GE Medical Systems
Technical
Publications
Vivid S5/Vivid S6
User Manual
Volume 1
Direction 5400908-100
Rev. 1
Operating Documentation
Copyright © 2010 By General Electric Co.
Regulatory Requirements
This product complies with regulatory requirements of the
following European Directive 93/42/EEC concerning medical
devices.
This manual is a reference for the Vivid S5 and Vivid S6. It
applies to all versions of the 11.x.x software for the Vivid S5
and Vivid S6 ultrasound systems.
g
MANUAL STATUS
5400908-100
06 October 2010
Doc ID: DOC0761471
GE Medical Systems
© 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.
PRELIMINARY
COMPANY DATA
GE Medical Systems, Israel Ltd.
4 Etgar Street
39120 Tirat Carmel
Israel
Tel: (+972) 4851 9555 Fax: (+972) 4851 9500
GE Medical Systems Information Technologies GmbH,
Munzinger Strasse 5 D-79111 Freiburg, Germany
Tel: (+49) 761 45 43 0 Fax: (+49) 76145 43 233
Table of Contents
Table of Contents
Revision History
List of effective pages................................................................. xv
Introduction
Attention......................................................................................... 1
Prescription Device ....................................................................... 1
Safety.............................................................................................. 2
Principles of Operation ................................................................. 2
Interference caution ...................................................................... 2
Indications for use ........................................................................ 3
Contraindications .......................................................................... 3
Documentation .............................................................................. 4
Manual contents ................................................................... 4
Conventions used in this manual ................................................ 5
Regulatory requirements .............................................................. 6
Contacting GE Healthcare Ultrasound ........................................ 7
Chapter 1
Safety
Introduction.................................................................................. 13
Hazard symbols .................................................................. 14
Owner responsibility ................................................................... 15
Important safety considerations ................................................ 16
Notice against user modification......................................... 16
Regulatory information ............................................................... 17
Directives ............................................................................ 17
Product Classifications ....................................................... 17
Conformity to Standards ..................................................... 17
Certifications ....................................................................... 19
Software License Acknowledgements ................................ 19
Device labels................................................................................ 20
Label Locations................................................................... 20
Label Icon Description ........................................................ 21
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Acoustic output............................................................................ 24
Definition of the acoustic output parameters ....................... 24
ALARA................................................................................. 24
Safety statement ................................................................. 25
System controls affecting acoustic output ........................... 25
OB Exam ....................................................................................... 27
Exam Preparation................................................................ 27
Acoustic Output Considerations ................................................ 28
Concerns surrounding fetal exposure ................................. 28
Patient safety................................................................................ 29
Patient identification ............................................................ 29
Diagnostic information......................................................... 29
Patient guidance.................................................................. 30
Probe Safety ................................................................................. 30
Mechanical hazards ............................................................ 30
Electrical Hazard ................................................................. 31
Biological hazards ...............................................................32
Personnel and equipment safety................................................ 33
Explosion hazard................................................................. 33
Electrical hazard.................................................................. 33
Smoke and fire hazard ........................................................34
Biological hazard ................................................................. 34
Pacemaker hazard .............................................................. 34
LCD Monitor ........................................................................ 35
Electrical safety............................................................................ 37
Internally connected peripheral devices .............................. 37
External Connection of other peripheral devices................. 37
Allergic reactions to latex-containing medical devices ........... 38
Use of ECG ................................................................................... 39
Use of Defibrillator ....................................................................... 39
Use of Electrosurgical Unit ......................................................... 39
Electromagnetic Compatibility (EMC) ........................................ 40
EMC performance ...............................................................41
Declaration of Emissions..................................................... 42
Declaration of Immunity....................................................... 42
Notice upon Installation of Product...................................... 42
General notice ..................................................................... 43
Peripheral Update for EC countries..................................... 44
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Patient Environmental Devices .................................................. 46
Acceptable devices............................................................. 47
Unapproved devices ........................................................... 47
Accessories, options, and supplies..................................... 47
Computer Virus precaution ................................................. 47
Environmental protection .................................................... 48
Chapter 2
Getting started
Introduction.................................................................................. 50
Preparing the unit for use........................................................... 51
Site requirements................................................................ 51
Connecting the unit............................................................. 52
Switching On/Off................................................................. 59
Moving and transporting the unit .............................................. 63
Wheels................................................................................ 63
Moving the unit ................................................................... 63
Transporting the unit........................................................... 65
Reinstalling at a new location ............................................. 65
Preparing Vivid S5/Vivid S6 for scanning ........................... 65
Unit acclimation time........................................................... 67
System description ..................................................................... 68
System overview................................................................. 68
Control panel ...................................................................... 70
The Scanning screen.......................................................... 83
Three-Pedal Footswitch operation...................................... 85
Connecting and disconnecting probes................................ 86
Adjusting the Display Monitor ............................................. 90
Starting an examination.............................................................. 95
Creating a new Patient record or starting an examination from
an existing patient record.................................................... 95
Selecting a Probe and an Application............................... 100
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Chapter 3
Basic scanning operations
Assignable keys and Soft Menu Rocker .................................. 103
Using the Assignable Keys Soft Menu .............................. 104
Using the Soft Menu Rocker ............................................. 107
Trackball operation ....................................................................108
Trackball assignment ........................................................ 108
The system menu.............................................................. 109
Cineloop operation ....................................................................110
Cineloop overview .............................................................110
Cineloop controls............................................................... 111
Using cineloop................................................................... 112
Storing images and cineloops .................................................. 113
To store a single image ..................................................... 113
To store a cineloop............................................................ 113
Removable Media....................................................................... 114
Intended use...................................................................... 114
Supported removable media ............................................. 115
Zoom ........................................................................................... 122
To Magnify an image (Display zoom)................................ 122
To activate the HR zoom................................................... 122
Performing measurements........................................................ 123
To perform measurements ................................................ 123
Physiological ECG/Respiratory traces..................................... 124
Connecting the internal ECG............................................. 125
Physio controls .................................................................. 134
Displaying the ECG trace .................................................. 135
Adjusting the display of the ECG trace.............................. 136
Displaying the Respiratory trace ....................................... 136
Annotations ................................................................................ 138
To insert an annotation......................................................138
To edit annotation.............................................................. 141
To erase annotation .......................................................... 141
Configuration of the pre-defined annotation list................. 142
Bodymarks ........................................................................ 144
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Chapter 4
Scanning Modes
Introduction................................................................................ 149
2D-Mode ..................................................................................... 150
2D-Mode overview............................................................ 150
2D-Mode controls ............................................................. 152
Using 2D ........................................................................... 158
Optimizing 2D ................................................................... 159
M-Mode ....................................................................................... 161
M-Mode overview ............................................................. 161
M-Mode controls ............................................................... 162
Using M-Mode .................................................................. 164
Optimizing M-Mode........................................................... 166
Color Mode................................................................................. 167
Color Mode overview ........................................................ 167
Color M-Mode overview.................................................... 168
Color Mode controls.......................................................... 169
Using Color Mode ............................................................. 172
Optimizing Color Mode ..................................................... 173
PW and CW Doppler.................................................................. 174
PW and CW Doppler overview ......................................... 174
PW and CW Doppler controls........................................... 175
Using PW/CW Doppler modes ......................................... 177
Optimizing PW/CW Doppler modes.................................. 178
Tissue Velocity Imaging (TVI)........................................... 180
Tissue Tracking ................................................................ 185
Strain rate................................................................................... 190
Strain rate overview .......................................................... 190
Strain rate controls............................................................ 191
Using Strain rate ............................................................... 193
Optimizing Strain rate ....................................................... 193
Strain .......................................................................................... 195
Strain overview ................................................................. 195
Strain controls................................................................... 196
Using Strain ...................................................................... 198
Optimizing Strain .............................................................. 198
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Tissue Synchronization Imaging (TSI) ..................................... 200
TSI overview...................................................................... 200
TSI controls ....................................................................... 201
Using TSI...........................................................................203
Optimizing TSI................................................................... 204
Additional scanning features.................................................... 205
LogiqView.......................................................................... 205
Compound......................................................................... 206
B-Flow ............................................................................... 207
Blood flow imaging ............................................................ 207
Virtual Convex ................................................................... 208
Chapter 5
Stress Echo
Introduction ................................................................................ 210
Selection of a stress test protocol template............................ 211
Image acquisition....................................................................... 212
Starting acquisition ............................................................ 213
Continuous capture mode ................................................. 217
Analysis ............................................................................. 225
Quantitative TVI Stress echo analysis ..................................... 230
Accessing QTVI Stress analysis tools............................... 231
Vpeak measurement ......................................................... 232
Tissue Tracking ................................................................. 235
Quantitative analysis ......................................................... 235
References ........................................................................ 236
Editing/creating a template ....................................................... 237
Entering the Template editor screen .................................237
Template editor screen overview ...................................... 238
Editing/Creating a template ...............................................241
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Chapter 6
Contrast Imaging
Introduction................................................................................ 246
Cardiac imaging................................................................ 246
Non-cardiac imaging......................................................... 247
Data acquisition......................................................................... 247
Left Ventricular Contrast Imaging ..................................... 247
LV Contrast overview................................................................ 248
LV Contrast controls ......................................................... 248
Using LV Contrast............................................................. 250
Optimizing LV Contrast..................................................... 251
Vascular Contrast Imaging ....................................................... 252
Abdominal Contrast Imaging ................................................... 253
Chapter 7
Measurement and Analysis
Introduction................................................................................ 258
About Measurement results display.................................. 259
The Assign and Measure modality .......................................... 260
Starting the Assign and Measure modality ....................... 260
Entering a study and performing measurements.............. 261
Measure and Assign modality.................................................. 263
Starting the Measure and Assign modality ....................... 263
Post-measurement assignment labels.............................. 264
Cardiac measurements ............................................................. 267
2D Measurements ............................................................ 267
M-Mode Measurements.................................................... 271
Doppler Measurements .................................................... 274
TSI Measurements ........................................................... 278
Automated Function Imaging............................................ 285
AutoEF Measurements ..................................................... 305
Vascular measurements ........................................................... 314
