type, describes button names on the screen.

Italic type: describes program windows, screens and dialogue boxes.

Icons, highlight safety issues as follow:

DANGER


WARNING

Indicates that a specific hazard exists that, given inappropriate conditions or actions, will cause:• Severe personal injury• Substantial property damage

CAUTION


5

Chapter 1 4D Imaging

• Introduction ................................................................................... ....... 6• 4D mode overview - Vivid 7 ......................................................... ....... 7

• Volume rendering mode screen ....................................................7• Slice mode screen ........................................................................8• 4D mode controls ..........................................................................9

• Using 4D mode - Vivid 7 ............................................................... ..... 21• Parasternal view acquisition .......................................................21• Apical view acquisition ................................................................22• Full volume acquisition ...............................................................23• Rotating/Translating the 4D image .............................................25• Zooming ......................................................................................26• Cropping .....................................................................................26• 9 Slice .........................................................................................29

• 4D mode overview - EchoPAC PC .............................................. ..... 32• Volume rendering mode screen ..................................................32• Slice mode screen ......................................................................33• 4D mode control panel ................................................................34• Display controls ..........................................................................36

• Working with 4D acquisitions - EchoPAC PC ............................ ..... 39• 9 Slice .........................................................................................39

• 4D LV Volume application ........................................................... ..... 41• Starting the 4D LV Volume application — EchoPAC PC ............41

6

IntroductionThe 3V probe enables real time acquisition of volume ultrasound data. Free rotation of the three-dimensional image combined with zooming and 4D image optimization controls enhance spatial understanding of the anatomical structure and function of the heart.

Two display modes are available, Volume rendering mode for three dimensional scanning and Slice mode for measurements and volume reconstruction purpose.

4D imaging is available from B mode only.

7

4D mode overview - Vivid 7

Volume rendering mode screenThe Volume rendering mode displays a volume rendering and 2D images from two perpendicular cut-planes.

Figure 1-1: The 4D screen (Volume rendering)

1. Volume rendering display from cut-plane 1 (yellow). The volume rendering may be adjusted by rotating and translating the cut-plane 1.

2. Cut-plane 2 (white): 2D image in the azimuth plane.3. Cut-plane 3 (green): 2D image in the elevation plane.4. Orientation window: displays a three-dimensional model with cut-planes position and orientation.5. Color coded cut-plane markers indicate the other cut-planes position relative to the displayed

cut-plane.6. View direction marker.7. Soft menu controls (see page 16)8. Trackball functions (see page 17)

8

Slice mode screenThe Slice mode displays three cut-planes. The cut-planes can be rotated and translated independently of each other. This mode is use to perform measurements and volume reconstruction based on contour traces done on several cut-planes.

Figure 1-2: The 4D screen (Slice mode)

1. Cut-plane 1 (yellow)2. Cut-plane 2 (white)3. Cut-plane 3 (green)4. Color coded cut-plane markers indicate the position of the other cut-planes relative to the displayed

cut-plane.5. Orientation window: displays a three-dimensional model with cut-planes position.6. View direction marker.7. Trackball functions (see page 17)

9

4D mode controls

Figure 1-3: The 4D controls on the control panel

1. 4D key2. Multiplane key (see page 63)3. Assigned 4D rotaries: see next page.4. Assigned 4D keys: see next page.5. Zoom/HR Zoom (see page 20)6. Layout (see page 19): toggles the display

between:• Multi screen with volume/slice• Single screen volume/slice

7. Soft menu

8. Trackball (see page 17)• Rotate/translate volume rendering or selected cut-plane (Slice mode)

• Scroll through the cineloop9. Clear: resets the orientation to default

positions. 10. Angle: predefined orientations optimized for

volume rendering.11. 4D Gain12. 2D Gain

Update /

MenuTrac

kBa

ll

Alt. Alt. Alt. Alt.

Width

4

3

10

Assigned rotaries and keys

Figure 1-4: Volume rendering and Slice mode assigned controls

Volume rendering assigned controls

1. Assigned rotaries• Width• Frequency• Focus position• Volume sizeMORE menu• Translate R

2. Assigned keys• Slice R• Front/Back• Crop (in Freeze only) R• Box (in Freeze only) R• Cineloop (in Freeze only) R• Full volume• 4D Colorize R• 9 Slice (in Full volume Freeze only) RMORE menu• Up/Down R• Flip R• Orientation window R• Cine rotate (in Freeze only) R

Slice mode assigned controls

1. Assigned rotaries• Width• Rotate R• Translate (in Freeze only) R• Focus position• Volume sizeMORE menu• Frequency

2. Assigned keys• Slice exit R• Reference plane R• Cineloop (in Freeze only) RMORE menu• Up/Down R• Orientation window R

Controls marked with R are also available in cine replay.

11

4D mode assigned controlsThis section describes only the 4D mode controls. The scanning mode controls are described in the system User manual.

Width

(Volume rendering and Slice mode, Live)

Controls both elevation and azimuth widths, an increase of the elevation width results in a decrease of the azimuth width.

Volume size

(Volume rendering and Slice mode, Live)

Controls the size of the volume. Adjusting the volume size may affect the volume rate.

Rotate

(Slice mode, Live and Replay)

Rotate the selected cut-plane around the z-axis (see Figure 1-5).

Figure 1-5: Cut-plane rotation around the z-axis

Slice/Slice exit

(Volume rendering and Slice mode, Live and Replay)

Toggles the display between Volume rendering (Figure 1-1) and Slice mode (Figure 1-2).

1. Rotate control

12

Front/Back

(Volume rendering, Live and Replay)

Tilts the volume in the elevation direction and rotates the view position in one operation. FRONT/BACK enables volume rendering display from different angles (Figure 1-6).

Figure 1-6: Front/Back control on a PLAX volume

Reference plane


Toggles the cut-plane selection between cut-plane 1, 2 or 3.

Crop (Free cropping)

(Volume rendering, Freeze and Replay)

1. Front/Back: Volume tilt and View position rotationA. Volume tilted to the left, view position looking towards the anterior wall.B. Volume tilted to the right, view position looking towards the inferior wall.

13

Removes all data up front of the active cut-plane. Cropping can be applied on several parts of the volume by rotating/translating the active cut-plane (see page 26).

Box (Box cropping)


Removes all data around a user-adjustable box (see page 27).

Full volume

(Volume rendering, Live)

Activates the ECG triggered sub-volume acquisition. This technique enables the acquisition of a larger volume without compromising the resolution, by combining several sub-volumes acquired over two to six heart cycles (see Figure 1-7). When acquisition is done for the number of heart cycles set, the process is repeated replacing the oldest sub-volumes.

Figure 1-7: ECG triggered volume acquisition (two heart cycles)

4D Colorize


Adjusts the volume rendering color from a color map menu.

Depth encoded color mapsFrom this menu the user can also select a depth encoded color map. These color maps use colors to improve the perception of depth. Selecting the bronze/blue color map will display structures that are close to the view plane with a bronze color. Structures that are farther behind will be colored with a gray

+ =

14

color, while the structures that are farthest behind will be colored in blue. Very bright colors are almost white, independent of the depth.

Stereo vision4D Stereo vision is a display technique that enhances the perception of depth in 3D renderings. This is achieved by mixing two different volume renderings with slightly separated viewing angles and presenting them separately to the user’s left and right eyes. This feature requires the use of anaglyph stereo glasses (glasses with one red and one cyan lens).

Normally you should be able to see the stereoscopic effect after a few seconds. The effect may gradually improve after a while. If you are already wearing glasses or lenses you should not take them off, since the stereo effect then may be greatly reduced.

Note: Not all users may be able to perceive depth using stereoscopic display techniques.

Additional 4D mode assigned controlsThe following controls are available after pressing MORE.

Up/Down


Flips the volume 180 degrees.

Flip


Flips the view position (Figure 1-8).

15

Figure 1-8: Flip control

Orientation window


Shows/hides the Orientation window.

Cine rotate

(Volume rendering, Replay)

Rotates back and forth the volume rendering.

1. Flip controlA. View position looking downwardB. View position looking upward

16

Soft menu controlsSoft menu controls are related to image quality adjustment. These controls are accessed using the 4-way rocker on the control panel. Only the 4D controls are described in this section, refer to the system user manual for general imaging controls.

Smoothness


Affects continuity of structures and image noise. Too much smoothness will blur the image, too little will leave too much noise.

Shading


Adjusts the shading effect on the image. Shading may improve three dimensional perception.

Tilt


Tilts the volume in the elevation direction.

Figure 1-9: Tilt control

1. Tilt control: volume tilting in the elevation direction

17

Number of Cycles

(Volume rendering, Live, Full volume acquisition)

Controls the number of cycles the ECG triggered full volume acquisition is based on. Select between two, three, four or six cycles. Four cycles is default setting.

DDP (Data Dependent Processing)


Performs temporal processing which reduces random noise without affecting the motion of significant tissue structures.

UD Clarity


Enables the user to create a personalized appearance of the tissue rendering by reducing noise and enhancing boundaries between different structures. Adjustment toward the left creates a smoother image. Adjustment toward the right creates a crisper image.

Volume optimize


Optimizes the volume rendering by adjusting several display controls simultaneously (e.g Shading, Smoothness... etc.).

Gamma

Adjusts the brightness of midtone values. A higher gamma value produces an overall darker image, a lower gamma value a lighter image.

Trackball controlsThe trackball has multiple functions. The trackball functions are organized in several functional groups as shown in the table below.

The function selected is displayed in the lower right corner of the screen (Figure 1-10).• Press SELECT to toggle between the trackball functions

within the active functional group. Groups with several

18

functions are marked with a + symbol.• Press TRACKBALL to toggle between the functional groups.

Figure 1-10: The Trackball area

1. Trackball key: toggles between trackball functional groups.2. Select key: toggles between the functions within the active group. Groups

with several functions are marked with a + symbol.

Orientation controls group

Function Description

Press SELECT to toggle between the controls.

Rotate Rotates the volume rendering (see page 25).

Translate Translates the volume rendering (see page 25).

Cineloop control group


Scroll Scrolls through a cineloop.

19

Display controls

Layout key on the front panel

Toggles the display between multi-screen and single-screen.• Multi-screen:

• In Volume rendering: displays a volume rendering and 2D images from two perpendicular cut-planes.

• In Slice mode: displays 2D images from three cut-planes with the selected cut-plane in the main window.

• Single-screen:• In Volume rendering: displays the volume rendering.• In Slice mode: display the 2D image of the selected

cut-plane.

Figure 1-11: 4D mode display options

4D Gain (Active Gain rotary)

Affects the image “depth” or transparency. Too much 4D Gain applied will take away structures, too little will leave opaque “Gray clouds” in the ventricle.

1. Display options for Volume rendering2. Display options for Slice mode

20

Zoom

Display zoom

Activated and adjusted by rotating the ZOOM rotary ( ). The rectangular shape of the zoomed area is displayed in the Orientation window.

High Resolution (HR) zoomHR zoom concentrates the image processing to a magnified, user selectable area in the image, resulting in a higher volume rate in the selected image area.

To be able to use the HR zoom in 4D imaging the HR zoom function must be activated in B mode before entering the 4D imaging mode.

21

Using 4D mode - Vivid 71. Select the 3V probe and cardiac application.2. Create an examination.

Parasternal view acquisition1. In 2D mode, acquire a PLAX view and optimize the image

quality, using DEPTH, GAIN, TGC...etc.2. Press 4D.3. Move the probe up or down so that the anterior wall is just

inside the image in the lower left window in the 4D screen (Figure 1-12).

Figure 1-12: PLAX volume rendering

4. Adjust 4D Gain to optimize the depth impression of the back wall.

5. To display a volume looking towards the inferior wall, press FRONT/BACK.The volume is tilted to the right and the view position is rotated 180 degrees.

Note: In this position the volume is tilted to the left and the view position is looking towards the anterior wall.

22

6. Press FREEZE, 2D FREEZE and rotate the volume to check the result.


Apical view acquisition1. In 2D mode, acquire a Apical view and optimize the image

quality, using DEPTH, GAIN, TGC...etc.2. Press 4D and follow the same procedure as for the PLAX

view (see page 21).Make sure to assess the image quality in the reference views and the volume rendering. Use FRONT/BACK to display the volume correctly.

3. Press FREEZE, 2D FREEZE and rotate the volume to check the result.


23

Full volume acquisitionFull volume acquisition is based on ECG triggering acquisition of sub-volumes. This technique enables the acquisition of a larger volume without compromising the resolution, by combining several sub-volumes acquired over two, three, four or six heart cycles (see Figure 1-7, page 13). When acquisition is done for the number of heart cycles set, the process is repeated replacing the oldest sub-volumes.

To avoid spatial artifacts, make sure that the probe and the patient are not moving during the acquisition. The patient should, if possible hold his/her breath. The ECG trace should be stable.1. Connect the ECG device and make sure to obtain a stable

ECG trace.2. In 2D mode, acquire an Apical view and optimize the image

quality, using DEPTH, GAIN, TGC...etc.3. Press 4D.4. Press FULL VOLUME.

The Full volume acquisition is started.5. You may adjust ANGLE to get different view. The default

top/down view is best for stitching quality assessment.6. Ask the patient to hold her/his breath at end expiration.

Keep the probe steady and look for stitching artifacts in both the volume rendering and the elevation plane in the lower left window of the screen (Figure 1-13).Attention should be brought on stitching quality during acquisition rather than volume rendering quality.

CAUTION

ECG triggering acquisition may by nature contain artifacts.

Artifacts may be caused by:• Movements of the probe caused by the operator during

acquisition.• Movements of the patient during acquisition.• Irregular heart rate during acquisition.

To validate the acquisition, perform a visual inspection in both the volume rendering and the elevation plane. Stitching artifacts are shown as visible transitions between the sub-volumes (Figure 1-13)

24

Figure 1-13: Stitching quality assessment

When no artifacts are seen over a few heart cycles, press FREEZE.

A: Acquisition with stitching artifacts1. Elevation plane2. Volume rendering

B: Acquisition without stitching artifacts1. Elevation plane2. Volume rendering

25

Note: it is recommended to acquire several heart cycles and use SELECT CYCLE to select the best one.

7. Once in Freeze, adjust 4D GAIN. Rotate the volume to check the result and tress IMG. STORE.

Rotating/Translating the 4D imageTranslation and rotation can be performed in either Volume rendering or Slice mode. Press SLICE to toggle between the two modes.1. Move the trackball to rotate or translate the cut-plane

according to the trackball function selected.2. Press SELECT to toggle between Rotate and Translate.

Move the trackball to apply the selected control (see Figure 1-14).The default position can be displayed again by pressing CLEAR.

Figure 1-14: Rotating/translating the 4D image

1. Select the trackball control “Translate” and use the trackball to translate the cut-plane.

2. Select the trackball control “Rotate” and use the trackball to rotate the cut-plane (all directions).

26

Zooming1. Rotate the ZOOM knob clockwise on the control panel.

The volume rendering is magnified. The frame of the Volume rendering cut-plane in the Orientation window is updated showing the magnified portion of the volume (Figure 1-15).

Figure 1-15: The Orientation window in zoom mode

CroppingThere are two cropping tools available: Free cropping tool and Box cropping tool.

The Free cropping tool removes all data up front of the active cut-plane. Cropping can be applied on several parts of the volume by rotating/translating the active cut-plane.

The Box cropping tool removes all data around a user-adjustable box.

It is not possible to use both cropping tools on the same acquisition.

Free cropping

The Free cropping tool is available in Volume rendering mode, when in Freeze or in Replay.1. While in Volume rendering live mode, press FREEZE.2. Press CROP.

Note: Pressing CROP will remove any previous Box cropping operations.

3. Rotate and translate the active cut-plane.All data above the cut-plane will be removed when applying crop.

1. Zoomed area

27

4. Press SET to apply crop. All data up front of the active cut-plane is removed.

5. Repeat steps 3 and 4 to remove other parts of the volume.Note: press UNDO CROP to undo the cropping actions stepwise.Press REMOVE CROP to undo all cropping actions in one operation.

Box cropping

The Box cropping tool is available in Volume rendering mode, when in Freeze or in Replay.1. While in Volume rendering live mode, press FREEZE.2. Press BOX.

A box frame is displayed with two adjustable sides (highlighted as red and blue), see Figure 1-16.Note: Pressing BOX will remove any previous Free cropping operations.

3. Rotate the RED and BLUE assigned rotaries to adjust the corresponding sides around the structure of interest.All data outside the box is removed.

4. Rotate the BOX SIDES assigned rotary to select two other sides of the box.

5. Repeat steps 3 and 4 to adjust the selected sides of the box until the structure of interest is within the box.Note: press RESET BOX to undo the box adjustments.

6. Press BOX EXIT to apply and exit box cropping.

28

Figure 1-16: Box cropping

1. Default cropping box with two active sides (red and blue). The other sides can be selected for adjustment

2. Cropped volume (from upper and lower sides)

29

9 Slice9 Slice enables simultaneous display of nine short axis views generated from an Apical full volume acquisition.

9 Slice is available only from a full volume acquisition when in Freeze.1. Acquire an apical Full volume view (see page 23).2. Press FREEZE.3. Press 9 SLICE.

The 9 Slice screen is displayed showing nine short axis views (Figure 1-17). The slices are evenly distributed and maximized in size for best assessment.

Figure 1-17: 9 Slice screen

If required, zoom in. All slices are zoomed in simultaneously.

4. The following adjustments can be done:• Adjust TOP and BOTTOM controls to change the slicing

area (Figure 1-18).

1. Upper slice2. Lower slice

30

Figure 1-18: Slice distribution adjustment

• Adjust the AXIS 1 and AXIS 2 controls to rotate the slices backward/forward and sideways (Figure 1-19), to align the slices with the anatomical structure.

Figure 1-19: Slice rotation adjustment

1. Top: upper slice adjustment2. Bottom: lower slice adjustment

1. Axis 1: slice rotation backward/forward2. Axis 2: slice rotation sideways

31

5. Press IMG. STORE to save.

32

4D mode overview - EchoPAC PC4D acquisitions from Vivid 7 can be opened and post processed on the EchoPAC PC workstation. This section describes the controls and procedures related to 4D mode on the workstation. Refer to the EchoPAC PC User manual about general use of the workstation.

Volume rendering mode screen

Figure 1-20: The 4D screen (Volume rendering)

1. Volume rendering display from cut-plane 1 (yellow). The volume rendering may be adjusted by rotating and translating the cut-plane 1.

2. Cut-plane 2 (white): 2D image in the azimuth plane.3. Cut-plane 3 (green): 2D image in the elevation plane.4. Orientation window: displays a three-dimensional model with cut-planes position and orientation.5. Color coded cut-plane markers indicate the other cut-planes position relative to the displayed

cut-plane.6. 4D control panel (Volume rendering mode)

33

Slice mode screen

Figure 1-21: The 4D screen (Slice mode)

1. Cut-plane 1 (yellow)2. Cut-plane 2 (white)3. Cut-plane 3 (green)4. Color coded cut-plane markers indicate the position of the other cut-planes relative to the displayed

cut-plane.5. View direction marker.6. Orientation window: displays a three-dimensional model with cut-planes position.7. 4D control panel (Slice mode)

34

4D mode control panel

Figure 1-22: The 4D Control panel

Refer to ’4D mode controls’ on page 9 for information on the 4D related controls. All other general imaging controls are described in the workstation User manual.

35

Figure 1-23: Rendering and orientation panel

Rendering controls

In volume rendering, select Rendering to display the rendering controls.

36

Display controls

Rotation

Rotation using the mouse1. Place the mouse cursor in the image area.2. Press and hold down the Left mouse button and drag the

mouse in any direction.The volume rendering is rotated following the mouse cursor movement.To rotate around the Z axis, press and hold down ALT and drag the mouse to the left or right.

Rotation from the control panel1. In Volume rendering, Select Rendering.

The Rendering control panel is displayed (see Figure 1-23).

2. Adjust Rotate X, Rotate Y or Rotate Z to rotate the volume rendering around the corresponding axis.

Figure 1-24: Rotation around the X, Y and Z axis

Translation

Translation using the mouse1. Place the mouse cursor in the image area.2. Press and hold down SHIFT and drag the mouse up or

down.The volume rendering cut-plane is translated.

Translation from the control panel1. In Volume rendering, Select Rendering.


2. Adjust the control Translate.

37

Zoom

Zooming1. Rotate the Mouse wheel to zoom in and out.

ORPress ARROW UP to zoom in, ARROW DOWN to zoom out.ORAdjust Zoom on the control panel.

Zoom panning1. While in zoom mode, press and hold down the mouse

wheel and drag the mouse.ORPress and hold down SHIFT and press the ARROW keys.

Cropping

Free cropping1. Select Rendering.


2. Select Crop.Note: Pressing Crop will remove any previous Box cropping operations.

3. Rotate and translate the active cut-plane.All data above the cut-plane will be removed when applying crop.

4. Press Set to apply crop. All data up front of the active cut-plane is removed.

5. Repeat steps 3 and 4 to remove other parts of the volume.Note: press Undo to undo the cropping actions stepwise.Press Remove crop to undo all cropping actions in one operation.

6. Press Crop to exit the Free cropping tool.

Box cropping1. Select Rendering.


2. Select Box.A box frame is displayed with two adjustable sides (highlighted as red and blue), see Figure 1-25.

38

Note: Pressing Box will remove any previous Free cropping operations.

3. Use the Red and Blue controls to adjust the corresponding sides around the structure of interest.All data outside the box is removed.

4. Use the Box Sides control to select two other sides of the box.

5. Repeat steps 3 and 4 to adjust the selected sides of the box until the structure of interest is within the box.Note: Press Reset Box to undo all cropping actions in one operation.

6. Press Box to apply and exit Box cropping tool.

Figure 1-25: Box cropping

1. Default cropping box with two active sides (red and blue). The other sides can be selected for adjustment

2. Cropped volume (from upper and lower sides)

39

Working with 4D acquisitions - EchoPAC PC1. In the Search/Create patient window (Archive menu), select

a patient record with 4D acquisitions.The Examination List window is displayed.

2. Select the desired examination and open (double-click) a 4D acquisition from the clipboard.ORPress Image browser and open (double-click) the 4D acquisition in the Image browser screen.The Volume rendering mode screen is displayed (see Figure 1-20, page 32).

3. Rotate and translate the volume rendering to display the structure of interest (see page 36).

4. Optimize the volume rendering using 4D Gain, Smoothness, Shading controls.

5. If desired, double-click on the image area to display the volume rendering in a single screen.

6. If desired, zoom in the structure of interest (see page 37).7. If necessary, use the cropping tools to remove unwanted

structures (see page 37).8. If desired, press Cine rotate to rotate the volume rendering

back and forth. 9. Press Store to save the changes.

9 Slice9 Slice enables simultaneous display of nine short axis views generated from an Apical full volume acquisition.1. Select an Apical full volume acquisition.2. Press 9 Slice.

The 9 Slice screen is displayed showing nine short axis views. The slices are evenly distributed and maximized in size for best assessment.If required, zoom in. All slices are zoomed in simultaneously.

3. The following adjustments can be done:• Adjust Top and Bottom controls to change the slicing

area.• Adjust the Axis 1 and Axis 2 controls to rotate the slices

40

backward/forward and sideways, to align the slices with the anatomical structure.

4. Press Store to save.

41

4D LV Volume applicationThe 4D LV Volume function may be analyzed on the Vivid 7 system or EchoPAC PC workstation using the TomTec 4D LV-Volume application. The 4D LV-Volume application enables analysis of global and regional volume measurement from a Full volume tissue acquisition.

The 4D LV-Volume application is an option.

Measurements generated in the 4D LV-Volume application are saved to the worksheet. The measurements have a specific TomTec label.

In addition 4D tissue acquisitions can be stored on a removable media to a format compatible with the TomTec application using the “Save as” function on the Vivid 7 system or the EchoPAC PC workstation (File format: VolDicom (*.dcm)). Refer to the Vivid 7 or EchoPAC PC user manual for additional information on the “Save as” function.

Starting the 4D LV Volume application — Vivid 71. In a 4D Full volume tissue acquisition, press MEASURE.2. Select Volume and 4D LV Volume in the Measurement

menu.The 4D LV-Volume application is started.Refer to the TomTec 4D LV-Volume User manual for proper use of the application.

Starting the 4D LV Volume application — EchoPAC PC1. In a 4D Full volume tissue acquisition, select 4D LV

Volume on the control panel.The 4D LV-Volume application is started.Refer to the TomTec 4D LV-Volume User manual for proper use of the application.Note: the 4D LV Volume application can also be started from the Measurement menu as described for the Vivid 7 above, and from the Rendering and orientation panel (Figure 1-23).

42

Chapter 2 4D Color Flow Imaging

• Introduction ................................................................................... ..... 43• 4D Color Flow mode overview - Vivid 7 ...................................... ..... 44

• Color Flow Volume rendering mode screen ...............................44• Color Flow Slice mode screen ....................................................45• 4D Color Flow mode controls .....................................................46

• Using 4D Color Flow mode - Vivid 7 ........................................... ..... 53• Full volume Color Flow acquisition .............................................54• 6 Slice .........................................................................................56

• 4D Color Flow mode overview - EchoPAC PC ........................... ..... 59• Real time 4D Color flow acquisition ............................................53• Volume rendering mode screen ..................................................59• Slice mode screen ......................................................................60• 4D mode control panel ................................................................61

43

IntroductionThe 4D Color Flow Imaging mode enables real time volume rendering display with color flow data. 4D Color Flow imaging based on Full volume acquisition is available.

44

4D Color Flow mode overview - Vivid 7

Color Flow Volume rendering mode screen

Figure 2-1: 4D Color Flow screen (Volume rendering)

1. Volume rendering display with Color Flow2. 2D Color Flow image in the azimuth plane3. 2D Color Flow image in the elevation plane4. Orientation window: displays a three-dimensional model with cut-planes position and orientation.5. Soft menu controls (see page 50)6. Trackball functions (see page 51)

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Color Flow Slice mode screen

Figure 2-2: 4D Color Flow screen (Slice mode)

1. Cut-plane 1 (yellow)2. Cut-plane 2 (white)3. Cut-plane 3 (green)4. Trackball functions (see page 51)

46

4D Color Flow mode controlsBoth Tissue and Color flow mode controls are available. Press ACTIVE MODE to toggle between the two modes.

Figure 2-3: 4D Color Flow mode controls on the control panel

1. 4D key2. Multiplane key3. Assigned 4D rotaries: see next page.4. Assigned 4D keys: see next page.5. Zoom (see page 20)6. Layout (see page 19): toggles the display

between:• Multi screen with volume/slice• Single screen volume/slice

7. Soft menu (see page 50)

8. Trackball (see page 51)• Rotate/translate volume rendering or selected cut-plane (Slice mode)

• Scroll through the cineloop9. Clear: resets the orientation to default

positions. 10. Angle: predefined orientations optimized for

volume rendering.11. Color Gain12. 2D Gain13. Color key

Update /

MenuTrac

kBa

ll

Alt. Alt. Alt. Alt.

Width

4

3

13

47


Figure 2-4: Color Flow Volume rendering and Slice mode assigned controls

Color Flow Volume rendering assigned controls

1. Assigned rotaries• Scale• Baseline R• Volume sizeMORE menu• Translate R

2. Assigned keys• Slice R• Invert• Crop (in Freeze only) R• Box (in Freeze only) R• Cineloop (in Freeze only) R• 4D CF Prepare• Full Volume• Color map R• 6 Slice (in Full volume Freeze only) R (page 56)MORE menu• Up/Down R• Flip R• Orientation window R• Cine rotate (in Freeze only) R• Variance• 4D Colorize R

Color Flow Slice mode assigned controls

1. Assigned rotaries• Rotate R• Translate (in Freeze only) R

2. Assigned keys• Slice exit R• Reference plane R• Cineloop (in Freeze only) RMORE menu• Up/Down R• Orientation window R


48

4D Color Flow mode assigned controls

Scale

Adjusts the repetition rate of the Doppler pulses transmitted to acquire the data for color flow mapping. The Scale (Nyquist limit) should be adjusted so that no aliasing occurs, while still having good resolution of velocities. The Nyquist limit should be somewhat above the maximum velocity found in the data.

Baseline

Adjusts the color map to emphasize flow either toward or away from the probe.

Volume size

The volume size control enables the adjustment of the color ROI. ROI adjustment may affect volume rate and/or resolution.

Slice/Slice exit

Toggles the display between Volume rendering and Slice mode.

Invert

Enables the color scheme assigned to positive and negative velocities to be inverted.

Variance

Controls the amount of variance data added to a color display. Variance enables computer-aided detection of turbulent flow (e.g. jets or regurgitation).

4D Colorize


Adjusts the volume rendering color from a color map menu.

Reference plane


Toggles the cut-plane selection between cut-plane 1, 2 or 3.

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Crop (Free cropping)

See page 12.

Box (Box cropping)

See page 13.

4D CF Prepare and Full volume

Enables preparation and acquisition of a color flow full volume based on ECG triggered sub-volume acquisitions of color flow data. Depending on the adjustment, four or seven heart cycles are acquired. The 4D CF Prepare control enables the user to adjust the probe placement for optimized color flow acquisition from a bi-plane display before acquiring the Full volume with color flow data (see page 54).

Color maps

Displays a menu of color map options. Each color map is assigning different color hues to different velocities.

6 Slice

6 Slice enables simultaneous display of six evenly distributed short axis views and two long axis views (in the azimuth and elevation planes) generated from an Apical full volume color flow acquisition (see page 56).

Additional 4D mode assigned controlsThe following controls are available after pressing MORE.

Up/Down

Flips the volume 180 degrees.

Flip

Flips the view position.

Orientation window

Shows/hides the Orientation window.

50

Cine rotate

Rotates back and forth the volume rendering.

Soft menu controlsSoft menu controls are related to image quality adjustment. These controls are accessed using the 4-way rocker on the control panel. Only the 4D controls are described in this section, refer to the system user manual for general imaging controls.

Number of cycles


Controls the number of heart cycles the ECG triggered color flow full volume acquisition is based on. Select between four or seven heart cycles.

Low velocity reject

Enables the extent of low velocity removal to be adjusted.

Flow transparency

(Volume rendering, Replay only)

Adjusts the color flow data transparency level. Higher setting may provide a better visualization of flow turbulences.

Tissue transparency


Adjusts the transparency level of the tissue structure. Maximum setting makes the tissue information invisible, leaving only color flow data displayed.

Flow direction


Enables to show/hide positive and/or negative velocities.

Smoothness


51

Smooths color rendering. Smoothness affects continuity of color display and image noise.

Trackball controlsThe trackball has multiple functions. The trackball functions are organized in several functional groups as shown in the table below.

The function selected is displayed in the lower right corner of the screen.• Press SELECT to toggle between the trackball functions

within the active functional group. Groups with several functions are marked with a + symbol.

• Press TRACKBALL to toggle between the functional groups.

Display controls

Color key

Starts/stops the color mode. In 4D color freeze, pressing COLOR show/hide the color data.

Layout key on the front panel

This control is working the same way as in 4D Mode (see page 19).

Orientation controls group



Rotate Rotates the volume rendering/slice.

Translate Translates the volume rendering/slice.



Scroll Scrolls through a cineloop.

Speed Adjust cine replay speed

52

Active mode Gain

With Color flow mode activated: gain amplifies the overall strength of echoes processed in the Color Flow window

Zoom

See page 20.

53

Using 4D Color Flow mode - Vivid 7Color Flow can be enabled in 2D mode before entering 4D mode or when in 4D mode.

Real time 4D Color flow acquisition1. Select the 3V probe and cardiac application.2. Create an examination.3. Press 4D and COLOR.

The 4D Color Flow mode is started.4. Acquire a volume.5. Press FREEZE, 2D FREEZE and rotate the volume to check

the result.6. Press IMG. STORE.

CAUTION

Tissue structures may obscure relevant flow information. If required, increase TISSUE TRANSPARENCY setting.

Color flow data may obscure other relevant color flow information (e.g jet). If required adjust FLOW TRANSPARENCY setting.

In some settings the volume rate can be less than 10 volumes per second. This may lead to small display mismatch between the color and tissue data. This is because of the rapid movement of structures (e.g. valves) compared to the time lag between the tissue and the color volume acquisitions.

54

Full volume Color Flow acquisitionFull volume Color Flow acquisition is based on ECG triggered sub-volume acquisitions of color flow data. Depending on the adjustment, four or seven heart cycles are acquired.

Full volume Color Flow acquisition is done in two steps:• Step 1: positioning of the probe for optimal full volume

acquisition with color flow data. This is done from a Bi-plane screen displaying azimuth and elevation planes.

• Step 2: acquisition over seven heart beats.

1. Connect the ECG device and make sure to obtain a stable ECG trace.

2. Adjust Num. Cycles to either four or seven cycles.3. In 4D Color Flow mode, press 4D CF PREPARE.

A Bi-plane screen is displayed. Acquire an apical view.4. Adjust the probe position to display optimal color flow image

in both planes. You may:• adjust VOLUME SIZE to change the color ROI size.• change the position of the ROI using the trackball (POS).

5. Ask the patient to hold her/his breath at end expiration. Keep the probe steady and press FULL VOLUME. The Full volume acquisition is started. the tissue color volume are build up over four/seven heart cycles. Make sure to keep the probe steady during the entire acquisition.

CAUTION

ECG triggering acquisition may by nature contain artifacts. The triggering works by acquiring the whole tissue volume during the first heart beat, followed by a series of color sub-volumes that are stitched together (three or six). Consequently, the tissue volume is updated only each fourth or seventh heart beat, and only the color data may have stitching artifacts.



To validate the acquisition, perform a visual inspection in both the volume rendering and the elevation plane. Stitching artifacts are shown as visible transitions between the sub-volumes in the color flow data.

55

Press FREEZE.6. In Freeze, look for stitching artifacts in the color flow data in

both the volume rendering and the elevation plane in the lower left window of the screen.

7. Press 2D FREEZE, rotate the volume to check the result. Depending on the result, you may press 4D CF PREPARE and make a new acquisition.


56

6 SliceThe purpose of the 6 slice mode is to be able to measure the size of the minimal area of a regurgitant flow jet, typically through the mitral valves.

6 Slice enables simultaneous display of six short axis views generated from an Apical full volume Color Flow acquisition and two apical long axis views.

6 Slice is available only from a full volume color flow acquisition when in Freeze.1. Acquire an apical Full volume view (see page 54).2. Press FREEZE.3. Press 6 SLICE.

The 6 Slice screen is displayed (Figure 2-5). The six slices are evenly distributed and maximized in size for best assessment.

Figure 2-5: 6 Slice screen

If required, zoom in. All slices are zoomed in simultaneously.

1. Upper slice2. Lower slice

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4. The following adjustments can be done:• Adjust TOP and BOTTOM controls to change the slicing

area (Figure 2-6).

Figure 2-6: Slice distribution adjustment

• Adjust the AXIS 1 and AXIS 2 controls to rotate the slices backward/forward and sideways (Figure 2-7), to align the slices with the anatomical structure.

1. Top: upper slice adjustment2. Bottom: lower slice adjustment

58

Figure 2-7: Slice rotation adjustment

• Adjust ROTATE to rotate all six slices around the center axis.

• Adjust TRANSLATE to move all six slices up or down.5. Press IMG. STORE to save.6. Press 6 SLICE EXIT.

1. Axis 1: slice rotation backward/forward2. Axis 2: slice rotation sideways

59

4D Color Flow mode overview - EchoPAC PC4D Color Flow mode acquisitions from Vivid 7 can be opened and post processed on the EchoPAC PC workstation. The controls are the same as in the Vivid 7 (see page 48). The procedures related to the 4D Color Flow mode are similar to the 4D mode (see page 32).

Volume rendering mode screen

Figure 2-8: 4D Color Flow screen (Volume rendering)

1. Volume rendering display with Color Flow2. Cut-plane 2 (white): 2D image in the azimuth plane3. Cut-plane 3 (green): 2D image in the elevation plane4. Orientation window: displays a three-dimensional model with cut-planes position and orientation.5. 4D control panel (Color Flow Volume rendering mode)

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Slice mode screen

Figure 2-9: 4D Color Flow screen (Slice mode)

1. Cut-plane 1 (yellow)2. Cut-plane 2 (white)3. Cut-plane 3 (green)4. Orientation window: displays a three-dimensional model with cut-planes position.5. 4D control panel (Color Flow Slice mode)

61

4D mode control panel

Figure 2-10: 4D Color Flow Control panel

Refer to ’4D Color Flow mode assigned controls’ on page 48 for information on the 4D Color Flow related controls. All other general imaging controls are described in the workstation User manual.

62

Figure 2-11: Rendering and orientation panels

Rendering controls

In volume rendering, select Rendering to display the rendering controls.

63

Chapter 3 Multi-plane imaging

• Introduction ................................................................................... ..... 64• Multi-plane mode overview - Vivid 7 ........................................... ..... 65

• Bi-plane mode screen .................................................................65• Tri-plane mode screen ................................................................66• Multi-plane mode controls ...........................................................67

• Using Multi-plane mode imaging - Vivid 7 .................................. ..... 75• Scan plane rotation .....................................................................76• Tilting scan plane 2 .....................................................................76• Zooming ......................................................................................77

• Multi-plane mode overview - EchoPAC PC ................................ ..... 80• Bi-plane mode screen .................................................................80• Tri-plane mode screen ................................................................81• The multi-plane control panel .....................................................82

• Working with multi-plane acquisitions - EchoPAC PC ............. ..... 83

64

IntroductionMulti-plane mode displays two (Bi-plane) or three (Tri-plane) rotated cross sections acquired simultaneously. This mode enables the investigation of anatomical structures from different angles.