B-Mode measurements .................................................... 314
Intima-Media Thickness.................................................... 315
M-Mode Measurements.................................................... 320
Doppler measurements .................................................... 321
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Pediatric Calculations................................................................ 326
Overview ...........................................................................326
Hip Dysplasia Calculation.................................................. 326
Making Hip Dysplasia Measurement.................................327
Performing an OB exam ............................................................ 329
Patient entry ...................................................................... 329
Selecting probe and OB application .................................. 333
OB Measurements and calculations ........................................335
Introduction........................................................................ 335
B-Mode measurements ..................................................... 336
M-Mode measurements .................................................... 342
Doppler Mode Measurements ........................................... 342
OB parameter configuration ..................................................... 346
Configuring OB M&A according to geographical regions .. 346
Measurement package configuration....................................... 351
Measurement package configuration - example ............... 351
User-defined formulas ............................................................... 356
User-defined formula - example ........................................356
About units ........................................................................ 362
Measurement result table.......................................................... 364
Minimizing the Measurement result table..........................364
Moving the Measurement result table ............................... 364
Deleting measurements .................................................... 365
Worksheet................................................................................... 366
Overview ...........................................................................366
Using Worksheet ............................................................... 367
OB worksheet ............................................................................. 369
Patient data ....................................................................... 370
Measurement information.................................................. 370
Calculation information......................................................371
OB graphs................................................................................... 372
Overview ...........................................................................372
Fetal Growth Curve Graph ................................................ 373
Fetal Trending ................................................................... 377
Fetal Growth Bar Graph .................................................... 378
OB-Multigestational ................................................................... 379
Multiple Fetus ....................................................................379
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GYN Measurements................................................................... 383
Introduction ....................................................................... 383
To Start a Gynecology Exam............................................ 383
B-Mode Measurements ............................................................. 384
Uterus length, width, and height ....................................... 384
Ovary length, width, and height ........................................ 385
Follicle measurements length, width, and height.............. 386
Endometrium thickness (Endo)......................................... 386
M-Mode Measurements............................................................. 387
Doppler Mode Measurements .................................................. 387
Chapter 8
Quantitative Analysis
Introduction................................................................................ 391
Accessing the Quantitative analysis package........................ 392
In replay mode .................................................................. 392
In live ................................................................................ 392
Quantitative Analysis window.................................................. 393
Overview........................................................................... 393
Generation of a trace................................................................. 400
About the sample area...................................................... 400
To generate a trace .......................................................... 400
Manual tracking of the sample area (dynamic anchored
sample area)..................................................................... 401
Zooming in the Analysis window....................................... 402
Deletion of a trace ..................................................................... 403
To delete all traces ........................................................... 403
To delete one specific trace.............................................. 403
Saving/retrieving Quantitative analysis .................................. 403
Frame disabling ......................................................................... 404
Disabling frames ............................................................... 404
Re-enabling all frames...................................................... 404
Optimizing sample area ............................................................ 406
Reshaping a sample area................................................. 406
Labelling a sample area.................................................... 407
Optimizing the trace display..................................................... 408
Optimizing the Y-axis........................................................ 408
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Trace smoothing................................................................ 409
Switching modes or traces ....................................................... 411
To switch mode ................................................................. 411
To switch trace .................................................................. 411
Cine compound .......................................................................... 412
Curved Anatomical M-Mode (CAMM) ....................................... 413
Introduction........................................................................ 413
Using CAMM ..................................................................... 413
Optimizing Curved Anatomical M-Mode............................ 415
Chapter 9
Archiving
Introduction ................................................................................ 419
Storing images and cineloops .................................................. 420
Storing an image ............................................................... 421
Storing a cineloop.............................................................. 421
Saving images and cineloops to a standard format .......... 422
MPEGVue/eVue ................................................................ 424
Retrieving and editing archived information........................... 427
Locating a patient record................................................... 427
Selecting a patient record and editing data in the archive. 433
Deleting archived information............................................ 437
Moving examinations......................................................... 439
Review images in archive.......................................................... 441
Review the images from a selected examination .............. 441
Select images from the Image list screen ......................... 442
Connectivity................................................................................ 446
The dataflow concept ........................................................ 446
Stand-alone scanner scenario........................................... 449
A stand-alone scanner and a stand-alone EchoPAC PC
environment....................................................................... 450
A scanner and EchoPAC PC in a direct connect
environment....................................................................... 452
A scanner and EchoPAC PC in a network environment ... 456
A scanner and a DICOM server in a network.................... 458
Export/Import patient records/examinations........................... 468
Exporting patient records/examinations ............................ 468
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Importing patient records/examinations............................ 477
Disk Management ...................................................................... 480
Configuring the Disk management function...................... 481
Running the Disk management function........................... 484
Data Backup and Restore................................................. 487
DICOM spooler........................................................................... 495
Starting the DICOM spooler.............................................. 495
Database import from Vivid 3 or Vivid 4.................................. 498
Transfer Procedure........................................................... 498
Installing the Vivid 3/4 Data Viewer .................................. 501
Using the Vivid 3/4 Data Viewer ....................................... 504
Chapter 10
Report
Introduction................................................................................ 508
Creating a report........................................................................ 509
Working with the report function ....................................... 509
To print a report ................................................................ 512
To store a report ............................................................... 512
Retrieving an archived report............................................ 513
Deleting an archived report............................................... 513
Structured Findings .................................................................. 514
Prerequisite....................................................................... 514
Starting Structured Findings ............................................. 515
Structured Findings structure............................................ 515
Using Structured Findings ................................................ 517
Structured Findings configuration ..................................... 520
Direct report ............................................................................... 530
Creating comments........................................................... 530
Creating pre-defined text inputs........................................ 531
Report designer ......................................................................... 532
Accessing the Report designer......................................... 532
Report designer overview ................................................. 532
Designing a report template.............................................. 535
Saving the report template................................................ 547
To exit the Report designer .............................................. 547
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Report templates management................................................. 548
Configuration of the Template selection menu.................. 549
Export/Import of Report templates .................................... 550
Chapter 11
Probes
Probe overview...........................................................................555
Supported probes.............................................................. 555
Vivid S5 Probe/Application Overview ................................ 560
Vivid S6 Probe/Application Overview ................................ 561
Probe surface-temperature safety mechanisms................ 562
Maximum probe temperature ............................................ 563
Probe orientation ............................................................... 564
Probe labelling................................................................... 565
Environmental Requirements ............................................ 566
Probe Integration ....................................................................... 567
Selecting probes................................................................ 567
Connecting the probe ........................................................ 567
Activating the probe........................................................... 569
Disconnecting the probe.................................................... 570
Care and Maintenance ............................................................... 571
Planned maintenance........................................................ 571
Inspecting the probe.......................................................... 572
Special handling instructions............................................. 573
Cleaning and disinfecting probes ...................................... 575
Probe safety................................................................................ 581
Biopsy .........................................................................................582
Precaution concerning the use of biopsy procedures ....... 582
Preparing the Biopsy guide attachment ............................ 584
Displaying the Guide zone ................................................ 588
Endocavitary Probe Biopsy Guide Assembly .................... 590
Biopsy needle path verification.......................................... 592
Starting the biopsy procedure ........................................... 592
Cleaning, disinfection and disposal ................................... 592
Surgery/Intra-operative Use ......................................................593
Preparing for Surgery/Intra-operative Procedures ............593
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Chapter 12
Peripherals
Introduction................................................................................ 596
Printing ....................................................................................... 597
To print an image.............................................................. 597
Specifications for peripherals .................................................. 597
Chapter 13
Presets and System setup
Introduction................................................................................ 601
Starting the Configuration package......................................... 604
To open the Configuration package.................................. 604
Overview..................................................................................... 605
Imaging....................................................................................... 606
The Global setup sheet..................................................... 606
Application ........................................................................ 609
Application menu .............................................................. 612
Measure Text.............................................................................. 614
The measurement menu sheet......................................... 614
Configuration of the Measurement menu ......................... 617
The Advanced sheet.................................................................. 619
Parameter configuration ................................................... 619
The Modify Calculations sheet................................................. 620
Parameter configuration ................................................... 620
The OB table sheet........................................................... 621
Report ......................................................................................... 627
The diagnostic codes sheet .............................................. 628
The Comment texts sheet................................................. 629
Connectivity ............................................................................... 632
Dataflow............................................................................ 632
Additional outputs ............................................................. 639
Tools ................................................................................. 641
Formats............................................................................. 642
TCP-IP .............................................................................. 648
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System ........................................................................................ 649
The system settings .......................................................... 649
About........................................................................................... 651
Administration............................................................................ 652
Users ................................................................................. 653
Unlock Patient ................................................................... 656
Chapter 14
User maintenance
System Care and Maintenance ................................................. 658
Inspecting the system........................................................ 658
Cleaning the unit ............................................................... 659
Prevention of static electricity interference........................ 662
Using disposable hygienic control-panel cover ................. 662
System self-test.......................................................................... 663
System malfunction ........................................................... 663
Using InSite ExC ........................................................................ 667
InSite ExC Functionalities ................................................. 667
Initiating a Request for Service (RFS)............................... 667
Clinical Lifeline Mode ........................................................ 670
Exiting InSite ExC.............................................................. 671
Index
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Revision History
Revision History
Revision
1
Date
6 October 2010
Reason for Change
Initial release
List of effective pages
Revision
1
Effective Pages
All
Please verify that you are using the latest revision of this
document. If you need to know the latest revision, contact your
distributor, local GE Sales Representative or in the USA call the
GE Medical Systems Clinical Answer Center at:
1-800-682-5327 or 1-262-524-5698.
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Revision History
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Introduction
Introduction
The Vivid S5/Vivid S6 ultrasound systems are light-weight, high
performance innovative ergonomic mobile digital ultrasound
imaging systems.