Multi-plane mode enables the creation of a left ventricular volume reconstruction based on contours drawn from three cross sections at both end-systole and end-diastole with calculation of end-systolic and end-diastolic volumes and ejection fraction (see Chapter 4, ’Measurements and Analysis’ on page 84).

Combined to specially designed Stress echo protocols, the Multi-plane mode enables faster stress examination as two projections can be acquired simultaneously (see Chapter 5, ’Multi-plane Stress Echo’ on page 97).

Multi-plane mode is available from B-Mode, Color flow mode and TVI related modes.

65

Multi-plane mode overview - Vivid 7

Bi-plane mode screen

Figure 3-1: The Bi-plane imaging mode screen

1. Scan plane 1 (yellow): default reference scan plane. This scan plane is fixed, cannot be tilted or rotated.

2. Scan plane 2 (white): this scan plane is by default perpendicular to scan plane 1 along the scanning axis. This scan plane can be either tilted or rotated.

3. Geometric model: displays both scan planes in a projection and the rotation angle (A1) and tilt angle (T) values for the scan plane 2 relative to the scan plane 1.

4. Scan plane marker for scan plane 2: crossing line of scan plane 2 in scan plane 1.5. Trackball functions (see page 71)

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Tri-plane mode screen

Figure 3-2: The Tri-plane imaging mode screen

1. Scan plane 1 (yellow): default reference scan plane. This scan plane is fixed, cannot be rotated.2. Scan plane 2 (white): this scan plane can be rotated using the trackball.3. Scan plane 3 (green): this scan plane can be rotated using the trackball.4. Geometric model: displays all the scan planes in a projection.5. Navigator: displays rotation angle values for the scan planes 2 (A1) and 3 (A2) relative to the scan

plane 1.6. Trackball functions (see page 71)

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Multi-plane mode controls

Figure 3-3: The Multi-plane controls on the control panel

1. Multi-plane key2. Mode specific assigned rotaries: see next

pages.3. Mode specific assigned keys: see next pages.4. Zoom5. Trackball

• Tilt scan plane 2 (Bi-plane mode only).• Rotate scan plane 2 and 3• Zoom adjustment.• Scroll through the cineloop.

6. Clear: resets the rotation and/or tilt angle of scan plane 2 and 3.

7. Angle: in Bi-plane mode, rotates scan plane 2 to a pre-defined angle relatively to scan plane 1.

Alt. Alt. Alt. Alt.

Width

2

3

4

68


Figure 3-4: Multi-plane B mode and CF modes assigned controls

¨Multi-plane B mode assigned controls

1. Assigned rotaries• Angle 1 (Tri-plane)• Angle 2 (Tri-plane)• Width (Bi-plane)• Frequency (Bi-plane)• Focus position• Frame rateALT menu• Angle 1 (Bi-plane)• Width (Tri-plane)• Frequency (Tri-plane)

2. Assigned keys• Up/Down R• Reference Plane R• Tri-plane• Cineloop (in Freeze only) R• B Color maps RALT menu• Curved Anatomical M Mode R• Q Analysis (in Freeze only)• Anatomical M Mode• Tissue Tracking• Strain rate• StrainALT + MORE menu• TSI

Multi-plane Color flow mode assigned controls

1. Assigned rotaries• 2D Width• Scale• Baseline R• Frame rateMORE menu• Angle 1• Angle 2 (Tri-plane)

2. Assigned keys• Invert R• Variance R• Reference Plane R• Tri-plane• Cineloop (in Freeze only) R• Color map RMORE menu• Up/Down RALT menu• Same as Multi-plane B modeALT + MORE menu• Same as Multi-plane B mode


69

Figure 3-5: Multi-plane TVI and TT modes assigned controls

Multi-plane TVI mode assigned controls

1. Assigned rotaries• 2D Width• Scale• Baseline R• Frame rateMORE menu• Angle 1• Angle 2 (Tri-plane)

2. Assigned keys• Invert R• TSI R• Reference Plane R• Tri-plane• Cineloop (in Freeze only) R• TVI visible RALT menu• Curved Anatomical M Mode R• Q Analysis (in Freeze only)• Anatomical M Mode• Tissue Tracking• Strain rate• StrainALT + MORE menu• TSI

Multi-plane Tissue Tracking mode assigned controls

1. Assigned rotaries• 2D Width• Track scale R• Track end R• Frame rateMORE menu• Angle 1• Angle 2 (Tri-plane)

2. Assigned keys• Invert R• TSI R• Reference Plane R• Tri-plane• Cineloop (in Freeze only) R• Color maps RALT menu• Same as Multi-plane TVI


70Figure 3-6: Multi-plane SI, SRI and TSI modes assigned controls

Multi-plane Strain imaging mode assigned controls

1. Assigned rotaries• 2D Width• Strain scale R• Strain end R• Frame rateMORE menu• Angle 1• Angle 2 (Tri-plane)

2. Assigned keys• Invert R• TSI R• Reference Plane R• Tri-plane• Cineloop (in Freeze only) R• Color maps RALT menu• Curved Anatomical M Mode• Q Analysis (in Freeze only)• Anatomical M Mode• Tissue Tracking• Strain rate• StrainALT + MORE menu• TSI

Multi-plane Strain rate imaging mode assigned controls

1. Assigned rotaries• 2D Width• SRI scale R• Frame rateMORE menu• Same as Multi-plane Strain imaging

2. Assigned keys• Same as Multi-plane Strain imaging

Multi-plane Tissue Synchronization Imaging mode assigned controls

1. Assigned rotaries• 2D Width• Frame rateMORE menu• TSI start• TSI end

2. Assigned keys• TSI R• Reference Plane R• Tri-plane• Cineloop (in Freeze only)• Color maps RALT menu• Same as Multi-plane Strain imaging


71

Multi-plane mode assigned controls

This section describes only the Multi-plane mode controls. The scanning mode controls are described in the system User manual.

Tri-plane(All modes, Live)

Toggles between Bi-plane and Tri-plane mode.

Reference Plane(All modes, Live and Replay)

In Tri-plane mode, toggles the reference plane between scan plane 1, 2 or 3.

The reference plane may also be selected using the trackball when the Pointer trackball tool selected (see below).

Trackball controls

The trackball has multiple functions depending on the scanner’s state (Live/Freeze, zoom/unzoom, Bi-plane/Tri-plane mode and selected scanning mode). The trackball functions are organized in several functional groups as shown in the table below. The function selected is highlighted in the lower right corner of the screen. • Press SELECT to toggle between the trackball functions

within the active functional group.• Press TRACKBALL to toggle between the functional groups.

Scan planes rotation controls group

Function State Description


Pos Bi-plane, Live, Unzoom Tilts the scan plane 2 (white) around the top of the sector.

Angle 1 Bi-plane/Tri-plane, Live, Unzoom

Adjusts the angle between the scan planes 2 (white) and scan plane 1 (yellow). Scan plane 2 is rotated around the crossing line between the scan planes. Scan plane 1 is fixed.

72

Angle 2 Tri-plane, Live, Unzoom Adjusts the angle between the scan planes 3 (green) and scan plane 1 (yellow). Scan plane 1 is fixed.

Scan plane selection


Pointer All states Selects the reference scan plane.

Zoom mode controls group



Pos Zoom, Live/Freeze Moves the zoom area.

Size Zoom, Live/Freeze, 2D Resizes the zoom area.

Color/TVI modes ROI controls group



Pos CFM, TVI modes, Live/Freeze, Zoom/Unzoom

Moves the color sector.In Bi-plane CFM mode, if scan plane 1 (yellow) is selected as reference scan plane, both color sectors are moved. If scan plane 2 (white) is selected as reference scan plane its color sector is moved independently. In Tri-plane CFM mode, all sectors are moved at the same time.

Size CFM, TVI modes, Live/Freeze, Zoom/Unzoom

Resizes the color sector.All sectors are resized at the same time

Scan planes rotation controls group


73

Display controls

Layout key• In Bi-plane mode, toggles the display between the default

Bi-plane dual screen and a single screen showing the selected scan plane.

• In Tri-plane mode, toggles the display between the default Tri-plane quad screen, a quad screen with enlarged Geometric model and a single screen showing the selected scan plane.

Figure 3-7: Multi-plane mode display options



Scroll Freeze, Zoom/Unzoom Scrolls through a cineloop.

1. Display options for Bi-plane mode2. Display options for Tri-plane mode

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ZoomDisplay zoom

Activated and adjusted by rotating the ZOOM rotary ( ). An orientation preview showing the outlined magnified area is displayed in the upper right corner of the screen. The position and size of the magnified area are adjusted with the trackball when in B mode (see page 77).

High Resolution (HR) zoomHR zoom concentrates the image processing to a magnified user selectable portion of the image, resulting in an improved image quality in the selected image portion.

HR zoom is activated and adjusted by pressing and rotating the zoom rotary ( ). An orientation preview showing the outlined magnified area is displayed in the upper right corner of the screen. The position and size of the magnified area are adjusted with the trackball.

Other controls

Clear keyResets all scan planes to the default position.

Angle keyIn Bi-plane mode, toggles the position of scan plane 2 between the default position and a pre-defined angle relatively to scan plane 1.

75

Using Multi-plane mode imaging - Vivid 71. Select the 3V probe.2. Create an examination.3. Press MP on the control panel.

The Bi-plane B mode screen is displayed.4. Press TRI-PLANE to select between bi-plane or tri-plane

acquisition.5. Adjust the angle increment between scan planes as

described below.6. If in Bi-plane mode, adjust the scan plane 2 tilt angle as

described below.7. To activate another scanning mode:

• Press COLOR to activate CF mode.• Press TVI to activate TVI mode.• In TVI mode, press TSI to activate TSI mode.• Press ALT and either TISSUE TRACKING, STRAIN or STRAIN

RATE to activate the corresponding mode in Multi-plane imaging.

8. Zoom in the structure of interest (see page 77).Note: scan plane rotation or tilting cannot be done when in zoom mode.

9. Press IMG. STORE to save the acquisition.

76

Scan plane rotationThe angle increment of scan plane 2 or 3 relative to the scan plane 1 (fixed) can be adjusted with the trackball. The rotation is done around the crossing line between the scan planes. Scan plane rotation is available only in Unzoom live mode.1. Press SELECT until the desired trackball function is

selected:• Angle 1: rotation of scan plane 2 (white)• Angle 2: rotation of scan plane 3 (green, Tri-plane)

2. Use the trackball to rotate the corresponding scan plane around the probe center axis.

Figure 3-8: Rotation of Scan plane 2 (Bi-plane mode)

3. To reset the scan planes to the original default position, press CLEAR.

Tilting scan plane 2In Bi-plane mode, the scan plane 2 can be tilted around the top of the scanning sector using the trackball. Tilting is available only in Unzoom live mode.1. In Bi-plane mode, press SELECT until the trackball function

Pos is selected.2. Use the trackball to tilt the scan plane 2.

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Figure 3-9: Tilting of scan plane 2 (Bi-plane mode)

3. To reset the scan planes to the original default position, press CLEAR.

Zooming

Activating the zoom1. Rotate the ZOOM knob clockwise on the control panel.

All scan plane images are zoomed in. A Navigation window is displayed with a frame highlighting the zoomed area (see Figure 3-10).

78

Figure 3-10: Zoom mode screen (Tri-plane mode)

Adjusting the zoomed area

The zoomed are can be moved within the sector or resized.1. In zoom mode, press SELECT to toggle the trackball function

to Pos and use the trackball to freely move the zoomed area within the scan plane.

2. Press SELECT to toggle the trackball function to Size and use the trackball to adjust the size of the zoomed area (B mode only).

1. Magnified scan planes2. Navigation window in Zoom mode3. Zoomed area

79

Note: If the trackball function Ptr (mouse pointer) or Scroll (when in Freeze) is selected, press TRACKBALL until the trackball functions Pos or Size is selected.

80

Multi-plane mode overview - EchoPAC PCMulti-plane acquisitions from Vivid 7 can be opened and post processed on the EchoPAC PC workstation. This section describes the controls and procedures related to Multi-plane mode on the workstation. Refer to the EchoPAC PC User manual about general use of the workstation.

Bi-plane mode screen

Figure 3-11: The Bi-plane mode screen

1. Scan plane 1 (yellow): default reference scan plane.2. Scan plane 2 (white): the tilt or rotation angle is set during acquisition.3. Geometric model: displays both scan planes in a projection and the rotation angle (A1) and tilt angle

(T) values for the scan plane 2 relative to the scan plane 1.4. Scan plane marker for scan plane 2: crossing line of scan plane 2 in scan plane 1.5. Multi-plane control panel

81

Tri-plane mode screen

Figure 3-12: The Tri-plane mode screen

1. Scan plane 1 (yellow): default reference scan plane.2. Scan plane 2 (white): the rotation angle is set during acquisition.3. Scan plane 3 (green): the rotation angle is set during acquisition.4. Geometric model: displays all three scan planes in a projection and/or reconstructed volume.5. Navigator: displays rotation angle values for the scan planes 2 (A1) and 3 (A2) relative to the scan

plane 1.6. Multi-plane control panel

82

The multi-plane control panel

Figure 3-13: The Multi-plane Control panel

The controls in multi-plane mode are similar to the controls for the associated scanning mode (B mode, Color or TVI related modes). Refer to the workstation User manual for additional informations on these controls.

83

Working with multi-plane acquisitions - EchoPAC PC

1. In the Search/Create patient window (Archive menu), select a patient record with multi-plane acquisitions.The Examination List window is displayed.

2. Select the desired examination and open (double-click) a multi-plane acquisition from the clipboard.ORPress Image browser and open (double-click) the multi-plane acquisition in the Image browser screen.The Multi-plane mode screen (bi-plane or tri-plane) is displayed.

3. Perform image optimization and measurements.4. Press Store to save the changes.

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Chapter 4 Measurements and Analysis

• Introduction ................................................................................... ..... 85• Left ventricular volume measurements ...................................... ..... 86

• Tri-plane acquisition ....................................................................86• Full volume acquisition ...............................................................89• Rotation of the Volume reconstruction ........................................90• Bi-plane acquisition .....................................................................91

• TSI surface model ......................................................................... ..... 93• Quantitative analysis .................................................................... ..... 95

• Starting Quantitative analysis from a multi-plane acquisition ......95

85

IntroductionAll cardiac measurements available in 2D are also available in 4D (when in Slice mode) and Multi-plane modes. In addition, the 4D and Multi-plane modes enable the creation of a left ventricular volume reconstruction based on contours drawn from three cross-sections at both end-systole and end-diastole with calculation of the end-systolic and end-diastolic volumes and the ejection fraction.

Left ventricular volume measurement may also be performed in Bi-plane mode based on contours drawn at both end-systole and end-diastole.

Refer to the scanner’s or the workstation’s User Manual for more information about 2D measurements.

From the TSI Tri-plane mode the user can create a TSI surface model of the left ventricle.

All these features are available on both Vivid 7 and EchoPAC PC.

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Left ventricular volume measurements

Tri-plane acquisitionThis procedure describes the calculation and reconstruction of the left ventricular volume from a Tri-plane acquisition.1. In Tri-plane mode, acquire an Apical 4 chamber view in

scan plane 1 (yellow).2. Rotate scan plane 2 and 3 to display an Apical 2 chamber

view in scan plane 2 (white) and an Apical long axis view in scan plane 3 (green).

3. Press FREEZE.4. Press MEASURE.

The Measurement menu is displayed.5. In the Measurement menu select Volume and Tri-plane.

The Measurement screen is displayed with the Ejection fraction tool selected (see Figure 4-1).The end diastolic frame of the current cardiac cycle is displayed and the cursor is moved to the reference scan plane.

87

Figure 4-1: The Tri-plane measurement screen

6. If desired, press LAYOUT twice to display the reference scan plane in a single screen.

7. Place the cursor to the start point for the trace.8. Press SELECT and draw a contour of the left ventricle.

To edit the contour while drawing:• Follow the contour backward to erase it and redraw.• Press UNDO or BACKSPACE to erase the contour

stepwise and redraw.• Press DELETE to remove the entire contour and redraw.

9. Press SELECT to complete the contour.The cursor is automatically moved to the next scan plane.The crossing point of the trace done in the first scan plane is marked in the second scan plane.

1. Ejection fraction tool for Tri-plane2. Scan plane 1 (yellow): Apical 4 chamber view3. Scan plane 2 (white): Apical 2 chamber view4. Scan plane 3 (green): Apical long axis view5. Volume reconstruction

88

10. Draw a contour of the left ventricle in scan plane 2 and 3 following the same procedure.When the last end-diastolic contour is drawn, an end-systolic frame is automatically displayed. The system automatically enters scroll mode. Using the trackball, ensure that the correct end-systolic frame is displayed.Press SELECT to leave scroll mode.

11. Repeat steps 7 to 10 to draw a contour of the left ventricle at end-systole in all the scan planes.The measurement results, including end-diastolic and end-systolic volumes and the left ventricular ejection fraction, are displayed in the Measurement result table.Note: Other measurements may be displayed by configuring the Measurement menu, refer to the scanner’s or workstation’s User manual for more information about Measurement menu configuration.

12. If in single screen mode, press LAYOUT to display the Volume reconstruction of the left ventricle in the Geometric model.

13. Press LAYOUT again to display an enlarged Geometric model.The Volume reconstruction can be rotated in all directions (see page 90).

89

Full volume acquisitionThis procedure describes the calculation and reconstruction of the left ventricular volume from a Full volume acquisition.

1. Using the Full volume acquisition mode (see page 23), acquire a 4D Apical 4 chamber image.

2. Press FREEZE.3. Orientate the reference cut-plane to display an Apical

4 chamber (see ’Rotating/Translating the 4D image’ on page 25).

4. Press MEASURE.The Measurement menu is displayed.

5. In the Measurement menu select Volume and Tri-plane.The Measurement screen is displayed with the Ejection fraction tool selected.

6. Follow the procedure described in ’Tri-plane acquisition’ on page 86from step 6.

CAUTION

ECG triggering acquisition may by nature contain artifacts, that may have impact on the measurements.



See recommendations on page 23 to avoid stitching artifacts during full volume acquisition.

It is recommended to specify in the Comments for the examination that the measurements are performed in a Full volume acquisition.

90

Rotation of the Volume reconstructionThe volume reconstruction displayed in the Geometric model can be rotated in any directions.1. Place the pointer in the Geometric model.2. Press and hold down SELECT and use the trackball to rotate

the volume reconstruction.

91

Bi-plane acquisitionThis procedure describes the calculations of the left ventricular volume from a Bi-plane acquisition. The volume calculation is based on the Method of disk.1. In Bi-plane mode, acquire an Apical 4 chamber view in scan

plane 1(yellow).2. If required, rotate scan plane 2 to display an Apical

2 chamber view.3. Press FREEZE.4. Using the trackball, scroll through the cineloop to display

the end-diastolic frame.5. Press MEASURE.

The Measurement menu is displayed.6. In the Measurement menu select Volume and Bi-plane.

The Trace tool for the Left ventricular end-diastolic volume for the Apical 4 chamber view is selected (see Figure 4-2).

Figure 4-2: The Volume measurement screen (Bi-plane)

7. In scan plane 1 (yellow), place the cursor to the start point for the trace.

1. Trace tools

92

8. Press SELECT and draw a contour of the left ventricle.9. Move the cursor to the apex and press SELECT to measure

the length.The trace tool for the Left ventricular end-diastolic volume for the Apical 2 chamber view is selected.

10. Repeat steps 8 and 9 in the scan plane 2 (measurement in the Apical 2 chamber view). The trace tool for the Left ventricular end-systolic volume for the Apical 4 chamber view is selected.

11. Using the trackball, scroll through the cineloop to display the end-systolic frame in the same heart cycle.

12. Press TRACKBALL to activate the M&A tool.13. Repeat steps 7 to 10 to perform the end-systolic

measurements in the Apical 4 chamber and 2 chamber views.The Ejection fraction (Bi-plane) and the end-diastolic and end-systolic left ventricular volumes are calculated.

93

TSI surface modelA Surface model representation of the left ventricle with TSI color coding can be generated from a TSI Tri-plane acquisition by applying a sampling path in the myocardium. The sampling path is created by placing control points in the myocardium.1. In Tri-plane TSI mode, acquire an Apical 4 chamber view in

scan plane 1 (yellow).2. Rotate scan plane 2 and 3 to display an Apical 2 chamber

view in scan plane 2 (white) and an Apical long axis view in scan plane 3 (green).

3. Press FREEZE.4. Press MEASURE.

The Measurement menu is displayed.5. In the Measurement menu select TSI surface.

The Mapping tool is selected (see Figure 4-3).

Figure 4-3: The Measurement screen (Geometry model)

1. Mapping tool for Geometry model2. TSI surface model

94

6. In scan plane 1 (yellow), place the cursor to the start point for the sampling path starting in the myocardium.

7. Move the cursor following the myocardium and press SELECT to place new points.By creating several control points the sampling path can be bent to follow the myocardium.

8. Press SELECT twice to end the sampling path.9. Create a sampling path in scan plane 2 and 3.

A TSI color coded surface model is displayed in the Geometric model.

10. To create a dynamic model, scroll to another frame in the same heart cycle and create a sampling path in each scan plane.

11. Press 2D FREEZE to run the model.

To edit the sampling path1. Place the cursor over a control point.2. Press SELECT twice (double-click) and move the control

point to a new position using the trackball.3. Press SELECT to place the control point to its new position.

95

Quantitative analysisMulti-plane acquisitions (all modes) can be further analyzed in the Quantitative analysis software package. Refer to the scanner’s or the workstation’s User manual for additional information on Quantitative analysis.

This section describes how to launch the Quantitative analysis software package from the Multi-plane mode and the features that are specific to multi-plane acquisitions.

Starting Quantitative analysis from a multi-plane acquisition1. From a Multi-plane (Bi-plane or Tri-plane) acquisition, press

FREEZE.2. Press ALT and press the assigned key Q ANALYSIS.

The Quantitative analysis screen is displayed showing the selected scan plane and the Geometric model.

3. To change scan plane, press Reference Image.

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Figure 4-4: The Quantitative analysis screen

1. Selected scan plane2. Geometric model

97

Chapter 5 Multi-plane Stress Echo

• Introduction ................................................................................... ..... 98• Creating a Multi-plane stress test template ............................... ..... 99

• Launching the Template editor .................................................100• Stress Template setup ..............................................................100

• Stress test acquisition ................................................................. ... 102• Baseline acquisitions ................................................................102• Low dose and Peak dose level acquisitions .............................105

• Image analysis .............................................................................. ... 108

98

IntroductionThe Multi-plane mode can be used with specially designed stress templates (factory or user-defined) that enables simultaneous acquisition of several projection planes into each cell in the template.

Two factory multi-plane stress templates are available:• Pharm. 4x2 Multiplane: consists of:

• Four levels: Baseline, Low dose, Peak dose and Recovery

• Two columns:- A Tri-plane mode column with simultaneous acquisition of Apical 4 chamber, Apical 2 chamber and Apical long axis views.- A Bi-plane mode column with simultaneous acquisition of Parasternal long axis and Parasternal short axis views.

• Pharm. 4x3 Biplane: consists of:• Four levels: Baseline, Low dose, Peak dose and

Recovery• Three columns:

- A Bi-plane mode column with simultaneous acquisition of Apical 4 chamber, and Apical 2 chamber views.- A Bi-plane mode column with simultaneous acquisition of Apical 4 chamber and Apical long axis views.- A Bi-plane mode column with simultaneous acquisition of Parasternal long axis and Parasternal short axis views.

Note: this template acquires the 5 standard projections using only biplane acquisition, this results in higher resolution / framerate than using triplane. The probe is fixed on the 4 chamber projection when acquiring both apical biplane recordings (only the second plane is changing).

The following section describes:• The basic procedure to create a Multi-plane

pharmacological stress template• The Multi-plane stress acquisition based on the Multi-plane

pharmacological stress template

99

• The Multi-plane stress analysis

Note: Not all Stress Echo features are described in the following example, refer to the system User manual for additional information on Stress Echo.

Creating a Multi-plane stress test templateThe following example describes the creation of a pharmacological protocol template consisting of:• Three levels:

• Baseline• Low dose• Peak dose

• Two columns:• A Tri-plane mode column with simultaneous acquisition

of Apical 4 chamber, Apical 2 chamber and Apical long axis views.

• A Bi-plane mode column with simultaneous acquisition of Parasternal long axis and Parasternal short axis views.

100

Launching the Template editor1. Press PROTOCOL.2. Select Template.

The Template pop-up menu is displayed.3. Select Template editor.

The Template editor screen is displayed.

Figure 5-1: The Template editor screen

Stress Template setup1. In the Grid size field, adjust the Number of levels to three

and the Number of projection views (columns) to two.2. From the Label drop-down menu of the first column select

the label Tri Ap 4 2 LAX.With this setting the system will automatically launch the Tri-plane mode enabling simultaneous acquisition of Apical 4 chamber, 2 chamber and Long axis views in all levels in the first column.

101

3. From the Label drop-down menu of the second column select the label Bi PLAX PSAX.With this setting the system will automatically launch the Bi-plane mode enabling simultaneous acquisition of Parasternal long axis and short axis views in all levels in the second column.

4. Enter the labels for the three levels.5. Make sure that Smart stress is checked. This will ensure

that all acquisition settings defined at Baseline will be preserved in the next levels, including rotation and tilt angle settings.

6. Delete any existing predefined groups (in case the template is based on an existing template with groups already defined).

7. Select all the views from the first column and select New group.The Group name window is displayed.Note: You should not mix bi-plane and tri-plane recordings in the same analysis group.

8. Give the group a name (e.g. Apical) and press OK.9. Likewise create a group for all the views from the second

column (e.g. Parasternal).10. All other settings should be as shown in Figure 5-1.

Refer to the system User manual for additional information on stress template creation.

11. Select Save as template and give the template a name (e.g Pharm. 3x2 Multiplane).

12. Select OK in the Template editor screen.The new template is selected and the Protocol screen is displayed.

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Stress test acquisition

Baseline acquisitions

Figure 5-2: The Baseline acquisition screen (Apical acquisition)

1. When in the Protocol screen with the Multi-plane stress template selected, press Begin/Cont to start the stress test acquisition.

2. The first Baseline view acquisition screen displays a Tri-plane mode. The positions of the scan planes are set so

1. Scan plane 1 (yellow): acquire an Apical 4 chamber view.2. Scan plane 2 (white): an Apical 2 chamber view is displayed.3. Scan plane 3 (green): an Apical long axis view is displayed.4. Active cell

103

that the acquisition of an Apical 4 chamber view in scan plane 1(yellow) displays an Apical 2 chamber in scan plane 2 (white) and an Apical long axis in scanplane 3 (green).If required, fine tune the angle of scan plane 2 and 3 to get optimal views in these scan planes and adjust the image quality.

3. Press IMAGE STORE.This template is set to preview cineloop before storing, use the cineloop controls to select and adjust the most appropriate heart cycle. Press IMAGE STORE or SELECT to save the cineloop.

4. The second Baseline view acquisition screen displays a Bi-plane mode. The acquisition of a Parasternal long axis view in scan plane 1 (yellow) displays a Parasternal short axis in scan plane 2 (white).If required, fine tune the position of scan plane 2 to display a mid short axis view (on level with papillary muscles) and adjust the image quality.

104

Figure 5-3: The Baseline acquisition screen (Parasternal acquisition)

5. Press IMAGE STORE.Select and adjust the most appropriate heart cycle. Press IMAGE STORE or SELECT to save the cineloop.The acquisition screen for the first Low dose level view is displayed.

1. Scan plane 1 (yellow): acquire a Parasternal long axis view.2. Scan plane 2 (white): a Parasternal short axis view is displayed.3. Active cell

105

Low dose and Peak dose level acquisitions

Figure 5-4: The Low dose acquisition screen (Apical acquisition)

1. When Show reference is enabled in the template, the corresponding Baseline view is displayed on the left side of the screen during Low dose and Peak dose acquisitions.Acquire an Apical 4 chamber view in scan plane 1. The angle and image adjustments done during Baseline

1. Scan plane 1 (yellow): acquire an Apical 4 chamber view.2. Scan plane 2 (white): an Apical 2 chamber view is displayed.3. Scan plane 3 (green): an Apical long axis view is displayed.4. Active cell5. Baseline acquisition corresponding to the current acquisition.

106

acquisition are automatically set for this acquisition (Smart stress enabled).

2. Press IMAGE STORE.Select and adjust the most appropriate heart cycle. Press IMAGE STORE or SELECT to save the cineloop.The second Low dose level acquisition view (Bi-plane mode) is displayed with the corresponding Baseline acquisition.

Figure 5-5: The Low dose acquisition screen (Parasternal acquisition)

1. Scan plane 1 (yellow): acquire a Parasternal long axis view.2. Scan plane 2 (white): a Parasternal short axis view is displayed.3. Active cell4. Baseline acquisition corresponding to the current acquisition.

107

3. Acquire a Parasternal long axis view in scan plane 1. The position/angle and image adjustments done during Baseline acquisition are automatically set for this acquisition.

4. Press IMAGE STORE.Select and adjust the most appropriate heart cycle. Press IMAGE STORE or SELECT to save the cineloop.The acquisition screen for the first Peak dose level acquisition view (Tri-plane mode) and corresponding base line acquisition are displayed.

5. Repeat step 1 to 4 to acquire Peak dose view.6. The Stress template is set to start analysis automatically.

When the last acquisition is stored a dialogue window is displayed asking the user to start analysis. Select Yes to start the protocol analysis.

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Image analysisThis section describes the basic procedure for image analysis for the current example. Refer to the system User manual for additional information on stress echo image analysis.

Figure 5-6: The Stress echo analysis screen (Apical group, 4 chamber acquisition)

1. When starting analysis, the Stress echo analysis screen is displayed, showing the first scan plane from the images in the first group (Apical 4 chamber for all three levels, acquired in scan plane 1 (yellow) in Tri-plane mode) and the corresponding wall segment diagrams.

2. Perform segment scoring.

1. Scan plane 1 (yellow): Apical 4 chamber, Baseline2. Scan plane 1 (yellow): Apical 4 chamber, Low dose3. Scan plane 1 (yellow): Apical 4 chamber, Peak dose4. Corresponding Wall segment diagrams5. Previous next images/group

109

3. Select the Right arrow in the lower right corner of the screen to display the next scan planes from the images in the first group (Apical 2 chamber for all three levels, acquired in scan plane 2 (white) in Tri-plane mode).

4. Perform segment scoring.5. Select the Right arrow in the lower right corner of the

screen to display the next scan planes from the images in the first group (Apical long axis for all three levels, acquired in scan plane 3 (green) in Tri-plane mode).


screen to display the first scan plane from the images in the second group (Parasternal long axis for all three levels, acquired in scan plane 1 (yellow) in Bi-plane mode).


screen to display the next scan planes from the images in the second group (Parasternal short axis for all three levels, acquired in scan plane 2 (white) in Bi-plane mode).

10. Press NEW EXAM or ARCHIVE and select END EXAM.The examination is stored.

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Index

Numerics4D

Controls ..............................................................................................................................9, 46Overview ............................................................................................................................7, 44Using 4D mode ....................................................................................................................21

4D Color Flow ...........................................................................................................................424D LV-Volume application ..................................................................................................41

CCrop .........................................................................................................................................12, 49Cropping

Using Cropping (EchoPAC PC)......................................................................................37Using Cropping (vivid 7)....................................................................................................26

FFull volume ...............................................................................................................13, 23, 49, 54

MMeasurements

Left ventricular volume ......................................................................................................86TSI surface model...............................................................................................................93

Multiplane modeControls ..................................................................................................................................67Overview ................................................................................................................................65Using .......................................................................................................................................75

RReference plane.................................................................................................................12, 48Rotate............................................................................................................................................25

SShading

4D image................................................................................................................................16Smoothness

4D image................................................................................................................................16

111

Stereo vision..............................................................................................................................14Stress Echo................................................................................................................................97

Acquisition ...........................................................................................................................102Analysis ................................................................................................................................108Creating a template ............................................................................................................99

TTilt

4D image................................................................................................................................16Translate......................................................................................................................................25

XYZZoom

4D imaging ............................................................................................................................20Multiplane mode ..................................................................................................................74


Vivid 7 Dimension/Vivid 7 PROVersion 7.x.x

Reference ManualVolume 2

GEVU #: FD092077GEVU Rev. 01Operating Documentation

Copyright 2007 By General Electric Co.

0470


GE Medical Systems. All rights reserved. No part of this manual may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of GE Medical Systems.


Table of Contents

Table of Contents

Chapter 1Measurements

Measurement overview..................................................................2Cardiac measurements .........................................................2

Measurement formulas................................................................15Formulas–Generic...............................................................15Formulas–Cardiac ...............................................................17Formulas–Vascular .............................................................58Formulas–OB ......................................................................60

Measurement accuracy ...............................................................69General................................................................................69Sources of error...................................................................69Optimizing Measurement Accuracy.....................................71

Chapter 2OB Tables

ASUM.............................................................................................74Berkowitz ......................................................................................75Brenner .........................................................................................76Campbell .......................................................................................76Eriksen ..........................................................................................77Goldstein.......................................................................................78Hadlock .........................................................................................79Hansmann.....................................................................................86Hellman .........................................................................................95Hill..................................................................................................95Hohler............................................................................................96Jeanty............................................................................................96JSUM ...........................................................................................108

Kurtz ............................................................................................112Mayden........................................................................................113Mercer .........................................................................................114Merz .............................................................................................115Moore ..........................................................................................125Nelson .........................................................................................125Osaka ..........................................................................................126Paris ............................................................................................130Rempen.......................................................................................133Robinson.....................................................................................138Tokyo...........................................................................................138Tokyo Shinozuka........................................................................142Williams.......................................................................................149Yarkoni ........................................................................................149

Chapter 3Acoustic information

The real-time display of acoustic output indices....................152Thermal Index ...................................................................152Mechanical Index ..............................................................153

Track 3 ALARA Educational Program......................................154Default Settings and Output Levels .........................................154Controls Affecting Acoustic Output.........................................155

Track 3 Summary Table ....................................................156Acoustic Parameters as Measured in Water ...........................158

Definitions, symbols and abbreviations .............................158Explanation of Footnotes...................................................181Multiple focal-zones...........................................................181Operating Conditions.........................................................181

Acoustic Output Reporting Tables for Track 3/IEC60601-2-37............................................................................. 182

Transducer Model: 3S.......................................................183Transducer Model: M3S....................................................189Transducer Model: M4S....................................................195Transducer Model: 5S.......................................................201Transducer Model: 6S.......................................................207

Transducer Model: 7S.......................................................213Transducer Model: 10S.....................................................219Transducer Model: 3V.......................................................225Transducer Model: 3.5C....................................................232Transducer Model: 4C.......................................................237Transducer Model: 5C.......................................................242Transducer Model: M7C....................................................247Transducer Model: 8C.......................................................252Transducer Model: 7L .......................................................257Transducer Model: 9L .......................................................262Transducer Model: 10L .....................................................267Transducer Model: 12L .....................................................272Transducer Model: M12L ..................................................277Transducer Model: E8C ....................................................282Transducer Model: 6T .......................................................287Transducer Model: 6Tc .....................................................293Transducer Model: 9T .......................................................299Transducer Model: P2D ....................................................305Transducer Model: P6D ....................................................307Transducer Model: i13L.....................................................309Transducer Model: i8L.......................................................314

Chapter 4Electromagnetic Compatibility

Electromagnetic emissions.......................................................320Electromagnetic immunity ........................................................321Separation distances.................................................................325

AppendixStatements on the safety of ultrasound...................................327

AIUM Statement on Clinical Safety ...................................327AIUM Statement on Mammalian in Vivo Ultrasonic Biological Effects ...............................................................................327

Medical Ultrasound Safety - AIUM............................................328Track 3 ALARA Educational Program...............................328

1

Chapter 1 Measurements

• Measurement overview ................................................................ ....... 2• Cardiac measurements .................................................................2

• Measurement formulas ................................................................ ..... 15• Formulas–Generic ......................................................................15• Formulas–Cardiac ......................................................................17• Formulas–Vascular .....................................................................58• Formulas–OB ..............................................................................60

• Measurement accuracy ................................................................ ..... 69• General .......................................................................................69• Sources of error ..........................................................................69• Optimizing Measurement Accuracy ............................................71

2

Measurement overviewThe following table shows the cardiac measurements available on the Vivid 7 ultrasound unit.

Cardiac measurements

Abbreviation Definition Unit

%FS LV Fractional Shortening, 2D %

%FS LV Fractional Shortening, M-mode %

%IVS Thck IVS Fractional Shortening, 2D %

%IVS Thck IVS Fractional Shortening, M-mode %

%LVPW Thck LV Posterior Wall Fractional Shortening, 2D %

%LVPW Thck LV Posterior Wall Fractional Shortening, M-mode %

Ao Arch Diam Aortic Arch Diameter cm

Ao asc Ascending Aortic Diameter cm

Ao Desc Diam Descending Aortic Diameter cm

Ao Isthmus Aortic Isthmus cm

Ao Root Diam Aortic Root Diameter cm

Ao Root Diam Aortic Root Diameter, M-mode cm

AR ERO PISA: Regurgitant Orifice Area cm2

AR Flow PISA: Regurgitant Flow ml/s

AR PHT AV Insuf. Pressure Half Time ms

AR Rad PISA: Radius of Aliased Point cm

AR RF Regurgitant fraction over the Aortic Valve %

AR RV PISA: Regurgitant Volume Flow ml

AR Vel PISA: Aliased Velocity m/s

AR Vmax Aortic Insuf. Peak Velocity m/s

AR VTI Aortic Insuf. Velocity Time Integral cm

ARed max PG Aortic Insuf. End-Diastole Pressure Gradient mm Hg

3

ARed Vmax Aortic Insuf. End-Diastolic Velocity m/s

AV Acc Slope Aortic Valve Flow Acceleration m/s2

AV Acc Time Aortic Valve Acceleration Time ms

AV AccT/ET AV Acceleration to Ejection Time Ratio

AV CO Cardiac Output by Aortic Flow l/min

AV Cusp Aortic Valve Cusp Separation, 2D cm

AV Cusp Aortic Valve Cusp Separation, M-mode cm

AV Dec Time Aortic Valve Deceleration Time ms

AV Diam Aortic Diameter, 2D cm

AV max PG Aortic Valve Peak Pressure Gradient mm Hg

AV mean PG Aortic Valve Mean Pressure Gradient mm Hg

AV SV Stroke Volume by Aortic Flow ml

AV Vmax Aortic Valve Peak Velocity m/s

AV Vmean AV Mean Velocity m/s

AV VTI Aortic Valve Velocity Time Integral cm

AVA (Vmax) AV Area by Continuity Equation by Peak V cm2

AVA (VTI) AV Area by Continuity Equation VTI cm2

AVA Planimetry Aortic Valve Area cm2

AVET Aortic Valve Ejection Time ms

AVET Aortic Valve Ejection Time, M-mode ms

CO (A-L A2C) CO 2CH, Single Plane, Area-Length l/min

CO (A-L A4C) CO 4CH, Single Plane, Area-Length l/min

CO (Biplane CO, Bi-Plane, MOD l/min

CO (bullet) CO, Bi-Plane, Bullet l/min

CO (MOD A2C) CO 2CH, Single Plane, MOD(Simpson) l/min

CO (MOD A4C) CO 4CH, Single Plane, 4CH, MOD(Simpson) l/min


4

CO(Cube) Cardiac Output, 2D, Cubic l/min

CO(Cube) Cardiac Output, M-mode, Cubic l/min

CO(Teich) Cardiac Output, 2D, Teicholtz l/min

CO(Teich) Cardiac Output, M-mode, Teicholtz l/min

D-E Excursion MV Anterior Leaflet Excursion cm

D-E Excursion Mitral Valve D-E Slope cm

EDV (bullet) LV Volume, Diastolic, Bi-Plane, Bullet ml

EDV(Cube) Left Ventricle Volume, Diastolic, 2D, Cubic ml

EDV(Cube) Left Ventricle Volume, Diastolic, M-mode, Cubic ml

EDV(Teich) Left Ventricle Volume, Diastolic, 2D, Teicholz ml

EDV(Teich) Left Ventricle Volume, Diastolic, M-mode, Teicholz

ml

EF (A-L A2C) Ejection Fraction 2CH, Single Plane, Area-Length %

EF (A-L A4C) Ejection Fraction 4CH, Single Plane, Area-Length %

EF (Biplane) Ejection Fraction, Bi-Plane, MOD %

EF (bullet) Ejection Fraction 2CH, Bi-Plane, Bullet %

EF (MOD A2C) Ejection Fraction 2CH, Single Plane, MOD(Simpson)

%

EF (MOD A4C) Ejection Fraction 4CH, Single Plane, 4CH, MOD(Simpson)

%

E-F Slope Mitral Valve E-F Slope m/s

EF(Cube) Ejection Fraction, 2D, Cubic %

EF(Cube) Ejection Fraction, M-mode, Cubic %

EF(Teich) Ejection Fraction, 2D, Teicholtz %

EF(Teich) Ejection Fraction, M-mode, Teicholtz %

EPSS E-Point-to-Septum Separation, M-mode cm

EPSS 2D E-Point-to-Septum Separation, 2D cm

ERO Effective Regurgitant Orifice cm2


5

ESV (bullet) LV Volume, Systolic, Bi-Plane, Bullet ml

ESV(Cube) Left Ventricle Volume, Systolic, 2D, Cubic ml

ESV(Cube) Left Ventricle Volume, Systolic, M-mode, Cubic ml

ESV(Teich) Left Ventricle Volume, Systolic, 2D, Teicholz ml

ESV(Teich) Left Ventricle Volume, Systolic, M-mode, Teicholz ml

HR AV Heart Rate, Dop BPM

HR Heart Rate, 2D, Teicholtz bpm

HR Heart Rate for 2CH study bpm

HR Heart Rate for 4CH study bpm

HR Heart Rate for 2CH AL study bpm

HR Heart Rate for 2CH MOD study bpm

HR Heart Rate for 4CH AL study bpm

HR Heart Rate for 4CH MOD study bpm

HR Heart Rate for Bullet study bpm

HR Heart Rate for BiPlane MOD study bpm

HR LV Heart Rate, Dop bpm

HR Heart Rate, M-mode, Teicholtz bpm

HR Heart Rate bpm

IVC Inferior Vena Cava cm

IVCT Isovolumic Contraction Time ms

IVRT Isovolumic Relaxation Time ms

IVSd Interventricular Septum Thickness, Diastolic, 2D cm

IVSd IVS Thickness, Diastolic, M-mode cm

IVSs Interventricular Septum Thickness, Systolic, 2D cm

IVSs IVS Thickness, Systolic, M-mode cm

LA Diam Left Atrium Diameter, 2D cm

LA Diam Left Atrium Diameter, M-mode cm


6

LA Diam Right Atrium Diameter, 2D cm

LA Major Left Atrium Major cm

LA Minor Left Atrium Minor cm

LA/Ao LA Diameter to AoRoot Diameter Ratio, 2D

LA/Ao LA Diameter to AoRoot Diameter Ratio, M-mode

LAEDV(A-L) LA End Diastolic Volume, Area-Length ml

LAEDV Index(A-L) LA End Diastolic Volume Index, Area-Length ml/m2

LAESV(A-L) LA End Systolic Volume, Area-Length ml

LAESV Index(A-L) LA End Systolic Volume Index, Area-Length ml/m2

LAEDV (MOD A4C) LA Volume, Single Plane, MOD ml

LAESV (MOD A4C) LA Volume, Systolic, Single Plane, MOD ml

LIMP Left Index of Myocardial Performance

LVA (s) Left Ventricular Area, Systolic, 2CH cm2

LVAd (A2C) Left Ventricular Area, Diastolic, 2CH cm2

LVAd (A4C) Left Ventricular Area, Diastolic, 4CH cm2

LVAd(sax) LV area, SAX, Diastolic cm2

LVAend (d) LV Endocardial Area, SAX cm2

LVAepi (d) LV Epicardial Area, SAX cm2

LVAs (A4C) Left Ventricular Area, Systolic, 4CH cm2

LVAs(sax) LV area, SAX, Systolic cm2

LVd Mass LV Mass, Diastolic, 2D g

LVd Mass LV Mass, Diastolic, M-mode g

LVd Mass Index LV Mass Index, Diastolic, 2D g/m2

LVd Mass Index LV Mass Index, Diastolic, M-mode g/m2

LVEDV (A-L A2C) LV Volume, Diastolic, 2CH, Area-Length ml

LVEDV (A-L A4C) LV Volume, Diastolic, 4CH, Area-Length ml


7

LVEDV (MOD A2C) LV Volume, Diastolic, Single Plane, 2CH, MOD ml

LVEDV (MOD A4C) LV Volume, Diastolic, Single Plane, 4CH, MOD ml

LVEDV (MOD BP) LV Volume, Diastolic, Bi-Plane, MOD ml

LVESV (A-L A2C) LV Volume, Systolic, 2CH, Area-Length ml

LVESV (A-L A4C) LV Volume, Systolic, 4CH, Area-Length ml

LVESV (MOD A2C) LV Volume, Systolic, Single Plane, 2CH, MOD ml

LVESV (MOD A4C) LV Volume, Systolic, Single Plane, 4CH, MOD ml

LVESV (MOD BP) LV Volume, Systolic, Bi-Plane, MOD ml

LVESV (MOD LAX) LV Volume, Diastolic, Apical View, LAX, MOD ml

LVESV (MOD LAX) LV Volume, Systolic, Apical View, LAX, MOD ml

LVET Left Ventricle Ejection Time ms

LVIDd LV Internal Dimension, Diastolic, 2D cm

LVIDd LV Internal Dimension, Diastolic, M-mode cm

LVIDs LV Internal Dimension, Systolic, 2D cm

LVIDs LV Internal Dimension, Systolic, M-mode cm

LVLd (apical) Left Ventricular Length, Diastolic, 2D cm

LVLs (apical) Left Ventricular Length, Systolic, 2D cm

LVOT Area Left Ventricle Outflow Tract Area cm2

LVOT CO Cardiac Output by Aortic Flow l/min

LVOT Diam Left Ventricular Outflow Tract Diameter cm

LVOT max PG LVOT Peak Pressure Gradient mm Hg

LVOT mean PG LVOT Mean Pressure Gradient mm Hg

LVOT SI Stroke Volume Index by Aortic Flow ml/m2

LVOT SV Stroke Volume by Aortic Flow ml

LVOT Vmax LVOT Peak Velocity m/s

LVOT Vmean LVOT Mean Velocity m/s


8

LVOT VTI LVOT Velocity Time Integral cm

LVPWd Left Ventricular Posterior Wall Thickness, Diastolic, 2D

cm

LVPWd Left Ventricular Posterior Wall Thickness, Diastolic, M-mode

cm

LVPWs Left Ventricular Posterior Wall Thickness, Systolic, 2D

cm

LVPWs Left Ventricular Posterior Wall Thickness, Systolic, M-mode

cm

LVs Mass LV Mass, Systolic, 2D g

LVs Mass LV Mass, Systolic, M-mode g

LVs Mass Index LV Mass Index, Systolic, 2D g/m2

LVs Mass Index LV Mass Index, Systolic, M-mode g/m2

LAAd (A2C) Left Atrium Area, Apical 2C cm2

LAAd (A4C) Left Atrium Area, Apical 4C cm2

MCO Mitral Valve closure to Opening ms

MP Area Mitral Valve Prosthesis cm2

MR Acc Time MV Regurg. Flow Acceleration s

MR ERO PISA: Regurgitant Orifice Area cm2

MR Flow PISA: Regurgitant Flow ml/s

MR max PG Mitral Regurg. Peak Pressure Gradient mm Hg

MR Rad PISA: Radius of Aliased Point cm

MR RF Regurgitant fraction over the Mitral Valve %

MR RV PISA: Regurgitant Volume Flow ml

MR Vel PISA: Aliased Velocity m/s

MR Vmax Mitral Regurg. Peak Velocity m/s

MR Vmax PISA: CW Peak Velocity m/s

MR Vmean Mitral Regurg. Mean Velocity m/s


9

MR VTI Mitral Regurg. Velocity Time Integral cm

MR VTI PISA: CW Velocity Time Integral cm

MV A Dur Mitral Valve A-Wave Duration ms

MV A Velocity MV Velocity Peak A m/s

MV Acc Slope Mitral Valve Flow Acceleration m/s2

MV Acc Time Mitral Valve Acceleration Time ms

MV Acc/Dec Time MV: Acc.Time/Decel.Time Ratio

MV an diam Mitral Valve Annulus Diameter, 2D cm

MV CO Cardiac Output by Mitral Flow l/min

MV Dec Slope Mitral Valve Flow Deceleration m/s2

MV Dec Time Mitral Valve Deceleration Time ms

MV E Velocity MV Velocity Peak E m/s

MV E/A Ratio Mitral Valve E-Peak to A-Peak Ratio

MV max PG Mitral Valve Peak Pressure Gradient mm Hg

MV mean PG Mitral Valve Mean Pressure Gradient mm Hg

MV PHT Mitral Valve Pressure Half Time ms

MV SI Stroke Volume Index by Mitral Flow ml/m2

MV SV Stroke Volume by Mitral Flow ml

MV Time to Peak Mitral Valve Time to Peak ms

MV Vmax Mitral Valve Peak Velocity m/s

MV Vmean MV Mean Velocity m/s

MV VTI Mitral Valve Velocity Time Integral cm

MVA Mitral Valve Area cm2

MVA By PHT Mitral Valve Area according to PHT cm2

MVA by plan Mitral Valve Area, 2D cm2

MVET Mitral Valve Ejection Time ms


10

P Vein A Pulmonary Vein Velocity Peak A (reverse) m/s

P Vein A Dur Pulmonary Vein A-Wave Duration ms

P Vein D Pulmonary Vein End-Diastolic Peak Velocity m/s

P Vein S Pulmonary Vein Systolic Peak Velocity m/s

PAEDP Pulmonary Artery Diastolic Pressure mm Hg

PE(d) Pericard Effusion, M-mode cm

PEs Pericard Effusion, 2D cm

PR max PG Pulmonic Insuf. Peak Pressure Gradient mm Hg

PR mean PG Pulmonic Insuf. Mean Pressure Gradient mm Hg

PR PHT Pulmonic Insuf. Pressure Half Time ms

PR Vmax Pulmonic Insuf. Peak Velocity m/s

PR VTI Pulmonic Insuf. Velocity Time Integral cm

PRend max PG Pulmonic Insuf. End-Diastole Pressure Gradient mm Hg

PRend Vmax Pulmonic Insuf. End-Diastolic Velocity m/s

Pulmonic Diam Pulmonary Artery Diameter, 2D cm

PV Acc Slope Pulmonic Valve Flow Acceleration m/s2

PV Acc Time Pulmonic Valve Acceleration Time ms

PV Acc Time/ET Ratio PV Acceleration to Ejection Time Ratio

PV an diam Pulmonic Valve Annulus Diameter, 2D cm

PV Ann Area Pulmonic Valve Area cm2

PV CO Cardiac Output by Pulmonic Flow l/min

PV CO Cardiac Output by Pulmonic Flow l/min

PV max PG Pulmonic Valve Peak Pressure Gradient mm Hg

PV mean PG Pulmonic Valve Mean Pressure Gradient mm Hg

PV SV Stroke Volume by Pulmonic Flow ml

PV Vmax Pulmonary Artery Peak Velocity m/s


11

PV Vmax Pulmonic Valve Peak Velocity m/s

PV Vmean PV Mean Velocity m/s

PV VTI Pulmonic Valve Velocity Time Integral cm

PVA (VTI) Pulmonary Artery Velocity Time Integral cm2

PVein S/D Ratio Pulmonary Vein SD Ratio

PVET Pulmonic Valve Ejection Time ms

PVPEP Pulmonic Valve Pre-Ejection Period ms

PVPEP/ET Ratio PV Pre-Ejection to Ejection Time Ratio

Qp/Qs Pulmonic-to-Systemic Flow Ratio

RA Major Right Atrium Major, 2D cm

RA Minor Right Atrium Minor, 2D cm

RAEDV A2C Right Atrium End Diastolic Volume, Apical 2 chamber

cm3

RAEDV A-L RA End Diastolic Volume (A-L) ml

RAEDV MOD RA Volume Diastolic, Single Plan, MOD ml

RAEDV MOD RA End Diastolic Volume (MOD) ml

RAESV A-L RA End Systole Volume (A-L) ml

RAESV MOD RA Volume, Systolic, Single Plane, MOD ml

RAESV MOD RA End Systole Volume (MOD) ml

RALd Right Atrium Length, Diastole cm

RALs RA Length, systole cm

RIMP Right Index of Myocardial Performance

RJA (A4C) Regurgitant jet area cm2

RJA/LAA Regurgitant jet area ratio RJA/LAA

RV Major Right Ventricle Major cm

RV Minor Right Ventricle Minor cm

RVAWd Right Ventricle Wall Thickness, Diastolic, 2D cm


12

RVAWs Right Ventricle Wall Thickness, Systolic, 2D cm

RVET Right Ventricle Ejection Time s

RVIDd Right Ventricle Diameter, Diastolic, 2D cm

RVIDd Right Ventricle Diameter, Diastolic, M-mode cm

RVIDs Right Ventricle Diameter, Systolic, 2D cm

RVIDs Right Ventricle Diameter, Systolic, M-mode cm

RVOT Area Right Ventricle Outflow Tract Area cm2

RVOT Diam RV Output Tract Diameter, 2D cm

RVOT Diam RV Output Tract Diameter, M-Mode cm

RVOT max PG RVOT Peak Pressure Gradient mm Hg

RVOT meanPG RVOT Mean Pressure Gradient mm Hg

RVOT SI LV Stroke Volume Index by Pulmonic Flow ml/m2

RVOT SV Stroke Volume by Pulmonic Flow ml

RVOT Vmax RVOT Peak Velocity m/s

RVOT Vmean RVOT Mean Velocity m/s

RVOT VTI RVOT Velocity Time Integral cm

RVSP Right Ventricle Systolic Pressure mm Hg

RVWd Right Ventricle Wall Thickness, Diastolic, M-mode cm

RVWs Right Ventricle Wall Thickness, Systolic, M-mode cm

RAA (d) Right Atrium Area, 2D, Diastole cm2

RAA (s) Right Atrium Area, 2D, Systole cm2

SI (A-L A2C) LV Stroke Index, Single Plane, 2CH, Area-Length ml/m2

SI (A-L A4C) LV Stroke Index, Single Plane, 4CH, Area-Length ml/m2

SI (Biplane) LV Stroke Index, Bi-Plane, MOD ml/m2

SI (bullet) LV Stroke Index, Bi-Plane, Bullet ml/m2

SI (MOD A2C LV Stroke Index, Single Plane, 2CH, MOD ml/m2


13

SI (MOD A4C LV Stroke Index, Single Plane, 4CH, MOD ml/m2

SI (Teich) LV Stroke Index, Teicholz, 2D ml/m2

SI (Teich) LV Stroke Index, Teicholz, M-mode ml/m2

SV (A-L A2C) LV Stroke Volume, Single Plane, 2CH, Area-Length

ml

SV (A-L A4C) LV Stroke Volume, Single Plane, 4CH, Area-Length

ml

SV (Biplane) LV Stroke Volume, Bi-Plane, MOD ml

SV (bullet) LV Stroke Volume, Bi-Plane, Bullet ml

SV (MOD A2C) LV Stroke Volume, Single Plane, 2CH, MOD(Simpson)

ml

SV (MOD A4C) LV Stroke Volume, Single Plane, 4CH, MOD(Simpson)

ml

SV(Cube) LV Stroke Volume, 2D, Cubic ml

SV(Cube) LV Stroke Volume, M-mode, Cubic ml

SV(Teich) LV Stroke Volume, 2D, Teicholtz ml

SV(Teich) LV Stroke Volume, M-mode, Teicholtz ml

Systemic Diam Systemic Vein Diameter, 2D cm

Systemic Vmax Systemic Vein Peak Velocity m/s

Systemic VTI Systemic Vein Velocity Time Integral cm

TCO Tricuspid Valve Closure to Opening ms

TR max PG Tricuspid Regurg. Peak Pressure Gradient mm Hg

TR mean PG Tricuspid Regurg. Mean Pressure Gradient mm Hg

TR Vmax Tricuspid Regurg. Peak Velocity m/s

TR Vmean Tricuspid Regurg. Mean Velocity m/s

TR VTI Tricuspid Regurgitation Velocity Time Integral cm

TV A dur Tricuspid Valve A-Wave Duration ms

TV A Velocity Tricuspid Valve A Velocity m/s


14

TV Acc Time Tricuspid Valve Time to Peak ms

TV Ann Area Tricuspid Valve Area cm2

TV ann diam Tricuspid Valve Annulus Diameter, 2D cm

TV Area Tricuspid Valve Area, 2D cm2

TV CO Cardiac Output by Tricuspid Flow l/min

TV Dec Slope Tricuspid Valve Flow Deceleration m/s2

TV E Velocity Tricuspid Valve E Velocity m/s

TV E/A Ratio Tricuspid Valve E-Peak to A-Peak Ratio

TV max PG Tricuspid Valve Peak Pressure Gradient mm Hg

TV mean PG Tricuspid Valve Mean Pressure Gradient mm Hg

TV mean PG Tricuspid Valve Mean Pressure Gradient mm Hg

TV PHT Tricuspid Valve Pressure Half Time ms

TV SV Stroke Volume by Tricuspid Flow ml

TV Vmean TV Mean Velocity m/s

TV VTI Tricuspid Valve Velocity Time Integral cm

VSD max PG VSD Peak Pressure Gradient mm Hg

VSD Vmax VSD Peak Velocity m/s


15

Measurement formulas

Formulas–Generic

Calc Mnemonic Calc Name

Input MeasurementsFormula

BSA Body Surface Area Patient weight (kg) and height (m)

BSA=0.007184 x Weight0.425 x Height0.725

BSA Body Surface Area Patient weight (kg)

BSA=0.1 x Weight0.667

MaxPG Maximum PressureGradient

two Doppler blood flow peak velocities

MaxPG[mmHg]=4x(v1^2-v2^2)

MeanPG Mean Pressure Gradient

flow velocities from one time marker to another time marker in a Doppler display

MeanPG[mmHg]=n4x (Vi^2)/n i=1

% Stenosis Stenosis Ratio two areas (by ellipse, trace, circle or distance)

% Stenosis= [1-(Aresidual/ Alumen)]x100

PI Pulsatility Index two Doppler blood flow peak velocities and TAMAX

PI=(Vmax-Vdiastole)/TAMAXa

RI Resistivity Index two Doppler blood flow peak velocities

RI=(Vmax-Vdiastole)/Vmaxa

HR Heart Rate (beats/minute)

one 2 beat time interval

HR[BPM]=120[sec]/2beat time [sec]

A/B Ratio Velocities Ratio two Doppler blood flow peak velocities

A/B=V1/V2

a) Vdiastole = Vmin or Vend-diastole (depends on preset selection)

16



TAMAX Time Averaged Maximum Velocity (Trace Method is Peak or manual)

two time marks in a Doppler display

TAMAX=sum{Vt} from t1 to t2/(t2-t1) [cm/s or m/s]

TAMIN Time Averaged Minimum Velocity (Trace method is Floor)


TAMIN=sum{Vt} from t1 to t2/(t2-t1) [cm/s or m/s]

TAMEAN Time Averaged Mean Velocity (Trace method is Mean)


TAMEAN=sum{Vt} from t1 to t2/(t2-t1) [cm/s or m/s]

Calc Name Input Measurements Formula

Volume (spherical) one distance Vol[ml]=( /6)xd^3

Volume (prolate spheroidal)

two distances, d1>d2 Vol[ml]= ( /6)xd1xd2^2

Volume (prolate spheroidal)

one ellipse, d1 major axis, d2 minor axis

Vol[ml]= ( /6)xd1xd2^2

Volume (spheroidal) three distances Vol[ml]= ( /6)xd1xd2xd3

Volume (spheroidal) one distance d1, one ellipse, d2 ma jor axis, d3 minor axis

Vol[ml]= ( /6)xd1xd2xd3

17

Formulas–CardiacThe following table lists the cardiac calculations. The folders where to find the calculations and related measurements are indicated in brakets "[ ]".

%FS [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({LVIDd}-{LVIDs})/{LVIDd})Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

%FS [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (({LVIDd}-{LVIDs})/{LVIDd})Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER] Belenkie, Israel, et al., “Assessment of Left Ventricular Dimensions and Function by Echocardiography,” American Journal of Cardiology, June 1973, Vol. 31.

%IVS Thck [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({IVSs}-{IVSd})/{IVSd})Needs measurement: IVSs [Dimension], IVSd [Dimension]Measured by: LVs [2DLV], IVSs [2DCALIPER] Roelandt, Joseph, Practical Echocardiology, Ultrasound in medicine Series, Vol. 1, Denis White, ed., Research Studies Press, 1977, p. 130.Schiller, N. B., et al., “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography,” J Am Soc Echo, Sept-Oct 1989, Vol. 2, No. 5, p.364.

%IVS Thck [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (({IVSs}-{IVSd})/{IVSd})Needs measurement: IVSs [Dimension], IVSd [Dimension]Measured by: IVSs [MMDISCALIPER]

18

%LVPW Thck [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({LVPWs}-{LVPWd})/{LVPWd})Needs measurement: LVPWs [Dimension], LVPWd [Dimension]Measured by: LVs [2DLV], LVPWs [2DCALIPER]

%LVPW Thck [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (({LVPWs}-{LVPWd})/{LVPWd})Needs measurement: LVPWs [Dimension], LVPWd [Dimension]Measured by: LVPWs [MMDISCALIPER] Belenkie, Israel, et al., “Assessment of Left Ventricular Dimensions and Function by Echocardiography,” American Journal of Cardiology, June 1973, Vol. 31. Roelandt, Joseph, Practical Echocardiology, Ultrasound in Medicine Series, Vol. 1, Denis White, ed., Research Studies Press, 1977, p. 129.

Ao st junct/Ao [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {Ao st junct}/{Ao Diam}Needs measurement: Ao st junct [Dimension], Ao Diam [Dimension]Measured by: Ao st junct [2DCALIPER]

Ao/LA [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {Ao Diam}/{LA Diam}Needs measurement: Ao Diam [Generic, Dimension], LA Diam [Generic, Dimension]Measured by: LA/Ao [MMLAAO]

AP Area [Aortic]Mode: CW:PW:VRCW:VRPWFormula: {LVOT Diam}^2*0.785*({LVOT VTI}/{AP VTI})Needs measurement: LVOT Diam [Aortic], LVOT VTI [Aortic], AP VTI [Aortic]Measured by: AP Area [SDMANTRACE]

AR RF [PISA]Mode:CF:CW:PW:VRCW:VRPW Formula: {AR RV}/{AV SV}Needs measurement: AV Diam [Dimension], AV Trace [Aortic], AR Flow [PISA], AR Trace [PISA]Measured by: AR RF [AUTOCALC]

19

AR ERO [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {AR Flow}/{AR Vmax}Needs measurement: AR Flow [PISA], AR Vmax [PISA]Measured by: AR Trace [AUTOCALC]

AR RV [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {AR Flow}/{AR Vmax}*{AR VTI}Needs measurement: AR Flow [PISA], AR Vmax [PISA], AR VTI [PISA]Measured by: AR Trace [AUTOCALC]

AV Acc Time/ET Ratio [Aortic]Mode: CW:PW:VRCW:VRPWFormula: {AV AccT}/{AVET}Needs measurement: AV AccT [Aortic], AVET [Aortic]Measured by: AVET [SDTIMECALIPER]

AV Area [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 3.14/4*{AV Diam}^2Needs measurement: AV Diam [Dimension]Measured by: AV Diam [2DCALIPER]

AV CI [Aortic]Mode: CW:PW:VRCW:VRPWFormula: (({AV Diam}^2*0.785*{AV VTI})*{HR}/60)/{BSA}Needs measurement: AV Diam [Aortic], AV VTI [Aortic], HR [Aortic]Measured by: AV Trace [SDMANTRACE]

AV CO [Aortic]Mode: CW:PW:VRCW:VRPWFormula: ({AV Diam}^2*0.785*{AV VTI})*{HR}/60Needs measurement: AV Diam [Aortic], AV VTI [Aortic], HR [Aortic]Measured by: AV Trace [SDMANTRACE]

AV SI [Aortic]Mode: CW:PW:VRCW:VRPWFormula: ({AV Diam}^2*0.785*{AV VTI})/{BSA}Needs measurement: AV Diam [Aortic], AV VTI [Aortic]Measured by: AV Trace [SDMANTRACE]

20

AV SV [Aortic]Mode: CW:PW:VRCW:VRPWFormula: {AV Diam}^2*0.785*{AV VTI}Needs measurement: AV Diam [Aortic], AV VTI [Aortic]Measured by: AV Trace [SDMANTRACE]

AVA (VTI) [Aortic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{LVOT Diam}^2*{LVOT VTI}/{AV VTI}Needs measurement: LVOT Diam [Aortic], LVOT VTI [Aortic], AV VTI [Aortic]Measured by: AV Trace [AUTOCALC]

AVA Vmax [Aortic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{LVOT Diam}^2*abs({LVOT Vmax}/{AV Vmax})Needs measurement: LVOT Diam [Aortic], LVOT Vmax [Aortic], AV Vmax [Aortic]Measured by: AV Vmax [AUTOCALC]

AVA Vmax [Aortic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{LVOT Diam}^2*abs({LVOT Vmax}/{AV Vmax})Needs measurement: LVOT Diam [Aortic], LVOT Vmax [Aortic], AV Vmax [Aortic]Measured by: AV Trace [AUTOCALC]

AVA Vmax, Pt [Aortic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{LVOT Diam}^2*abs({LVOT Vmax}/{AV Vmax})Needs measurement: LVOT Diam [Aortic], LVOT Vmax [Aortic], AV Vmax [Aortic]Measured by: AV Vmax [AUTOCALC]

AVA Vmax, Pt [Aortic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{LVOT Diam}^2*abs({LVOT Vmax}/{AV Vmax})Needs measurement: LVOT Diam [Aortic], LVOT Vmax [Aortic], AV Vmax [Aortic]Measured by: AV Trace [AUTOCALC]

21

CI A-L A2C [Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (({LVEDV A-L A2C}-{LVESV A-L A2C})*{HR}/60)/{BSA}Needs measurement: LVEDV A-L A2C [Single Plane A2C, AutoBiplane], LVESV A-L A2C [Single Plane A2C, AutoBiplane], HR [Single Plane A2C, AutoBiplane]Measured by: R-R [2DCALIPER], A2C [2DAUTOVOLUME]

CI A-L A2C [Single Plane A2C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({LVEDV A-L A2C}-{LVESV A-L A2C})*{HR}/60/Auto)/{BSA}Needs measurement: LVEDV A-L A2C [Single Plane A2C], LVESV A-L A2C [Single Plane A2C], HR [Single Plane A2C] Measured by: LVESV A2C [2DVOLUMETRACE]

CI A-L A4C [Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (({LVEDV A-L A4C}-{LVESV A-L A4C})*{HR}/60)/{BSA}Needs measurement: LVEDV A-L A4C [Single Plane A4C, AutoBiplane], LVESV A-L A4C [Single Plane A4C, AutoBiplane], HR [Single Plane A4C, AutoBiplane] Measured by: R-R [2DCALIPER], A4C [2DAUTOVOLUME]

CI A-L A4C [Single Plane A4C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({LVEDV A-L A4C}-{LVESV A-L A4C})*{HR}/60)/{BSA}Needs measurement: LVEDV A-L A4C [Single Plane A4C], LVESV A-L A4C [Single Plane A4C], HR [Single Plane A4C]Measured by: LVESV A4C [2DVOLUMETRACE]

CI A-L LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (({LVEDV A-L LAX}-{LVESV A-L LAX})*{HR}/60)/{BSA}Needs measurement: LVEDV A-L LAX [Single Plane LAX, AutoBiplane], LVESV A-L LAX [Single Plane LAX, AutoBiplane], HR [Single Plane LAX, AutoBiplane]Measured by: R-R [2DCALIPER], AutoVolume [2DAUTOVOLUME]

CI Biplane [Biplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: d = biplane({LVLd A4C},{LVDisks},{LVLd A2C},{LVDisks})Needs measurement: LVLd A4C [Biplane], LVLd A2C [Biplane], LVLs A4C [Biplane], LVLs A2C [Biplane], HR [Biplane] Measured by: R-R [2DCALIPER]

22

CI bp el [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ((d-s)*{ECG/HeartRate}/60)/{BSA} where: s = (8/(3*3.14159))*{LVAs(A4C)}*{LVAs(sax MV)}/{2D/LVIDs} d = (8/(3*3.14159))*{LVAd A4C}*{LVAd (sax MV)}/{LVIDd}Needs measurement: LVAd A4C [Biplane Ellipse], LVAd (sax MV) [Biplane Ellipse], LVIDd [Biplane Ellipse], LVAs A4C [Biplane Ellipse], LVAs sax MV [Biplane Ellipse], LVIDs [Biplane Ellipse], HR [Biplane Ellipse] Measured by: R-R [2DCALIPER]

CI bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ((d-s)*{ECG/HeartRate}/60)/{BSA} where: s =5/6*{LVAs(sax)}*{LVLs(apical)} d = 5/6*{LVAd sax)}*{LVLd apical}Needs measurement: LVAd sax) [Bullet], LVLd apical [Bullet], LVAs sax) [Bullet], LVLs apical [Bullet], HR [Bullet] Measured by: R-R [2DCALIPER]

CI MOD A2C [Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (({LVEDV MOD A2C}-{LVESV MOD A2C})*{HR}/60)/{BSA}Needs measurement: LVEDV MOD A2C [Single Plane A2C, AutoBiplane], LVESV MOD A2C [Single Plane A2C, AutoBiplane], HR [Single Plane A2C, AutoBiplane] Measured by: R-R [2DCALIPER], A2C [2DAUTOVOLUME]

CI MOD A2C [Single Plane A2C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({LVEDV MOD A2C}-{LVESV MOD A2C})*{HR}/60)/{BSA}Needs measurement: LVEDV MOD A2C [Single Plane A2C], LVESV MOD A2C [Single Plane A2C], HR [Single Plane A2C]Measured by: LVESV A2C [2DVOLUMETRACE]

CI MOD A4C [Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (({LVEDV MOD A4C}-{LVESV MOD A4C})*{HR}/60)/{BSA}Needs measurement: LVEDV MOD A4C [Single Plane A4C, AutoBiplane], LVESV MOD A4C [Single Plane A4C, AutoBiplane], HR [Single Plane A4C, AutoBiplane]Measured by: R-R [2DCALIPER], A4C [2DAUTOVOLUME]

23

CI MOD A4C [Single Plane A4C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (({LVEDV MOD A4C}-{LVESV MOD A4C})*{HR}/60)/{BSA}Needs measurement: LVEDV MOD A4C [Single Plane A4C], LVESV MOD A4C [Single Plane A4C], HR [Single Plane A4C] Measured by: LVESV A4C [2DVOLUMETRACE]

CI MOD LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (({LVEDV MOD LAX}-{LVESV MOD LAX})*{HR}/60)/{BSA}Needs measurement: LVEDV MOD LAX [Single Plane LAX, AutoBiplane], LVESV MOD LAX [Single Plane LAX, AutoBiplane], HR [Single Plane LAX, AutoBiplane]Measured by: R-R [2DCALIPER], AutoVolume [2DAUTOVOLUME]

CI mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ((d-s)*{ECG/HeartRate}/60)/{BSA} where: s = ({LVLs(apical)}/9)*((4*{LVAs(sax MV)})+(2*{LVAs(sax PM)})+ sqrt({LVAs(sax MV)}*{LVAs(sax PM)})) d = ({LVLd apical}/9)*((4*{LVAd (sax MV)})+(2*{LVAd sax PM})+ sqrt({LVAd (sax MV)}*{LVAd sax PM}))Needs measurement: LVLd apical [Modified Simpson], LVAd (sax MV) [Modified Simpson], LVAd sax PM [Modified Simpson], LVLs apical [Modified Simpson], LVAs sax MV [Modified Simpson], LVAs sax PM [Modified Simpson], HR [Modified Simpson]Measured by: R-R [2DCALIPER]

CI(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ((d-s)*{ECG/HeartRate}/60)/{BSA} where: s = {2D/LVIDs}^3 d = {LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz], HR [Dimension, Cube/Teicholz] Measured by: R-R [2DCALIPER]

CI(Cube) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: ((dv-sv)*{MM/HeartRate}/60)/{BSA} where: sv = {MM/LVIDs}^3 dv = {LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension], HR [Generic, Dimension]Measured by: Heartrate [MMTIMECALIPER]

24

CI(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ((d-s)*{ECG/HeartRate}/60)/{BSA} where: s = 7/(2.4+{2D/LVIDs})*{2D/LVIDs}^3 d = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz], HR [Dimension, Cube/Teicholz] Measured by: R-R [2DCALIPER]

CI(Teich) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: ((dv-sv)*{MM/HeartRate}/60)/{BSA} where: sv = 7/(2.4+{MM/LVIDs})*{MM/LVIDs}^3 dv = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension], HR [Generic, Dimension]Measured by: Heartrate [MMTIMECALIPER]

CO A-L A2C [Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ({LVEDV A-L A2C}-{LVESV A-L A2C})*{HR}/60Needs measurement: LVEDV A-L A2C [Single Plane A2C, AutoBiplane], LVESV A-L A2C [Single Plane A2C, AutoBiplane], HR [Single Plane A2C, AutoBiplane]Measured by: R-R [2DCALIPER], A2C [2DAUTOVOLUME]

CO A-L A2C [Single Plane A2C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L A2C}-{LVESV A-L A2C})*{HR}/60Needs measurement: LVEDV A-L A2C [Single Plane A2C], LVESV A-L A2C [Single Plane A2C], HR [Single Plane A2C]Measured by: LVESV A2C [2DVOLUMETRACE]

CO A-L A4C [Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ({LVEDV A-L A4C}-{LVESV A-L A4C})*{HR}/60Needs measurement: LVEDV A-L A4C [Single Plane A4C, AutoBiplane], LVESV A-L A4C [Single Plane A4C, AutoBiplane], HR [Single Plane A4C, AutoBiplane]Measured by: R-R [2DCALIPER], A4C [2DAUTOVOLUME]

25

CO A-L A4C [Single Plane A4C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L A4C}-{LVESV A-L A4C})*{HR}/60Needs measurement: LVEDV A-L A4C [Single Plane A4C], LVESV A-L A4C [Single Plane A4C], HR [Single Plane A4C]Measured by: LVESV A4C [2DVOLUMETRACE]