Both systems provide image generation in 2D (B) Mode, Color
Doppler, Power Doppler (Angio), M-Mode, Color M-Mode, PW
and CW Doppler spectra, Tissue Velocity Imaging(TVI), Tissue
Tracking, LVO Contrast, B-Flow, and BFI (B Flow imaging)
applications. Some of the above modes are optional, as
detailed further in this manual.
Vivid S6 offers additional optional modes, such as TSI (Tissue
Synchronization Imaging), SI/SRI (Strain/Strain-rate imaging,
and vascular/abdominal contrast).
The fully digital architecture of the Vivid S5/Vivid S6 unit allows
optimal usage of all scanning modes and probe types,
throughout the full spectrum of operating frequencies.
Attention
This manual contains necessary and sufficient information to
operate the system safely. Advanced equipment training may
be provided by a factory trained Applications Specialist for the
agreed-upon time period.
Read and understand all instructions in the User's Manual
before attempting to use the Vivid S5/Vivid S6 ultrasound unit.
Keep the manual with the equipment at all time. Periodically
review the procedures for operation and safety precautions.
Prescription Device
For USA only:
CAUTION
United States law restricts this device to sale or use by, or on the
order of a physician.
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Introduction
Safety
All information in the Safety chapter (Chapter 1, "Safety",
page 11), should be read and understood before operating the
Vivid S5/Vivid S6 ultrasound unit.
Principles of Operation
Medical ultrasound images are created by computer and digital
memory from the transmission and reception of mechanical
high-frequency waves applied through a transducer. The
mechanical ultrasound waves spread through the body,
producing an echo where density changes occur. For example,
in the case of human tissue, an echo is created where a signal
passes from an adipose tissue (fat) region to a muscular tissue
region. The echoes return to the transducer where they are
converted back into electrical signals.
These echo signals are highly amplified and processed by
several analog and digital circuits having filters with many
frequency and time response options, transforming the
high-frequency electrical signals into a series of digital image
signals which are stored in memory. Once in memory, the
image can be displayed in real-time on the image monitor. All
signal transmission, reception and processing characteristics
are controlled by the main computer. By selection from the
system control panel, the user can alter the characteristics and
features of the system, allowing a wide range of uses, from
obstetrics to peripheral vascular examinations.
Transducers are accurate, solid-state devices, providing
multiple image formats. The digital design and use of
solid-state components provides highly stable and consistent
imaging performance with minimal required maintenance. A
sophisticated system design with computer controlled
extensive features and functions make the Vivid S5 and
Vivid S6 easy systems to use and very user friendly.
Interference caution
Use of devices that transmit radio waves near the unit could
cause it to malfunction.
CAUTION
2
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Introduction
Devices not to be used near this equipment:
Devices which intrinsically transmit radio waves such as
cellular phones, radio transceivers, mobile radio transmitters,
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 S5/Vivid S6 ultrasound unit is intended for the
following applications:
•
Abdominal
•
Cardiac
•
Musculoskeletal including Superficial
•
Small Organ
•
Pediatric
•
OB/Gyn
•
Fetal Heart
•
Transesophageal
•
Peripheral Vascular
•
Neonatal Cephalic
•
Adult Cephalic
•
Intraoperative
This machine should be used in compliance with law. Some
jurisdictions restrict certain uses, such as gender determination.
CAUTION
Contraindications
DANGER
The Vivid S5/Vivid S6 ultrasound unit is not intended for
ophthalmic use or any use causing the acoustic beam to pass
through the eye.
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Introduction
Documentation
Vivid S5/Vivid S6 documentation consists of two manuals:
•
The Basic User Manual (TRANSLATED) provides
information needed by the user to operate the system
safely. It describes the basic functions of the system, safety
features, operating modes, measurements/calculations,
probes, and user care and maintenance.
Note: Probe information displayed on screen examples
does not necessarily reflect the probes available on your
ultrasound system. Please refer to the Probes chapter
(Chapter 11, "Probes", page 553) for a listing of available
probes and features.
•
The Advanced Reference Manual (ENGLISH ONLY)
contains M&A formulas and parameter-names, data tables,
such as OB and Acoustic Output tables.
Note: The documentation kit provides the Basic User
Manual and Advanced Reference Manual in electronic
format only. The CD-ROM includes English and all
translations. Paper documentation may be ordered.
The Vivid S5/Vivid S6 documentation is written for users who
are familiar with basic ultrasound principles and techniques.
They do not include sonographic training or detailed clinical
procedures.
Note: The original documentation was written in English.
Manual contents
The Vivid S5/Vivid S6 User's Manual is organized to provide
the information needed to start scanning immediately.
Some of the functions or features described in this manual are
optional and may not be available in the configuration of your
specific system.
Note: Not all features or products described in this document
may be available or cleared for sale in all markets. Please
contact your local GE Healthcare Ultrasound representative to
get the latest information.
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Introduction
The safety instruction must be reviewed before operation of the
unit.
CAUTION
Finding information
Table 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.
Conventions used in this manual
2-column layout, the right column contains the main text. The
left column contains notes, hints, and warnings.
Keys and buttons, 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.
Safety icons, highlight safety issues as described below.
Product icons, indicate product variant features as follows:
Indicates that the relevant feature exists in the standard configuration
of Vivid S6 and is not available on Vivid S5.
Indicates that the relevant feature exists as an option of the Vivid S6
and is not available on Vivid S5.
Indicates that the relevant feature exists as an option on both Vivid S6
and Vivid S5 systems.
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Introduction
Indicates that the relevant feature exists in the standard configuration
of Vivid S6 and is available as an option on Vivid S5.
Indicates that the relevant feature exists in the standard configuration
of Vivid S5 and is not available on Vivid S6.
DANGER
Indicates that a specific hazard is known to exist which through
inappropriate conditions or actions, will cause:
• Severe or fatal personal injury
• Substantial property damage
WARNING
Indicates that a specific hazard is known to exist which through
inappropriate conditions or actions, may cause:
• Severe personal injury
• Substantial property damage
CAUTION
Indicates that a potential hazard may exist which through
inappropriate conditions or actions, will or can cause:
• Minor injury
• Property damage
Regulatory requirements
The Vivid S5/Vivid S6 ultrasound unit confirms to directives,
classifications, and standards ("Regulatory information",
page 17).
6
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Introduction
Contacting GE Healthcare Ultrasound
For additional information or assistance, please contact your
local distributor or the appropriate support resource listed on
the following pages:
INTERNET
USA
http://www.gehealthcare.com
http://www.gehealthcare.com/usen/ultrasound/products/probe_care.html
GE Healthcare TEL: (1) 800-437-1171
Ultrasound Service Engineering FAX: (1) 414-721-3865
9900 Innovation Drive
Wauwatosa, WI 53226
Clinical
Questions
For information in the United States, Canada, Mexico and parts of the
Caribbean, call the Customer Answer Center TEL: (1) 800-682-5327 or (1)
262-524-5698
In other locations, contact your local Applications, Sales or Service
Representative.
Service
Questions
For service in the United States, call GE CARES
TEL: (1) 800-437-1171
In other locations, contact your local Service Representative.
Accessories
Catalog
Requests
Placing an
Order
CANADA
To request the latest GE Accessories catalog or equipment brochures in the
United States, call the Response Center
TEL: (1) 800-643-6439
In other locations, contact your local Applications, Sales or Service
Representative.
To place an order, order supplies or ask an accessory-related question in the
United States, call the GE Access Center
TEL: (1) 800-472-3666
In other locations, contact your local Applications, Sales or Service
Representative.
GE Healthcare TEL: (1) 800-664-0732
Ultrasound Service Engineering
9900 Innovation Drive
Wauwatosa, WI 53226
Customer Answer Center TEL: (1) 262-524-5698
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Introduction
LATIN &
SOUTH
AMERICA
EUROPE
ASIA
JAPAN
ARGENTINA
GE Ultraschall
TEL: 0130 81 6370 toll free
Deutschland GmbH & Co. KG TEL: (33) 130.831.300
Beethovenstrasse 239 FAX: (49) 212.28.02.431
Postfach 11 05 60
D-42655 Solingen
GE Ultrasound Asia (Singapore) TEL: 65-291 8528
Service Department - Ultrasound FAX: 65-272-3997
298 Tiong Bahru Road #15-01/06
Central Plaza
Singapore 169730
GE Healthcare Japan Corporation TEL: (81) 42-648-2910
Customer Service Center FAX: (81) 42-648-2905
GEME S.A. TEL: (1) 639-1619
Miranda 5237 FAX: (1) 567-2678
Buenos Aires - 1407
AUSTRIA
GE GesmbH Medical Systems Austria TEL: 0660 8459 toll free
Prinz Eugen Strasse 8/8 FAX: +43 1 505 38 74
A-1040 WIEN TLX: 136314
BELGIUM
GE Medical Systems Benelux TEL: 0 800 11733 toll free
Gulkenrodestraat 3 FAX: +32 0 3 320 12 59
B-2160 WOMMELGEM TLX: 72722
BRAZIL
CHINA
8
GE Healthcare TEL: (1) 262-524-5300
Ultrasound Service Engineering
9900 Innovation Drive
Wauwatosa, WI 53226
Customer Answer Center TEL: (1) 262-524-5698
GE Sistemas Medicos TEL: 0800-122345
Av Nove de Julho 5229 FAX: (011) 3067-8298
01407-907 Sao Paulo SP
GE Healthcare - Asia TEL: (8610) 5806 9403
No. 1, Yongchang North Road FAX: (8610) 6787 1162
Beijing Economic & Technology Development Area
Beijing 100176, China
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Introduction
DENMARK
FRANCE
GERMANY
GREECE
ITALY
LUXEMBOURG
MEXICO
NETHERLANDS
POLAND
GE Healthcare TEL: +45 43295400
Park Alle 295 FAX: +45 4329 5399
DK-2605 Brøndby
GE Medical Systems TEL: 05 49 33 71 toll free
738 rue Yves Carmen FAX: +33 1 46 10 01 20
F-92658 BOULOGNE CEDEX
GE Ultraschall TEL: 0130 81 6370 toll free
Deutschland GmbH & Co. KG TEL: (49) 212.28.02.207
Beethovenstrasse 239 FAX: (49) 212.28.02.431
Postfach 11 05 60
D-42655 Solingen
GE Medical Systems Hellas TEL: +30 1 93 24 582
41, Nikolaou Plastira Street FAX: +30 1 93 58 414
G-171 21 NEA SMYRNI
GE Medical Systems Italia TEL: 1678 744 73 toll free
Via Monte Albenza 9 FAX: +39 39 73 37 86
I-20052 MONZA TLX: 3333 28
TEL: 0800 2603 toll free
GE Sistemas Medicos de Mexico S.A. de C.V.
Rio Lerma #302, 1° y 2° Pisos TEL: (5) 228-9600
Colonia Cuauhtemoc FAX: (5) 211-4631
06500-Mexico, D.F.
GE Medical Systems Nederland B.V. TEL: 06 022 3797 toll free
Atoomweg 512 FAX: +31 304 11702
NL-3542 AB UTRECHT
GE Medical Systems Polska TEL: +48 2 625 59 62
Krzywickiego 34 FAX: +48 2 615 59 66
P-02-078 WARSZAWA
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Introduction
PORTUGAL
RUSSIA
SPAIN
SWEDEN
SWITZERLAND
GE VNIIEM TEL: +7 495 739 6931
18C, Krasnopresnenskaya nab. FAX: +7 495 739 6932
123317 MOSCOW
GE Healthcare TEL: +34 91 663 25 00
Edificio Gobelas I FAX: + 34 91 663 25 01
C/ Gobelas 35-37
E-28023 Madrid
GE Medical Systems TEL: +46 (0)8 - 559 500 00
FE 314 FAX: +46 (0)8 - 559 501 24
S-171 75 Stockholm
GE Medical Systems (Schweiz) AG TEL: 155 5306 toll free
Sternmattweg 1 FAX: +41 41 421859
CH-6010 KRIENS
TURKEY
GE Healthcare, Turkiye TEL: +90 212 366 29 00
Sun Plaza FAX: +90 212 366 29 99
Dereboyu Sok. No 24/7
34398 Maslak
ISTANBUL
UNITED
KINGDOM
GE Medical Systems TEL: 0800 89 7905 toll free
Coolidge House FAX: +44 753 696067
352 Buckingham Avenue
SLOUGH
Berkshire SL1 4ER
OTHER
COUNTRIES
Manufacturer
10
GE Medical Systems Portuguesa S.A.
TEL: 05 05 33 7313 toll free
Rua Sa da Bandeira, 585 FAX: +351 2 2084494
Apartado 4094 TLX: 22804
P-4002 PORTO CODEX
NO TOLL FREE TEL: international code + 33 1 39 20 0007
GE Medical Systems, Israel, Ltd.
4 Etgar st.
39120 Tirat carmel
Israel
Tel.: (+972) 4851 9555, Fax: (+972) 4851 9500
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Safety
Chapter 1
Safety
• Introduction ................................................................................... .... 13
• Hazard symbols ......................................................................... 14
• Owner responsibility .................................................................... .... 15
• Important safety considerations ................................................. .... 16
• Notice against user modification ................................................ 16
• Regulatory information ................................................................ .... 17
• Directives ................................................................................... 17
• Product Classifications ............................................................... 17
• Conformity to Standards ............................................................ 17
• Certifications .............................................................................. 19
• Software License Acknowledgements ....................................... 19
• Device labels ................................................................................. .... 20
• Label Locations .......................................................................... 20
• Label Icon Description ................................................................ 21
• Acoustic output ............................................................................. .... 24
• Definition of the acoustic output parameters .............................. 24
• ALARA ....................................................................................... 24
• Safety statement ........................................................................ 25
• System controls affecting acoustic output .................................. 25
• OB Exam ........................................................................................ .... 27
• Exam Preparation ...................................................................... 27
• Acoustic Output Considerations ................................................. .... 28
• Concerns surrounding fetal exposure ........................................ 28
• Patient safety ................................................................................. .... 29
• Patient identification ................................................................... 29
• Diagnostic information ................................................................ 29
• Patient guidance ........................................................................ 30
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Safety
• Probe Safety .................................................................................. ..... 30
• Mechanical hazards .................................................................... 30
• Electrical Hazard ......................................................................... 31
• Biological hazards ....................................................................... 32
• Personnel and equipment safety ................................................ ..... 33
• Explosion hazard ........................................................................ 33
• Electrical hazard ......................................................................... 33
• Smoke and fire hazard ................................................................ 34
• Biological hazard ........................................................................ 34
• Pacemaker hazard ......................................................................34
• LCD Monitor ................................................................................ 35
• Electrical safety ............................................................................ ..... 37
• Internally connected peripheral devices ..................................... 37
• External Connection of other peripheral devices ........................ 37
• Allergic reactions to latex-containing medical devices ............ ..... 38
• Use of ECG .................................................................................... ..... 39
• Use of Defibrillator ....................................................................... ..... 39
• Use of Electrosurgical Unit .......................................................... ..... 39
• Electromagnetic Compatibility (EMC) ........................................ ..... 40
• EMC performance ....................................................................... 41
• Declaration of Emissions ............................................................ 42
• Declaration of Immunity .............................................................. 42
• Notice upon Installation of Product ............................................. 42
• General notice ............................................................................ 43
• Peripheral Update for EC countries ............................................ 44
• Patient Environmental Devices ................................................... ..... 46
• Acceptable devices ..................................................................... 47
• Unapproved devices ................................................................... 47
• Accessories, options, and supplies ............................................. 47
• Computer Virus precaution ......................................................... 47
• Environmental protection ............................................................ 48
12
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Safety
Introduction
This section describes the important safety measures which
should be taken before operating the Vivid S5/Vivid S6
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 and conventions are used to indicate
precautions:
DANGER
Indicates that a specific hazard is known to exist which through
inappropriate conditions or actions, will cause:
• Severe or fatal personal injury
• Substantial property damage
WARNING
Indicates that a specific hazard is known to exist which through
inappropriate conditions or actions, will cause:
• Severe personal injury
• Substantial property damage
CAUTION
Indicates that a potential hazard may exist which through
inappropriate conditions or actions, will or can cause:
• Minor injury
• Property damage
Note: Indicates precautions or recommendations that should be
used in the operation of the ultrasound system, specifically:
•
•
•
Maintaining an optimum system environment
Using this Manual
Notes to emphasize or clarify a point
Other precautions or prudent-use recommendations are
indicated in the note sections in the left column. These are:
•
Use of the Vivid S5/Vivid S6 ultrasound unit as a
prescription device, under the order of a physician.
•
Maintaining an optimum unit environment.
•
Reference to the User's Manual.
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Safety
Hazard symbols
Icon description
Potential hazards are indicated by the following icons:
Icon
14
Potential hazard
Usage
• Patient/user infection due to
contaminated equipment
• Cleaning and care
instructions
• Sheath and glove
guidelines
• Electrical micro-shock to
patient, e.g., ventricular
• Probes
• ECG (if applicable)
• Connections to back panel
• Console, accessories or
optional storage devices
that can fall on patient, user,
or others.
• Collision with persons or
objects may result in injury
while maneuvering or during
system transport.
• Injury to user from moving
the console
• Moving
• Using brakes
• Transporting
• Patient injury or tissue
damage from ultrasound
radiation
• ALARA, the use of Power
Output following the 'as
low as reasonably
achievable' principle
• Risk of explosion if used in
the presence of flammable
anesthetics
• Flammable anesthetic
• Patient/user injury or
adverse reaction from fire or
smoke
• Patient/user injury from
explosion and fire
• Replacing fuses
• Outlet guidelines
Source
ISO 7000
No. 0659
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Safety
Owner responsibility
For USA only:
CAUTION
Federal law restricts this device to use by, or on the orders of, a
physician.
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 S5/Vivid S6 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 Medical Systems
Service Office.
For information about specific requirements and regulations
applicable to the use of electronic medical equipment, consult
the local, state and federal agencies.
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Safety
Important safety considerations
Notice against user modification
Never 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.
The equipment is not suitable for use in the presence of
flammable anesthetic mixture with air or with Oxygen or Nitrous
Oxide.
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.
CAUTION
Improper use can result in serious injury. The user must be
thoroughly familiar with the instructions and potential hazards
involving ultrasound examination before attempting to use the
device. Training assistance is available from GE Medical
Systems if needed.
Users are obligated to familiarize themselves with these safety
considerations and to avoid conditions that could result in injury
or damage.
16
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Safety
Regulatory information
CAUTION
Any changes to accessories, peripheral units or any other part of
the system must be approved by the manufacturer. Ignoring this
advice may compromise the regulatory approvals obtained for
the product.
Directives
The GE Healthcare Ultrasound product families are tested to
meet all applicable requirements in relevant EU Directives and
European/International standards.
•
Council Directive 93/42/EEC concerning MDD (Medical
Devices Directive): the CE label affixed to the product
testifies compliance to this Directive.
The location of the CE marking is specified later in this
chapter ("Device labels", page 20).
Product Classifications
The Vivid S5/Vivid S6 ultrasound unit confirms to the following
classifications, in accordance with the IEC/EN 60601-1:6.8.1:
•
According to 93/42/EEC Medical Device Directive, this is
Class IIa Medical Device.
•
According to IEC/EN 60601-1, Equipment is Class I, Type
B with BF or CF Applied Parts.
•
According to CISPR 11, this is Group 1, Class B ISM
Equipment.
•
According to IEC 60529, the footswitch rate IPx8 is suitable
for use in surgical rooms.
•
Classification according to the degree of protection against
ingress of water as detailed in the current edition of IEC 529
(section 6.1.1): Ordinary for Main Unit (PC), IPX1, IPX7,
IPX8 for ultrasound probes (transducers).
Conformity to Standards
To fulfill the requirements of relevant EC directives and/or
European Harmonized/International standards, the following
documents/standards have been used:
•
International Electrotechnical Commission (IEC).