CO A-L LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ({LVEDV A-L LAX}-{LVESV A-L LAX})*{HR}/60Needs measurement: LVEDV A-L LAX [Single Plane LAX, AutoBiplane], LVESV A-L LAX [Single Plane LAX, AutoBiplane], HR [Single Plane LAX, AutoBiplane]Measured by: R-R [2DCALIPER], AutoVolume [2DAUTOVOLUME]

CO A-L LAX [Single Plane LAX]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L LAX}-{LVESV A-L LAX})*{HR}/60Needs measurement: LVEDV A-L LAX [Single Plane LAX], LVESV A-L LAX [Single Plane LAX], HR [Single Plane LAX]Measured by: LVESV LAX [2DVOLUMETRACE]

CO Biplane [Biplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: d = biplane({LVLd A4C},{LVDisks},{LVLd A2C},{LVDisks})Needs measurement: LVLd A4C [Biplane], LVLd A2C [Biplane], LVLs A4C [Biplane], LVLs A2C [Biplane], HR [Biplane]Measured by: R-R [2DCALIPER]

CO bp el [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (d-s)*{ECG/HeartRate}/60 where: s = (8/(3*3.14159))*{LVAs(A4C)}*{LVAs(sax MV)}/{2D/LVIDs} d = (8/(3*3.14159))*{LVAd A4C}*{LVAd (sax MV)}/{LVIDd}Needs measurement: LVAd A4C [Biplane Ellipse], LVAd (sax MV) [Biplane Ellipse], LVIDd [Biplane Ellipse], LVAs A4C [Biplane Ellipse], LVAs sax MV [Biplane Ellipse], LVIDs [Biplane Ellipse], HR [Biplane Ellipse]Measured by: R-R [2DCALIPER]

26

CO bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (d-s)*{ECG/HeartRate}/60 where: s =5/6*{LVAs(sax)}*{LVLs(apical)} d = 5/6*{LVAd sax)}*{LVLd apical}Needs measurement: LVAd sax) [Bullet], LVLd apical [Bullet], LVLs apical [Bullet], HR [Bullet]Measured by: R-R [2DCALIPER]

CO MOD A2C [Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ({LVEDV MOD A2C}-{LVESV MOD A2C})*{HR}/60Needs measurement: LVEDV MOD A2C [Single Plane A2C, AutoBiplane], LVESV MOD A2C [Single Plane A2C, AutoBiplane], HR [Single Plane A2C, AutoBiplane]Measured by: R-R [2DCALIPER], A2C [2DAUTOVOLUME]

CO MOD A2C [Single Plane A2C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD A2C}-{LVESV MOD A2C})*{HR}/60Needs measurement: LVEDV MOD A2C [Single Plane A2C], LVESV MOD A2C [Single Plane A2C], HR [Single Plane A2C]Measured by: LVESV A2C [2DVOLUMETRACE]

CO MOD A4C [Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ({LVEDV MOD A4C}-{LVESV MOD A4C})*{HR}/60Needs measurement: LVEDV MOD A4C [Single Plane A4C, AutoBiplane], LVESV MOD A4C [Single Plane A4C, AutoBiplane], HR [Single Plane A4C, AutoBiplane]Measured by: R-R [2DCALIPER], A4C [2DAUTOVOLUME]

CO MOD A4C [Single Plane A4C]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD A4C}-{LVESV MOD A4C})*{HR}/60Needs measurement: LVEDV MOD A4C [Single Plane A4C], LVESV MOD A4C [Single Plane A4C], HR [Single Plane A4C]Measured by: LVESV A4C [2DVOLUMETRACE]

27

CO MOD LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: ({LVEDV MOD LAX}-{LVESV MOD LAX})*{HR}/60Needs measurement: LVEDV MOD LAX [Single Plane LAX, AutoBiplane], LVESV MOD LAX [Single Plane LAX, AutoBiplane], HR [Single Plane LAX, AutoBiplane]Measured by: R-R [2DCALIPER], AutoVolume [2DAUTOVOLUME]

CO MOD LAX [Single Plane LAX]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD LAX}-{LVESV MOD LAX})*{HR}/60Needs measurement: LVEDV MOD LAX [Single Plane LAX], LVESV MOD LAX [Single Plane LAX], HR [Single Plane LAX]Measured by: LVESV LAX [2DVOLUMETRACE]

CO mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (d-s)*{ECG/HeartRate}/60 where: s = ({LVLs(apical)}/9)*((4*{LVAs(sax MV)})+(2*{LVAs(saxd = ({LVLd apical}/9)*((4*{LVAd (sax MV)})+(2*{LVAd sax PM}) + sqrt({LVAd (sax MV)}*{LVAd sax PM}))Needs measurement: LVLd apical [Modified Simpson], LVAd (sax MV) [Modified Simpson], LVAd sax PM [Modified Simpson], LVLs apical [Modified Simpson], LVAs sax MV [Modified Simpson], LVAs sax PM [Modified Simpson], HR [Modified Simpson]Measured by: R-R [2DCALIPER]

CO(A-L) [Generic]Mode: 2D:CF:TT:SI:SRI:TraceFormula: ({EDV(A-L)}-{ESV(A-L)})*{HR}/60Needs measurement: ESV(A-L) [Generic], HR [Generic]Measured by: R-R [2DCALIPER]

CO(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (d-s)*{ECG/HeartRate}/60 where: s = {2D/LVIDs}^3 d = {LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz], HR [Dimension, Cube/Teicholz]Measured by: R-R [2DCALIPER]

28

CO(Cube) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (dv-sv)*{MM/HeartRate}/60 where: sv = {MM/LVIDs}^3 dv = {LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension], HR [Generic, Dimension]Measured by: Heartrate [MMTIMECALIPER]

CO(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2D:TraceFormula: (d-s)*{ECG/HeartRate}/60 where: s = 7/(2.4+{2D/LVIDs})*{2D/LVIDs}^3 d = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz], HR [Dimension, Cube/Teicholz]Measured by: R-R [2DCALIPER]

CO(Teich) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (dv-sv)*{MM/HeartRate}/60 where: sv = 7/(2.4+{MM/LVIDs})*{MM/LVIDs}^3 dv = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension], HR [Generic, Dimension]Measured by: Heartrate [MMTIMECALIPER]

EDV bp el [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (8/(3*3.14159))*{LVAd A4C}*{LVAd (sax MV)}/{LVIDd}Needs measurement: LVAd A4C [Biplane Ellipse], LVAd (sax MV) [Biplane Ellipse], LVIDd [Biplane Ellipse]Measured by: LVEF BP-EL [AUTOCALC]

EDV bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 5/6*{LVAd sax)}*{LVLd apical}Needs measurement: LVAd sax) [Bullet], LVLd apical [Bullet]Measured by: LVEF Bullet [AUTOCALC]

29

EDV mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVLd apical}/9)*((4*{LVAd (sax MV)})+(2*{LVAd sax PM})+ sqrt({LVAd (sax MV)}*{LVAd sax PM}))Needs measurement: LVLd apical [Modified Simpson], LVAd (sax MV) [Modified Simpson], LVAd sax PM [Modified Simpson]Measured by: EF mod sim [AUTOCALC]

EDV(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz]Measured by: LVd [2DLV], LVIDd [2DCALIPER], EF(Cube) [AUTOCALC]

EDV(Cube) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {LVIDd}^3Needs measurement: LVIDd [Generic, Dimension]Measured by: LV Study [MMLV], LVIDd [MMDISCALIPER]

EDV(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz]Measured by: LVd [2DLV], LVIDd [2DCALIPER], EF(Cube) [AUTOCALC]

EDV(Teich) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Generic, Dimension]Measured by: LV Study [MMLV], LVIDd [MMDISCALIPER]

EF A-L A2C [Biplane, Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L A2C}-{LVESV A-L A2C})/{LVEDV A-L A2C}Needs measurement: LVEDV A-L A2C [Biplane, Single Plane A2C, AutoBiplane], LVESV A-L A2C [Biplane, Single Plane A2C, AutoBiplane]Measured by: EF SP A2C [AUTOCALC], LVESV A2C [2DVOLUMETRACE], A2C [2DAUTOVOLUME]

30

EF A-L A4C [Biplane, Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L A4C}-{LVESV A-L A4C})/{LVEDV A-L A4C}Needs measurement: LVEDV A-L A4C [Biplane, Single Plane A4C, AutoBiplane], LVESV A-L A4C [Biplane, Single Plane A4C, AutoBiplane]Measured by: EF SP A4C [AUTOCALC], LVESV A4C [2DVOLUMETRACE], A4C [2DAUTOVOLUME]

EF A-L LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L LAX}-{LVESV A-L LAX})/{LVEDV A-L LAX}Needs measurement: LVEDV A-L LAX [Single Plane LAX, AutoBiplane], LVESV A-L LAX [Single Plane LAX, AutoBiplane]Measured by: LVESV LAX [2DVOLUMETRACE], EF SP LAX [AUTOCALC], AutoVolume [2DAUTOVOLUME]

EF Biplane [Biplane, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d = biplane({LVLd A4C},{LVDisks},{LVLd A2C},{LVDisks})Needs measurement: LVLd A4C [Biplane, AutoBiplane], LVLd A2C [Biplane, AutoBiplane], LVLs A4C [Biplane, AutoBiplane], LVLs A2C [Biplane, AutoBiplane]Measured by: EF Biplane [AUTOCALC]

EF mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVLd apical}/9)*((4*{LVAd (sax MV)})+(2*{LVAd sax PM})+ sqrt({LVAd (sax MV)}*{LVAd sax PM}))Needs measurement: LVLd apical [Modified Simpson], LVAd (sax MV) [Modified Simpson], LVAd sax PM [Modified Simpson], LVLs apical [Modified Simpson], LVAs sax MV [Modified Simpson], LVAs sax PM [Modified Simpson]Measured by: EF mod sim [AUTOCALC]

EF(A-L) [Generic]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({EDV(A-L)}-{ESV(A-L)})/{EDV(A-L)}Needs measurement: ESV(A-L) [Generic], EDV(A-L) [Generic]Measured by: EF Volume [AUTOCALC]

31

EF(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/d where: s = {2D/LVIDs}^3 d = {LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

EF(Cube) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (dv-sv)/dv where: sv = {MM/LVIDs}^3 dv = {LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER]

EF(MOD) [Generic]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({EDV(MOD)}-{ESV(MOD)})/{EDV(MOD)}Needs measurement: EDV(MOD) [Generic], ESV(MOD) [Generic]Measured by: EF Volume [AUTOCALC]

EF(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/d where:s = 7/(2.4+{2D/LVIDs})*{2D/LVIDs}^3 d = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

EF(Teich) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (dv-sv)/dv where: sv = 7/(2.4+{MM/LVIDs})*{MM/LVIDs}^3 dv = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER]

32

ESV bp el [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (8/(3*3.14159))*{LVAs A4C}*{LVAs sax MV}/{LVIDs}Needs measurement: LVAs A4C [Biplane Ellipse], LVAs sax MV [Biplane Ellipse], LVIDs [Biplane Ellipse]Measured by: LVEF BP-EL [AUTOCALC]

ESV bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 5/6*{LVAs sax)}*{LVLs apical}Needs measurement: LVAs sax) [Bullet], LVLs apical [Bullet]Measured by: LVEF Bullet [AUTOCALC]

ESV mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVLs apical}/9)*((4*{LVAs sax MV})+(2*{LVAs sax PM})+ sqrt({LVAs sax MV}*{LVAs sax PM}))Needs measurement: LVLs apical [Modified Simpson], LVAs sax MV [Modified Simpson], LVAs sax PM [Modified Simpson]Measured by: EF mod sim [AUTOCALC]

ESV(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVIDs}^3Needs measurement: LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

ESV(Cube) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {LVIDs}^3Needs measurement: LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER]

ESV(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 7/(2.4+{LVIDs})*{LVIDs}^3Needs measurement: LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

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ESV(Teich) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: 7/(2.4+{LVIDs})*{LVIDs}^3Needs measurement: LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER]

HR (Generic, Dimension, Biplane, Modified Simpson, Cube/Teicholz, Single Plane A4C, Single Plane A2C, Single Plane LAX, Bullet, Biplane Ellipse)Mode: 2D:CF:TT:SI:SRI:Trace:VR2DFormula: 60/{R-R}Needs measurement: R-R [Generic, Dimension, Biplane, Modified Simpson, Cube/Teicholz, Single Plane A4C, Single Plane A2C, Single Plane LAX, Bullet, Biplane Ellipse]Measured by: R-R [2DCALIPER] Used to calculate: CO(A-L),CO(Teich),CI(Teich),CO(Cube),CI(Cube),CO Biplane,CI Biplane,CO mod sim,CI mod sim,CI A-L A4C,CO MOD A4C,CI MOD A4C,CI A-L A2C,CO A-L A2C,CI A-L A2C,CO MOD A2C,CI MOD A2C,CO A-L LAX,CI A-L LAX,CO MOD LAX,CI MOD LAX,CO bullet,CI bullet,CO bp el,CI bp el

HR [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: 60/{Time}Needs measurement: Time [Generic, Dimension]Measured by: Heartrate [MMTIMECALIPER]Used to calculate: CO(Cube),CO(Teich),CI(Teich),CI(Cube)Dorland’s Illustrated Medical Dictionary, ed. 27, W. B. Sanders Co., Philadelphia, 1988, p. 1425.

HR [Generic]Mode: CW:PW:VRCW:VRPWFormula: 60/{Time}Needs measurement: Time [Generic]Measured by: Heartrate [SDTIMECALIPER]

IVSd/LVPWd [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {IVSd}/{LVPWd}Needs measurement: IVSd [Dimension], LVPWd [Dimension]Measured by: LVPWd [MMDISCALIPER] Roelandt, Joseph, Practical Echocardiology, Ultrasound in Medicine Series, Vol. 1, Denis White, ed., Research Studies Press, 1977, p. 270.

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LA/Ao [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {LA Diam}/{Ao Diam}Needs measurement: LA Diam [Generic, Dimension], Ao Diam [Generic, Dimension]Measured by: LA/Ao [MMLAAO]Roelandt, Joseph, Practical Echocardiology, Ultrasound in Medicine Series, Vol. 1, Denis White, ed., Research Studies Press,1977, p. 270.Schiller, N.B., et al., “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography,” J Am Soc Echo, Sept-Oct 1989, Vol. 2, No. 5, p. 364.

LIMP [Mitral Valve, Aortic]Mode: CW:PW:VRCW:VRPWFormula: ({MCO}-{AVET})/{AVET}Needs measurement: MCO [Mitral Valve, Aortic], AVET [Mitral Valve, Aortic]Measured by: LIMP [AUTOCALC] Nishimura RA et.al. Doppler Echocardiography: theory, instrumentation, technique and application. Mayo Clinic Proc 1985; 60:321-343Yoganathan AP, et al. Review of hydrodynamic principles for the cardiologist: Application to the study of blood flow and jets by imaging techniques. J Am Coll Cardio 1988; 12:1344-1353

LVCI Dopp [Aortic]Mode: PW:VRPWFormula: ({LVOT Diam}^2*0.785*{LVOT VTI}*{HR}/60)/{BSA}Needs measurement: LVOT Diam [Aortic], LVOT VTI [Aortic], HR [Aortic], Measured by: LVOT Trace [SDMANTRACE]

LVCO Dopp [Aortic]Mode: PW:VRPWFormula: {LVOT Diam}^2*0.785*{LVOT VTI}*{HR}/60Needs measurement: LVOT Diam [Aortic], LVOT VTI [Aortic], HR [Aortic]Measured by: LVOT Trace [SDMANTRACE]

LVd Mass (ASE) [Generic]Mode: MM:CM:AMM:CAMM:VRMMFormula: ((1.04*(({IVSd}+{LVIDd}+{LVPWd})^3-({LVIDd})^3))*0.8+0.6)/1000Needs measurement: IVSd [Generic], LVIDd [Generic], LVPWd [Generic]Measured by: LV Study [MMLV]

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LVd Mass [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ((1.04*(({IVSd}+{LVIDd}+{LVPWd})^3-({LVIDd})^3))-13.6)/1000Needs measurement: IVSd [Dimension], LVIDd [Dimension], LVPWd [Dimension], LVIDd [Dimension]Measured by: LVPWd [2DCALIPER]

LVd Mass [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: ((1.04*(({IVSd}+{LVIDd}+{LVPWd})^3-({LVIDd})^3))-13.6)/1000Needs measurement: IVSd [Generic, Dimension], LVPWd [Generic, Dimension], LVIDd [Generic, Dimension]Measured by: LV Study [MMLV], LVPWs [MMDISCALIPER]

LVd Mass A-L [Mass]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 1.05*5/6*({LVAd(sax epi)}*({LVLd(apical)}+t)-{LVAd(sax PM)}*{LVLd(apical)})/1000 where: t = sqrt({LVAd sax EPI}/3.14159)-sqrt({LVAd sax PM}/3.14159)Needs measurement: LVAd sax EPI [Mass], LVAd sax PM [Mass], LVLd apical [Mass]Measured by: LVMass(d) [AUTOCALC]

LVd Mass I A-L [Mass]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: m/{BSA} where: m = 1.05*5/6*({LVAd(sax epi)}*({LVLd(apical)}+t)-{LVAd(sax PM)}*{LVLd(apical)})/1000t = sqrt({LVAd sax EPI}/3.14159)-sqrt({LVAd sax PM}/3.14159)Needs measurement: LVAd sax EPI [Mass], LVAd sax PM [Mass], LVLd apical [Mass] Measured by: LVMass(d) [AUTOCALC]

LVd Mass Ind (ASE) [Generic]Mode: MM:CM:AMM:CAMM:VRMMFormula: (((1.04*(({IVSd}+{LVIDd}+{LVPWd})^3-({LVIDd})^3))*0.8+0.6)/1000)/{BSA}Needs measurement: IVSd [Generic], LVIDd [Generic], LVPWd [Generic] Measured by: LV Study [MMLV]

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LVd Mass Index [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: m/{BSA} where m = ((1.04*(({IVSd}+{LVIDd}+{LVPWd})^3-({LVIDd})^3))-13.6)/1000Needs measurement: IVSd [Dimension], LVIDd [Dimension], LVPWd [Dimension], LVIDd [Dimension]Measured by: LVPWd [2DCALIPER]

LVd Mass Index [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (((1.04*(({IVSd}+{LVIDd}+{LVPWd})^3-({LVIDd})^3))-13.6)/1000)/{BSA}Needs measurement: IVSd [Generic, Dimension], LVIDd [Generic, Dimension], LVPWd [Generic, Dimension] Measured by: LV Study [MMLV], LVPWs [MMDISCALIPER]

LVEDV MOD BP [Biplane, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: biplane({LVLd A4C},{LVDisks},{LVLd A2C},{LVDisks})Needs measurement: LVLd A4C [Biplane, AutoBiplane], LVLd A2C [Biplane, AutoBiplane]Measured by: EF Biplane [AUTOCALC]Schiller, N.B., et al., “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography, “J Am Soc Echo, Sept-Oct 1989, Vol. 2, No. 5. p. 364.

LVEF BP-EL [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/d where: s = (8/(3*3.14159))*{LVAs(A4C)}*{LVAs(sax MV)}/{2D/LVIDs} d = (8/(3*3.14159))*{LVAd A4C}*{LVAd (sax MV)}/{LVIDd}Needs measurement: LVAd A4C [Biplane Ellipse], LVAd (sax MV) [Biplane Ellipse], LVIDd [Biplane Ellipse], LVAs A4C [Biplane Ellipse], LVAs sax MV [Biplane Ellipse], LVIDs [Biplane Ellipse]Measured by: LVEF BP-EL [AUTOCALC]

LVEF Bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/d where: s =5/6*{LVAs(sax)}*{LVLs(apical)} d = 5/6*{LVAd sax)}*{LVLd apical}Needs measurement: LVAd sax) [Bullet], LVLd apical [Bullet], LVLs apical [Bullet]Measured by: LVEF Bullet [AUTOCALC]

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LVEF MOD A2C [Biplane, Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD A2C}-{LVESV MOD A2C})/{LVEDV MOD A2C}Needs measurement: LVEDV MOD A2C [Biplane, Single Plane A2C, AutoBiplane], LVESV MOD A2C [Biplane, Single Plane A2C, AutoBiplane]Measured by: EF SP A2C [AUTOCALC], LVESV A2C [2DVOLUMETRACE], A2C [2DAUTOVOLUME]

LVEF MOD A4C [Biplane, Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD A4C}-{LVESV MOD A4C})/{LVEDV MOD A4C}Needs measurement: LVEDV MOD A4C [Biplane, Single Plane A4C, AutoBiplane], LVESV MOD A4C [Biplane, Single Plane A4C, AutoBiplane]Measured by: EF SP A4C [AUTOCALC], LVESV A4C [2DVOLUMETRACE], A4C [2DAUTOVOLUME]

LVEF MOD LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD LAX}-{LVESV MOD LAX})/{LVEDV MOD LAX}Needs measurement: LVEDV MOD LAX [Single Plane LAX, AutoBiplane], LVESV MOD LAX [Single Plane LAX, AutoBiplane]Measured by: LVESV LAX [2DVOLUMETRACE], EF SP LAX [AUTOCALC], AutoVolume [2DAUTOVOLUME]

LVESV MOD BP [Biplane, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: biplane({LVLs A4C},{LVDisks},{LVLs A2C},{LVDisks})Needs measurement: LVLs A4C [Biplane, AutoBiplane], LVLs A2C [Biplane, AutoBiplane] Measured by: EF Biplane [AUTOCALC]

LVIDd Index [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVIDd}/{BSA}Needs measurement: LVIDd [Dimension], Measured by: LVIDd [2DCALIPER]

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LVIDd Index [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {LVIDd}/{BSA}Needs measurement: LVIDd [Dimension]Measured by: LVIDd [MMDISCALIPER]

LVIDs Index [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVIDs}/{BSA}Needs measurement: LVIDs [Dimension]Measured by: LVIDs [2DCALIPER]

LVIDs Index [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: {LVIDs}/{BSA}Needs measurement: LVIDs [Dimension]Measured by: LVIDs [MMDISCALIPER]

LVOT Area [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 3.14/4*{LVOT Diam}^2Needs measurement: LVOT Diam [Dimension]Measured by: LVOT Diam [2DCALIPER]

LVOT Diam [Aortic]Mode: CW:PW:VRCW:VRPWFormula: {LVOT Diam}Needs measurement: LVOT Diam [Aortic]Measured by: AP Area [SDMANTRACE] Used to calculate: AP Area

LVOT Diam [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {LVOT Diam}Needs measurement: LVOT Diam [Mitral Valve]Measured by: MP Area [SDMANTRACE] Used to calculate: MP Area

LVOT VTI [Aortic]Mode: CW:PW:VRCW:VRPWFormula: {LVOT VTI}Needs measurement: LVOT VTI [Aortic]Measured by: AP Area [SDMANTRACE] Used to calculate: AP Area

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LVOT VTI [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {LVOT VTI}Needs measurement: LVOT VTI [Mitral Valve]Measured by: MP Area [SDMANTRACE] Used to calculate: MP Area

LVPEP/ET [Aortic]Mode: CW:PW:VRCW:VRPWFormula: {LVPEP}/{LVET}Needs measurement: LVPEP [Aortic], LVET [Aortic]Measured by: LVET [SDTIMECALIPER]

LVPEP/ET [Time]Mode: MM:CM:AMM:CAMM:VRMMFormula: {LVPEP}/{LVET}Needs measurement: LVPEP [Time], LVET [Time]Measured by: LVET [MMTIMECALIPER]

LVs Mass (ASE) [Generic]Mode: MM:CM:AMM:CAMM:VRMMFormula: ((1.04*(({IVSs}+{LVIDs}+{LVPWs})^3-({LVIDs})^3))*0.8+0.6)/1000Needs measurement: IVSs [Generic], LVIDs [Generic], LVPWs [Generic]Measured by: LV Study [MMLV]

LVs Mass [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ((1.04*(({IVSs}+{LVIDs}+{LVPWs})^3-({LVIDs})^3))-13.6)/1000Needs measurement: IVSs [Dimension], LVIDs [Dimension], LVPWs [Dimension]Measured by: LVPWs [2DCALIPER]

LVs Mass [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: ((1.04*(({IVSs}+{LVIDs}+{LVPWs})^3-({LVIDs})^3))-13.6)/1000Needs measurement: IVSs [Generic, Dimension], LVIDs [Generic, Dimension], LVPWs [Generic, Dimension]Measured by: LV Study [MMLV], LVPWs [MMDISCALIPER]

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LVs Mass A-L [Mass]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 1.05*5/6*({LVAs(sax epi)}*({LVLs(apical)}+t)-{LVAs(sax PM)}*{LVLs(apical)})/1000 where: t = sqrt({LVAs sax EPI}/3.14159)-sqrt({LVAs sax PM}/3.14159)Needs measurement: LVAs sax EPI [Mass], LVAs sax PM [Mass], LVLs apical [Mass]Measured by: LVMass(s) [AUTOCALC]

LVs Mass Ind (ASE) [Generic]Mode: MM:CM:AMM:CAMM:VRMMFormula: (((1.04*(({IVSs}+{LVIDs}+{LVPWs})^3-({LVIDs})^3))*0.8+0.6)/1000)/{BSA}Needs measurement: IVSs [Generic], LVIDs [Generic], LVPWs [Generic] Measured by: LV Study [MMLV]

LVs Mass Ind A-L [Mass]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: m/{BSA} where: m = 1.05*5/6*({LVAs(sax epi)}*({LVLs(apical)}+t)-{LVAs(sax PM)}*{LVLs(apical)})/1000t = sqrt({LVAs sax EPI}/3.14159)-sqrt({LVAs sax PM}/3.14159)Needs measurement: LVAs sax EPI [Mass], LVAs sax PM [Mass], LVLs apical [Mass] Measured by: LVMass(s) [AUTOCALC]

LVs Mass Index [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: m/{BSA} where: m = ((1.04*(({IVSs}+{LVIDs}+{LVPWs})^3-({LVIDs})^3))-13.6)/1000Needs measurement: IVSs [Dimension], LVIDs [Dimension], LVPWs [Dimension]Measured by: LVPWs [2DCALIPER]

LVs Mass Index [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: (((1.04*(({IVSs}+{LVIDs}+{LVPWs})^3-({LVIDs})^3))-13.6)/1000)/{BSA}Needs measurement: IVSs [Generic, Dimension], LVIDs [Generic, Dimension], LVPWs [Generic, Dimension] Measured by: LV Study [MMLV], LVPWs [MMDISCALIPER]

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LVSI Dopp [Aortic]Mode: PW:VRPWFormula: {LVOT Diam}^2*0.785*{LVOT VTI}/{BSA}Needs measurement: LVOT Diam [Aortic], LVOT VTI [Aortic], Measured by: LVOT Trace [SDMANTRACE]

LVSV Dopp [Aortic]Mode: PW:VRPWFormula: {LVOT Diam}^2*0.785*{LVOT VTI}Needs measurement: LVOT Diam [Aortic], LVOT VTI [Aortic]Measured by: LVOT Trace [SDMANTRACE]

MP Area [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {LVOT Diam}^2*0.785*({LVOT VTI}/{MP VTI})Needs measurement: LVOT Diam [Mitral Valve], LVOT VTI [Mitral Valve], MP VTI [Mitral Valve]Measured by: MP Area [SDMANTRACE]

MR ERO [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {MR Flow}/{MR Vmax}Needs measurement: MR Flow [PISA], MR Vmax [PISA]Measured by: MR Trace [AUTOCALC]

MR RF [PISA]Mode:CF:CW:PW:VRCW:VRPW Formula: {MR RV}/{MV SV}Needs measurement: MV Ann Diam [Dimension], MV Trace [Mitral Valve], MR Flow [PISA], MR Trace [PISA]Measured by: MR RF [AUTOCALC]

MR RV [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {MR Flow}/{MR Vmax}*{MR VTI}Needs measurement: MR Flow [PISA], MR Vmax [PISA], MR VTI [PISA]Measured by: MR Trace [AUTOCALC]

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MV AccT/DecT [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {MV AccT}/{MV DecT}Needs measurement: MV AccT [Mitral Valve], MV DecT [Mitral Valve]Measured by: MV AccT [SDCALIPER]

MV Area [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 3.14/4*{MV Ann Diam}^2Needs measurement: MV Ann Diam [Dimension]Measured by: MV Ann Diam [2DCALIPER]

MV CI [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {MV Ann Diam}^2*0.785*{MV VTI}*{HR}/60/{BSA}Needs measurement: MV Ann Diam [Mitral Valve], MV VTI [Mitral Valve], HR [Mitral Valve]Measured by: MV Trace [SDMANTRACE]

MV CO [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {MV Ann Diam}^2*0.785*{MV VTI}*{HR}/60Needs measurement: MV Ann Diam [Mitral Valve], MV VTI [Mitral Valve], HR [Mitral Valve]Measured by: MV Trace [SDMANTRACE]

MV E/A Ratio [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {MV E Vel}/{MV A Vel}Needs measurement: MV E Vel [Mitral Valve], MV A Vel [Mitral Valve]Measured by: MV A Vel [SDPTCALIPER], MV A Vel [AUTOCALC]

MV SI [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {MV Ann Diam}^2*0.785*{MV VTI}/{BSA}Needs measurement: MV Ann Diam [Mitral Valve], MV VTI [Mitral Valve], Measured by: MV Trace [SDMANTRACE]

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MV SV [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: {MV Ann Diam}^2*0.785*{MV VTI}Needs measurement: MV Ann Diam [Mitral Valve], MV VTI [Mitral Valve]Measured by: MV Trace [SDMANTRACE]

MVA (VTI) [Mitral Valve]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{LVOT Diam}^2*{LVOT VTI}/{MV VTI}Needs measurement: LVOT Diam [Mitral Valve], LVOT VTI [Mitral Valve], MV VTI [Mitral Valve]Measured by: MV Trace [AUTOCALC]

MVA By PHT [Mitral Valve]Mode: CW:PW:VRCW:VRPWFormula: 22/({MV PHT})Needs measurement: MV PHT [Mitral Valve]Measured by: MV E/A Velocity [SDEA3], MV PHT [SDCALIPER] Hatle, L. et al, “Non-invasive Assessment of Atrioventricular Pressure Halftime by Doppler Ultrasound,” Circulation, Vol. 60, 1979, pp 1096-1104.

P Vein S/D Ratio [Pulmonary Vein]Mode: PW:VRPWFormula: {P Vein S}/{P Vein D}Needs measurement: P Vein S [Pulmonary Vein], P Vein D [Pulmonary Vein]Measured by: P Vein D [SDPTCALIPER]

PAEDP [Pulmonic]Mode: CW:PW:VRCW:VRPWFormula: {PRend PG}+{RAP}Needs measurement: PRend PG [Pulmonic], RAP [Pulmonic]Measured by: PRend Vmax [AUTOCALC]

PR ERO [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {PR Flow}/{PR Vmax}Needs measurement: PR Flow [PISA], PR Vmax [PISA]Measured by: PR Trace [AUTOCALC]

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PR RV [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {PR Flow}/{PR Vmax}*{PR VTI}Needs measurement: PR Flow [PISA], PR Vmax [PISA], PR VTI [PISA]Measured by: PR Trace [AUTOCALC]

Pulmonic CO [Shunts, Congenital Heart]Mode: CW:PW:VRCW:VRPWFormula: {Pulmonic SV}*{Pulmonic HR}/60Needs measurement: Pulmonic SV [Shunts, Congenital Heart], Pulmonic HR [Shunts, Congenital Heart]Measured by: Pulmonic VTI [SDMANTRACE]

Pulmonic SV [Shunts, Congenital Heart]Mode: CW:PW:VRCW:VRPWFormula: 3.14159/4*{Pulmonic Diam}^2*{Pulmonic VTI}Needs measurement: Pulmonic Diam [Shunts, Congenital Heart], Pulmonic VTI [Shunts, Congenital Heart]Measured by: Pulmonic VTI [SDMANTRACE], Pulmonic VTI [SDMANTRACE] Used to calculate: Pulmonic COHatle, Liv, Angelsen, Bjorn., Doppler Ultrasound in Cardiology: Physical Principles and Clinical Applications, ed. 2, Lea and Febiger, Philadelphia, Pennsylvania, 1985, p. 306.

PV A/MV A Dur [Pulmonary Vein]Mode: PW:VRPWFormula: {P Vein A Dur}/{MV A Dur}Needs measurement: P Vein A Dur [Pulmonary Vein], MV A Dur [Pulmonary Vein]Measured by: P Vein A Dur [SDTIMECALIPER]

PV A/MV VTI [Pulmonary Vein]Mode: PW:VRPWFormula: {P Vein A Dur}/{MV VTI}Needs measurement: P Vein A Dur [Pulmonary Vein], MV VTI [Pulmonary Vein]Measured by: P Vein A Dur [SDTIMECALIPER]

PV AccT/ET [Pulmonic]Mode: CW:PW:VRCW:VRPWFormula: {PV AccT}/{PVET}Needs measurement: PV AccT [Pulmonic], PVET [Pulmonic]Measured by: PVET [SDTIMECALIPER]

45

PV A-MV A Dur [Pulmonary Vein]Mode: PW:VRPWFormula: {P Vein A Dur}-{MV A Dur}Needs measurement: P Vein A Dur [Pulmonary Vein], MV A Dur [Pulmonary Vein]Measured by: P Vein A Dur [SDTIMECALIPER]

PV Area [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 3.14/4*{PV Ann Diam}^2Needs measurement: PV Ann Diam [Dimension]Measured by: PV Ann Diam [2DCALIPER]

PV CI [Pulmonic, Valvular PS]Mode: CW:PW:VRCW:VRPWFormula: (({PV Ann Diam}^2*0.785*{PV VTI})*{HR}/60)/{BSA}Needs measurement: PV Ann Diam [Pulmonic, Valvular PS], PV VTI [Pulmonic, Valvular PS], HR [Pulmonic, Valvular PS]Measured by: PV Trace [SDMANTRACE]

PV CO [Pulmonic, Valvular PS]Mode: CW:PW:VRCW:VRPWFormula: ({PV Ann Diam}^2*0.785*{PV VTI})*{HR}/60Needs measurement: PV Ann Diam [Pulmonic, Valvular PS], PV VTI [Pulmonic, Valvular PS], HR [Pulmonic, Valvular PS]Measured by: PV Trace [SDMANTRACE]

PV SI [Pulmonic, Valvular PS]Mode: CW:PW:VRCW:VRPWFormula: ({PV Ann Diam}^2*0.785*{PV VTI})/{BSA}Needs measurement: PV Ann Diam [Pulmonic, Valvular PS], PV VTI [Pulmonic, Valvular PS]Measured by: PV Trace [SDMANTRACE] Gorge, G., et al., “High Resolution Two-dimensional Echocardiography Improves Quantification of Left Ventricular Function, “J Am Soc Echo, 1992, Vol. 5, pp. 125-134.

PV SV [Pulmonic, Valvular PS]Mode: CW:PW:VRCW:VRPWFormula: {PV Ann Diam}^2*0.785*{PV VTI}Needs measurement: PV Ann Diam [Pulmonic, Valvular PS], PV VTI [Pulmonic, Valvular PS]Measured by: PV Trace [SDMANTRACE]

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PVA (Vmax) [Pulmonic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{RVOT Diam}^2*{RVOT Vmax}/{PV Vmax}Needs measurement: RVOT Diam [Pulmonic], RVOT Vmax [Pulmonic], PV Vmax [Pulmonic]Measured by: PV Vmax [AUTOCALC]

PVA (Vmax) [Pulmonic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{RVOT Diam}^2*{RVOT Vmax}/{PV Vmax}Needs measurement: RVOT Diam [Pulmonic], RVOT Vmax [Pulmonic], PV Vmax [Pulmonic]Measured by: PV Trace [AUTOCALC]

PVA (VTI) [Pulmonic]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{RVOT Diam}^2*{RVOT VTI}/{PV VTI}Needs measurement: RVOT Diam [Pulmonic], RVOT VTI [Pulmonic], PV VTI [Pulmonic]Measured by: PV Trace [AUTOCALC]

Qp/Qs [Shunts, Congenital Heart]Mode: CW:PW:VRCW:VRPWFormula: 3.14159/4*{Pulmonic Diam}^2*{Pulmonic VTI}/(3.14159/4*{Systemic Diam}^2*{Systemic VTI})Needs measurement: Pulmonic Diam [Shunts, Congenital Heart], Pulmonic VTI [Shunts, Congenital Heart], Systemic Diam [Shunts, Congenital Heart], Systemic VTI [Shunts, Congenital Heart]Measured by: Qp/Qs [AUTOCALC]

RIMP [Pulmonic, Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: ({TCO}-{PVET})/{PVET}Needs measurement: TCO [Pulmonic, Tricuspid Valve], PVET [Pulmonic, Tricuspid Valve], PVET [Pulmonic, Tricuspid Valve]Measured by: RIMP [AUTOCALC]

RVOT Area [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 3.14/4*{RVOT Diam}^2Needs measurement: RVOT Diam [Dimension]Measured by: RVOT Diam [2DCALIPER]

47

RVOT CI [Pulmonic, Valvular PS]Mode: PW:VRPWFormula: (({RVOT Diam}^2*0.785*{RVOT VTI})*{HR}/60)/{BSA}Needs measurement: RVOT Diam [Pulmonic, Valvular PS], RVOT VTI [Pulmonic, Valvular PS], HR [Pulmonic, Valvular PS], Measured by: RVOT Trace [SDMANTRACE]

RVOT CO [Pulmonic, Valvular PS]Mode: PW:VRPWFormula: ({RVOT Diam}^2*0.785*{RVOT VTI})*{HR}/60Needs measurement: RVOT Diam [Pulmonic, Valvular PS], RVOT VTI [Pulmonic, Valvular PS], HR [Pulmonic, Valvular PS]Measured by: RVOT Trace [SDMANTRACE]

RVOT SI [Pulmonic, Valvular PS]Mode: PW:VRPWFormula: ({RVOT Diam}^2*0.785*{RVOT VTI})/{BSA}Needs measurement: RVOT Diam [Pulmonic, Valvular PS], RVOT VTI [Pulmonic, Valvular PS], Measured by: RVOT Trace [SDMANTRACE]

RVOT SV [Pulmonic, Valvular PS]Mode: PW:VRPWFormula: {RVOT Diam}^2*0.785*{RVOT VTI}Needs measurement: RVOT Diam [Pulmonic, Valvular PS], RVOT VTI [Pulmonic, Valvular PS]Measured by: RVOT Trace [SDMANTRACE]

RVPEP/ET [Pulmonic]Mode: CW:PW:VRCW:VRPWFormula: {RVPEP}/{RVET}Needs measurement: RVPEP [Pulmonic], RVET [Pulmonic]Measured by: RVET [SDTIMECALIPER]

RVPEP/ET [Time]Mode: MM:CM:AMM:CAMM:VRMMFormula: {RVPEP}/{RVET}Needs measurement: RVPEP [Time], RVET [Time]Measured by: RVET [MMTIMECALIPER]

48

RVSP [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: {TR maxPG}+{RAP}Needs measurement: TR maxPG [Tricuspid Valve], RAP [Tricuspid Valve]Measured by: TR Vmax [AUTOCALC]

SI A-L A2C [Biplane, Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L A2C}-{LVESV A-L A2C})/{BSA}Needs measurement: LVEDV A-L A2C [Biplane, Single Plane A2C, AutoBiplane], LVESV A-L A2C [Biplane, Single Plane A2C, AutoBiplane]Measured by: EF SP A2C [AUTOCALC], LVESV A2C [2DVOLUMETRACE], A2C [2DAUTOVOLUME]

SI A-L A4C [Biplane, Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L A4C}-{LVESV A-L A4C})/{BSA}Needs measurement: LVEDV A-L A4C [Biplane, Single Plane A4C, AutoBiplane], LVESV A-L A4C [Biplane, Single Plane A4C, AutoBiplane]Measured by: EF SP A4C [AUTOCALC], LVESV A4C [2DVOLUMETRACE], A4C [2DAUTOVOLUME]

SI A-L LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV A-L LAX}-{LVESV A-L LAX})/{BSA}Needs measurement: LVEDV A-L LAX [Single Plane LAX, AutoBiplane], LVESV A-L LAX [Single Plane LAX, AutoBiplane] Measured by: LVESV LAX [2DVOLUMETRACE], EF SP LAX [AUTOCALC], AutoVolume [2DAUTOVOLUME]

SI Biplane [Biplane, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d = biplane({LVLd A4C},{LVDisks},{LVLd A2C},{LVDisks})Needs measurement: LVLd A4C [Biplane, AutoBiplane], LVLd A2C [Biplane, AutoBiplane], LVLs A4C [Biplane, AutoBiplane], LVLs A2C [Biplane, AutoBiplane] Measured by: EF Biplane [AUTOCALC]

49

SI bp el [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/{BSA} where: s = (8/(3*3.14159))*{LVAs(A4C)}*{LVAs(sax MV)}/{2D/LVIDs} d = (8/(3*3.14159))*{LVAd A4C}*{LVAd (sax MV)}/{LVIDd}Needs measurement: LVAd A4C [Biplane Ellipse], LVAd (sax MV) [Biplane Ellipse], LVIDd [Biplane Ellipse], LVAs A4C [Biplane Ellipse], LVAs sax MV [Biplane Ellipse], LVIDs [Biplane Ellipse] Measured by: LVEF BP-EL [AUTOCALC]

SI bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/{BSA} where: s =5/6*{LVAs(sax)}*{LVLs(apical)} d = 5/6*{LVAd sax)}*{LVLd apical}Needs measurement: LVAd sax) [Bullet], LVLd apical [Bullet], LVLs apical [Bullet], Measured by: LVEF Bullet [AUTOCALC]

SI MOD A2C [Biplane, Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD A2C}-{LVESV MOD A2C})/{BSA}Needs measurement: LVEDV MOD A2C [Biplane, Single Plane A2C, AutoBiplane], LVESV MOD A2C [Biplane, Single Plane A2C, AutoBiplane]Measured by: EF SP A2C [AUTOCALC], LVESV A2C [2DVOLUMETRACE], A2C [2DAUTOVOLUME]

SI MOD A4C [Biplane, Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD A4C}-{LVESV MOD A4C})/{BSA}Needs measurement: LVEDV MOD A4C [Biplane, Single Plane A4C, AutoBiplane], LVESV MOD A4C [Biplane, Single Plane A4C, AutoBiplane]Measured by: EF SP A4C [AUTOCALC], LVESV A4C [2DVOLUMETRACE], A4C [2DAUTOVOLUME]

SI MOD LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVEDV MOD LAX}-{LVESV MOD LAX})/{BSA}Needs measurement: LVEDV MOD LAX [Single Plane LAX, AutoBiplane], LVESV MOD LAX [Single Plane LAX, AutoBiplane] Measured by: LVESV LAX [2DVOLUMETRACE], EF SP LAX [AUTOCALC], AutoVolume [2DAUTOVOLUME]

50

SI mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d-s/{BSA} where: s = ({LVLs(apical)}/9)*((4*{LVAs(sax MV)})+(2*{LVAs(sax PM)})+ sqrt({LVAs(sax MV)}*{LVAs(sax PM)}))d = ({LVLd apical}/9)*((4*{LVAd (sax MV)})+(2*{LVAd sax PM})+ sqrt({LVAd (sax MV)}*{LVAd sax PM}))Needs measurement: LVLd apical [Modified Simpson], LVAd (sax MV) [Modified Simpson], LVAd sax PM [Modified Simpson], LVLs apical [Modified Simpson], LVAs sax MV [Modified Simpson], LVAs sax PM [Modified Simpson] Measured by: EF mod sim [AUTOCALC] Gorge, G., et al., “High Resolution Two-dimensional Echocardiography Improves Quantification of Left Ventricular Function, “J Am Soc Echo, 1992, Vol. 5, pp. 125-134.

SI(A-L) [Generic]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({EDV(A-L)}-{ESV(A-L)})/{BSA}Needs measurement: ESV(A-L) [Generic]Measured by: EF Volume [AUTOCALC]

SI(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/{BSA} where: s = {2D/LVIDs}^3 d = {LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

SI(Cube) [Generic]Mode: MM:CM:AMM:CAMM:VRMMFormula: (dv-sv)/{BSA} where: sv = {MM/LVIDs}^3 dv = {LVIDd}^3Needs measurement: LVIDd [Generic], LVIDs [Generic], Measured by: LV Study [MMLV]

SI(MOD) [Generic]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({EDV(MOD)}-{ESV(MOD)})/{BSA}Needs measurement: EDV(MOD) [Generic], ESV(MOD) [Generic]Measured by: EF Volume [AUTOCALC]

51

SI(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: (d-s)/{BSA} s = 7/(2.4+{2D/LVIDs})*{2D/LVIDs}^3 d = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz] Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

SI(Teich) [Generic]Mode: MM:CM:AMM:CAMM:VRMMFormula: (dv-sv)/{BSA} where: sv = 7/(2.4+{MM/LVIDs})*{MM/LVIDs}^3 dv = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Generic], LVIDd [Generic], LVIDs [Generic] Measured by: LV Study [MMLV]

SV A-L A2C [Biplane, Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVEDV A-L A2C}-{LVESV A-L A2C}Needs measurement: LVEDV A-L A2C [Biplane, Single Plane A2C, AutoBiplane], LVESV A-L A2C [Biplane, Single Plane A2C, AutoBiplane]Measured by: EF SP A2C [AUTOCALC], LVESV A2C [2DVOLUMETRACE], A2C [2DAUTOVOLUME]

SV A-L A4C [Biplane, Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVEDV A-L A4C}-{LVESV A-L A4C}Needs measurement: LVEDV A-L A4C [Biplane, Single Plane A4C, AutoBiplane], LVESV A-L A4C [Biplane, Single Plane A4C, AutoBiplane]Measured by: EF SP A4C [AUTOCALC], LVESV A4C [2DVOLUMETRACE], A4C [2DAUTOVOLUME]

SV A-L LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVEDV A-L LAX}-{LVESV A-L LAX}Needs measurement: LVEDV A-L LAX [Single Plane LAX, AutoBiplane], LVESV A-L LAX [Single Plane LAX, AutoBiplane]Measured by: LVESV LAX [2DVOLUMETRACE], EF SP LAX [AUTOCALC], AutoVolume [2DAUTOVOLUME]

52

SV Biplane [Biplane, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d = biplane({LVLd A4C},{LVDisks},{LVLd A2C},{LVDisks})Needs measurement: LVLd A4C [Biplane, AutoBiplane], LVLd A2C [Biplane, AutoBiplane], LVLs A4C [Biplane, AutoBiplane], LVLs A2C [Biplane, AutoBiplane] Measured by: EF Biplane [AUTOCALC]

SV bp el [Biplane Ellipse]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d = (8/(3*3.14159))*{LVAd A4C}*{LVAd (sax MV)}/{LVIDd}Needs measurement: LVAd A4C [Biplane Ellipse], LVAd (sax MV) [Biplane Ellipse], LVIDd [Biplane Ellipse], LVAs A4C [Biplane Ellipse], LVAs sax MV [Biplane Ellipse], LVIDs [Biplane Ellipse]Measured by: LVEF BP-EL [AUTOCALC]

SV bullet [Bullet]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d-s where: s = 5/6*{LVAs(sax)}*{LVLs(apical)} d = 5/6*{LVAd sax)}*{LVLd apical}Needs measurement: LVAd sax) [Bullet], LVLd apical [Bullet], LVLs apical [Bullet]Measured by: LVEF Bullet [AUTOCALC]

SV MOD A2C [Biplane, Single Plane A2C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVEDV MOD A2C}-{LVESV MOD A2C}Needs measurement: LVEDV MOD A2C [Biplane, Single Plane A2C, AutoBiplane], LVESV MOD A2C [Biplane, Single Plane A2C, AutoBiplane]Measured by: EF SP A2C [AUTOCALC], LVESV A2C [2DVOLUMETRACE], A2C [2DAUTOVOLUME]

SV MOD A4C [Biplane, Single Plane A4C, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVEDV MOD A4C}-{LVESV MOD A4C}Needs measurement: LVEDV MOD A4C [Biplane, Single Plane A4C, AutoBiplane], LVESV MOD A4C [Biplane, Single Plane A4C, AutoBiplane]Measured by: EF SP A4C [AUTOCALC], LVESV A4C [2DVOLUMETRACE], A4C [2DAUTOVOLUME]

53

SV MOD LAX [Single Plane LAX, AutoBiplane]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {LVEDV MOD LAX}-{LVESV MOD LAX}Needs measurement: LVEDV MOD LAX [Single Plane LAX, AutoBiplane], LVESV MOD LAX [Single Plane LAX, AutoBiplane]Measured by: LVESV LAX [2DVOLUMETRACE], EF SP LAX [AUTOCALC], AutoVolume [2DAUTOVOLUME]

SV mod sim [Modified Simpson]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: ({LVLd apical}/9)*((4*{LVAd (sax MV)})+(2*{LVAd sax PM})+sqrt({LVAd (sax MV)}*{LVAd sax PM}))Needs measurement: LVLd apical [Modified Simpson], LVAd (sax MV) [Modified Simpson], LVAd sax PM [Modified Simpson], LVLs apical [Modified Simpson], LVAs sax MV [Modified Simpson], LVAs sax PM [Modified Simpson]Measured by: EF mod sim [AUTOCALC] Pombo, J.F., “Left Ventricular Volumes and Ejection by Echocardiography,” Circulation 1971, Vol 43, pp. 480-490

SV(A-L) [Generic]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {EDV(A-L)}-{ESV(A-L)}Needs measurement: ESV(A-L) [Generic]Measured by: EF Volume [AUTOCALC]

SV(Cube) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d-s where: s = {2D/LVIDs}^3 d = {LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

SV(Cube) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: dv-sv where: sv = {MM/LVIDs}^3 dv = {LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER]

54

SV(MOD) [Generic]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: {EDV(MOD)}-{ESV(MOD)}Needs measurement: EDV(MOD) [Generic], ESV(MOD) [Generic]Measured by: EF Volume [AUTOCALC]

SV(Teich) [Dimension, Cube/Teicholz]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: d-s where:s = 7/(2.4+{2D/LVIDs})*{2D/LVIDs}^3 d = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Dimension, Cube/Teicholz], LVIDs [Dimension, Cube/Teicholz]Measured by: LVs [2DLV], LVIDs [2DCALIPER], EF(Cube) [AUTOCALC]

SV(Teich) [Generic, Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: dv-sv where: sv = 7/(2.4+{MM/LVIDs})*{MM/LVIDs}^3 dv = 7/(2.4+{LVIDd})*{LVIDd}^3Needs measurement: LVIDd [Generic, Dimension], LVIDs [Generic, Dimension]Measured by: LV Study [MMLV], LVIDs [MMDISCALIPER]

Systemic CO [Shunts, Congenital Heart]Mode: CW:PW:VRCW:VRPWFormula: {Systemic SV}*{Systemic HR}/60Needs measurement: Systemic SV [Shunts, Congenital Heart], Systemic HR [Shunts, Congenital Heart]Measured by: Systemic VTI [SDMANTRACE]

Systemic SV [Shunts, Congenital Heart]Mode: CW:PW:VRCW:VRPWFormula: 3.14159/4*{Systemic Diam}^2*{Systemic VTI}Needs measurement: Systemic Diam [Shunts, Congenital Heart], Systemic VTI [Shunts, Congenital Heart]Measured by: Systemic VTI [SDMANTRACE], Systemic VTI [SDMANTRACE] Used to calculate: Systemic COCalafiore P, MBBS, Stewart WJ, Doppler Echocardiographic Quantitation of Volumetric Flow Rate, Cardiology Clinics, vol. 8, No. 2, 1990

55

TR ERO [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {TR Flow}/{TR Vmax}Needs measurement: TR Flow [PISA], TR Vmax [PISA]Measured by: TR Trace [AUTOCALC]

TR RV [PISA]Mode: CF:CW:PW:VRCW:VRPWFormula: {TR Flow}/{TR Vmax}*{TR VTI}Needs measurement: TR Flow [PISA], TR Vmax [PISA], TR VTI [PISA]Measured by: TR Trace [AUTOCALC]

TV AccT/DecT [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: {TV AccT}/{TV Dec Time}Needs measurement: TV AccT [Tricuspid Valve], TV Dec Time [Tricuspid Valve]Measured by: TV AccT [SDCALIPER]

TV Area [Dimension]Mode: 2D:CF:TT:SI:SRI:VR2DFormula: 3.14/4*{TV Ann Diam}^2Needs measurement: TV Ann Diam [Dimension]Measured by: TV Ann Diam [2DCALIPER]

TV CI [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: (({TV Ann Diam}^2*0.785*{TV VTI})*{HR}/60)/{BSA}Needs measurement: TV Ann Diam [Tricuspid Valve], TV VTI [Tricuspid Valve], HR [Tricuspid Valve]Measured by: TV Trace [SDMANTRACE] The Merc Manual of Diagnosis and Therapy, ed. 15, Robert Berkon, ed., Merck and Co., Rahway, NJ, 1987, p. 387Schiller, N.B., et al., “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography, “J Am Soc Echo, Sept-Oct 1989, Vol. 2, No. 5. p. 364.

56

TV CO [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: ({TV Ann Diam}^2*0.785*{TV VTI})*{HR}/60Needs measurement: TV Ann Diam [Tricuspid Valve], TV VTI [Tricuspid Valve], HR [Tricuspid Valve]Measured by: TV Trace [SDMANTRACE] Calafiore, P., Stewart, W.J., “Doppler Echocardiographic Quantitation of Volumetric Flow Rate, “ Cardiology Clinics, May 1990, Vol. 8, No. 2, pp. 191-202.

TV E/A Ratio [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: {TV E Vel}/{TV A Vel}Needs measurement: TV E Vel [Tricuspid Valve], TV A Vel [Tricuspid Valve]Measured by: TV A Vel [SDPTCALIPER]

TV SI [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: ({TV Ann Diam}^2*0.785*{TV VTI})/{BSA}Needs measurement: TV Ann Diam [Tricuspid Valve], TV VTI [Tricuspid Valve]Measured by: TV Trace [SDMANTRACE]

TV SV [Tricuspid Valve]Mode: CW:PW:VRCW:VRPWFormula: {TV Ann Diam}^2*0.785*{TV VTI}Needs measurement: TV Ann Diam [Tricuspid Valve], TV VTI [Tricuspid Valve]Measured by: TV Trace [SDMANTRACE]

TVA (Vmax) [Tricuspid Valve]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{RVOT Diam}^2*{RVOT Vmax}/{TV Vmax}Needs measurement: RVOT Diam [Tricuspid Valve], RVOT Vmax [Tricuspid Valve], TV Vmax [Tricuspid Valve]Measured by: TV Vmax [AUTOCALC]

TVA (Vmax) [Tricuspid Valve]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{RVOT Diam}^2*{RVOT Vmax}/{TV Vmax}Needs measurement: RVOT Diam [Tricuspid Valve], RVOT Vmax [Tricuspid Valve], TV Vmax [Tricuspid Valve]Measured by: TV Trace [AUTOCALC]

57

TVA (VTI) [Tricuspid Valve]Mode: 2D:CW:PW:VRCW:VRPWFormula: 3.14/4*{RVOT Diam}^2*{RVOT VTI}/{TV VTI}Needs measurement: RVOT Diam [Tricuspid Valve], RVOT VTI [Tricuspid Valve], TV VTI [Tricuspid Valve]Measured by: TV Trace [AUTOCALC]

Vcf mean [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: ({LVIDd}-{LVIDs})/({LVIDd}*{LVET})Needs measurement: LVIDd [Dimension], LVIDs [Dimension], LVET [Dimension]Measured by: Vcf [MMTIMECALIPER]

Vcf mn (corr) [Dimension]Mode: MM:CM:AMM:CAMM:VRMMFormula: ({LVIDd}-{LVIDs})/({LVIDd}*({LVET}/sqrt({Time})))Needs measurement: LVIDd [Dimension], LVIDs [Dimension], LVET [Dimension], Time [Dimension]Measured by: Vcf [MMTIMECALIPER]

58

Formulas–Vascular

Vascular Calculation Formulas



RT ECA Right External Carotid Artery Velocity

one Doppler blood flow peak velocity

RT ECA=v1[cm/s or m/s]

RT CCA Right Common Carotid Artery Velocity


RT CCA=v1[cm/s or m/s]

RT BIFURC Right Carotid Bifurcation Velocity


RT BIFURC=v1[cm/s or m/s]

RT ICA Right Internal Carotid Artery Velocity


RT ICA=v1[cm/s or m/s]

RT ICA/CCA

Right Internal Carotid Artery Velocity/Common Carotid Artery Velocity Ratio


RT ICA/CCA=VICA/VCCA

LT ECA, LT CCA, LT BIFURC, LT ICA, LT ICA/CCA

Same as above, for Left Carotid Artery

Same as above

A/B Ratio Velocities Ratio two Doppler blood flow peak velocities

A/B=V1/V2

% Stenosis Stenosis Ratio two areas (by ellipse, trace, circle or distance)

% Stenosis=[1-(Aresidual/ Alumen)]x100

59

S/D Ratio Systolic Velocity/Diastolic Velocities Ratio


S/D=Vsystole/Vdiastolea

PI Pulsatility Index two Doppler blood flow peak velocities and TAMAX

PI=(Vmax-Vdiastole)/TAMAXa

RI Resistivity Index two Doppler blood flow peak velocities

RI=(Vmax-Vdiastole)/ Vmaxa

HR Heart Rate (beats/minute) one 2 beat time interval (measured manually or automatically)

HR[BPM]=120[sec]/2 beat time[sec]

a) Vdiastole = Vmin or Vend-diastole (depends on preset selection)



60

Formulas–OB

OB Calculation Formulas



Author Reference

AC Abdominal Circumference

circumference by trace, ellipse, circle or two distances

Hadlock et al, Radiology, 152:497-501, 1984AC=13.3+1.61 (GA) -0.00998 (GA)2

BPD Biparietal Diameter

one distance

BPD = -3.08+0.41 (GA) - 0.000061 (GA)3

CRL Crown Rump Length

one distance

CRL=1.684969+ 0.315646xd1+ 0.049306xd1^2+ 0.004057xd1^3+ 0.000120456xd1^4

FL Femur Length

one distance

FL = -3.91 + 0.427 (GA) - 0.0034 (GA)2

GS Gestational Sac

three distances

GS [wk] = 1.42450142 * (d1+d2+d3)/3+ 3.6225

HC Head Circumference

circumference by trace, ellipse, circle or two distances

HC=-11.48 + 1.56 (GA) - 0.0002548 (GA)3

61



Author Reference

HC Head Circumference

one ellipse Hansmann, Ultrasound Diagnosis in Obstetrics and Gynecology 438-9, 1985

HC [mm] = 2.325 * (BPD [mm]^2 + OFD [mm]^2)^0.5

EF Ejection Fraction

two distances on M-Mode (End-diastolic dimension and End-systolic dimension on M-Mode)

n/a

EF = (1 - Ds^3 / Dd^3)

62

CUA Hadlock Formulas

Calc Mnemonic

Calc Name Formula

CUAa Composite Ultrasound Age

1. CUA (BPD) = 9.54 + 1.482 * BPD + 0.1676 * BPD2

2. CUA (HC) = 8.96 + 0.540 * HC + 0.0003 * HC3

3. CUA (AC) = 8.14 + 0.753 * AC + 0.0036 * AC2

4. CUA (FL) = 10.35 + 2.460 * FL + 0.170 * FL2

5. CUA (BPD, HC) = 10.32 + 0.009 * HC2 + 1.3200 * BPD + 0.00012 * HC3

6. CUA (BPD, AC) = 9.57 + 0.524 * AC + 0.1220 * BPD2

7. CUA (BPD, FL) = 10.50 + 0.197 * BPD * FL + 0.9500 * FL + 0.7300 * BPD

8. CUA (HC, AC) = 10.31 + 0.012 * HC2 + 0.3850 * AC

9. CUA (HC, FL) = 11.19 + 0.070 * HC * FL + 0.2630 * HC

10. CUA (AC, FL) = 10.47 + 0.442 *AC + 0.3140 * FL2 -0.0121 * FL3

11. CUA (BPD, HC, AC) = 10.58 + 0.005 * HC2 + 0.3635 * AC + 0.02864 * BPD * AC

12. CUA (BPD, HC, FL) = 11.38 = 0.070 * HC * FL + 0.9800 * BPD

13. CUA (BPD, AC, FL) = 10.61 + 0.175 * BPD * FL + 0.2970 * AC + 0.7100 * FL

14. CUA (HC, AC, FL) = 10.33 + 0.031 * HC * FL + 0.3610 * HC + 0.0298 * AC * FL

15. CUA (BPD, HC, AC, FL) = 10.85 + 0.060 * HC * FL + 0.6700 * BPD + 0.1680 * AC

Author Reference: Hadlock, Radiology, 1984 152:497-501

a) Formulas are used only if Hadlock HC, FL, AC and BPD are used and CUA is selected as the preset in the CUA/AUA for Hadlock preset in the System M&A Preset Menu. If other authors are used, CUA automatically changes to AUA and an average value is displayed.

63

EFW Calculation Formulas



Author Reference

EFW Estimated Fetal Weight

AC and HC Hadlock, Radiology, 150:535, 1984

EFW [kg] = 10^ (1.182+(0.0273*HC [cm])+(0.07057*AC [cm] - (0.00063*AC [cm]^2)-(0.0002184*AC [cm] * HC [cm]))


BPD, AC, and FL Hadlock, AJOG, 151:333, 1985

EFW [g]=10^(1.335-(0.0034*AC [cm] * FL [cm]) + (0.0316 * BPD [cm]) + (0.0457 * AC [cm]) + (0.1623 * FL [cm]


AC, HC, and FL Hadlock, AJOG, 151:333, 1985

EFW [g]=10^(1.326-(0.00326 * AC [cm] * FL [cm]) + (0.0107 * HC [cm]) + (0.0438 * AC [cm]) + (0.158 * FL [cm]))


AC, HC, BPD, FL Hadlock, AJOG, 151:333, 1985

EFW [g] = 10^(1.3596- (0.00386 * AC [cm] * FL [cm]) + (0.0064 * HC [cm]) + (0.00061 * BPD [cm] * AC [cm]) + (0.0424 * AC [cm]) + (0.174 * FL [cm]))

64



Author Reference


AC and FL Hadlock, Radiology, 150:535, 1984

EFW [g] = 10^(1.304 + 0.05281 * AC [cm] + 0.1938 * FL [cm] - 0.004 * AC [cm] * FL [cm])


EFW [g] = -3200.40479 + 157.07186 * AC [cm] + 15.90391 * BPD [cm]^2

Merz


EFW [g] = 0.515263 -0.105775 * BPD [mm] + (0.000930707 * BPD [mm]^2 + 0.0649145 * TTD [mm] - 0.00020562 * TTD [mm]^2

Hansmann


AC and BPD Shepard, AJOG, 142:47, 1982

EFW [kg] = 10^(-1.7492 + 0.166 * BPD [cm] + 0.046 * AC [cm] - 2.646 * AC [cm] * BPD [cm]/1000)


BPD [cm] and AC [cm] Shepard/Warsoff

EFW [g] = 10^(1.7288+0.09184 * BPD [cm] + 0.02581 * AC [cm] + 0.00011 * BPD [cm] * AC [cm])


BPD [cm] and AC [cm] Richards/Berkowitz

EFW [g] =10^(3-1.7492 + (0.166 * BPD [cm]) + (0.04 * A [cm]) - (0.002646 * AC [cm] * BPD [cm]))


EFW [g] = 1.07 * BPD [cm]^3 + 3.42 * APTD [cm] * TTD [cm] * FL [cm]

Tokyo University

65



Author Reference


BPD, AxT, FL [cm] Tokyo Shinozuka

EFW1 [g] =1.07 * BPD [cm]^3 + 3.42 * AxT [cm2] * FL [cm]


BPD, AC, FL [cm] Tokyo Shinozuka

EFW2 [g] = 1.07 * BPD [cm]^3 + 0.30 * AC [cm]^2 * FL [cm]


BPD, AxT, LV [cm] Tokyo Shinozuka

EFW3 [g] = 1.07 * BPD [cm] ^3 + 2.91 * AxT [cm2] * LV [cm]

66

Amniotic Fluid Index (AFI)

The normal values are considered to be:

• 36-40 weeks• 0-5 cm = very low• 5.1-8.0 cm = low• 8.1-18.0 cm = normal• >18.0 = high

Sagittal

Dr. Rutherford/Dr. Phelan, Obstetrics and Gynecology, Volume 70, No. 3, Part 1, p.353-6, Sept. 1987.

• 28-40 weeks• 15.0 cm = average• >20.0 - 24.0 = hydramnios• <5.0-6.0 = Oligohydramnios Transverse

Dr. C.C. Smith, The Female Patient, Volume 15, p.85-97, March 1990.

67

Formulas–GYN

GYN Calculation Formulas


Input Measurements Formula

UT-L Uterine Length one distance Ut-L[cm or mm]=d1

UT-H Uterine Height one distance Ut-H[cm or mm]=d1

UT-W Uterine Width one distance Ut-W[cm or mm]=d1

UT-Volume Uterine Volume

UtPFD Uterus Portio-Fundus Distance

UtAP Anterior-Posterior Uterus Diameter

UtQ Transverse Uterus Diameter

Endo Endometrium Thickness

one distance Endo[cm or mm]=d1

Lt. Ov-L Left Ovarian Length one distance Lt. Ov-L[cm or mm]=d1

Lt. Ov-H Left Ovarian Height one distance Lt. Ov-H[cm or mm]=d1

Lt. Ov-W Left Ovarian Width one distance Lt. Ov-W[cm or mm]=d1

Lt. Ov-Volume Left Ovarian Volume

Rt. Ov-L Right Ovarian Length

one distance Rt. Ov-L[cm or mm]=d1

Rt. Ov-H Right Ovarian Height one distance Rt. Ov-H[cm or mm]=d1

Rt. Ov-W Right Ovarian Width one distance Rt. Ov-W[cm or mm]=d1

Rt. Ov-Volume

Right Ovarian Volume

Lt. Ov-RI Left Ovarian Vessel Resistive Index


Lt. Ov-RI= (Vmax-Vdiastole)/Vmaxa

68

Ut-RI Uterine Vessel Resistive Index


Ut-RI= (Vmax-Vdiastole)/Vmaxa

Rt. Ov-RI Right Ovarian Vessel Resistive Index


Rt. Ov-RI= (Vmax-Vdiastole)/Vmaxa

LtOvFo[ml] Left Ovary Follicles One distanceb D1[cm]3 x /6

Two distancesb D1[cm]2 x D2x[cm] /6 : (D1<D2)

D1[cm] x D2[cm] 2x /6 : (D2<D1)

Three distances D1[cm] x D2[cm]x D3[cm] x /6

RtOvFo[ml] Right Ovary Follicles One distanceb D1[cm]3 x /6

Two distancesb D1[cm]2 x D2[cm] x /6 : (D1 <D2)

D1[cm] x D2[cm]2 x /6 : (D2 <D1)

Three distances D1[cm] x D2[cm] x D3[cm] x /6

Lt. Ov-PI Left Ovarian Vessel Pulsatility Index

Rt. Ov-PI Right Ovarian Vessel Pulsatility Index

a) Vdiastole = Vmin or Vend-diastole (depends on preset selection)b) To calculate LtOvFo or RtOvFo with one (or two distances), press the CLEAR key after the first (or second distance) measurement(s).


Input Measurements Formula

69

Measurement accuracy

GeneralWhen using the Measurement and Analysis (M&A) package, it is important to keep in mind the different aspects that affect the accuracy of the measurements. These include acoustical properties, patient echogenicity, measurement tools and algorithms, scanner setup (especially Field-of-view or Range settings), probe type used, and operator inputs.

Sources of error

Image Quality

The accuracy of each measurement is highly dependent on image quality. Image quality is highly dependent on system design, operator variability, and patient echogenicity. The operator variability and patient echogenicity are independent of the ultrasound system.

Operator variability

See also �’Optimiz-ing Measurement Accuracy�’ on page 71for recom-mended techniques.

One of the largest potential sources of error is operator variability. A skilled operator can reduce this by optimizing the image quality for each type of measurement. Clear identification of structures, good probe alignment and correct cursor placement is important. Because of pixel resolution, the accuracy of a measurement decreases with decreasing distance on screen. Therefore it is important when scaling the object on the screen to avoid measuring objects that are too small.

Image measurement

The accuracy in lateral direction is limited by the beam width and the beam positioning. The radial accuracy is mainly limited by the acoustic pulse length.

70

Doppler alignment

If alignment is not possible, you may use the Angle Cor-rection control to compensate if the flow direction is known.

Errors in velocity measurements increase with the cosine of the angle between the measured flow and the ultrasound beam. For example, an alignment error of 20 degrees, will give a 6% under-estimation of the velocities, while an error of 40 degrees will cause the under-estimation to be 24%.Optimize transducer position to align the beam with the flow direction.

Screen pixel resolution

The display screen is composed of an array of square picture elements (pixels). The smallest resolvable unit is +/- 1pixel. This pixel error is only significant when measuring short distances on the screen. By observing good scanning practices, the settings of the field of view should be such that the measured distance covers a relatively large portion of the screen. When such scaling is impossible, the pixel error may come into play. The pixel error is +/- 0.2% of the full ultrasound area in the User Screen.

Algorithms

Some formulae used in clinical calculations are based on assumptions or approximations. For example the volume calculations from 2D or M mode assume a certain, ‘ideal’ shape of the heart chamber, while the actual shape can vary quite much between individuals. Also, formulae taking several “raw” measurements as inputs are prone to increased errors, depending on the combination of input variable accuracies. For example, the Cardiac Output formula from Doppler is sensitive to errors in the entered Diameter, since this will be squared in the formula.

Speed of Sound in Tissue

The average value 1540 meters / second is used for all calculations. Depending on the tissue structures, this generalization may give errors from 2% (typical) to 5% (much fatty tissue layers present).

71

Optimizing Measurement Accuracy

Probe selection

Select a transducer appropriate for the application, and optimize the transducer frequencies used. Higher imaging frequencies give better resolution, but less penetration than lower frequencies. Lower Doppler frequencies can measure higher max velocities, and at greater depths, but with less velocity resolution than higher Doppler frequencies.

Field of View

All display modes should be adjusted so that the area of interest covers as large portion of the display as possible. Use Depth, Angle, Zoom, Horizontal Sweep and Velocity controls to optimize the different modes.

Cursor Placement

Avoid placement of the cursor near the array edges when using convex or lin-ear probes.

All measurements are dependent on the accuracy of their “input” data. Consistency and precision in placing cursors and drawing traces correctly on the images are important.

Measurement Uncertainties

The accuracy percentages reported below are based on data taken with optimum control settings, using calibrated phantoms and test equipment. The table below only includes errors related to the system with probes.

The calibration was done for the basic measurable parameters: Distance, Time and Velocity.

Independent sources of uncertainty contribute to a total uncertainty by a RMS (Root Mean Square) combination of the sources. Refer to the discussions above regarding measurement accuracy and sources of error when reading the table below.