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Safety
•
•
•
•
18
• IEC/EN 60601-1: Medical Electrical Eqiupment, Part 1
General Requirements for Safety
• IEC/EN 60601-1-2: Medical electrical equipment Part 1-2: General requirements for safety - Collateral
standard: Electromagnetic compatibility - Requirements
and tests
• EN 55011/ CISPR11+A2: Emitted noise according to
Class B requirements + Electromagnetic Susceptibility
• IEC/EN 60601-1-4: Medical electrical equipment - Part
1-4: General requirements for safety - Collateral
standard: Programmable electrical medical systems
• IEC/EN 60601-1-6: Medical electrical equipment - Part
1-6: General requirements for basic safety and essential
performance - Collateral Standard: Usability
• IEC/EN 60601-2-37: Medical Electrical Equipment Part
2-37: Particular Requirements for the Safety of
Ultrasonic Medical Diagnostic and Monitoring
Equipment
• EN60601-1-1: Medical Electrical Equipment Part 1-1:
General Requirements for Safety Collateral Standard:
Safety Requirements for Medical Electrical Systems
International Organization of Standards (ISO)
• ISO 10993-1: Biological Evaluation of Medical Devices Part 1: Evaluation & Testing
• ISO 10993-5: Biological Evaluation of Medical Devices Part 5: Tests for In Vitro Cytotoxicity
• ISO 10993-10:Biological evaluation of medical devices Part 10: Tests for irritation and delayed-type
hypersensitivity
Underwriters' Laboratories, Inc. (UL), an independent
testing laboratory.
• UL 60601-1 Medical Electrical Equipment, Part 1
General Requirements for Safety.
Canadian Standards Association (CSA).
• CSA 22.2, 601.1 Medical Electrical Equipment, Part 1
General Requirements for Safety.
NEMA/AIUM Acoustic Output Display Standard (NEMA
US-3, 1998).
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Safety
•
Medical Device Good Manufacturing Practice Manual
issued by the FDA (Food and Drug Administration,
Department of Health, USA).
Certifications
•
Quality management standards for medical devices:
General Electric Medical Systems is ISO 9001 and
ISO13485 certified.
Software License Acknowledgements
•
WindowBlinds ™ OCX © Stardock ®
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Safety
Device labels
Label Locations
1
Label 1 - Vivid S5 100-120V
2
Label 2 - Vivid S5 220-240V
3
Label 3 - Vivid S6 100-120V
4
Label 4 - Vivid S6 220-240V
1
2
3
4
5
5
Label 5 - Universal Label, for all systems
Vivid S5/Vivid S6 label locations
Figure 1-1: System Label and Location
20
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Safety
Label Icon Description
The following table describes the purpose and location of
safety labels and other important information provided on the
equipment.
Label
Purpose
Location
Identification and
Rating Plate
• Manufacturer's name and address
• Date of Manufacture
• Model and serial numbers
• Electrical ratings (Volts, Amps,
phase, and frequency)
• Device Listing/Certification Labels
Bottom of unit
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
Bottom of unit.
Alternating current
Various
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
an authorized representative of the
manufacturer for information
concerning the decommissioning of
your equipment.
Bottom Cover
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Safety
Label
Purpose
Location
Protective earth (ground)
Internal
Earth (ground)
Internal
Equipotentiality: indicates terminal to
be used for connecting equipotential
conductors when interconnecting
(grounding) with other equipment.
Bottom of unit
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.
Attention - Consult accompanying
documents: alerts the user to refer to
the user documentation when
complete information cannot be
provided on the label.
Various
This marking on the control panel is
especially intended to alert the user
to consult the user manual for use
BEFORE operation of the system.
CAUTION - Dangerous voltage: used
to indicate electric shock hazards.
22
Various
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Safety
Label
Purpose
Location
Apply a short push on the ON/OFF
button to shut down the system.
Keyboard
CAUTION: This Power Switch DOES
NOT ISOLATE Mains Supply.
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.)
Date of manufacture: The date
could be a year, year and month, or
year, month and day, as appropriate.
See ISO 8601 for date formats.
Rear of unit
Catalog or model number
Rear of unit
Serial number
Rear of unit
Direct Current: For products to be
powered from a DC supply.
Rear of unit
GOST-R Mark: per Law of the
Russian Federation No. 184-FZ. The
field 0000 will contain the number of
the institute that issued the GOST
label.
Bottom of unit
Prescription Device Label for United
States per 21 CFR 801.109(b)(1)
Bottom of unit
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Safety
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.
Note: Further explanation on "cavitation" appears in the
Reference Manual Chapter 3 - Nonthermal Bioeffects.
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.
ALARA
Ultrasound 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.
24
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Safety
It is recommended that all users receive proper training in
applications before performing them in a clinical setting. Please
contact the local GE sales representative for training
assistance.
Safety statement
GE Medical Systems safety statement
Although no harmful biological effects have been demonstrated
for ultrasound frequencies, intensities and exposure times used
in examination with the GE Vivid S5/Vivid S6 system, GE
Medical Systems recommends using the lowest acoustic
output settings which will produce diagnostically acceptable
information.
System controls affecting acoustic
output
The 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
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.
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Safety
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 ("Selecting a Probe and an
Application", page 100).
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
(Chapter 4, "Scanning Modes", page 147).
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.
26
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OB Exam
Exam Preparation
Prior to an ultrasound examination, the patient should be
informed of the clinical indication, specific benefits, potential
risks, and alternatives, if any. In addition, if the patient requests
information about the exposure time and intensity, it should be
provided. Patient access to educational materials regarding
ultrasound is strongly encouraged to supplement the
information communicated directly to the patient. Furthermore,
these examinations should be conducted in a manner and take
place in a setting which assures patient dignity and privacy.
•
Prior material knowledge and approval of the presence of
nonessential personnel with the number of such personnel
kept to a minimum.
•
An intent to share with the parents per the physician's
judgment, either during the examination or shortly
hereafter, the information derived.
•
An offer of choice about viewing the fetus.
•
An offer of choice about learning the sex of the fetus, if such
information becomes available.
Ultrasound examinations performed solely to satisfy the
family's desire to know the fetal sex, to view the fetus, or to
obtain a picture of the fetus should be discouraged.
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Safety
Acoustic Output Considerations
WARNING
CAUTION
The Vivid S5/Vivid S6 system is a multi-use device which is
capable of exceeding FDA Pre-enactment acoustic output
(spatial peak-temporal average) intensity limits for fetal
applications.
It is prudent to conduct an exam with the minimum amount and
duration of acoustic output necessary to optimize the image's
diagnostic value.
Concerns surrounding fetal exposure
Always be aware of the acoustic output level by observing the
Acoustic Output Display. In addition, become thoroughly
familiar with the Acoustic Output Display and equipment
controls affecting output.
28
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Patient safety
Patient identification
The concerns listed in this section can seriously affect the safety
of the patient undergoing a diagnostic ultrasound examination.
WARNING
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.
Note: For further information on patient identification, see
"Starting an examination", page 95.
Diagnostic information
The 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 Medical
Systems 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.
Be certain to ensure privacy data of patient information.
CAUTION
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Safety
Patient guidance
CAUTION
Remember to assist the patient when moving up to the
examination bed, moving down from the bed, or when moving in
the vicinity of the system.
Make sure to keep the patient in full view at all times and never
leave the patient unattended while on the examination bed.
Probe Safety
This section includes information on hazards to both the user
and the equipment, as follow:
•
Mechanical hazards
•
Electrical hazards
•
Biological hazards
Mechanical hazards
Damaged probes or improper use and manipulation of the
transesophageal probe may result in injury or increased risk of
infection. Inspect probes frequently for sharp, pointed or rough
surface damage that could cause injury or tear protective
barriers (gloves and sheaths).
Never use excessive force when manipulating intracavity
probes. Become familiar with all instructions and precautions
provided with special purpose probes.
The use of damaged probes can result in injury or increased
risk of infection. Inspect probes often for sharp, pointed, or
rough surface damage that could cause injury or tear protective
barriers. Become familiar with all instructions and precautions
provided with special purpose probes.
Observe immersion levels (Figure 11-5).
WARNING
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.
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CAUTION
Allowing the machine to transmit acoustic output with the probe
not in use (or in its holder) can cause the transducer to build up
heat. Always turn off acoustic output or freeze the image when
not in use. The system's acoustic output remains transmitting
when the user controls are being used.
The system is equipped with an Auto Freeze feature which
disables acoustic output and freezes the image when the
machine is not in use.
CAUTION
Ultrasound transducers are sensitive instruments which can
easily be damaged by rough handling. Take extra care not to
drop transducers and avoid contact with sharp or abrasive
surfaces. A damaged housing, lens or cable can result in patient
injury or serious impairment or operation.
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
Probes are driven by electricity, which can injure the patient or
user when exposed to contact with conductive solution.
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 (Chapter 11, "Probes", page 553).
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Safety
WARNING
Do not immerse the probe into any liquid beyond the allowed
immersion level (Figure 11-5). 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 for damage or
degradation to the housing, strain relief, lens, and seal
("Inspecting the probe", page 572).
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.
CAUTION
Ultrasound can produce harmful effects in tissue and potentially
result in patient injury. Always minimize exposure time and keep
ultrasound levels low when there is no medical benefit. Use the
principle of ALARA (As Low As Reasonably Achievable),
increasing output only when needed to obtain diagnostic image
quality. Observe the acoustic output display and be familiar with
all controls affecting the output level. See the Bioeffects section
of the Acoustic Output chapter in the Advanced Reference
Manual for more information.
Biological hazards
Transesophageal probes require a special handling. Refer to the
user documentation enclosed with these probes.
CAUTION
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.
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Personnel and equipment safety
DANGER
The hazards listed below can seriously affect the safety of
personnel and equipment during a diagnostic ultrasound
examination.
Explosion hazard
Never 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.
Electrical hazard
The internal circuits of the unit use high voltages, capable of
causing serious injury or death by electrical shock.