Measurement Range Accuracy Comments

2D Calipers

Distance 1 - 10 cm 7%

> 10 cm 5%

72

M-mode Calipers

Distance 1 - 10 cm 7%

dt 0.5 - 1.5 s 0.5% With optimal sweep speed setting

Spectrum Calipers

Velocity 0.2 - 1.5 m/s 6%

dt 0.5 - 1.5 s 0.5% With optimal sweep speed setting

Measurement Range Accuracy Comments

73

Chapter 2 OB Tables

• ASUM ............................................................................................. ..... 74• Berkowitz ....................................................................................... ..... 75• Brenner .......................................................................................... ..... 76• Campbell ....................................................................................... ..... 76• Eriksen ........................................................................................... ..... 77• Goldstein ....................................................................................... ..... 78• Hadlock .......................................................................................... ..... 79• Hansmann ..................................................................................... ..... 86• Hellman .......................................................................................... ..... 95• Hill .................................................................................................. ..... 95• Hohler ............................................................................................ ..... 96• Jeanty ............................................................................................ ..... 96• JSUM .............................................................................................. ... 108• Kurtz .............................................................................................. ... 112• Mayden .......................................................................................... ... 113• Mercer ............................................................................................ ... 114• Merz ............................................................................................... ... 115• Moore ............................................................................................. ... 125• Nelson ............................................................................................ ... 125• Osaka ............................................................................................. ... 126• Paris ............................................................................................... ... 130• Rempen ......................................................................................... ... 133• Robinson ....................................................................................... ... 138• Tokyo ............................................................................................. ... 138• Tokyo Shinozuka .......................................................................... ... 142• Williams ......................................................................................... ... 149• Yarkoni .......................................................................................... ... 149

74

ASUMTable 2-1: AC: ASUM, Deler (Fetal Age)Unit: AC (mm); Age (Days); 2SD (Days)

AC Age 2SD AC Age 2SD AC Age 2SD AC Age 2SD

<35354657698092103114

n/a7077849198105112119

——88889999

126137149160171183194206217

126133140147154161168175182

101010101010121212

228240251263274285297308320

189196203210217224231238245

141414141416161818

331342354365377>377

252259266273280n/a

1818202020——

Table 2-2: BPD: ASUM, Aust NZ, Obstet Gynaecol 1989: 29:26 (Fetal Age)Unit: BPD (mm); Age (Week); 2SD (Week - * signifies No Data)

BPD Age 2SD BPD Age 2SD BPD Age 2SD BPD Age 2SD

<202021222324252627282930313233343536373839

n/a848688909294959799101103105107109111113115117119121

——44445555566667777888

404142434445464748495051525354555657585960

123126128130132134136139141143145147149152154157159161164166169

899999101010101111111112121212131313

616263646566676869707172737475767778798081

171173176178181183186188191193196199201204206209212214217220222

131314141414151515151616161617171717171818

8283848586878889909192939495969798>98

225228231234237240244247251255259264270276284292301n/a

18181900000000000000——

75

Berkowitz

Table 2-3: CRL: ASUM, Silva et al 1991.6 (Fetal Age)Unit: CRL (mm); Age (Days); 2SD (* No Data available)

CRL Age 2SD CRL Age 2SD CRL Age 2SD CRL Age 2SD

<223456789101112131415

n/a4243444546474849505152535455

——**************

161718192022232425262729303133

565758596061626364656667686970

***************

343637384041434546485051535557

717273747576777879808182838485

***************

58606264666870727476788082>82

86878889909192939495969798n/a

*************——

Table 2-4: BD: Berkowitz (Fetal Age)Unit: BD (mm); Age (Day); SD (mm)

BD Age SD BD Age SD BD Age SD BD Age SD

<13131415161718192021222324

n/a8182848688919598102105109110

——000000000000

25262728293031323334353637

112116120124128130132135138142145149152

0000000000000

38394041424344454647484950

155159162166169173179185191197202207212

0000000000000

515253545556575859>59

217223230237244251258266275n/a

000000000——

76

Brenner

Campbell

Table 2-5: EFW: Brenner (Fetal Growth)GP, Table/Graph Range = 10%: 90%Age (Weeks); Mini/Mean/Max (grams)

Age Min Mean Max Age Min Mean Max

21.022.023.024.025.026.027.028.029.030.031.032.0

280320370420490570660770890103011801310

41048055064074086099011501310146016301810

860920990108011801320147016601890210022902500

33.034.035.036.037.038.039.040.041.042.043.044.0

148016701870219023102510268027502800283028402790

201022202430265028703030317032803360341034203390

269028803090329034703610375038703980406041004110

Table 2-6: HC/AC Ratio: Campbell, Br J Obstet Gynaecol 1977, 84:165-174 (Fetal Growth)Unit: GA (Weeks); Min/Max (Index)

GA Min Max GA Min Max GA Min Max

<131315171921

n/a1.141.051.071.091.06

——1.311.391.291.261.25

232527293133

1.051.041.050.990.960.96

1.211.221.221.211.171.11

35373941>42

0.930.920.870.93n/a

1.111.051.061.00n/a

77

EriksenTable 2-7: TAD: Eriksen (Fetal Age)Unit: TAD (mm); Age (Day); SD (mm)

TAD Age SD TAD Age SD TAD Age SD TAD Age SD

<2323242526272829303132333435363738394041424344

n/a9193959799101103105107109111113115117119120122124126128130132

——0000000000000000000000

4546474849505152535455565758596061626364656667

134136138140142144146148150152154156158161163165167169171173175177179

00000000000000000000000

6869707172737475767778798081828384858687888990

182184186188190192195197199201203206208210212214217219221223225228230

00000000000000000000000

919293949596979899100101102103104105106107108109110111112>112

232234236239241243245247250252254256259261263266268270273275277280n/a

0000000000000000000000——

78

GoldsteinTable 2-8: TCD: Goldstein et a, Am J OB/GYN, May 1987 (Fetal Growth)Unit: TCD (Weeks); Age/Quat1/Mean/Quat3/Max (mm)

Age Min Quat1 Mean Quat3 Max

15161718192021222324252627282930313233343536373839

10141617181819212222232526272931323332333136374052

1216171818192023232421.52828.5303232353636383729374052

141617181920222324252829303134353838404040.5434548.552

15161819192023242527283031323637394043414352525255

16171819222224242628293232343840434244444755555555

79

HadlockTable 2-9: AC: Hadlock, Radiology 1984, Vol. 152:497 (Fetal Age)Unit: AC (mm); Age (Week); 2SD (Week)


<5050556065707580859095100105110115120123124125130

n/a12.012.412.813.213.614.014.414.815.215.616.016.416.917.317.717.918.018.118.5

—— 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 2.1 2.1 2.1

135140145150155160165170175180185190192193195200205210215220

19.019.419.820.220.721.121.522.022.422.923.323.723.924.024.224.625.125.526.026.4

2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.2 2.2 2.2 2.2 2.2 2.2 2.2

225230235240245250255258259260265270275280285290295300305310

26.927.427.828.328.729.229.730.030.130.230.631.131.632.032.533.033.534.034.534.9

2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0

315320321325330335340345350355360365370375380385>385

35.435.936.036.436.937.437.938.438.939.439.940.440.941.442.042.5n/a

3.0 3.0 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1

——

Table 2-10: AC: Hadlock, AJR; 139: 367-370; 1982 (Fetal Age)Unit: AC (mm); Age (Days); SD (Days)

AC Age SD AC Age SD AC Age SD AC Age SD

<474753606774808793100106113119126132

n/a8487919498101105106112115119122126129

——1313131313131313131313131314

138144151157163174180186192197203208214219225

133136140143147154157161164168171175178182185

141414141414141414141515151515

230235241246251256261266271276281286291296300

189192196199203206210213217220224227231234238

151515151515152121212121212121

305310314319323328332337341344349353>353

241245248252255259262266269273276280n/a

212121211818181818181818——

80

Table 2-11: BPD: Hadlock, Radiology 1984, Vol. 152:497 (Fetal Age) aUnit: BPD (mm); Age (Week); 2SD (Week)


<1414151617181920212223242526272829303132333435

n/a11.912.112.312.512.813.013.213.413.613.814.114.314.514.815.015.215.515.716.016.316.516.8

—— 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2

3637383940414243444546474849505152535455565758

17.017.317.617.918.118.418.719.019.319.619.920.220.520.821.121.521.822.122.422.823.123.423.8

1.2 1.2 1.2 1.2 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.7

5960616263646566676869707172737475767778798081

24.124.524.825.225.525.926.326.627.027.427.728.128.528.929.329.730.130.530.931.331.732.132.5

2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.2 3.1 3.1 3.1 3.1 3.1 3.1 3.1

828384858687888990919293949596979899100101102103>103

33.033.433.834.234.735.135.636.036.536.937.437.838.338.739.239.740.240.641.141.642.142.6n/a

3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2

——

a.Variability of GA estimate by BPD at term is 2 SD (6 weeks)

81

Table 2-12: BPD: Hadlock, J Ultrasound Med 1:97-104, April 1982 (Fetal Age)Unit: BPD (mm); Age (Days ); SD (Days)


<202021222324252627282930313233343536373839

n/a8588909293959799102103105107109111113116118120122124

——66666666666666666666

404142434445464748495051525354555657585960

126128130132134137139141144146148151153155158160162163167169172

1010101010101010101010101010101010101099

616263646566676869707172737475767778798081

175177180183185188190193196198201204207209213216218221224228230

9999999999999914141414141414

828384858687888990919293949596979899100>100

233237239243246249253256259263266270272276279284287291294n/a

14141414141425252525252525252525252525——

Table 2-13: CI: Hadlock, AJR, 137: 83, 1981 (Fetal Growth)

Min (Index) Max (Index)

70 86

82

Table 2-14: CRL: Hadlock, Radiology 1992, Vol. 182:501 (Fetal Age)Unit: CRL (mm); Age (Week); SD (Week)

CRL Age SD CRL Age SD CRL Age SD CRL Age SD

<22345678910111213141516171819202122232425262728293031

n/a5.75.96.16.26.46.66.76.97.17.27.47.57.77.98.08.18.38.48.68.78.99.09.19.29.49.59.69.79.910.0

—— 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4

32333435363738394041424344454647484950515253545556575859606162

10.110.210.310.410.510.610.710.810.911.011.111.211.211.311.411.511.611.711.711.811.912.012.012.112.212.312.312.412.512.612.6

0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.6 0.6 0.6 0.6

63646566676869707172737475767778798081828384858687888990919293

12.712.812.812.913.013.113.113.213.313.413.413.513.613.713.813.813.914.014.114.214.214.314.414.514.614.714.814.915.015.115.2

0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.7 0.7 0.7 0.7 0.7 0.7

949596979899100101102103104105106107108109110111112113114115116117118119120121>121

15.315.315.415.515.615.715.916.016.116.216.316.416.516.616.716.816.917.017.117.217.317.417.517.617.717.817.918.0n/a

0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8

——

Table 2-15: EFW: Hadlock (Fetal Age)Unit: EFW (grams); Mean (Weeks); SD (grams)

EFW Mean 2SD EFW Mean 2SD EFW Mean 2SD

<353545587393117146181223273331

n/a1011121314151617181920

——467912151923283542

399478568670785913105512101379155917511953

212223242526272829303132

51617285101116134154175198222248

216223772595281330283236343536193787>3787

333435363738394041n/a

275302330357385411436460481——

83

Table 2-16: FL: Hadlock, Radiology 1984, Vol. 152:497 (Fetal Age)Unit: FL (mm); Age (Week); 2SD (Week)

FL Age 2SD FL Age 2SD FL Age 2SD FL Age 2SD

<66789101112131415161718192021222324

n/a11.912.212.412.713.013.313.513.814.114.414.715.015.315.616.016.316.616.917.2

—— 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.4

2526272829303132333435363738394041424344

17.617.918.218.618.919.319.620.020.320.721.021.421.822.222.522.923.323.724.124.5

1.4 1.4 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 2.1 2.1

4546474849505152535455565758596061626364

24.925.325.726.126.526.927.327.728.228.629.029.529.930.330.831.231.732.132.633.1

2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 3.0 3.0 3.0 3.0 3.0 3.0 3.0

65666768697071727374757677787980818283>83

33.534.034.534.935.435.936.436.937.437.938.438.939.439.940.440.941.442.042.5n/a

3.0 3.0 3.0 3.0 3.0 3.0 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3.1

——

Table 2-17: FL: Hadlock, AJR 138: 875-878, May 1982 (Fetal Age)Unit: FL (mm); Age (Days); 2SD (Days)

FL Age SD FL Age SD FL Age SD FL Age SD

<101011121314151617181920212223242526

n/a909294959799101104106108110112114116118120123

——66666666666666666

272829303132333435363738394041424344

125127130132134137139142145147150153155157160163166169

6666666666666666610

454647484950515253545556575859606162

171174177180183185189192195197201204207210213216220223

101010101010101010101010101010101010

6364656667686970717273747576777879>79

226230233237239243246250253257260264268272275279283n/a

1010101010101010111111111111111111——

84

Table 2-18: HC: Hadlock, Radiology 1984, Vol. 152:497 (Fetal Age)Unit: HC (mm); Age (Week); 2SD (Week)

HC Age 2SD HC Age 2SD HC Age 2SD HC Age 2SD

<55556065707580859095100105110115120125130

n/a12.012.312.612.813.113.413.714.014.314.715.015.315.616.016.316.6

—— 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2

135140145149150155160165170175180185190195200205210

17.017.317.718.018.118.418.819.219.620.020.420.821.321.722.222.623.1

1.2 1.2 1.2 1.2 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5

215219220225230235240245250255260265270274275280285

23.623.924.024.525.025.526.126.627.127.728.328.929.429.930.030.731.3

1.5 1.5 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 3.0 3.0 3.0

290295300305310315319320325330335340345350355360>360

31.932.633.333.934.635.335.936.136.837.638.339.139.940.741.642.4n/a

3.0 3.0 3.0 3.0 3.0 3.0 3.0 2.7 2.7 2.7 2.7 2.7 2.7 2.7 2.7 2.7

——

Table 2-19: HC: Hadlock, AJR 138: 649-653, 1982 (Fetal Age)Unit: HC (mm); Age (Days); 2SD (Days)

HC Age SD HC Age SD HC Age SD HC Age SD

<696975818896103110117124131137144150157163

n/a8487919498101105108112115119122126129133

——99999999999991111

169175181187193198204209215220225230240245250255

136140143147150154157161164168171175182185189192

11111111111111111111161616161616

260264269273278282286291294298302306309312316319

196199203206210213217220224227231234238241245248

16161616161919191919191919191919

322325328331334337340343345348351353354>354

252255259262266269273276280286287290294n/a

19242424242424242424242424——

85

Table 2-20: FL/HC Ratio: Hadlock, J Ultrasound Med 1984, 3: 439-442 (Fetal Growth)Unit: GA (Weeks)

GA Min Max GA Min Max GA Min Max

<15151617181920212223

n/a15.313.314.615.816.116.815.918.419.2

——17.116.517.618.018.319.820.320.220.8

24252627282930313233

18.718.718.618.618.819.619.219.319.119.9

20.920.320.420.420.620.821.421.321.321.5

343536373839404142>42

19.420.120.120.820.920.620.721.620.1n/a

21.822.322.122.622.723.422.523.223.9n/a

Table 2-21: FL/AC Ratio: Hadlock (Fetal Growth)Unit: Age (Weeks)

Age Min (Index) Max (Index)

2142

2020

2424

86

HansmannTable 2-22: AC: Hansmann (Fetal Age) (Hansmann:M & Al:Geburtsh, u, Frauenheilk 39:656, 1979) Unit: AC (mm); Age (Weeks/Days); SD (mm)


<5353545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798

n/a11w1d11w2d11w2d11w3d11w3d11w4d11w4d11w5d11w6d12w0d12w1d12w2d12w2d12w3d12w3d12w4d12w5d12w5d12w6d12w6d13w0d13w0d13w1d13w2d13w2d13w3d13w3d13w4d13w4d13w5d13w6d14w0d14w1d14w2d14w2d14w3d14w3d14w4d14w5d14w5d14w6d14w6d15w0d15w0d15w1d15w2d

——0000000000000000000000000000000000000000000000

99100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145

15w2d15w3d15w4d15w5d15w5d15w6d16w0d16w0d16w1d16w2d16w3d16w3d16w4d16w5d16w6d16w6d17w0d17w1d17w2d17w2d17w3d17w3d17w4d17w4d17w5d17w6d18w0d18w1d18w2d18w3d18w3d18w4d18w5d18w6d18w6d19w0d19w1d19w2d19w2d19w3d19w3d19w4d19w4d19w5d19w6d20w0d20w1d

00000000000000000000000000000000000000000000000

146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192


00000000000000000000000000000000000000000000000

193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239


00000000000000000000000000000000000000000000000

87

240241242243244245246247248249250251252253254255256257258259260

30w1d30w2d30w3d30w3d30w4d30w5d30w6d30w6d31w0d31w1d31w2d31w3d31w3d31w4d31w5d31w6d31w6d32w0d32w1d32w2d32w2d

000000000000000000000

261262263264265266267268269270271272273274275276277278279280281


000000000000000000000

282283284285286287288289290291292293294295296297298299300301302


000000000000000000000

303304305306307308309310311312313314315316317318319320>320

36w5d36w6d37w0d37w1d37w2d37w3d37w3d37w4d37w5d37w6d37w6d38w0d38w1d38w2d38w4d38w5d39w0d39w1dn/a

000000000000000000——

Table 2-22: AC: Hansmann (Fetal Age) (Hansmann:M & Al:Geburtsh, u, Frauenheilk 39:656, 1979)(Continued)Unit: AC (mm); Age (Weeks/Days); SD (mm)


88

Table 2-23: BPD: Hansmann (Fetal Age)Ultrasound Diagnosis in Obstetrics & Gynecology, 438-439, 1985Known LMP (left)—Unknown LMP (right)Unit: BPD (mm); Age (Weeks/Days); 2SD (mm [Known LMP] or day [Unknown LMP])


<1414151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859


——0000000000555544444444444444444444555555555555

60616263646566676869707172737475767778798081828384858687888990919293949596979899100101>101

22w6d23w1d23w4d23w6d24w1d24w4d24w6d25w1d25w3d25w5d26w1d26w3d26w6d27w1d27w3d27w6d28w1d28w4d28w6d29w2d29w5d30w0d30w3d30w5d31w2d31w5d32w1d32w4d33w0d33w3d33w6d34w3d34w6d35w3d36w0d36w3d37w1d37w6d38w4d39w3d40w3d41w3dn/a

555566666666666666666666666677777777777777——

<1414151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859


——77777777777777787889989899999999910101010101011101099910

60616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105>105

23w2d23w4d24w0d24w2d24w4d24w6d25w1d25w3d25w6d26w1d26w3d26w5d27w1d27w3d27w6d28w1d28w4d28w6d29w2d29w5d30w0d30w3d31w0d31w2d31w6d32w2d32w5d33w2d33w5d34w2d34w5d35w1d35w6d36w5d37w3d38w3d38w6d39w0d39w2d39w3d39w4d39w5d39w6d40w0d40w1d40w2dn/a

10101010101011121010101211131212131315161515151617171820191919252421192225222022202019191917——

89

Table 2-24: CRL: Hansmann (Fetal Age) Ultrasound Diagnosis in Obstetrics & Gynecology, 438-439, 1985Unit: CRL (mm); Age (Weeks/Days); 2SD (mm [Known LMP] or day [Unknown LMP])


Known LMP

<131314151617181920212223242526272829303132333435363738394041424344454647484950515253

n/a7w4d7w5d8w0d8w1d8w2d8w3d8w4d8w5d8w6d9w0d9w1d9w2d9w3d9w4d9w4d9w5d9w6d10w0d10w0d10w1d10w2d10w3d10w3d10w4d10w5d10w5d10w6d10w6d11w0d11w1d11w1d11w2d11w2d11w3d11w3d11w4d11w4d11w5d11w5d11w6d11w6d

——000000778810101111111111121212121213131313131314141414141415151515151515

545556575859606162636465666768697071727374757677787980818283848586878889909192939495

12w0d12w1d12w1d12w2d12w2d12w3d12w3d12w4d12w4d12w5d12w5d12w6d12w6d13w0d13w1d13w1d13w2d13w3d13w3d13w4d13w4d13w5d13w5d13w6d13w6d14w0d14w0d14w1d14w1d14w2d14w2d14w3d14w3d14w4d14w4d14w5d14w6d14w6d15w0d15w0d15w1d15w2d

151616161616161515151515151515151515151515151515151515131313131313131313131212121212

96979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137

15w3d15w3d15w4d15w4d15w5d15w5d15w6d15w6d16w0d16w1d16w2d16w2d16w3d16w3d16w4d16w4d16w5d16w5d16w6d17w0d17w1d17w2d17w2d17w3d17w3d17w4d17w5d17w5d17w6d18w0d18w1d18w1d18w2d18w2d18w3d18w4d18w4d18w5d18w6d19w0d19w1d19w1d

111111111110101010101010101010111111111112121212121313131313141414141515151515151515

138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175>175

19w2d19w3d19w4d19w4d19w5d19w5d19w6d20w0d20w1d20w2d20w2d20w3d20w4d20w4d20w5d20w5d20w6d21w0d21w0d21w1d21w1d21w2d21w3d21w3d21w4d21w4d21w5d21w6d21w6d22w0d22w0d22w1d22w1d22w2d22w2d22w3d22w3d22w4dn/a

151515161616161617171717170000000000000000000000000——

Unknown LMP

90

<66789101112131415161718192021

n/a6w1d6w2d6w4d6w6d7w0d7w2d7w3d7w4d7w6d8w0d8w2d8w3d8w4d8w5d8w6d9w0d

——7777777777777777

2223242628303234363840424446485052

9w1d9w2d9w3d9w5d10w0d10w2d10w3d10w5d10w6d11w1d11w2d11w3d11w4d11w6d12w0d12w1d12w2d

77778888888899999

545658606366707376808386909396100103


999910101011111112121212121213

106110113116120123126130133136140143146150>150

16w2d16w4d17w0d17w2d17w4d18w0d18w2d18w6d19w1d19w4d20w0d20w3d20w6d21w3dn/a

1314141414141414151616161616——

Table 2-25: FL: Hansmann (Fetal Age)Ultrasound Diagnosis in Obstetrics and Gynecology, 438-439, 1985Known/Unknown LMP; Unit: FL (mm); Age (Weeks/Days); 2SD (Week)

FL Age 2SD FL Age 2SD FL Age 2SD FL Age 2SD

<1212131415161718192021222324252627

n/a13w4d13w6d14w1d14w3d14w5d15w1d15w2d15w5d16w0d16w2d16w4d16w6d17w2d17w4d17w6d18w2d

——0000554444444444

2829303132333435363738394041424344


44444445555555555

4546474849505152535455565758596061


55555555555666555

6263646566676869707172737475>75

32w1d32w5d33w1d33w5d34w1d34w5d35w1d35w5d36w1d36w5d37w2d37w6d38w3d39w0dn/a

55666666666677——

Table 2-24: CRL: Hansmann (Fetal Age) (Continued)Ultrasound Diagnosis in Obstetrics & Gynecology, 438-439, 1985Unit: CRL (mm); Age (Weeks/Days); 2SD (mm [Known LMP] or day [Unknown LMP])


91

Table 2-26: GS: Hansmann (Fetal Age)Hansmann: M and Al: Geburtsh, u, Frauenheilk 39: 656, 1979Unit: GS (mm); Age (Days); SD (mm)

GS Age SD GS Age SD GS Age SD GS Age SD

<101011121314151617181920212223

n/a3334353637383940414243444546

——55555555555555

242526272829303132333435363738

474849505152535455565758585960

555555555555555

394041424344454647484950515253

616263646566676869707172737475

555555555555555

545556575859606162636465>65

767778798081828384858687n/a

555555555555——

Table 2-27: HC: Hansmann (Fetal Age)Ultrasound Diagnosis in Obstetrics and Gynecology, 438-439, 1985Known/Unknown LMP; Unit: HC (mm); Age (Weeks/Days); 2SD (mm)

HC Age 2SD HC Age 2SD HC Age 2SD HC Age 2SD

<105105110115120125130135140145150155160

n/a13w3d14w0d14w3d14w6d15w3d15w5d16w1d16w4d17w0d17w3d17w6d18w1d

——0014141414141415151616

165170175180185190195200205210215220225

18w4d19w0d19w3d19w5d20w1d20w4d21w0d21w2d21w5d22w1d22w4d23w0d23w3d

16161616171717171717171717

230235240245250255260265270275280285290


18181818181818181819191919

295300305310315320325330335340345>345

29w5d30w2d30w5d31w2d32w1d32w5d33w3d34w2d35w1d36w2d37w6dn/a

1919191920202020202020——

92

Table 2-28: OFD: Hansmann (Fetal Age)Ultrasound Diagnosis in Obstetrics and Gynecology, 438-439, 1985Known/Unknown LMP; Unit: OFD (mm); Age (Weeks/Days); 2SD (mm)

OFD Age 2SD OFD Age 2SD OFD Age 2SD OFD Age 2SD

<343435363738394041424344454647484950515253

n/a13w3d13w5d14w0d14w2d14w4d14w6d15w1d15w3d15w5d16w0d16w1d16w3d16w4d16w6d17w1d17w3d17w4d17w6d18w1d18w2d

——00055555555555555555

545556575859606162636465666768697071727374


556666666666666677777

757677787980818283848586878889909192939495


777777777777777788888

96979899100101102103104105106107108109110111112113114115>115

29w0d29w3d29w5d30w0d30w3d30w5d31w1d31w4d32w0d32w3d32w6d33w3d33w6d34w3d35w0d35w4d36w2d37w0d38w0d39w0dn/a

88888888888888888888——

93

Table 2-29: TAD: Hansmann (Fetal Age)Hansmann: M and Al: Geburtsh, u, Frauenheilk 39: 656, 1979Unit: TAD (mm); Age (Days); SD (mm)


<20202122232425262728293031323334353637383940

n/a87899193959799101103105107109111113115117119122124126128

——444444444444444444444

41424344454647484950515253545556575859606162

130132135137139141143146148150152155157159161164166168170173175177

4444444444444444444444

63646566676869707172737475767778798081828384

179182184186188191193195198200203205208210212215217220222225227230

4444455555555555555555

858687888990919293949596979899100101102103>103

232235237240242245247250252255258261264267270273276279282n/a

5555555555555555555——

94

Table 2-30: ThD: Hansmann (Fetal Age)Ultrasound Diagnosis in Obstetrics and Gynecology, 438-439, 1985Known/Unknown LMP; Unit: ThD (mm); Age (Weeks/Days); 2SD (mm)

ThD Age 2SD ThD Age 2SD ThD Age 2SD ThD Age 2SD

<20202122232425262728293031323334353637383940

n/a12w4d12w6d13w1d13w3d13w4d13w6d14w1d14w3d14w6d15w1d15w2d15w4d15w6d16w2d16w4d16w6d17w1d17w3d17w5d18w1d18w3d

——000044444444444455555

41424344454647484950515253545556575859606162

18w5d19w0d19w3d19w5d19w6d20w2d20w4d20w6d21w2d21w4d21w6d22w1d22w4d22w6d23w1d23w3d23w6d24w1d24w3d24w6d25w1d25w3d

5555556666666666777777

63646566676869707172737475767778798081828384

25w5d26w1d26w3d26w5d27w0d27w3d27w5d28w0d28w3d28w5d29w1d29w3d29w5d30w1d30w3d30w5d31w1d31w3d31w5d32w1d32w4d32w6d

7777788888888888888999

858687888990919293949596979899100101102103104105>105

33w1d33w4d33w6d34w2d34w4d35w0d35w3d35w5d36w1d36w3d36w6d37w1d37w4d38w1d38w4d38w6d39w3d39w6d40w2d40w5d41w2dn/a

999999101010101010101111111214141414——

95

Hellman

Hill

Table 2-31: GS: Hellman (Fetal Age)A/OG 103: 789, 1969Unit: GS (mm); Age (Week); SD (Week)


<1010111213141516171819202122

n/a5.05.25.35.55.65.85.96.06.26.36.56.66.8

—— 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0

2324252627282930313233343536

6.97.07.27.37.57.67.87.98.08.28.38.58.68.8

1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0

3738394041424344454647484950

8.99.09.29.39.59.69.79.910.010.210.310.510.610.7

1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0

51525354555657585960>60

10.911.011.211.311.511.611.711.912.012.2n/a

1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0

——

Table 2-32: TCD: Hill (Fetal Age)Obstet Gyn, 75: 981-984, 1990Unit: TCD (mm); Age (Weeks); SD (Week)

TCD Age SD TCD Age SD TCD Age SD

<141415161718192021222324252627

n/a15.215.816.517.217.918.619.320.020.721.422.122.823.524.2

—— 0.5 0.5 0.5 0.5 0.5 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 1.01

282930313233343536373839404142

24.925.526.226.927.528.128.829.430.030.631.231.832.332.833.4

1.01 1.01 1.01 1.01 1.01 1.01 1.01 1.01 1.2 1.2 1.2 1.2 1.2 1.2 1.2

43444546474849505152545556>56

33.934.434.835.335.736.136.536.837.237.538.038.338.5n/a

1.2 1.2 1.2 1.2 1.2 1.6 1.6 1.6 1.6 1.6 1.6 1.6 1.6

——

96

Hohler

Jeanty

Table 2-33: FL: Hohler (Fetal Growth)Communications in Brief, 143: 479-481, 1982

Age (Weeks) Min (Index) Max (Index)

2340

7171

8787

Table 2-34: AC: Jeanty (Fetal Age)Jeanty, Radiology 143: 513, 1982Unit: AC (mm); Age (Day); SD (mm)


<5050556065707580859095100105110

n/a79828589929599102105109112115119

——22222222222222222222222222

115120125130135140145150155160165170175180

122125129132135139142146149152156159162166

2222222222222222222222222222

185190195200205210215220225230235240245250

169172176179182186189192196199203206210214

2222222222222222222222222222

255260265270275280285290295300305310315>315

218222226230234239244249254259265272279n/a

22222222222222222222222222——

Table 2-35: BD: Jeanty (Fetal Age)Jeanty: Radiology 143: 513, 1982Unit: BD (mm); Age (Days); SD (mm)

BD Age SD BD Age SD BD Age SD BD Age SD

<1515161718192021222324252627

n/a73778185899397102106110114118122

——0000000000000

2829303132333435363738394041

127131135139143147152156160164168172177181

00000000000000

4243444546474849505152535455

185189193197201206210214218222226231235239

00000000000000

56575859606162636465>65

243247251256260264268272276281n/a

0000000000——

97

Table 2-36: BPD: Jeanty (Fetal Age)Jeanty: Radiology 143: 513, 1982Unit: Meas (mm); Min/Mean/Max (Weeks/Days); Table/Graph Range: 5%:95%

Meas Min Mean Max Meas Min Mean Max

<1010111213141516171819202122232425262728293031323334353637383940414243444546474849505152

n/a6w4d6w6d7w0d7w2d7w4d7w6d8w1d8w3d8w4d8w6d9w1d9w3d9w5d9w6d10w1d10w4d10w5d11w0d11w2d11w4d11w6d12w1d12w2d12w4d12w6d13w1d13w4d13w5d14w0d14w2d14w4d14w6d15w1d15w3d15w5d16w0d16w2d16w4d16w6d17w1d17w4d17w6d18w1d



53545556575859606162636465666768697071727374757677787980818283848586878889909192939495>95

18w4d18w6d19w1d19w4d19w6d20w1d20w4d20w6d21w1d21w4d21w6d22w1d22w4d22w6d23w2d23w5d24w0d24w3d24w6d25w1d25w4d26w0d26w3d26w6d27w1d27w4d28w0d28w4d28w6d29w2d29w6d30w1d30w5d31w1d31w4d32w1d32w4d33w0d33w4d34w0d34w4d35w0d35w4dn/a



98

Table 2-37: BPD: Jeanty (Fetal Growth)Jeanty: Radiology 143: 513, 1982Unit: Age (Weeks/Days); Min/Mean/Max (mm); Table/Graph Range: 5%:95%


10.0+011.0+012.0+013.0+014.0+015.0+016.0+017.0+018.0+019.0+020.0+021.0+022.0+023.0+024.0+025.0+0

9131620232730343740444750535659

14172124283135384245485155586164

18222529323639434649535659626568

26.0+027.0+028.0+029.0+030.0+031.0+032.0+033.0+034.0+035.0+036.0+037.0+038.0+039.0+040.0+0

626568707375777981838486878889

677072757779828486878990919393

717477798284868890929395969798

Table 2-38: CRL: Jeanty (Fetal Age)Jeanty: Radiology 143: 513, 1982Unit: CRL (mm); Age (Days); SD (mm)


<55678910111213141516

n/a444546485051525354555657

——444444444455

17181920212223242526272829

58596061626364656667676768

5555666667777

30313233343536373839404142

69707071727373747576767677

7777777777777

434445464748495051525354>54

777879798081818283838485n/a

777777777777——

99

Table 2-39: FIB: Jeanty (Fetal Growth)Fetal Limb Bimetry (Letter), Radiology 147:602, 1983Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range: 5%:95%


111213141516171819202122232425

258610671018182421232633

258111417192224272931333537

258101822312830303437444142

262728293031323334353637383940

323536403840404346515155545554

394143454748505152545556575859

434747505257565956575658596262

100

Table 2-40: FL: Jeanty (Fetal Age)Jeanty: Radiology 143: 513, 1982Unit: Meas (mm); Min/Mean/Max (Weeks/Days); Table/Graph Range: 5%:95%


<1414151617181920212223242526272829303132333435363738394041424344454647

n/a11w5d12w0d12w3d12w5d13w0d13w3d13w5d14w1d14w3d14w5d15w1d15w3d15w6d16w1d16w4d16w6d17w1d17w4d17w6d18w2d18w5d19w0d19w3d19w6d20w1d20w4d20w6d21w2d21w5d22w1d22w4d22w6d23w1d23w4d



484950515253545556575859606162636465666768697071727374757677787980>80

24w0d24w3d24w6d25w1d25w4d26w0d26w3d26w6d27w2d27w5d28w1d28w4d28w6d29w3d29w6d30w1d30w5d31w1d31w4d32w0d32w3d32w6d33w2d33w5d34w1d34w4d35w1d35w4d36w0d36w3d36w6d37w2d37w6dn/a



101

Table 2-41: FL: Jeanty (Fetal Growth)Jeanty: Radiology 143: 513, 1982Unit: Age (Weeks/Days); Min/Mean/Max (mm); Table/Graph Range: 5%:95%


12.0+013.0+014.0+015.0+016.0+017.0+018.0+019.0+020.0+021.0+022.0+023.0+024.0+025.0+026.0+0

469121518212426293235374042

81114172023252831343639424447

131618212427303336384144464951

27.0+028.0+029.0+030.0+031.0+032.0+033.0+034.0+035.0+036.0+037.0+038.0+039.0+040.0+0

4547505254565860626465676870

4952545659616365676870717374

5456596163656769717374767779

102

Table 2-42: HC: Jeanty (Fetal Age)Jeanty: Radiology 143: 513, 1982Unit: Meas (mm); Min/Mean/Max (Weeks/Days); Table/Graph Range: 5%:95%


<8080859095100105110115120125130135140145150155160165170175180185190195200205210215220

n/a11w3d11w5d11w7d12w2d12w4d12w7d13w2d13w4d13w6d14w2d14w4d14w7d15w2d15w5d16w0d16w3d16w6d17w1d17w4d17w7d18w3d18w6d19w1d19w4d20w1d20w4d20w7d21w3d21w6d



225230235240245250255260265270275280285290295300305310315320325330335340345350355360>360

22w3d22w6d23w3d23w6d24w3d24w7d25w4d26w0d26w4d27w1d27w6d28w3d28w7d29w4d30w2d30w6d31w4d32w2d32w6d33w4d34w2d35w0d35w6d36w4d37w2d38w1d38w6d39w5dn/a



103

Table 2-43: HC: Jeanty (Fetal Growth)Jeanty: Radiology 143: 513, 1982Unit: Age (Weeks/Days); Min/Mean/Max (mm); Table/Graph Range: 5%:95%


12.0+013.0+014.0+015.0+016.0+017.0+018.0+019.0+020.0+021.0+022.0+023.0+024.0+025.0+026.0+0

51647689101114126138150162174185196207218

7588101113126138151163175187198210221232242

100112125138150163175187199211223234245256266

27.0+028.0+029.0+030.0+031.0+032.0+033.0+034.0+035.0+036.0+037.0+038.0+039.0+040.0+0

228238247256265273281288294300306311315319

252262271281289297305312319325330335339343

277286296305313322329336343349355359364367

104

Table 2-44: HL: Jeanty (Fetal Age)Obstetrical Ultrasound, Table 13.9, 1984Unit: Meas (mm); Min/Mean/Max (Weeks/Days); Table/Graph Range: 5%:95%


<10101112131415161718192021222324252627282930313233343536373839

n/a9w6d10w1d10w3d10w6d11w1d11w3d11w6d21w1d12w4d12w6d13w1d13w4d13w6d14w2d14w5d15w1d15w4d15w6d16w2d16w5d17w1d17w4d18w0d18w3d18w6d19w2d19w5d20w1d20w4d21w1d



404142434445464748495051525354555657585960616263646566676869>69

21w4d22w0d22w4d23w0d23w4d24w0d24w4d25w0d25w4d26w0d26w4d27w1d27w4d28w1d28w5d29w1d29w6d30w2d30w6d31w3d32w0d32w4d33w1d33w6d34w3d35w0d35w4d36w1d36w6d37w3dn/a



105

Table 2-45: Radius: Jeanty (Fetal Growth)Fetal Limb Bimetry (Letter), Radiology 147:602, 1983Unit: Age (weeks); Min/Mean/Max (mm); Table/Graph Range: 5%:95%


<11111213141516171819202122232425

n/a57108129111420212524262731

n/a5710131518202224272931323436

n/a5710121921292629283234393840

262728293031323334353637383940>40

303333363434374139384145454646n/a

373940424344454647484849495050n/a

414545474953515153575453535454n/a

106

Table 2-46: TIB: Jeanty (Fetal Age)Obstetrical Ultrasound, Table 13.9, 1984Unit: Meas (mm); Min/Mean/Max (Weeks/Days); Table/Graph Range: 5%:95%


<10101112131415161718192021222324252627282930313233343536373839




404142434445464748495051525354555657585960616263646566676869>69




107

Table 2-47: ULNA: Jeanty (Fetal Age)Obstetrical Ultrasound, Table 13.9, 1984Unit: Meas (mm); Min/Mean/Max (Weeks/Days); Table/Graph Range: 5%:95%


<1010111213141516171819202122232425262728293031323334353637

n/a10w1d10w4d10w6d11w1d11w4d11w6d12w2d12w5d13w1d13w4d13w6d14w2d14w5d15w1d15w4d16w0d16w3d16w6d17w2d17w5d18w1d18w4d19w1d19w4d20w1d20w4d21w1d21w4d



383940414243444546474849505152535455565758596061626364>64

22w1d22w4d23w1d23w4d24w1d24w5d25w1d25w6d26w2d26w6d27w3d28w0d28w4d29w1d29w5d30w2d30w6d31w4d32w1d32w6d33w3d34w0d34w4d35w2d35w6d36w4d37w1dn/a



108

JSUMTable 2-48: AC, JSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: AC (cm); Age (w+d); SD (cm)

Age AC Age 1SD Age AC Age 1SD

1617181920212223242526272829

10.411.412.513.514.515.516.517.518.519.520.521.422.423.3

16+017+018+019+020+021+022+023+024+025+026+027+028+029+0

0.570.620.670.710.760.810.860.900.951.001.051.101.141.19

30313233343536373839404142

24.225.125.926.827.628.429.229.930.631.331.932.533.1

30+031+032+033+034+035+036+037+038+039+040+041+042+0

1.241.291.331.381.431.481.521.571.621.671.711.761.81

Table 2-49: BPD, JSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: BPD (mm); Age (w+d); SD (mm)

Age BPD Age 1SD Age BPD Age 1SD

1011121314151617181920212223242526

12.615.919.322.726.129.532.936.339.643.046.249.552.655.758.861.764.6

10+011+012+013+014+015+016+017+018+019+020+021+022+023+024+025+026+0

2.292.342.402.452.512.572.622.682.732.792.842.902.963.013.073.123.18

27282930313233343536373839404142

67.470.172.675.177.479.681.783.685.386.988.389.690.691.592.292.6

27+028+029+030+031+032+033+034+035+036+037+038+039+040+041+042+0

3.233.293.353.403.463.513.573.623.683.743.793.853.903.964.014.07

109

Table 2-50: CRL, JSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: GA (week+day); CRL (mm)

GA

CRL

5% 10% 50% 90% 95%

7W+07W+27W+47W+68W+18W+38W+59W+09W+29W+49W+610W+110W+310W+511W+011W+211W+4

5.76.06.57.28.19.110.311.713.315.117.119.221.524.126.729.632.7

6.87.38.19.010.211.613.114.916.718.720.923.125.427.930.432.935.5

10.110.511.312.514.015.817.820.022.525.027.630.333.135.838.440.943.3

16.015.716.017.018.420.422.725.428.331.434.637.841.044.147.049.651.9

17.216.416.617.519.121.324.027.030.333.737.340.744.147.149.852.153.8

Table 2-51: EFW, JSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: EFW (g); Age (w+d); 1SD (g)

Age EFW Age 1SD Age EFW Age 1SD

181920212223242526272829

1872473133874695606607718921,0231,1631,313

18+019+020+021+022+023+024+025+026+027+028+029+0

30.1340.4751.3062.6174.3986.6699.41112.64126.35140.53155.20170.35

303132333435363738394041

1,4701,6351,8051,9802,1562,3332,5072,6762,8382,9893,1253,244

30+031+032+033+034+035+036+037+038+039+040+041+0

185.98202.09218.68235.75253.30271.33289.84308.83328.30348.25368.68389.59

110

Table 2-52: FL, JSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: FL (mm); Age (w+d); SD (mm)

Age FL Age 1SD Age FL Age 1SD

1617181920212223242526272829

20.122.725.327.830.432.935.437.940.342.745.047.349.651.7

16+017+018+019+020+021+022+023+024+025+026+027+028+029+0

2.642.672.712.742.772.812.842.882.912.942.983.013.043.08

30313233343536373839404142

53.855.857.859.661.463.064.666.067.468.669.670.671.4

30+031+032+033+034+035+036+037+038+039+040+041+042+0

3.113.153.183.213.253.283.313.353.383.423.453.483.52

Table 2-53: MCA PI values with advance in gestationJSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: Age (Weeks)

Age 5% 10% 50% 90% 95% Age 5% 10% 50% 90% 95%

2021222324252627282930

1.2711.3181.3591.3931.4211.4441.4591.4691.4731.4701.461

1.2701.3291.3811.4261.4631.4931.5151.5301.5371.5371.530

1.4401.5371.6231.6991.7651.8201.8651.8991.9231.9371.940

1.8801.9862.0802.1642.2362.2982.3482.3882.4162.4342.440

1.9902.0912.1822.2612.3282.3852.4302.4652.4882.4992.500

3132333435363738394041

1.4461.4251.3971.3631.3241.2771.2251.1671.1021.0310.954

1.5151.4931.4641.4271.3831.3311.2721.2051.1311.0500.961

1.9331.9151.8871.8491.8001.7411.6711.5911.5011.4001.289

2.4362.4202.3942.3562.3082.2482.1782.0962.0041.9001.786

2.4892.4682.4352.3902.3352.2682.1912.1022.0011.8901.767

Table 2-54: MCA RI values with advance in gestationJSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: Age (Weeks)

Age 5% 10% 50% 90% 95% Age 5% 10% 50% 90% 95%

2021222324252627282930

0.7170.7310.7420.7530.7610.7670.7720.7750.7760.7750.773

0.7180.7350.7490.7610.7720.7800.7870.7910.7930.7940.792

0.7750.7930.8080.8210.8330.7430.8510.8570.8620.8650.865

0.8420.8570.8710.8830.8940.9030.9100.9160.9200.9220.923

0.8710.8830.8940.9030.9110.9180.9230.9270.9290.9300.930

3132333435363738394041

0.7690.7620.7550.7450.7330.7200.7050.6880.6690.6490.627

0.7890.7830.7750.7660.7540.7400.7250.7070.6880.6660.643

0.8650.8620.8570.8510.8430.8330.8210.8080.7930.7750.757

0.9220.9200.9160.9110.9040.8950.8850.8730.8590.8440.827

0.9280.9250.9200.9140.9070.8980.8880.8760.8630.8490.833

111

Table 2-55: UMA PI values with advance in gestationJSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: Age (Weeks)

Age 5% 10% 50% 90% 95% Age 5% 10% 50% 90% 95%

2021222324252627282930

1.1181.0751.0340.9960.9590.9250.8930.8630.8360.8100.787

1.1441.1061.0691.0341.0010.9700.9410.9130.8870.8630.841

1.3901.3401.2931.2491.2071.1681.1311.0971.0651.0361.010

1.6201.5651.5131.4641.4171.3731.3311.2921.2551.2211.190

1.6881.6411.5971.5541.5141.4751.4381.4041.3711.3411.312

3132333435363738394041

0.7660.7470.7310.7160.7040.6940.6860.6810.6770.6760.677

0.8210.8020.7850.7700.7570.7460.7360.7280.7220.7180.716

0.9860.9650.9470.9310.9180.9070.8990.8930.8900.8900.892

1.1611.1351.1121.0911.0731.0571.0441.0331.0251.0201.017

1.2851.2611.2381.2181.1991.1821.1681.1551.1451.1361.129

Table 2-56: UMA RI values with advance in gestationJSUM, J Med Ultrasound Vol.28 No.5 (2001)Unit: Age (Weeks)

Age 5% 10% 50% 90% 95% Age 5% 10% 50% 90% 95%

2021222324252627282930

0.6980.6800.6630.6460.6300.6150.6000.5860.5720.5590.547

0.7220.7070.6920.6790.6650.6530.6400.6290.6180.6080.598

0.7780.7630.7490.7350.7220.7100.6980.6870.6760.6660.657

0.8200.8080.7960.7850.7740.7630.7520.7410.7300.7200.710

0.8460.8360.8260.8160.8070.7980.7880.7800.7710.7620.754

3132333435363738394041

0.5350.5240.5130.5030.4940.4850.4770.4690.4620.4560.450

0.5890.5800.5730.5650.5590.5520.5470.5420.5380.5340.531

0.6480.6400.6320.6250.6190.6130.6080.6030.5990.5960.593

0.7000.6900.6810.6720.6630.6540.6450.6360.6280.6200.612

0.7460.7380.7300.7230.7160.7080.7020.6950.6880.6820.676

112

KurtzTable 2-57: BPD: Kurtz (Fetal Age)Journal of Clinical Ultrasound, 8: 319-326, 1980Unit: BPD (mm); Age (Days); SD (mm)

BPD Age SD BPD Age SD BPD Age SD BPD Age SD

<2121222324252627282930313233343536373839

n/a84879193959799101103105107109111113115117119121123

——4444444444444444444

4041424344454647484950515253545556575859

125127129131133135137139141143145147149151153155157160162165

44444444444444455555

6061626364656667686970717273747576777879

168170173175178181183186188191194196199201204207210213216219

55555555555555555555

80818283848586878889909192939495969798>98

222225229232235238241244248252257262267272276280284288293n/a

5555555555555555555——

113

MaydenTable 2-58: IOD: Mayden (Fetal Age)Am J Obstet Gynecol 144:289, 1982Unit: Meas (mm); Mean (Weeks)

Meas Mean Meas Mean Meas Mean Meas Mean

556667778889991010101011

11.611.612.112.612.613.113.613.614.114.614.615.015.515.516.016.516.517.017.5

11121212131313131414141414151515151516

17.918.418.919.419.419.920.420.420.921.321.321.822.322.322.823.323.323.824.3

16161616171717171717171818181818181818

24.324.725.225.225.726.226.226.727.227.628.128.629.129.630.030.631.031.532.0

19191919191919191919191919191919

32.533.033.534.034.435.035.435.936.436.937.337.838.338.339.339.8

Table 2-59: OOD: Mayden (Fetal Age)Am J Obstet Gynecol 144:289, 1982Unit: Meas (mm); Mean (Weeks)

Meas Mean Meas Mean Meas Mean Meas Mean

13141516171718192021212223242525262727

11.611.612.112.612.613.113.613.614.114.614.615.015.515.516.016.516.517.017.5

28303132323334343536363738383940404141

17.918.418.919.419.419.920.420.420.921.321.321.822.322.322.823.323.323.824.3

42434344444545464647474848495050515152

24.324.725.225.225.726.226.226.727.227.628.128.629.129.630.030.631.031.532.0

52535454545555565657575858585959

32.533.033.534.034.435.035.435.936.436.937.337.838.338.339.339.8

114

MercerTable 2-60: Ft: Mercer (Fetal Age)Am J Obstet Gynecol, 156: 350-355, 1987Unit: Meas (mm); Min/Mean/Max (Weeks); Table/Graph Range: 2SD


<101012141618202224262830323436384042444648

n/a11.512.112.713.313.914.515.115.716.316.917.618.218.919.520.220.821.522.222.923.6

n/a12.513.113.814.415.115.716.417.117.718.419.119.820.521.221.922.723.424.124.925.6

n/a13.514.214.915.516.317.017.718.419.119.920.621.422.122.923.724.525.226.026.827.6

50525456586062646668707274767880828486>86

24.324.925.726.427.127.828.529.330.030.731.532.233.033.834.535.336.136.937.7n/a

26.427.127.928.429.430.231.031.832.633.434.235.035.936.837.538.439.240.141.0n/a

28.429.330.130.931.832.633.534.335.236.136.937.838.739.640.541.442.443.344.2n/a

115

MerzTable 2-61: AC: Merz (Fetal Age) Habilitationsschrift, Mainz University Women’s Hospital, 1988, Unit: Meas (mm); Min/Mean/Max (Weeks); Table/Graph Range: 5%:95%


<5656586062646668707274767880828486889092949698100102104106108110112114116118120122124126128130132134136138140142144

n/a10w6d11w1d11w2d11w4d11w5d11w6d12w0d12w1d12w3d12w4d12w6d12w6d13w1d13w2d13w4d13w5d13w6d14w0d14w1d14w3d14w4d14w6d14w6d15w1d15w2d15w4d15w5d15w6d16w0d16w1d16w3d16w4d16w6d17w0d17w1d17w2d17w4d17w5d17w6d18w0d18w1d18w3d18w4d18w6d19w0d



146148150152154156158160162164166168170172174176178180182184186188190192194196198200202204206208210212214216218220222224226228230232234236

19w1d19w2d19w4d19w5d19w6d20w1d20w1d20w3d20w4d20w6d21w0d21w1d21w2d21w4d21w5d21w6d22w1d22w1d22w3d22w4d22w6d23w0d23w1d23w2d23w4d23w5d23w6d24w1d24w2d24w3d24w4d24w6d25w0d25w1d25w2d25w4d25w5d25w6d26w1d26w2d26w3d26w4d26w6d27w0d27w1d27w3d



116

238240242244246248250252254256258260262264266268270272274276278280282284286288290292294296

27w4d27w5d27w6d28w1d28w2d28w3d28w4d28w6d29w0d29w1d29w3d29w4d29w5d29w6d30w1d30w2d30w4d30w4d30w6d31w0d31w1d31w3d31w4d31w5d31w6d32w1d32w2d32w4d32w4d32w6d



298300302304306308310312314316318320322324326328330332334336338340342344346348>348

33w0d33w1d33w3d33w4d33w5d33w6d34w1d34w2d34w4d34w4d34w6d35w0d35w1d35w3d35w4d35w5d35w6d36w1d36w2d36w4d36w5d36w6d37w0d37w1d37w3d37w4dn/a



Table 2-61: AC: Merz (Fetal Age)(Continued)Habilitationsschrift, Mainz University Women’s Hospital, 1988, Unit: Meas (mm); Min/Mean/Max (Weeks); Table/Graph Range:


117

Table 2-62: AC: Merz (Fetal Growth) Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range 5%:95%)


12.513.013.514.014.515.015.516.016.517.017.518.018.519.019.520.020.521.021.522.022.523.023.524.024.525.025.526.026.527.0

50556065717681869196102107112117122127133138143148153158163168173178183188193198

62677378838994100105111116122127132138143149154159165170175181186191196202207212217

7480859196102108114119125131136142148153159165170176181187193198204209215220226231236

27.528.028.529.029.530.030.531.031.532.032.533.033.534.034.535.035.536.036.537.037.538.038.539.039.540.040.541.041.5

202207212217221226231235240244249253258262266270275279283287290294298301305308311314317

222227232237242247252257262266271276280285289294298303307311315319323327331334338341343

242247252257263268273278283288293298303308313317322327331336340344348352356360364367370

118

Table 2-63: BPD: Merz (Fetal Age)Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: BPD (mm); % Age (Weeks/Days)


<212122232425262728293031323334353637383940414243444546474849505152535455565758596061




6263646566676869707172737475767778798081828384858687888990919293949596979899100101102>102

22w1d22w4d22w6d23w1d23w4d23w6d24w1d24w3d24w5d25w1d25w4d25w6d26w1d26w4d26w6d27w1d27w4d27w6d28w2d28w5d29w1d29w4d29w6d30w2d30w5d31w0d31w4d31w6d32w2d32w6d33w1d33w4d34w0d34w4d34w6d35w3d35w6d36w3d36w6d37w2d37w6dn/a



119

Table 2-64: BPD: Merz (Fetal Growth)Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range 5%:95%)


12.513.013.514.014.515.015.516.016.517.017.518.018.519.019.520.020.521.021.522.022.523.023.524.024.525.025.526.026.527.0

212324252728303133353638404143454648495153545657596162646566

252628293132343537394042444647495152545657596162646567687071

293031333536383941434546485052535557596062646567697072737577

27.528.028.529.029.530.030.531.031.532.032.533.033.534.034.535.035.536.036.537.037.538.038.539.039.540.040.541.041.5

6869717273747677787980818283848586878788898990909191919192

7374767778808182838586878889909192929394959596969797979898

78798182848586888990919293959697979899100101101102103103103104104104

120

Table 2-65: FL: Merz (Fetal Age)Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: FL (mm); % Age (Weeks/Days)


<10101112131415161718192021222324252627282930313233343536373839404142434445

n/a11w1d11w4d11w6d12w1d12w3d12w5d13w1d13w3d13w6d14w1d14w4d14w6d15w1d15w3d15w6d16w1d16w3d16w6d17w1d17w4d17w6d18w1d18w4d18w6d19w1d19w4d20w0d20w2d20w5d21w0d21w3d21w5d22w1d22w4d22w6d23w1d



4647484950515253545556575859606162636465666768697071727374757677787980>80

23w4d24w0d24w3d24w5d25w1d25w4d25w6d26w1d26w4d27w0d27w3d27w6d28w1d28w4d29w0d29w4d29w6d30w2d30w6d31w1d31w4d32w0d32w3d32w6d33w2d33w6d34w1d34w4d35w1d35w4d36w0d36w4d37w0d37w3d37w6dn/a



121

Table 2-66: FL: Merz (Fetal Growth)Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range 5%:95%)


12.513.013.514.014.515.015.516.016.517.017.518.018.519.019.520.020.521.021.522.022.523.023.524.024.525.025.526.026.527.0

6810111315161819212224252728293132333536373940414243454647

91113151618202123242627293032333536373940414344454648495051

121416182021232526282931323435373840414244454648495052535455

27.528.028.529.029.530.030.531.031.532.032.533.033.534.034.535.035.536.036.537.037.538.038.539.039.540.040.541.041.5

4849505152535455565758596061626364656666676869697071717272

5253555657585960616263646566676869707071727374747576767777

5758596061626364666768697071727374747576777879798081818283

122

Table 2-67: HC: Merz (Fetal Age) Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: HC (mm); % Age (Weeks/Days)


>727274767880828486889092949698100102104106108110112114116118120122124126128130132134136138140142144146148150152154156158160162164166168170

n/a11w0d11w1d11w1d11w2d11w4d11w4d11w5d11w6d12w0d12w1d12w2d12w3d12w4d12w5d12w6d12w6d13w0d13w1d13w2d13w3d13w4d13w5d13w6d14w0d14w1d14w1d14w2d14w3d14w4d14w5d14w6d15w0d15w1d15w2d15w4d15w4d15w6d15w6d16w0d16w1d16w2d16w3d16w4d16w5d16w6d17w0d17w1d17w2d17w4d17w4d



172174176178180182184186188190192194196198200202204206208210212214216218220222224226228230232234236238240242244246248250252254256258260262264266268270272

17w6d17w6d18w0d18w1d18w2d18w4d18w4d18w6d19w0d19w1d19w2d19w4d19w4d19w5d19w6d20w0d20w1d20w3d20w4d20w5d20w6d21w0d21w1d21w3d21w4d21w6d21w6d22w1d22w1d22w3d22w4d22w5d22w6d23w1d23w2d23w4d23w5d23w6d24w1d24w1d24w3d24w4d24w6d25w0d25w1d25w3d25w4d25w6d26w0d26w1d26w3d



123

274276278280282284286288290292294296298300302304306308310312314316318320

26w4d26w6d27w0d27w1d27w3d27w5d27w6d28w1d28w2d28w4d28w6d29w0d29w1d29w3d29w4d29w6d30w1d30w2d30w4d30w6d31w1d31w3d31w4d31w6d



322324326328330332334336338340342344346348350352354356358360362364>364

32w0d32w2d32w4d32w6d33w1d33w2d33w4d33w6d34w1d34w3d34w5d35w0d35w2d35w4d35w6d36w1d36w4d36w6d37w1d37w4d37w6d38w1dn/a



Table 2-67: HC: Merz (Fetal Age)(Continued)Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: HC (mm); % Age (Weeks/Days)


124

Table 2-68: HC: Merz (Fetal Growth) Habilitationsschrift, Mainz University Women’s Hospital, 1988Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range 5%:95%)


12.513.013.514.014.515.015.516.016.517.017.518.018.519.019.520.020.521.021.522.022.523.023.524.024.525.025.526.026.527.0

80848994100105111117123130136142148155161167173180186192198204210216221227232238243248

9296101106112118124130136143149155162168174181187193200206212218224230236241247253258263

104108113119124130137143149156162168175181188194201207214220226232238244250256262267273278

27.528.028.529.029.530.030.531.031.532.032.533.033.534.034.535.035.536.036.537.037.538.038.539.039.540.040.541.041.5

253258263268272277281285289293297300303307310313315318320322324326327329330331332332332

268273278283288292297301305309313316320323326329332335337339341343345346348349349350350

284289294299303308313317321325329333336340343346349352354356359361362364365366367368369

125

Moore

Nelson

Table 2-69: AFI: MooreUnit: Age (Days); Min/Max (mm); Table/Graph Range (2.5%: 97.5%)

Age Min Max CRL Age SD CRL Age SD

161718192021222324

737780838688899090

201211220225230233235237238

252627282930313233

898985868482797774

240242245249254258263269274

343536373839404142

727068666564636363

278279279275269255240216192

Table 2-70: CRL: Nelson (Fetal Age), Journal of Clinical Ultrasound, 9: 67-70, 1981, Unit: CRL (mm); GA (Days)

CRL GA CRL GA CRL GA CRL GA CRL GA

1415161718192021222324252627282930313233

5960616162626364646565666767686869707071

3435363738394041424344454647484950515253

7172737374747576767777787979808081828283

5455565758596061626364656667686970717273

8384858586868788888989909191929293949495

7475767778798081828384858687888990919293

95969797989899100100101101102103103104104105106106107

949596979899100101102103104105106107108109110111

107108109109110110111112112113113114115115116116117118

126

OsakaTable 2-71: BPD: Osaka (Fetal Age), Osaka University Method 1989, 3 by Univ. Osaka, Unit: BPD (mm); Age (Days); SD (mm)


<131314151617181920212223242526272829303132

n/a7071737577788082848688909294969899101103105

—1.91.91.91.92.02.02.02.12.12.12.12.22.22.22.32.32.32.32.42.4

333435363738394041424344454647484950515253

107109112114116118120122124126128130132135137139141143145148150

2.42.52.52.52.52.62.62.62.72.72.72.72.82.82.82.82.92.92.92.93.0

545556575859606162636465666768697071727374

152154157159161164166168171173175178180182185187190193195198200

3.03.03.03.13.13.13.13.23.23.23.23.33.33.33.33.33.43.43.43.43.5

7576777879808182838485868788899091929394>94

203206209212214217220224227230234237238245249254259265273280n/a

3.53.53.53.53.63.63.63.63.63.73.73.73.73.73.83.83.83.83.93.9—

Table 2-72: CRL: Osaka (Fetal Age), Osaka University Method 1989, 3 by Univ. Osaka, Unit: CRL (mm); Age (Days); SD (mm)


<9910111213141516171819202122

n/a5052535556575859606162636364

——1.72.02.22.52.62.82.93.13.23.43.53.73.73.8

232425262728293031323334353637

656666676869697071717273737474

4.04.14.14.34.54.64.64.84.94.95.15.25.25.45.4

383940414243444546474849505152

757676777778797980808182838383

5.55.75.75.85.86.06.16.16.36.36.46.66.76.76.7

5354555657585960616263>63

8485858686878788898990n/a

6.97.07.07.27.27.37.37.57.67.67.8——

127

Table 2-73: EFW: Osaka (Fetal Age), Osaka University Method 1989, 3 by Univ. Osaka, Unit: EFW (grams); Age (Days); SD (grams)

EFW Age SD EFW Age SD EFW Age SD EFW Age SD

<137137140150160170180190200210220230240250260270280290300310320330340350360370380390400410420430440450460470480490500510520530540550560570580

n/a112113115116118120121123124126127128130131132133134135136137138139140141142143144145146147148149149150151152153153154155155156157157158159

——29292930303132333435363739404142434445464849505153545657586061636365666869697173737476767880

590600610620630640650660670680690700720740760780800820840860880900920940960980100010201040106010801100112011401160118012001220124012601280130013201340136013801400

160160161162162163164164165165166167168169170171173174175176177178179180181182183185186187188189190191192193194195195196197198199200201202203

8181838585878989919192949698100102106108110112114116118120123125127131133135138140142144146149151153153155158160162164167169171

14201440146014801500152015401560158016001620164016601680170017201740176017801800182018401860188019001920194019601980200020202040206020802100212021402160218022002220224022602280230023202340

203204205206207208209210210211212213214215216216217218219220220221222223224224225226227228229229230231232233233234235236236237238239240241241

171174176178181183185188188190192195197200202202204207209212212214217219222222224227229232234234237239242244244247250252252255257260263265265

23602380240024202440246024802500252025402560258026002620264026602680270027202740276027802800282028402860288029002920294029602980300030203040306030803100312031403160318032003220>3220

242243244245245246247248249249250251252253254254255256257258259259260261262263264265266266267268269270271272273274275276277278279280n/a

268271274276276279282285288288290293296299302302305308311314317317320323326329332335339339342345348352355358362365369372376379383387—

128

Table 2-74: FL: Osaka (Fetal Age), Osaka University Method 1989, 3 by Univ. Osaka, Unit: FL (mm); Age (Days); SD (mm)


<99101112131415161718192021222324

n/a9193959799102104106108110113115118120122125

——2.12.12.12.22.22.22.22.22.22.22.22.32.32.32.32.3

2526272829303132333435363738394041

127130132135137140142145147150152155158162163166169

2.32.32.32.42.42.42.42.42.42.42.52.52.52.52.52.52.6

4243444546474849505152535455565758

172175178181184186190193196199202205209212216220223

2.62.62.62.62.62.62.72.72.72.72.62.82.82.82.82.82.9

59606162636465666768697071>71

227230235239242247250255258260269274279n/a

2.92.92.92.93.03.03.03.03.03.13.13.13.2——

Table 2-75: FTA: Osaka (Fetal Age), Osaka University Method 1989, 3 by Univ. Osaka, Unit: FTA (mm2); Age (Days); SD (mm2)

FTA Age SD FTA Age SD FTA Age SD FTA Age SD

<5605606007008009001000110012001300140015001600170018001900200021002200230024002500

n/a98100103108113115117122125128130134137139142145147150152155157

——120120130150160170170190200210220230240250260270280290300310330

2600270028002900300031003200330034003500360037003800390040004100420043004400450046004700

159162164166168170173175177179181183185187189191193195197199201203

330340350360370380390400410420430440450460470480490500510520530540

4800490050005100520053005400550056005700580059006000610062006300640065006600670068006900

205207209211213215216218220222224226227229231233235237238240242244

560570580590600610620630640650670680680700710720730750750760780790

700071007200730074007500760077007800790080008100820083008400850086008660>8660

246248250252254256258260262264265268270273274276279280n/a

8008208308408608708809009109309309609709901000101010401040——

129

Table 2-76: HL: Osaka (Fetal Age), Osaka University Method 1989, 3 by Univ. Osaka, Unit: HL (mm); Age (Days); SD (mm)

HL Age SD HL Age SD HL Age SD HL Age SD

<1010111213141516171819202122

n/a91939698100103105108110113115117121

——2.02.02.02.12.12.12.12.12.12.12.12.12.2

2324252627282930313233343536

123126129132134137140143145149151155158161

2.22.22.22.22.22.22.32.32.32.32.32.32.32.4

3738394041424344454647484950

164167170174178182185188192196200204208213

2.42.42.42.42.42.52.52.52.52.52.52.62.62.6

515253545556575859606162>62

217222227232237242248254260267275280n/a

2.62.62.72.72.72.72.82.82.82.92.92.9——

130

ParisTable 2-77: BPD: Paris (Fetal Age), Unit: BPD (mm); Age (Days); SD (mm)


<131314151617181920212223242526272829303132

n/a777879808182838485878991939597100102104106108

——33333333333333333333

333435363738394041424344454647484950515253

110113115117119121123126128130133135137140142144147149151154156

333333344444444444444

545556575859606162636465666768697071727374

158161163165168170172175177179182184187189192194197199202204207

444444444444444444444

75767778798081828384858687888990>90

210213217220224227231234238242247252256261266287n/a

5555555555555555——

Table 2-78: CRL: Paris (Fetal Age), Unit: CRL (mm); Age (Days); SD (mm)


<556789101112131415161718192021222324

n/a4243444647495051525354555657585960616363

——44444444444555666667

252627282930313233343536373839404142434445

646566666768697070717172737374747576767777

777777777777777777777

464748495051525354555657585960616263646566

787979808081828283848485858686878788888989

777777777777777777777

67686970717273747576777879808182838485>85

90909191919292939394949495959696979798n/a

7777777777777777777——

131

Table 2-79: FL: Paris (Fetal Age), Unit: FL (mm); Age (Days); SD (mm)


<1515161718192021222324252627282930

n/a98100102105107109112114116119121123126128131134

——4444444444445555

3132333435363738394041424344454647

137139142145148150153156159161164167170172175178181

55555555555555555

4849505152535455565758596061626364

183186189192194197200203206210213217219221224231234

55555555555555555

65666768697071727374757677>77

238241245248252255259262266271276281287n/a

5555555555555——

Table 2-80: Ft: Paris (Fetal Age), Unit: Ft (mm); Age (Days); SD (mm)

Ft Age SD Ft Age SD Ft Age SD Ft Age SD

<1313141516171819202122232425262728

n/a919497100103106109112114116119121123126128130

——2222333444444444

2930313233343536373839404142434445

133135137140142144147149151154156158161163165168170

44444444444444444

4647484950515253545556575859606162

173175178180183185188190193196199202205208211215218

44444444444444444

63646566676869707172737475>75

221224227231234238242246250254258262266n/a

4445555555556——

132

Table 2-81: TAD: Paris (Fetal Age), Unit: TAD (mm); Age (Days); SD (mm)


<1010111213141516171819202122232425262728293031

n/a8484858687878889909192949698100102104106108110112114

——0000000000000000000000

3233343536373839404142434445464748495051525354

116118120122124126128131133136138141143146148151153156158161163166169

00000000000000000000000

5556575859606162636465666768697071727374757677

171174176179181184186189191194196199201204207209212214217219222224227

00000000000000000000000

78798081828384858687888990919293949596>96

229232234237239242245248252255259262266269273276280283287n/a

0000000000000000000——

133

RempenTable 2-82: BPD: Rempen (Fetal Age), Der Frauenarzt 32, 4 (1991) 425-30’ Known LMP (left)—Unknown LMP (right), Unit: BPD (mm); Age (Weeks/Days); 2SD (mm [Known LMP] or day [Unknown LMP])


<2234567891011121314

n/a6w2d6w4d6w6d7w1d7w4d7w6d8w1d8w3d8w5d9w1d9w3d9w5d10w0d

——4444444444444

15161718192021222324>24

10w2d10w5d11w0d11w2d11w5d12w0d12w2d12w4d13w0d13w2dn/a

4444444444——

<33456789101112131415

n/a6w6d7w1d7w3d7w5d8w0d8w2d8w4d8w6d9w1d9w3d9w5d10w0d10w2d

——8888888888888

161718192021222324252627>27

10w4d10w6d11w1d11w3d11w5d12w0d12w2d12w4d12w6d13w1d13w3d13w5dn/a

888888888888——

Table 2-83: BPD: Rempen (Fetal Growth), Der Frauenarzt 32, 4 (1991) 425-30, Unit: Age (Weeks/Days); Mean (mm); 2SD (mm); Table/Graph Range (5%:95%)

Age Mean SD Age Mean SD Age Mean SD


2.02.53.03.43.94.34.85.35.76.26.77.17.68.08.58.99.4

3.73.73.73.73.73.73.73.73.73.73.73.73.73.73.73.73.7


9.810.310.711.211.612.112.513.013.413.914.314.815.215.716.116.517.0

3.73.73.73.73.73.73.73.73.73.73.73.73.73.73.73.73.7

11w1d11w2d11w3d11w4d11w5d11w6d12w0d12w1d12w2d12w3d12w4d12w5d12w6d13w0d13w1d13w2d

17.417.918.318.719.219.620.020.520.921.321.822.222.623.123.523.9

3.73.73.73.73.73.73.73.73.73.73.73.73.73.73.73.7

134

Table 2-84: CRL: Rempen (Fetal Age), Der Frauenarzt 32, 4 (1991) 425-30, Known LMP (left)—Unknown LMP (right), Unit: CRL (mm); Age (Weeks/Days); 2SD (mm [Known LMP] or day [Unknown LMP])


<1123456789101112131415161718192021222324252627282930313233343536373839

n/a5w5d5w6d6w0d6w1d6w2d6w3d6w4d6w6d6w6d7w0d7w2d7w2d7w4d7w4d7w5d7w6d8w0d8w1d8w2d8w3d8w4d8w5d8w6d8w6d9w0d9w1d9w2d9w3d9w4d9w4d9w5d9w6d10w0d10w1d10w1d10w2d10w3d10w4d10w4d

——888888888888888888888888888888888888888

404142434445464748495051525354555657585960616263646566>66


888888888888888888888888888——

<22345678910111213141516171819202122232425262728293031323334353637383940

n/a6w0d6w1d6w2d6w3d6w4d6w5d6w6d7w0d7w1d7w2d7w3d7w4d7w5d7w6d7w6d8w0d8w1d8w2d8w3d8w4d8w5d8w5d8w6d9w0d9w1d9w2d9w3d9w3d9w4d9w5d9w6d9w6d10w0d10w1d10w2d10w2d10w3d10w4d10w5d

——666666666667777766677776677777776677667

4142434445464748495051525354555657585960616263646566676869707172737475767778>78

10w5d10w6d11w0d11w0d11w1d11w2d11w2d11w3d11w4d11w4d11w5d11w5d11w6d12w0d12w0d12w1d12w1d12w2d12w3d12w3d12w4d12w4d12w5d12w5d12w6d12w6d13w0d13w0d13w1d13w1d13w2d13w2d13w3d13w3d13w4d13w4d13w4d13w5dn/a

76776776766767767676767767676776767676——

135

Table 2-85: CRL: Rempen (Fetal Growth), Der Frauenarzt 32, 4 (1991) 425-30, Unit: Age (Weeks/Days); Mean (mm); 2SD (mm); Table/Graph Range (5%:95%)


5w5d5w6d6w0d6w1d6w2d6w3d6w4d6w5d6w6d7w0d7w1d7w2d7w3d7w4d7w5d7w6d8w0d8w1d

1.22.13.03.84.75.76.67.58.59.510.511.512.513.514.615.616.717.8

7.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.8


18.920.021.122.323.524.625.827.028.329.530.732.033.334.635.937.238.539.9

7.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.8


41.342.644.045.446.948.349.851.252.754.255.757.358.860.361.963.565.166.7

7.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.87.8

136

Table 2-86: GS: Rempen (Fetal Age), Der Frauenarzt 32, 4 (1991) 425-30, Known LMP (left)—Unknown LMP (right), Unit: GS (mm); Age (Weeks/Days); 2SD (mm [Known LMP] or day [Unknown LMP])

GS Age 2SD GS Age 2SD GS Age 2SD GS Age 2SD

<112345678910111213141516171819202122232425262728293031323334353637

n/a4w4d4w5d4w6d5w0d5w0d5w1d5w2d5w3d5w3d5w4d5w5d5w6d6w0d6w0d6w1d6w2d6w3d6w4d6w5d6w6d6w6d7w0d7w1d7w2d7w3d7w4d7w5d7w6d8w0d8w0d8w1d8w2d8w3d8w4d8w5d8w6d9w0d

——11111111111111111111111111111111111111111111111111111111111111111111111111

3839404142434445464748495051525354555657585960>60

9w1d9w2d9w4d9w5d9w6d10w0d10w1d10w2d10w3d10w4d10w6d11w0d11w1d11w2d11w4d11w5d12w0d12w1d12w2d12w4d12w5d13w0d13w1dn/a

1111111111111111111111111111111111111111111111——

<112345678910111213141516171819202122232425262728293031323334353637

n/a4w5d4w6d5w0d5w1d5w2d5w2d5w3d5w4d5w5d5w5d5w6d6w0d6w1d6w2d6w2d6w3d6w4d6w5d6w6d6w6d7w0d7w1d7w2d7w3d7w4d7w4d7w5d7w6d8w0d8w1d8w2d8w3d8w3d8w4d8w5d8w6d9w0d

——10101010101010101010101010101010101010101010101010101010101010101010101010

383940414243444546474849505152535455565758596061626364656667686970717273>73

9w1d9w2d9w3d9w4d9w5d9w6d9w6d10w0d10w1d10w2d10w3d10w4d10w5d10w6d11w0d11w1d11w2d11w3d11w4d11w5d11w6d12w0d12w1d12w2d12w3d12w4d12w5d12w6d13w0d13w1d13w2d13w3d13w4d13w5d14w0d14w1dn/a

101010101010101010101010101010101010101010101010101010101010101010101010——

137

Table 2-87: GS: Rempen (Fetal Growth), Der Frauenarzt 32, 4 (1991) 425-30, Unit: Age (Weeks/Days); Mean (mm); 2SD (mm); Table/Graph Range (5%:95%)



0.51.83.24.55.87.18.49.710.912.213.414.615.917.118.319.420.621.722.924.025.1

10.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.5


26.227.328.429.530.531.632.633.634.635.636.637.638.539.540.441.342.243.144.044.945.7

10.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.5

10w4d10w5d10w6d11w0d11w1d11w2d11w3d11w4d11w5d11w6d12w0d12w1d12w2d12w3d12w4d12w5d12w6d13w0d13w1d13w2d

46.647.448.249.049.850.651.452.152.953.654.355.155.856.457.157.858.459.159.760.3

10.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.510.5

138

Robinson

Tokyo

Table 2-88: CRL: Robinson (Fetal Age), Br J Gynecol, 82: 702, 1975, Unit: CRL (mm); Age (Days); SD (mm)


<778910111213141516171819202122232425

n/a45464748505253545556575859606061626364

——4444444444444444455

2627282930313233343536373839404142434445

6465666768696970707172727374747575767777

55666777777777777777

4647484950515253545556575859606162636465

7879798081828383838484848585868687888990

77777777777777777777

6667686970717273747576777879808182>82

9090919191929293939394949595969798n/a

77777777777777777——

Table 2-89: APTDxTTD: Tokyo (Fetal Age), Tokyo University Method 1986, 6 by University Tokyo, Unit: Meas (cm2); Age (Weeks/Days); SD (Days)

Meas Age SD Meas Age SD Meas Age SD

<101012141618202224262830323436

n/a16w1d17w0d17w6d18w4d19w3d20w1d20w6d21w4d22w2d22w6d23w4d24w1d24w5d25w2d

——± 8d± 8d± 8d± 8d± 8d± 8d± 9d± 9d± 9d± 9d± 9d± 10d± 10d± 10d

384042444648505254565860626466

25w6d26w3d27w0d27w3d28w0d28w4d29w0d29w3d30w0d30w3d31w0d31w3d31w6d32w3d32w6d

± 10d± 11d± 11d± 11d± 12d± 12d± 12d± 13d± 13d± 13d± 14d± 14d± 14d± 15d± 15d

687072747678808284868890>90


± 15d± 16d± 16d± 17d± 17d± 17d± 18d± 18d± 18d± 18d± 19d± 19d——

139

Table 2-90: APTDxTTD by Gestational Age: Tokyo, Tokyo University Method 1986, 6 by University Tokyo

Weeks -1.64 SD -1.5 SD -1.28 SD Mean +1.28 SD +1.5 SD +1.64 SD

16.017.018.019.020.021.022.023.024.025.026.027.028.029.030.031.032.033.034.035.036.037.038.039.040.041.042.0

7.08.710.512.514.717.119.622.225.027.930.933.937.140.343.546.850.053.356.559.762.865.968.871.674.376.879.1

7.49.010.913.015.217.620.222.925.728.631.734.838.041.344.547.951.254.557.861.164.367.470.473.376.178.681.1

7.99.711.613.716.118.521.223.926.829.833.036.239.442.846.249.653.056.559.963.366.669.872.976.078.981.684.1

11.213.315.618.120.823.626.729.933.236.740.344.147.951.855.759.763.867.871.975.979.983.987.791.595.198.6102.0

14.617.019.622.425.528.832.235.939.743.647.752.056.360.865.369.974.579.283.988.693.397.9102.5107.0111.4115.7119.8

15.117.620.323.226.329.633.236.940.844.849.053.357.862.366.971.676.481.286.090.895.6100.3105.0109.7114.2118.6122.9

15.518.020.723.626.830.233.837.541.545.649.854.258.763.368.072.777.682.487.392.297.0101.9106.7111.4116.0120.5124.8

140

Table 2-91: BPD: Tokyo (Fetal Age), Tokyo University Method 1986, 6 by University Tokyo, Unit: BPD (mm); Age (Days); SD (Days)