WARNING
If any defects are observed or malfunctions occur, stop
operating the equipment and perform the proper action for the
patient. Inform a qualified service person and contact a Service
Representative for information.
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
outlet to ensure adequate grounding.
Never use any adaptor or converter of a three-prong-to
two-prong type to connect with a mains power plug. The
protective earth connection will loosen.
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Safety
•
•
Do not place liquids on or above the unit. Conductive fluids
seeping into the active circuit components may cause a
short-circuit, 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 Medical Systems service
personnel. No attempt should be made to replace the fuses
with others of a higher rating.
CAUTION
Do not use this equipment if a safety problem is known to exist.
Have the unit repaired and performance verified by qualified
service personnel before returning to use.
Smoke and fire hazard
The system must be supplied from an adequately rated
electrical circuit. The capacity of the supply circuit must be as
specified.
Biological hazard
For 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 (Chapter 11, "Probes", page 553).
•
Follow all in-house infection control policies as they apply
to personnel and equipment.
Pacemaker hazard
The 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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To avoid injury or system damage, NEVER place any object or
liquid on the monitor.
CAUTION
Archived data is managed at the individual sites. Performing data
backup (to any device) is recommended.
CAUTION
Do not unpack the Vivid S5/Vivid S6. This must be performed by
qualified service personnel only.
CAUTION
Do not use the Vivid S5/Vivid S6 Ultrasound system ECG or
respiratory waveforms for diagnosis or monitoring.
CAUTION
DO NOT load non-system software on the system computer.
CAUTION
LCD Monitor
•
DO NOT place a finger, hand or any object on the joint of
the monitor or monitor arm to avoid injury when moving the
monitor and monitor arm.
•
To avoid result of injury or system damage, NEVER place
any object or liquid on the monitor, whether in the home or
flip down/transport position.
DO NOT place any object on the ventilation slots on the
upper rear side of the monitor cabinet. Blocking the
ventilation slots prevents proper airflow and may result in
fire, electric shock, or equipment damage.
•
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Safety
•
•
36
Keep small objects or liquids away from the LCD monitor.
Small objects or liquid may accidentally fall through the
ventilation slots into the cabinet or spill into the cabinet
which may result in fire, electric shock, or equipment
damage.
If an object or liquid falls/spills into the cabinet, unplug the
system immediately. Call a Service Representative for
information.
DO NOT scratch or press on the panel with any sharp
objects, such as a pencil or pen, as this may result in
damage to the panel.
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Safety
Electrical safety
Internally connected peripheral devices
The system, together with peripheral devices, such as video
tape recorders and printers, meets UL 60601-1 and
IEC 60601-1 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
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 must be verified.
External devices meeting EN 60950 should be kept outside of the
patient environment, as defined in IEC 60601-1-1.
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 UL60601-1 and
IEC 60601-1 standards for electrical leakage.
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Safety
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, 1991 Medical Alert on
latex products.
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Safety
Use of ECG
Do not use the Vivid S5/Vivid S6 Ultrasound system ECG wave
for diagnosis and monitoring.
CAUTION
Use of Defibrillator
CAUTION
Do not use the Vivid S5/Vivid S6 Ultrasound system with
Defibrillator. This equipment does not have defibrillatorapproved applied parts.
Remove the TEE probe from the patient when defibrillators are
used.
CAUTION
Use of Electrosurgical Unit
CAUTION
To avoid skin burns in surgical use, do not place ECG electrodes
in current path between Electrosurgical Unit (ESU) active and
dispersive electrodes. Keep ESU cables away from ECG leads.
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
while operating the ESU. Where contact cannot be avoided, as
in the case of TEE monitoring during surgery, make sure the
transducer is not located between the ESU active and
dispersive electrodes and keep the ESU cables away from the
transducer cable.
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Safety
Electromagnetic Compatibility (EMC)
Note: This unit carries the CE mark. It complies with regulatory
requirements of the European Directive 93/42/EEC concerning
medical devices. It also complies with emission limits for a
Group 1, Class B Medical Device as stated in IEC/EN
60601-1-2.
All 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
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Safety
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
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.
EMC performance
Portable and mobile radio communications equipment (e.g.
two-way radio, cellular/cordless telephones, wireless computer
networks), other than those supplied by GE, should be used no
closer to any part of this system, including cables, than
determined according to the following method:
Table 1-1: Portable and mobile radio communications equipment distance requirements
Frequency range:
Calculation
Method:
150 kHz - 80 MHz
d=[3.5/V1] square
root of P
80 MHz - 800 MHz
800 MHz - 2.5 GHz
d = [3.5/E1] square
root of P
d = [7/E1] square
root of P
Where: d= separation distance in meters, P = rated power of the transmitter,
V1=compliance value for conducted RF, E1 = compliance value for radiated RF
If the maximum
transmitter power
in watts is rated
The separation distance in meters should be:
5
2.6
2.6
5.2
20
5.2
5.2
10.5
100
12.0
12.0
24.0
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Safety
Declaration of Emissions
This system is suitable for use in the following environment.
The user must assure that it is used only in the electromagnetic
environment as specified.
Table 1-2: Declaration of Emissions
Emission Type
Compliance
CISPR 11
Group 1
RF Emissions
Class B
IEC 61000-3-2
Class B
Electromagnetic Environment
This system uses RF energy only for its
internal function. Therefore, RF
emissions are very low and are not likely
to cause any interference in nearby
electronic equipment. It 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.
230V 50Hz
Harmonic
Disturbance
Emissions
Complies
IEC 61000-3-3
Voltage
Fluctuations/Flicker
Emissions
Declaration of Immunity
This system is suitable for use in the following environment.
The user must assure that the system is used according to the
specified guidance and only in the electromagnetic
environment listed.
Notice upon Installation of Product
Separation distance and effect from fixed radio
communications equipment: 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 transmitter cannot be
predicted theoretically with accuracy. To assess the
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Safety
electromagnetic environment due to fixed RF transmitters, an
electromagnetic site survey should be considered. If the
measured field strength in the location in which the ultrasound
system is used exceeds the applicable RF compliance level as
stated in the immunity declaration, the ultrasound system
should be observed to verify normal operation. If abnormal
operation is observed, additional measures may be necessary,
such as re-orienting or relocating the ultrasound system or
using an RF shielded examination room may be necessary.
1. Use either power supply cords provided by GE Medical
Systems or ones designated by GE Medical Systems.
Products equipped with a power source plug should be
plugged into the fixed power socket which has the
protective grounding conductor. Never use any adaptor or
converter to connect with a power source plug (e.g.
three-prong-to-two-prong converter).
2. Locate the equipment as far away as possible from other
electronic equipment.
3. Be sure to use only the cables provided by or designated by
GE Medical Systems. Connect these cables following the
installation procedures (e.g. wire power cables separately
from signal cables).
4. Lay out the main equipment and other peripherals following
the installation procedures described in the Option
Installation manuals.
General notice
1.
2.
Designation of Peripheral Equipment Connectable to This
Product.
Peripheral equipment (Chapter 12, "Peripherals",
page 595) can be hooked up to the product without
compromising its EMC performance. Avoid using
equipment not designated in the list. Failure to comply with
this instruction may result in poor EMC performance of the
product.
Notice against User Modification The user should never
modify this product. User modifications may cause
degradation in EMC performance. Modification of the
product includes changes in:
• Cables (length, material, wiring, etc.)
• System installation/layout
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Safety
3.
4.
• System configuration/components
• Securing system parts (cover open/close, cover
screwing)
Operate the system with all covers closed. If a cover is
opened for some reason, be sure to shut it before starting/
resuming operation.
Operating the system with any cover open may affect EMC
performance.
Peripheral Update for EC countries
The following is intended to provide the users in EC countries
with updated information concerning the connection of the
Vivid S5/Vivid S6 to image recording and other devices or
communication networks.
The Vivid S5/Vivid S6 has been verified for overall safety,
compatibility and compliance with the following on-board image
recording devices:
•
Sony UP-D895 MD/D897MD Digital Printer
•
Sony UP-D23 MD Digital Color Printer
•
HP DeskJet 460 Series Inkjet printer
•
HP OfficeJet Pro K5400 Series Inkjet printer
The Vivid S5/Vivid S6 has also been verified for compatibility,
and compliance for connection to a local area network (LAN)
via the rear panel Ethernet connection, provided the LAN
components are IEC/EN 60950 compliant.
Connection may also be made to a CE Marked and IEC/ EN
60950 compliant modem using one of the serial or USB ports
on the system.
The Vivid S5/Vivid S6 may also be used safely while connected
to devices other than those recommended above if the devices
and their specifications, installation, and interconnection with
the system conform to the requirements of IEC/EN 60601-1-1.
General precautions for installing an alternate on-board device
would include:
•
The added device must have appropriate safety standard
conformance and CE Marking.
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Safety
•
•
•
•
•
The total power consumption of the added devices, which
connect to Vivid S5/Vivid S6 and are used simultaneously,
must be less than or equal to the rated supply of the
Vivid S5/Vivid S6.
There must be adequate heat dissipation and ventilation to
prevent overheating of the device.
There must be adequate mechanical mounting of the
device and stability of the combination.
Risk and leakage current of the combination must comply
with IEC/EN 60601-1.
Electromagnetic emissions and immunity of the
combination must conform to IEC/EN 60601-1-2.
General precautions for installing an alternate off-board,
remote device or a network would include:
•
The added device(s) must have appropriate safety
standard conformance and CE Marking.
•
The added device(s) must be used for their intended
purpose having a compatible interface.
•
Signal or mains isolation devices and additional protective
earth may be needed to assure compliance with IEC/EN
60601-1-1.
CAUTION
The connection of equipment or transmission networks other
than as specified in the user instructions can result in an electric
shock hazard or equipment malfunction. Substitute or alternate
equipment and connections requires verification of compatibility
and conformity to IEC/EN 60601-1-1 by the installer. Equipment
modifications and possible resulting malfunctions and
electromagnetic interference are the responsibility of the owner.
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Safety
Patient Environmental Devices
1. Rear Panel
(numbers 12 through19 not used in figure)
2. Peripheral Devices Power
20. LCD
3. Ethernet network
21. LCD Folding Lever
4. Rear USB Ports
22. Up/Down & Left/right swivel release levers
5. Audio Output
23. Front USB Ports
6. DVI Video output
24. RS Probe Connectors
7. Power Line Circuit Breaker
25. LOGIQ Probe Connector (Vivid S6 only)
8. Ground Line
26. Non-imaging Pencil Probe Connector
9. Power Line (AC~)
27. ECG connector
10. DVD Drive
11. Hard-Copy Printer
Figure 1-2: Patient Environmental Devices
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Acceptable devices
The Patient Environmental devices shown on the previous
page are specified to be suitable for use within the PATIENT
ENVIRONMENT.
CAUTION
DO NOT connect any probes or accessories without approval by
GE within the PATIENT ENVIRONMENT ("Peripheral Update for
EC countries", page 44).
Unapproved devices
DO NOT use unapproved devices.
CAUTION
If devices are connected without the approval of GE, the warranty
will be INVALID.
Any device connected to the Vivid S5/Vivid S6 must conform to
one or more of the requirements listed below:
• IEC standard or equivalent standards appropriate to devices.
• The devices shall be connected to PROTECTIVE EARTH
(GROUND).
Accessories, options, and supplies
CAUTION
Unsafe operation or malfunction may result. Use only the
accessories, options and supplies approved or recommended in
these instructions for use.
Computer Virus precaution
If you connect a USB Flash card to a virus-infected computer, the
USB Flash card may also become infected with a computer virus.
CAUTION
If you connect a USB Flash card infected with a computer virus
to the Vivid S5/Vivid S6 system, the computer virus may be
transferred to the system.
If you suspect that a USB Flash card that was used on the
Vivid S5/Vivid S6 contains a computer virus:
1.
2.
Stop operating the equipment and perform the proper
action for the patient.
Inform a qualified service person and contact a Service
Representative for instructions.
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Safety
Environmental protection
System and battery disposal
the waste of electrical and electronic equipment must not be
disposed as unsorted municipal waste and must be collected
separately. Please contact an authorized representative of the
manufacturer for information concerning the decommissioning
of 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.)
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Getting started
Chapter 2
Getting started
• Introduction ................................................................................... .... 50
• Preparing the unit for use ............................................................ .... 51
• Site requirements ....................................................................... 51
• Connecting the unit .................................................................... 52
• Switching On/Off ........................................................................ 59
• Moving and transporting the unit ................................................ .... 63
• Wheels ....................................................................................... 63
• Moving the unit ........................................................................... 63
• Transporting the unit .................................................................. 65
• Reinstalling at a new location ..................................................... 65
• Unit acclimation time .................................................................. 67
• System description ....................................................................... .... 68
• System overview ........................................................................ 68
• Control panel .............................................................................. 70
• The Scanning screen ................................................................. 83
• Three-Pedal Footswitch operation ............................................. 85
• Connecting and disconnecting probes ....................................... 86
• Adjusting the Display Monitor ..................................................... 90
• Starting an examination ............................................................... .... 95
• Creating a new Patient record or starting an examination from an
existing patient record ............................................................... 95
• Selecting a Probe and an Application ...................................... 100
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Getting started
Introduction
Only 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 Medical Systems 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 ("System Care and
Maintenance", page 658).
Carry out regular preventative maintenance (Chapter 14, "User
maintenance", page 657).
All the warnings should be read and understood before
operating the unit ("Important safety considerations", page 16).
WARNING
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Getting started
Preparing the unit for use
The Vivid S5/Vivid S6 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 requirements
Optimal operation of the unit can be obtained by implementing
the following requirements:
Power requirements
The Vivid S5/Vivid S6 ultrasound unit uses a separate power
outlet for 100 – 120 VAC or 240 VAC, 50–60 Hz.
Operating the unit with the wrong voltage range causes
damages, voiding the factory warranty.
WARNING
Operating Environment
Ensure that there is sufficient air flow around the
Vivid S5/Vivid S6 ultrasound unit when installed or operated.
Environmental requirements
The Vivid S5/Vivid S6 ultrasound unit requires constant
maintenance of its operational environment. Different
temperature and humidity requirements are specified for
operation, storage and transportation.
Table 2-1: Vivid S5/Vivid S6 temperature and humidity requirements
Requirement
Temperature
Humidity
Air Pressure
Operational
10–40 °C
30–85%
700–1060 hPa
Storage
-10–60 °C
30–70%
700–1060 hPa
Transport
-10–60 °C
30–70%
700–1060 hPa
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Getting started
Electromagnetic interferences
The
Vivid S5/Vivid S6
ultrasound unit is
approved for use in
hospitals, clinics
and other
environmentally
qualified facilities,
in terms of the
prevention of radio
wave interference.
Operation of the
unit in an
inappropriate
environment can
cause electronic
interference to
radios and
television sets
situated near the
medical 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 unit
A GE-qualified person should perform the initial system
installation.
Connecting the Vivid S5/Vivid S6 ultrasound unit involves
preliminary checks of the power adaptor unit and 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.
Failure to provide an adequate earth circuit can cause electrical
shock, resulting in serious injury.
WARNING
WARNING
52
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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Getting started
Voltage level check
Check the label near the circuit breaker on the rear side of the
system (Figure 2-1 or Figure 2-2).
Figure 2-1: Vivid S5 rating labels
Figure 2-2: Vivid S6 rating labels
Check the voltage range indicated on the label:
•
100–120 VAC, 50/60 Hz, 5 A
Or
•
230 VAC, 50/60 Hz, 2.5 A
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.
Figure 2-3: Universal label
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Getting started
Connecting to the electrical outlet
WARNING
POWER OUTAGE MAY OCCUR. The Vivid S5/Vivid S6 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 ("Power requirements", page 51).
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.
1.
2.
3.
4.
Ensure that the wall outlet is of appropriate type, and that
the power switch is turned off.
Uncoil the power cable, allowing sufficient slack so that the
unit can be moved slightly.
Attach the power plug to the system and secure it in place
by using the retaining clamp.
Secure the power plug in the wall outlet.
a. Retaining clamp for power plug
Figure 2-4: Power plug
Ensure that the retaining clamp for the power plug is fixed firmly.
CAUTION
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CAUTION
Use caution to ensure that the power cable does not disconnect
during system use. If the system is accidentally unplugged, data
may be lost.
To avoid risk of fire, the system power must be supplied from a
separate, properly rated outlet.
WARNING
Under no circumstances should the AC power plug be altered,
changed, or adapted to a configuration rated less than specified.
Never use an extension cord or adapter plug.
To help assure grounding reliability, connect to a "hospital
grade" or "hospital only" grounded power outlet.
1. 100-120 VAC, 1200 VA Plug and Outlet Configuration
2. 220-240 VAC, 1200 VA Plug and Outlet Configuration
Figure 2-5: Example Plug and Outlet Configurations
Battery
The System contains an internal battery (optional), which is not
user-accessible. The internal battery acts as a limited
alternative power source, which becomes active when the AC
power fails or AC cable is abruptly pulled out.
Display turns off and no scanning is possible while in battery
mode ("Battery Power Mode", page 62).
The battery may
only be
disassembled and
re-assembled by an
authorized
field-service
engineer.
Battery technology
The lithium ion technology used in the system’s battery is
significantly less hazardous to the environment than the lithium
metal technology used in some other batteries (such as watch
batteries). Used batteries should not be placed with common
household waste products. Contact local authorities for the
location of a chemical waste collection program nearest you.
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Viewing Current Battery Status
When the system is running, a status icon is displayed in the
system Status bar to indicate the current battery status.
Table 2-2: Battery status icons
Icon
Status Description
AC Power is ON; no battery present
AC Power is ON; battery is fully charged (80%-100%)
AC Power is ON; battery is partially charged (40%-80%)
AC Power is ON; battery is almost empty (10%-40%)
Note: The % values mentioned above may fluctuate by up to +/- 3%
points.
View Detailed Battery Status
In order to view further details about the battery status, click on
the battery-status icon. A more detailed status description
appears.
A special message may appear, suggestion to replace the
battery soon. This message may appear when the battery has
aged to such an extent that even after prolonged charging it will
not hold enough charge.
Peripherals/Accessory connection
The external Peripherals / accessories connectors are situated
on the rear side of the unit (Figure 2-6).
Refer to the
Peripherals chapter
for further
information on
peripherals
(Chapter 12,
"Peripherals",
page 595).
56
Peripherals/Accessory Connector Panel
Vivid S5/Vivid S6 peripherals and accessories can be properly
connected using the rear connector panel.
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Use only approved peripherals, accessories or probes.
CAUTION
DO NOT connect any accessories or probes without approval by GE
1. Two isolated AC sockets for peripherals (Max. 250VA total)
2. LAN 10/100 Base-TX Ethernet network connector
3. Two interchangeable USB ports (digital printers or other peripherals)
4. Audio output
5. DVI video output connection to external display
Figure 2-6: Peripherals/Accessory Connector Panel
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 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. 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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Getting started
CAUTION
The connection of equipment or transmission networks other
than as specified in these instructions can result in electric
shock hazard. Alternate connections will require verification of
compatibility and conformity to IEC/EN 60601-1-1 by the installer.
Table 2-3: Contents of the Rear Panel
Socket
Signal type
Device type
DVI-I Out
DVI-I output high
resolution video
External monitor
USB
Universal serial
bus x2
USB Cable /
Device
Ethernet
10/100 Base-TX
Ethernet IEEE
8023
Network device
Network device
58
Note
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Switching On/Off
To switch on the unit:
When turning ON
a system while
system is in
standby, it takes a
few seconds before it
responds. Do not
push the on/off
button again
during this period
(A second push will
initiate a full
shutdown).
1.
Switch on the circuit breaker on the rear of the unit
(Figure 2-6).
2.
Press
(on/off button) on the top left of the control panel
(Figure 2-11).
After initialization the default scanning screen (2D mode) is
displayed, the active probe being the one connected to the
left most connector socket.