<20202122232425262728293031323334353637

n/a85878992949698100102102106108110112114116118120

——± 6± 6± 6± 6± 6± 6± 6± 6± 6± 6± 5± 5± 5± 5± 5± 5± 5± 5

38394041424344454647484950515253545556

123125127129131133135138140142144146148151153154157160162

± 5± 5± 5± 5± 5± 5± 5± 6± 6± 6± 6± 6± 6± 6± 6± 6± 6± 6± 6

57585960616263646566676869707172737475

164167169171174176179181183186188191194196199201204207210

± 6± 6± 6± 6± 7± 7± 7± 7± 7± 7± 7± 7± 7± 7± 8± 8± 8± 8± 8

767778798081828384858687888990>90

213216218221225228231234238241245249253258262n/a

± 8± 8± 8± 8± 8± 8± 8± 9± 9± 9± 9± 9± 9± 9± 9——

Table 2-92: CRL: Tokyo (Fetal Age), Tokyo University Method 1986, 6 by University Tokyo, Unit: CRL (mm); Age (Days); SD (Days)


<13131415161718192021

n/a555657585960616263

——± 8± 9± 10± 8± 9± 10± 8± 9± 7

22232425262728293031

64656667686869707172

± 7± 7± 7± 7± 7± 7± 7± 7± 7± 7

32333435363738394041

73747475767778787980

± 7± 7± 7± 7± 7± 7± 7± 7± 7± 7

424344454647484950>50

818182838484858686n/a

± 7± 7± 7± 7± 7± 7± 7± 7± 7——

141

Table 2-93: FL: Tokyo (Fetal Age), Tokyo University Method 1986, 6 by University Tokyo, Unit: FL (mm); Age (Days); SD (mm)


<3333343536373839404142

n/a143146149153156159162166169172

——± 6± 6± 6± 6± 6± 6± 6± 6± 6± 6

4344454647484950515253

175178181185188191194197200204207

± 6± 6± 6± 7± 7± 7± 7± 7± 7± 7± 7

5455565758596061626364

210214217220224228231235239243247

± 7± 7± 7± 7± 7± 8± 8± 8± 8± 8± 8

65666768697071>71

251256260266271278286n/a

± 8± 8± 8± 7± 7± 7± 6——

Table 2-94: GS: Tokyo (Fetal Age), Tokyo University Method 1986, 6 by University Tokyo, Unit: GS (mm); Age (Days); SD (Days)


<1212131415161718192021

n/a31323334363738404142

——± 7± 7± 7± 7± 7± 7± 7± 7± 7± 7

2223242526272829303132

4344464748495051525355

± 7± 7± 7± 7± 8± 9± 10± 0± 0± 0± 0

3334353637383940414243

5657585960616263646565

± 0± 0± 0± 0± 0± 0± 0± 0± 0± 0± 0

44454647484950>50

66676869707172n/a

± 0± 0± 0± 0± 0± 0± 0——

Table 2-95: LV: Tokyo (Fetal Age), Tokyo University Method 1986, 6 by University Tokyo, Unit: LV (mm); Age (Days); SD (Days)

LV Age SD LV Age SD LV Age SD LV Age SD

<444445464748495051525354

n/a154157159161163166168171173176178

——± 5± 5± 5± 5± 5± 6± 6± 6± 6± 7± 7

555657585960616263646566

181183186189192195198201204207210213

± 7± 8± 8± 8± 8± 9± 9± 9± 9± 10± 10± 10

676869707172737475767778

217220224227231234238241245249252256

± 10± 10± 10± 11± 11± 11± 11± 11± 11± 11± 11± 11

7980818283848586>86

260264267271275278282285n/a

± 10± 10± 10± 10± 10± 10± 10± 10——

142

Tokyo ShinozukaTable 2-96: AC: Tokyo Shinozuka (Fetal Age), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: AC (cm); Age (Weeks/Days); SD (cm)

AC Age 1SD AC Age 1SD AC Age 1SD

<101011121314151617

n/a15w3d16w4d17w4d18w4d19w4d20w3d21w3d22w3d

——0.50.60.60.70.70.80.80.9

181920212223242526

23w3d24w3d25w3d26w3d27w3d28w4d29w4d30w5d31w6d

0.91.01.01.11.11.21.21.31.3

27282930313233>33

33w1d34w2d35w4d37w0d38w2d39w6d41w2dn/a

1.41.41.51.61.61.71.8——

Table 2-97: AC: Tokyo Shinozuka (Fetal Growth), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: Age (Weeks/Days); Min/Mean/Max (cm); Table/Graph Range: 1.64SD


1617181920212223242526272829

9.310.311.212.213.114.015.015.916.817.718.619.520.321.1

10.912.013.014.015.116.117.118.119.120.121.022.022.923.8

12.513.614.715.816.918.019.120.221.222.323.324.425.426.4

30313233343536373839404142

22.022.823.524.325.025.726.427.027.628.228.829.329.7

24.725.626.527.328.128.929.730.431.131.832.433.033.6

27.328.329.230.131.031.932.733.534.335.035.736.437.0

143

Table 2-98: AxT (APTDxTTD): Tokyo Shinozuka (Fetal Age), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: AxT (mm); Age (Weeks/Days); SD (cm2)

AxT Age 1SD AxT Age 1SD AxT Age 1SD

<101012141618202224262830323436

n/a16w1d17w0d17w6d18w4d19w3d20w1d20w6d21w4d22w2d22w6d23w4d24w1d24w5d25w2d

——2.52.72.93.13.43.63.84.04.34.44.74.95.15.3

384042444648505254565860626466


5.55.76.06.16.46.66.87.07.27.47.77.98.18.48.6

687072747678808284868890>90


8.89.19.39.69.910.110.210.711.011.311.712.0——

Table 2-99: AxT (APTDxTTD): Tokyo Shinozuka (Fetal Growth), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: Age (Weeks); Min/Mean/Max (cm2); Table/Graph Range: 1.64SD


1617181920212223242526272829

7.08.710.512.514.717.119.622.225.027.930.933.937.140.3

11.213.315.618.120.823.626.729.933.236.740.344.147.951.8

15.518.020.723.626.830.233.837.541.545.649.854.258.763.3

30313233343536373839404142

43.546.850.053.356.559.762.865.968.871.674.376.879.1

55.759.763.867.871.975.979.983.987.791.595.198.6102.0

68.072.777.682.487.392.297.0101.9106.7111.4116.0120.5124.8

144

Table 2-100: BPD: Tokyo Shinozuka (Fetal Age), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: BPD (mm); Age (Weeks/Days); SD (mm)

BPD Age 1SD BPD Age 1SD BPD Age 1SD

<131314151617181920212223242526272829303132333435363738

n/a10w1d10w3d10w5d11w0d11w2d11w4d11w6d12w1d12w3d12w6d13w1d13w3d13w5d14w0d14w2d14w4d14w6d15w1d15w3d15w5d16w0d16w2d16w4d16w6d17w1d17w4d

——2.32.32.32.32.42.42.42.42.42.42.52.52.52.52.52.52.62.62.62.62.62.62.72.72.72.7

394041424344454647484950515253545556575859606162636465

17w6d18w1d18w3d18w5d19w0d19w2d19w4d20w0d20w2d20w4d20w6d21w1d21w3d21w6d22w1d22w3d22w5d23w1d23w3d23w5d24w1d24w3d24w5d25w1d25w3d25w5d26w1d

2.72.72.82.82.82.82.82.82.92.92.92.92.92.93.03.03.03.03.03.13.13.13.13.13.13.23.2

66676869707172737475767778798081828384858687888990>90

26w3d26w6d27w2d27w4d28w0d28w3d28w5d29w1d29w4d30w0d30w3d30w6d31w2d31w5d32w1d32w5d33w1d33w5d34w2d34w6d35w3d36w0d36w5d37w4d38w3dn/a

3.23.23.33.33.33.33.33.43.43.43.43.43.53.53.53.63.63.63.63.73.73.73.83.83.9——

145

Table 2-101: BPD: Tokyo Shinozuka (Fetal Growth), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range: 1.64SD


1011121314151617181920212223242526

10.513.717.020.423.727.030.333.536.840.043.246.349.352.355.258.060.8

14.317.621.024.427.831.234.638.041.344.647.951.154.257.360.363.266.0

18.121.525.028.532.035.539.042.445.849.252.655.959.162.365.368.471.3

27282930313233343536373839404142

63.465.968.370.672.874.876.778.580.181.582.783.884.685.385.886.0

68.771.473.976.378.580.682.684.586.187.689.090.191.191.892.492.8

74.176.879.481.984.286.588.590.492.293.895.296.597.598.499.099.5

Table 2-102: CRL: Tokyo Shinozuka (Fetal Age), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: CRL (mm); Age (Weeks/Days); SD (mm)

CRL Age 1SD CRL Age 1SD CRL Age 1SD

<55678910111213141516171819

n/a6w3d6w4d6w6d7w0d7w1d7w2d7w3d7w4d7w5d7w6d8w1d8w2d8w3d8w4d8w5d

——1.11.31.61.71.92.02.22.32.52.62.93.13.33.43.6

20212223242526272829303132333435

8w6d9w0d9w1d9w2d9w3d9w4d9w4d9w5d9w6d10w0d10w1d10w2d10w3d10w4d10w5d10w6d

3.73.94.04.24.34.54.54.64.84.95.15.25.45.55.75.9

363738394041424344454647484950>50

10w6d11w0d11w0d11w1d11w2d11w3d11w3d11w4d11w5d11w6d11w6d12w0d12w1d12w1d12w2dn/a

5.96.06.06.26.36.56.56.66.86.96.97.17.27.27.4——

146

Table 2-103: CRL: Tokyo Shinozuka (Fetal Growth), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: Age (Weeks/Days); Mean (mm); SD (mm); Table/Graph Range: 1.64SD



7.98.69.310.110.911.712.513.414.315.216.117.118.119.120.1

1.71.92.02.22.32.52.62.82.93.13.33.43.63.73.9


21.222.323.424.525.726.828.029.330.531.833.134.435.837.138.5

4.04.24.34.54.64.84.95.15.25.45.55.75.96.06.2


40.041.442.944.445.947.449.050.652.253.955.557.258.9

6.36.56.66.86.97.17.27.47.57.77.88.08.2

Table 2-104: EFW: Tokyo Shinozuka (Fetal Age), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: EFW (grams); Age (Weeks/Days); SD (grams)

EFW Age 1SD EFW Age 1SD EFW Age 1SD

<2502503003504004505005506006507007508008509009501000105011001150

n/a19w3d20w0d20w4d21w2d21w5d22w2d22w6d23w2d23w6d24w2d24w5d25w2d25w5d26w1d26w4d26w6d27w2d27w5d28w0d

——455158667178859098103109116122128134138145151155

12001250130013501400145015001550160016501700175018001850190019502000205021002150

28w3d28w5d29w1d29w3d29w5d30w0d30w2d30w5d30w7d31w2d31w4d31w6d32w1d32w3d32w5d32w7d33w1d33w3d33w5d34w0d

162166173177181186191197202207211216221226231236238243248253

22002250230023502400245025002550260026502700275028002850290029503000>3000

34w2d34w4d34w6d35w1d35w3d35w5d35w7d36w2d36w4d36w6d37w2d37w4d37w6d38w1d38w4d38w6d39w2dn/a

258264269274279284290295301306314320325331340345354——

147

Table 2-105: EFW: Tokyo Shinozuka (Fetal Growth), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: Age (Weeks); Min/Mean/Max (grams); Table/Graph Range: 1.64SD


181920212223242526272829

1582042563143814565416347378499701099

216279349427513609714830956109212371391

27435544253964576188810261175133415041683

303132333435363738394041

123413751520166718141960210222362360247125652639

155217201892206822442420259227582915305931873296

187020642265246926752880308332803469364738093952

Table 2-106: FL: Tokyo Shinozuka (Fetal Age), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: FL (mm); Age (Weeks/Days); SD (mm)

FL Age 1SD FL Age 1SD FL Age 1SD

<202021222324252627282930313233343536

n/a16w1d16w3d16w6d17w1d17w3d17w6d18w1d18w3d18w6d19w1d19w4d20w0d20w2d20w5d21w1d21w3d21w6d

——2.62.72.72.72.72.72.72.72.72.72.82.82.82.82.82.82.8

373839404142434445464748495051525354


2.92.92.92.92.92.92.93.03.03.03.03.03.03.13.13.13.13.1

55565758596061626364656667686970>70

30w5d31w2d31w6d32w3d33w0d33w3d34w0d34w4d35w1d35w5d36w2d37w0d37w4d38w1d38w5d39w3dn/a

3.13.23.23.23.23.23.23.33.33.33.33.33.43.43.43.4——

148

Table 2-107: FL: Tokyo Shinozuka (Fetal Growth), Shinozuka Jpn J Med Ultrasonics vol 23: 12 1996, Unit: Age (Weeks); Min/Mean/Max (mm); Table/Graph Range: 1.64SD


1617181920212223242526272829

17.119.622.124.627.129.531.934.336.739.041.343.545.647.7

21.424.026.529.131.634.136.639.141.543.946.248.450.652.8

25.828.431.033.636.238.841.343.846.348.751.153.455.757.9

30313233343536373839404142

49.751.653.555.256.958.459.961.262.463.564.465.365.9

54.856.858.760.562.263.865.366.768.069.170.171.071.7

60.062.064.065.867.669.270.872.273.674.775.876.777.5

149

Williams

Yarkoni

Table 2-108: EFW: Williams (Fetal Growth), Unit: Age (Weeks); Min/Mean/Max (grams)


22.023.024.025.026.027.028.029.030.031.032.033.0

320365417477546627720829955110012841499

5135896757738821005114312981484169519202155

746861989113212891463165318592136240226732910

34.035.036.037.038.039.040.041.042.043.044.0

17281974222424552642279028812946301130443043

23942628284930523227336434623524358936263633

31323333352137063867399440804127418542214233

Table 2-109: CLA:Yarkoni S, Journal of Ultrasound in Medicine, 4:467-470, 1985 (Fetal Age), Unit: Meas (mm); Min/Mean/Max (Weeks/Days)


111213141516171819202122232425262728




2930313233343536373839404142434445




150

Chapter 3 Acoustic information

• The real-time display of acoustic output indices ...................... ... 152• Thermal Index ...........................................................................152• Mechanical Index ......................................................................153

• Track 3 ALARA Educational Program ........................................ ... 154• Default Settings and Output Levels ............................................ ... 154• Controls Affecting Acoustic Output ........................................... ... 155

• Track 3 Summary Table ...........................................................156• Acoustic Parameters as Measured in Water .............................. ... 158

• Definitions, symbols and abbreviations ....................................158• Explanation of Footnotes ..........................................................181• Multiple focal-zones ..................................................................181• Operating Conditions ................................................................181

• Acoustic Output Reporting Tables for Track 3/IEC 60601-2-37 ... 182• Transducer Model: 3S ..............................................................183• Transducer Model: M3S ...........................................................189• Transducer Model: M4S ...........................................................195• Transducer Model: 5S ..............................................................201• Transducer Model: 6S ..............................................................207• Transducer Model: 7S ..............................................................213• Transducer Model: 10S ............................................................219• Transducer Model: 3V ..............................................................225• Transducer Model: 3.5C ...........................................................232• Transducer Model: 4C ..............................................................237• Transducer Model: 5C ..............................................................242• Transducer Model: M7C ...........................................................247• Transducer Model: 8C ..............................................................252• Transducer Model: 7L ...............................................................257

151

• Transducer Model: 9L ...............................................................262• Transducer Model: 10L .............................................................267• Transducer Model: 12L .............................................................272• Transducer Model: M12L ..........................................................277• Transducer Model: E8C ............................................................282• Transducer Model: 6T ...............................................................287• Transducer Model: 6Tc .............................................................293• Transducer Model: 9T ...............................................................299• Transducer Model: P2D ............................................................305• Transducer Model: P6D ............................................................307• Transducer Model: i13L ............................................................309• Transducer Model: i8L ..............................................................314

152

The real-time display of acoustic output indices

The Vivid 7 has real-time display features according to Track 3 in the FDA 510(k) Guidance of 1997.It displays both a thermal (TI) and a mechanical (MI) index in all operating modes. These two indices are intended to estimate the potential for thermal and mechanical bioeffects induced by ultrasound. Both TI and MI are displayed with increments of 0.1. Neither are displayed if the value is below 0.4. The displayed (estimated) TI and MI are nominal values.

Thermal Index

TI is defined as:

where: W0 is the time-averaged acoustic power and Wdeg is the estimated power necessary to raise the target tissue one degree C.

The displayed TI is an estimate of temperature increase of soft tissue or bone, presented to make it easier for the operator to implement the ALARA (As Low As Reasonably Achievable) principle. There are three thermal index categories:• TIS: Soft tissue thermal index. The main TI category. Used

for applications that do not image bone.• TIB: Bone thermal index (bone located in a focal region).

Used for fetal application.• TIC: Cranial bone thermal index (bone located close to the

surface). Used for transcranial application.

The Vivid 7 chooses the correct category based on mode of operation and chosen application, and presents only one TI to the operator. It is therefore important that the operator chooses the right application.

Vivid 7 has an internal limit of 3.0 on TI. IEC87 has suggested some time dependent thresholds that are partly implemented on Vivid 7 as color-coding of the thermal index. The color-coding scheme together with the thermal exposure times in the table below are not meant as limits on TI or exposure time, but as an aid for the operator. Note that Vivid 7 does not

TI =W0Wdeg

153

monitor the thermal exposure time. The displayed TI is coded like this:

Mechanical IndexMI is the estimated likelihood of tissue damage due to cavitation. MI is defined as:

where pr.3 is the derated (attenuated) peak rarefactional (negative) pressure (MPa) and fc is the center frequency (MHz).

The MI will not exceed a value of 1.9 according to Track 3 in the FDA 510(k) guidance of 1997.

Display Accuracy and Acoustic Measurement Uncertainties

The display accuracy and measurement precision of the output display are summarized in the table below. Accuracy of the output display (TI, MI) parameters depends on the measurement system precision, the acoustic model used to calculate the parameters and variation in the acoustic output of probes and systems. The measurement precision and overall accuracy of the measurements have been assessed by determining both the random and the systematic uncertainties and given in percent at 95% confidence level.

TI Color Recommended thermal exposure time

0.0 – 0.4 Dimmed -

0.4 – 1.5 White -

1.5 – 2.0 White < 12 h

2.0 – 3.0 White < 1 h

MI =Pr.3(Zsp)

c

ParameterEstimated accuracya Measurement precision

M/Color/PW/CW 2D/CFM mode

Pressure, MI ±25% ±15%

154

a. Accuracy = (Measured value - displayed value)/displayed value * 100%

Track 3 ALARA Educational ProgramThe user should be familiar with the enclosed document “Medical Ultrasound Safety” (see XXX), published by AIUM (American Institute of Ultrasound in Medicine). This document is acceptable to FDA as meeting the content of the ALARA educational program. ALARA is an acronym for the principle of prudent use of diagnostic ultrasound by obtaining the diagnostic information at an output that is As Low As Reasonably Achievable.In addition to the AIUM document, the sections “The real-time display of acoustic output indices” on page 2 and “Controls Affecting Acoustic Output” on page 5 should be studied carefully in order to implement ALARA.

Default Settings and Output Levelshe default acoustic output level will not exceed a thermal index (TI) of 3.0 or a mechanical index (MI) of 1.5.

The maximum default TI is 50% of the maximum possible TI (6.0) and the maximum default MI is 80% of the maximum possible MI (1.9).

The output level will not exceed the default level until the user intentionally increases the power level by adjusting the power control on the system.

The output level will return to default each time• a new probe is chosen• a new application is chosen• a new patient is chosen.

Power, TI ±50% ±30% ±40%

Frequency ±1% ±1%

ParameterEstimated accuracya Measurement precision

M/Color/PW/CW 2D/CFM mode

155

Controls Affecting Acoustic OutputThe initial means by which the user can affect acoustic output are by 1) selecting a probe, 2) selecting an application (exam category) and then 3) selecting the imaging mode or particular imaging characteristics. After these selections are made, the only user control that can affect the output is the acoustic output control. This is achieved through an acoustic output control scheme in which all parameters that directly or indirectly affect acoustic output are fed to the control algorithm. The algorithm estimates all relevant parameters and compares them to the FDA limits.

Output levels remain below the limits with a 95% confidence margin. The absolute maximum allowable output for all applications is:• ISPTA 720 mW/cm2

• MI 1.9• TI 6

Figure 3-1: The Vivid 7 Acoustic Output Control Scheme

The following table summarizes the mode/probe combinations for which the global maximum displayed MI or TI may be

156

greater than 1.0. For each probe/mode combination checked, a Track 3 acoustic output table exists.

Not all probes listed may be supported wordwide. Please refer to your local language User Manual for an overview of the probes that are supported in your country.

Track 3 Summary Table

Operating Mode Transducer Model

3S M3S M4S 5S 6S 7S 10S

B-Mode (2D) Yes Yes Yes Yes Yes Yes Yes

M-Mode Yes Yes Yes Yes Yes Yes Yes

Pulsed Doppler (PW) Yes Yes Yes Yes Yes Yes Yes

CW Doppler (CW) Yes Yes Yes Yes Yes Yes Yes

Color Flow Yes Yes Yes Yes Yes Yes Yes

Color M-Mode Yes Yes Yes Yes Yes Yes Yes


6T 6Tc3.5C

(358C) 4C5C

(548C)7L

(546L) 9L

B-Mode (2D) Yes Yes Yes Yes Yes Yes Yes

M-Mode Yes Yes Yes Yes Yes Yes Yes


CW Doppler (CW) Yes Yes - - - - -

Color Flow Yes Yes Yes Yes Yes Yes Yes

Color M-Mode Yes Yes Yes Yes Yes Yes Yes


10L(739L)

12L(LA39) M12L

2D(P2D)

6D(P6D) i13L i8L

B-Mode (2D) Yes Yes Yes - - Yes Yes

157

M-Mode Yes Yes Yes - - Yes Yes


CW Doppler (CW) - - - Yes Yes - -

Color Flow Yes Yes Yes - - Yes Yes

Color M-Mode Yes Yes - - - Yes Yes


8C M7C 9T 3V E8C

B-Mode (2D) Yes Yes Yes Yes Yes

M-Mode Yes Yes Yes Yes Yes

Pulsed Doppler (PW) Yes Yes Yes Yes Yes

CW Doppler (CW) - - Yes Yes -

Color Flow Yes Yes Yes Yes Yes

Color M-Mode Yes Yes Yes Yes Yes


10L(739L)

12L(LA39) M12L

2D(P2D)

6D(P6D) i13L i8L

158

Acoustic Parameters as Measured in Water

Definitions, symbols and abbreviationsThe following definitions, symbols and abbreviations are used in the acoustic output reporting tables in this chapter:

FDA IEC Meaning—IEC 60601-2-37 / FDA & NEMA UD2, UD3

a a Acoustic Attenuation Coefficient / Derating factor (usually 0.3 dB/cm-MHz)

Aaprt Aaprt -12db Output Beam Area / Active aperture area

CMI Normalizing Coefficient

Deq Deq Equivalent Aperture Diameter / (same)

d-6 d-6 Pulse Beam Width / Beam diameter at –6 dB

deq deq Equivalent Beam Diameter

fc ƒawf Acoustic Working Frequency / Center frequency

Ipa Ipa Pulse-Average Intensity

Ipa.3 Ipa,a Attenuated Pulse-Average Intensity

PII Ipi Pulse-Intensity Integral

PII.3 Ipi,a Attenuated Pulse-Intensity Integral

ITA Ita(z) Temporal-Average Intensity

ITA.3(Z) Ita,a(z) Attenuated Temporal-Average Intensity / (at depth z)

ISPTA(Z) Izpta(z) Spatial-Peak Temporal-Average Intensity

ISPTA.3(Z) Izpta,a(z) Attenuated Spatial-Peak Temporal-Average Intensity

MI MI Mechanical Index

Wo P Output Power / Time average acoustic power at the source

W.3(Z) Pa Attenuated Output Power / Time average acoustic power derated to depth z

Wo1 P1 Bounded Output Power / Power emitted from the central 1cm of aperture

159

PII pi Pulse Pressure Squared Integral / Pulse intensity integral

pr pr Peak-Rarefactional Acoustic Pressure / (same)

pr.3 pra Attenuated Peak-Rarefactional Acoustic Pressure / (same)

PRF prr Pulse Repetition Rate / Pulse repetition frequency

TI TI Thermal Index / (same)

TIB TIB Bone Thermal Index / (same)

TIC TIC Cranial-Bone Thermal Index / (same)

TIS TIS Soft-Tissue Thermal Index / (same)

PD td Pulse Duration / (same)

x-12,y-12 X, Y -12 dB Output Beam Dimensions / (same)

Z z Distance from the Source to a Specified Point / (same)

Zsp zb Depth for TIB / Depth at which the relevant index is maximum

Zbp zbp Break-Point Depth / (same)

Zsp zs Depth for TIS / Depth at whcih the relevant index is maximum

FDA IEC Meaning—IEC 60601-2-37 / FDA & NEMA UD2, UD3

181

Explanation of FootnotesThe mechanical and thermal indices may be replaced by one of the following footnotes because of the reasons listed:• a: Display of this index is not required for this operating

mode.• b: This probe is not intended for transcranial or neonatal

cephalic uses.• c: This formulation for TIS is less than that for an alternate

formulation in this mode.

If so, the table entries are replaced by a “#”, meaning: no data are provided for this operating condition since the maximum reported value is not reported for the reason listed.

If neither an index or a footnote is given, this means that the index is irrelevant for this transducer/mode combination.

Multiple focal-zonesWhen using multiple focal-zones on Vivid 7, the time in one frame is divided between the different focal-zones. When measuring this, the MI is found as the maximum MI of all zones:

while the TI and W0 is found as the time-weighted sum of all zones:

tzone is the time fraction used per zone in a frame.

Some of the parameters in the acoustic output report tables will have one value per zone. In this case, the range of the parameter values is reported. The number of zones and which zone has the greater MI is also given in the tables.

Operating ConditionsAll table entries are with the operating conditions specified at the end of the table.

MI = max (MI)all zones

TI = !all zones

tzone

W0 = !all zones

tzone

.

.zone

TIzone

W0

182

Acoustic Output Reporting Tables for Track 3/IEC 60601-2-37

Not all probes listed may be supported wordwide. Please refer to your local language User Manual for an overview of the probes that are supported in your country.

183

Transducer Model: 3SOperating Mode: 2D

See explanation of measurements with several focal zones on page 181.

184

Transducer Model: 3S

Operating Mode: M-Mode

185


Operating Mode: CF

186


Operating Mode: CM

187


Operating Mode: PW

188


Operating Mode: CW

189

Transducer Model: M3SOperating Mode: 2D


190

Transducer Model: M3S


191


Operating Mode: CF

192


Operating Mode: CM

193


Operating Mode: PW

194


Operating Mode: CW

195

Transducer Model: M4SOperating Mode: 2D


196



197


Operating Mode: CF

198


Operating Mode: CM

199


Operating Mode: PW

200


Operating Mode: CW

201



202



203


Operating Mode: CF

204


Operating Mode: CM

205


Operating Mode: PW

206


Operating Mode: CW

207



208



209


Operating Mode: CF

210


Operating Mode: CM

211


Operating Mode: PW

212


Operating Mode: CW

213



214



215


Operating Mode: CF

216


Operating Mode: CM

217


Operating Mode: PW

218


Operating Mode: CW

219



220



221


Operating Mode: CF

222


Operating Mode: CM

223


Operating Mode: PW

224


Operating Mode: CW

225

Transducer Model: 3VOperating Mode: 4D / Multi-plane


226

Transducer Model: 3V

Operating Mode: 2D

227



228


Operating Mode: CF

229


Operating Mode: CM

230


Operating Mode: PW

231


Operating Mode: CW

232

Transducer Model: 3.5COperating Mode: 2D


233

Transducer Model: 3.5C


234


Operating Mode: CF

235


Operating Mode: CM

236


Operating Mode: PW

237

Transducer Model: 4COperating Mode: 2D


238

Transducer Model: 4C


239


Operating Mode: CF

240


Operating Mode: CM

241


Operating Mode: PW

242



243



244


Operating Mode: CF

245


Operating Mode: CM

246


Operating Mode: PW

247

Transducer Model: M7COperating Mode: 2D


248

Transducer Model: M7C


249


Operating Mode: CF

250


Operating Mode: CM

251


Operating Mode: PW

252



253



254


Operating Mode: CF

255


Operating Mode: CM

256


Operating Mode: PW

257

Transducer Model: 7LOperating Mode: 2D


258

Transducer Model: 7L


259


Operating Mode: CF

260


Operating Mode: CM

261


Operating Mode: PW

262



263



264


Operating Mode: CF

265


Operating Mode: CM

266


Operating Mode: PW

267



268



269


Operating Mode: CF

270


Operating Mode: CM

271


Operating Mode: PW

272



273



274


Operating Mode: CF

275


Operating Mode: CM

276


Operating Mode: PW

277

Transducer Model: M12LOperating Mode: 2D


278

Transducer Model: M12L


279


Operating Mode: CF

280


Operating Mode: CM

281


Operating Mode: PW

282

Transducer Model: E8COperating Mode: 2D


283

Transducer Model: E8C


284


Operating Mode: CF

285


Operating Mode: CM

286


Operating Mode: PW

287

Transducer Model: 6TOperating Mode: 2D


288

Transducer Model: 6T


289


Operating Mode: CF

290


Operating Mode: CM

291


Operating Mode: PW

292


Operating Mode: CW

293

Transducer Model: 6TcOperating Mode: 2D


294

Transducer Model: 6Tc


295


Operating Mode: CF

296


Operating Mode: CM

297


Operating Mode: PW

298


Operating Mode: CW

299

Transducer Model: 9TOperating Mode: 2D

300



301


Operating Mode: CF

302


Operating Mode: CM

303


Operating Mode: PW

304


Operating Mode: CW

305

Transducer Model: P2DOperating Mode: PW

a. This probe is shaped as a double D, transmitting on one element.

306

Transducer Model: P2D

Operating Mode: CW

307

Transducer Model: P6DOperating Mode: PW

a. This probe is shaped as a double D, transmitting on one element.

308

Transducer Model: P6D

Operating Mode: CW

309

Transducer Model: i13LOperating Mode: 2D


310

Transducer Model: i13L


311


Operating Mode: CF

312


Operating Mode: CM

313


Operating Mode: PW

314

Transducer Model: i8LOperating Mode: 2D


315



316


Operating Mode: CF

317


Operating Mode: CM

318


Operating Mode: PW

319

Chapter 4 Electromagnetic Compatibility

Vivid 7 / Vivid 7 PRO is intended for use in the electromagnetic environment specified in the tables below.

The user of Vivid 7 / Vivid 7 PRO should assure that the device is used in such an environment.

• Electromagnetic emissions ......................................................... ... 320• Electromagnetic immunity ........................................................... ... 321• Separation distances ................................................................... ... 325

320

Electromagnetic emissions

Guidance and manufacturer’s declaration – electromagnetic emissions.

Emissions test Compliance Electromagnetic environment - guidance

RF emissionCISPR 11EN55011:1998 +A1:1999

Group 1 Vivid 7 / Vivid 7 PRO uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.

RF emissionCISPR 11EN55011:1998 + A1:1999

Class B Vivid 7 / Vivid 7 PRO is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.Harmonic emission

IEC 61000-3-2:2000Class A

Voltage fluctuations/flicker emissionsIEC 61000-3-3:1995 + A1:2001

Complies

321

Electromagnetic immunity

Guidance and manufacturer’s declaration – electromagnetic immunity.

Immunity testIEC 60601test level

Compliance level

Electromagnetic environment -

guidance

Electrostatic discharge (ESD)

IEC 61000-4-2:1995 +A1:1998+A2:2001

± 6 kV contact

± 8 kV air

± 6 kV

± 8 kV

Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30 %.

Electrostatic transient / burstIEC 61000-4-4:1995 +A1:2001+A2:2001

± 2 kV for power-supply lines

± 1 kV for input/output lines

± 2 kV

± 1 kV

Mains power quality should be that of a typical commercial or hospital environment.

Surge

IEC 61000-4-5:1995 +A1:2001

± 1 kV differential mode

± 2 kV common mode

± 1 kV

± 2 kV

Mains power quality should be that of a typical commercial or hospital environment.

Voltage dips, short interruptions and voltage variations on power supply input lines

IEC 61000-4-11:1994 A1:2001

< 5% UT

(>95% dip in UT) for 0.5 cycle40% UT

(60% dip in UT) for 5 cycles

70% UT

(30% dip in UT) for 25 cycles

< 5% UT

(>95 % dip in UT) for 5 sec

Compliance for all test levels.

Controlled shutdown with return to pre-disturbance condition after operator’s intervention.(Power-on switch)

Mains power quality should be that of a typical commercial or hospital environment. If the user of Vivid 7 / Vivid 7 PRO requires continued operation during power mains interruptions, it is recommended that Vivid 7 / Vivid 7 PRO is powered from an uninterruptible power supply or a battery.

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Power frequency (50/60 Hz) magnetic field

IEC 61000-4-8:1993 +A1:2001

3 A/m 3A/m50 and 60 Hz

Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.

NOTE: UT is the a. c. mains voltage prior to application of the test level.


Immunity testIEC 60601test level

Compliance level

Electromagnetic environment -

guidance

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Immunity testIEC 60601 test

levelCompliance

levelElectromagnetic

environment – guidancec

Conducted RF

IEC 61000-4-6:1996 +A1:2001

Conducted RF

IEC 61000-4-3:1996 +A1:1998 +A2:2001

3 Vrms

150 kHz to 80 MHz

3 V/m

80 MHz to 2.5 GHz

3 Vrms [V1]

3 V/m [E1]

Portable and mobile RF communications equipment should be used no closer to any part of Vivid 7 / Vivid 7 PRO, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter.Recommended separation distance

80 MHz to 800 MHz

800 MHz to 2.5 GHz

where p is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m).b

Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey,a should be less than the compliance level in each frequency range.b

Interference may occur in the vicinity of equipment marked with the following symbol

324

NOTE 1: At 80 MHz and 800 MHz, the higher frequency range applies.NOTE 2: These guidelines may not apply in all situations. Electromagnetic is affected by absorption and reflection from structures, objects and people.

a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which Vivid 7/Vivid 7 PRO is used exceeds the applicable RF compliance level above, Vivid 7/Vivid 7 PRO should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating Vivid 7/Vivid 7 PRO.b Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.c See examples of calculated separation distances in next table.


Immunity testIEC 60601 test

levelCompliance

levelElectromagnetic

environment – guidancec

325

Separation distances

Recommended separation distances between portable and mobile RF communications equipment and Vivid 7 / Vivid 7 PRO

Vivid 7/Vivid 7 PRO is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the Vivid 7/Vivid 7 PRO can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and Vivid 7/Vivid 7 PRO as recommended below, according to the maximum output power of the communications equipment.

Separation distance according to frequency of transmitter m

Rated maximum output of transmitter W

150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz

0.01 0.12 0.12 0.23

0.1 0.38 0.38 0.73

1 1.2 1.2 2.3

10 3.8 3.8 7.3

100 12 12 23

For transmitters rated at a maximum output power not listed above the recommended separation distance d in metres (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.NOTE 1: At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.

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Appendix

• Statements on the safety of ultrasound ..................................... ... 327• AIUM Statement on Clinical Safety ...........................................327• AIUM Statement on Mammalian in Vivo Ultrasonic Biological

Effects .......................................................................................327• Medical Ultrasound Safety - AIUM .............................................. ... 328

• Track 3 ALARA Educational Program ......................................328

327

Statements on the safety of ultrasound

AIUM Statement on Clinical SafetyOctober 1982, revised March 1983 and October 1983

Diagnostic ultrasound has been in use for over 35 years. Given its known benefits and recognized efficacy for medical diagnosis, including use during human pregnancy, the American Institute of Ultrasound In Medicine herein addresses the clinical safety of such use:

No confirmed biological effects on patients or instrument operators caused by exposure at intensities typical of present diagnostic ultrasound instruments have ever been reported. Although the possibility exists that such biological effects may be identified in the future, current data indicate that the benefits to patients of the prudent use of diagnostic ultrasound outweigh the risks, if any, that may be present.

AIUM Statement on Mammalian in Vivo Ultrasonic Biological EffectsAugust 1976, revised October 1978, reaffirmed October 1982 and October 1983

In the low megahertz frequency range there have been (as of this date) no independently confirmed significant biological effects in mammalian tissues exposed to intensities”a” below 100 mW/cm2. For ultrasound exposure times “b” less than 500 seconds and greater than 1 second, such effects have not been demonstrated even at higher intensities when the product of intensity “a” and exposure time “b” is less than 50 Joules/cm2.1. Spatial peak, temporal average as measured in a free field

in water.2. Total time, this includes off-time as well as on-time for a

repeated pulse regime.

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Medical Ultrasound Safety - AIUM

Track 3 ALARA Educational ProgramThe user should be familiar with the enclosed document “Medical Ultrasound Safety”, published by AIUM (American Institute of Ultrasound in Medicine).

This document is acceptable to FDA as meeting the content of the ALARA educational program.

ALARA is an acronym for the principle of prudent use of diagnostic ultrasound by obtaining the diagnostic information at an output that is As Low As Reasonably Achievable.

In addition to the AIUM document, the sections “The real-time display of acoustic output indices” and “Acoustic Output Operating Controls” should be studied carefully in order to implement ALARA.

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