Note: When CD or DVD media is located in the drive while
system is being turned ON or OFF, the boot up or shutdown
procedures may take longer than expected.
LEDs
There are two LEDs above the On/Off switch that indicate the
status of the system.
Indicates power status.
After pressing the On/Standby switch, the system
power is ON and this LED is lit.
Color: Green
Indicates battery status.
When the battery is charged, the LED is green.
When the battery power is low, the LED is orange.
Color: Green and Orange
Flashing LED lights
The Power status LEDs near the Power On/Off button may
sometimes be seen flashing, as result of one of the following
states:
•
When AC power is interrupted and the system is in "Battery
Power mode" the green LED by the battery symbol flashes
at a regular rate.
•
When turning system off to "Standby mode" the green LED
by the moon symbol flashes during the shut-down process
and stops flashing when standby mode is stable.
•
When one of several fault conditions occurs during power
boot-up, or power-down sequence, the LEDs flash briefly
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Getting started
for a few seconds repeating after every 20 seconds interval.
This should be reported to your service representative.
Password Protection
Log In
By factory Login
default, the
Operator ID is USR
and there is no need
to enter a password
During the turn-on process the system may require the user to
enter a password in order to operate it. Personal IDs and
associated passwords can be configured in the
Vivid S5/Vivid S6 ("Presets and System setup", page 599) .
If IDs and passwords have been entered and "Use Auto Logon"
is Off ("Users", page 653), the Operator Login window appears,
requesting for an ID and password when Power up sequence is
completed, or when it is required.
1. Operator: Select the relevant Operator name
2. Password: Enter the Operator’s password
3. Emergency: Data stored for the duration of the current examination only
4. Log on: Select type of Log on (for example, Standard logon)
5. Cancel: Cancel Log on
Figure 2-7: Operator Login Window
Switching off the unit
When the Vivid S5/Vivid S6 is switched off, the system
performs an automatic shutdown sequence. The unit can be
switched off into one of three states.
•
Full shutdown: the entire system is shut down. Full
shutdown is recommended if the system is not intended to
be used for a whole day or longer. It is recommended to
perform a full shutdown at least once a week. This will
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•
•
After switching off
the system, wait at
least ten seconds
before turning it on
again.
prevent extreme memory fragmentation, which might cause
some computer slowdown.
Standby mode: most of the system is powered down, but
a certain portion of the unit remains energized. The standby
mode allows a shorter reboot time when the system is used
on a daily basis or moved from one place to another.
Battery mode: When AC power is interrupted, the screen
and keyboard are powered down. The rest of the system is
still powered ON. The fans are heard. When AC power is
resumed, the system will turn ON in less than 10 seconds
("Battery Power Mode", page 62).
Full shutdown
1. Press
(on/off button) on the top left of the control panel.
The Exit dialogue window is displayed.
Figure 2-8: The Exit dialogue window
In case of total
lockup of the
system, hold the
on/off button down
a few seconds 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.
Booting up from Full Shut-down mode may take about 60
seconds.
Standby mode
1. Press
(on/off button) on the top left of the control panel.
The Exit dialogue window is displayed (Figure 2-8).
2. Select Standby.
The system enters Standby mode.
Booting up from Standby mode may take about 20
seconds.
Note: Whenever the system is fully shut down or put in
standby mode, the system will automatically perform "End
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Getting started
Exam" to save all data and images of the current patient
into the archiving system.
Turning on the system at the new location
1.
Plug the AC cable into a proper power outlet.
2.
Press
(on/off button) (Figure 2-11).
Battery Power Mode
When the system is operating normally, if the AC power is
interrupted or the power cable is removed from the wall outlet
the screen and keyboard will turn off, but the rest of the system
will continue to operate in "Battery Mode", powered by the
internal battery.
While in battery mode, if the AC power is restored within 10
minutes, the system will turn back on within less than 10
seconds.
While in Battery-power mode the system will maintain the
current patient active and not perform "End-Exam". As a result,
when power is restored, the current patient's details and stored
images are readily available on display.
If the AC power is not restored within 10 minutes, the system
will shut-down into Standby mode.
If AC is not restored, the system can remain in Standby mode
for approximately 1 hour using the internal battery power
(assuming battery is fully charged and relatively new). If left for
more than about 1 hour while in standby-mode without AC
power, the system will switch from Standby in to full Shut-down
mode.
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Moving and transporting the unit
Wheels
The front wheels of the unit are controlled by the break-pedals
situated above each wheel.
The rear wheels of the unit are controlled by the swivel lock /
release pedals situated above each wheel (Figure 2-11,
item 10).
Examine the wheels frequently for defects to avoid breaking or
jamming.
Moving the unit
To prepare the unit to be moved
1.
2.
3.
4.
5.
6.
7.
8.
CAUTION
Turn system Off to Full shut-down or Standby mode.
Remove the AC plug from the power outlet.
Wrap the AC power cord to ensure cord is not hanging in
the wheel area or beyond the sides of the system.
Pull the left handle and swivel the keyboard so it will lock in
its central position ("Monitor position adjustment",
page 93).
Disconnect all external cables linking the unit to any
off-board peripheral devices and network. (Note the marks
on each cable to reconnect them later).
Place all probes securely in proper probe holders. Ensure
that the probe cables do not protrude from the side of the
unit or interfere with the wheels, or foot area. Hang the
cords on respective hooks provided, ensuring cords are
secure and out of lower portion of the system and do not
extend beyond the sides of system.
Ensure that no loose items are left on the unit.
If intending to travel over bumpy surface or if more visibility
is required during transportation, fold the LCD screen
forward to a horizontal position ("Position Adjustment",
page 92).
Before folding the LCD monitor, please make sure that the gel
bottle is placed with the dispenser tip down into gel holder or
moved sideways in order not touch the monitor's faceplate.
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9. Unlock the front-wheel’s brakes.
10. Lock the rear wheel brakes (Swivel Brake) for long travel or
free it for short distance traveling where maneuvering is
needed.
Once all cables and cords are wrapped and secure out of
the lower portion of the system, not extending beyond
sides of system, you are ready for transport.
To ensure safety while moving the unit
1.
Ensure that the keyboard console is in central-locked
position.
Ensure that the hands of the patient are away from the console
when moving the system or keyboard console.
WARNING
2.
CAUTION
Proceed cautiously when crossing door or elevator
thresholds. Grasp the front handle grips and push or pull or
use the rear handle bar for pushing the system. Do not
attempt to move the unit using cables or probe connectors.
Take extra care while moving the unit on inclines. Do not
hang or lean body weight on the handles.
The rear handle should only be used for pushing the system, not
for pulling, The system might become unstable when hitting an
obstacle while pulled with the rear handle.
3.
4.
5.
Ensure that the unit does not strike the walls or door
frames.
Ensure the pathway is clear, and probe cables are secure
not to catch onto anything in the path (including wheels and
feet).
Move the unit slowly and carefully.
Avoid ramps that are steeper than 10 degrees.
CAUTION
WARNING
64
Probe cables may get caught on external devices, such as doors,
medical devices in the transporting path, wheels, or feet. Please
ensure cords are wrapped properly, not extended beyond sides
of system and out of the way for portables.
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Getting started
Transporting the unit
Take extra care when transporting the unit by vehicle. In
addition to the moving precautions ("Moving the unit",
page 63), follow the procedure described below.
1. Disconnect all probes and secure them in their boxes.
2. Lower the system's keyboard to its minimum height.
3. Park the vehicle on a level surface for loading and
unloading.
4. 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.
5. Ensure that the unit is secured inside the vehicle. Secure it
with straps to prevent movement while in transit.
6. Drive cautiously to prevent vibration damage.
Reinstalling at a new location
1.
2.
When the unit is in place at a new location, lock the wheel
brakes ("Moving and transporting the unit", page 63).
Follow the installation procedure ("Connecting the unit",
page 52).
Preparing Vivid S5/Vivid S6 for scanning
1.
2.
3.
4.
5.
6.
7.
Lock front Wheel brakes
Un-Wrap the AC power cord and plug into power source.
Lift the LCD screen to the fully open position while pulling
out the lock. Secure the Monitor at full upright position.
Turn the system on.
Connect external cables if needed (LAN, USB, etc.).
Probe being used to scan should be ready, with cables
clear of foot area and wheels by wrapping un-used portion
of the cord on respective hooks provided.
Adjust keyboard's height and swivel ("Monitor position
adjustment", page 93).
Note: Ensure that the probe cables do not protrude from the
unit or interfere with the wheels, or foot area. The Hanging
cords may cause damage to system if lodged or hooked onto
nearby items. By ensuring cords are secure and out of lower
portion of the system, this may provide a more secure
atmosphere and avoid unnecessary damage.
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Getting started
Avoiding possible hazards
•
•
•
Proper Gel bottle storage
Avoid dragging cables on the floor. In cases where the
wheel rolls over cable or person pushing the system steps
on cables, it may generate severe force to break the cable
or the connector.
Avoid hanging cables beyond sides of the system. When
system is moved, these cables may be caught in
door-knobs or other medical equipment and apply severe
forces that may break probe cables or connectors.
Check that the Gel bottle is not interfering with the folding
screen. The gel bottle needs to be placed with dispenser tip
down into gel holder or moved sideways in order not to
push on the LCD frame (Figure 2-9).
Improper Gel bottle storage
Figure 2-9: Proper Gel bottle storage
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Unit acclimation time
Following 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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Getting started
System description
System overview
Figure 2-10: Vivid S5/Vivid S6 System Overview
Note: Above figure is Vivid S6.
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
LCD Display Monitor: Swivels to the left and right, tilts
backwards and forwards.
Display Monitor Spring-lock Release: Pull knob and fold
screen forward to a horizontal position. To unfold the
screen pull the same knob and lift the screen up.
Accessory tray (removable)
Rear Handle
Probe and gel holders: Removable for cleaning. Situated
on either side of the Control panel.
Up/down "Flex-Fit" arm
DVD Drive
Black and white video printer
Fans Service Cover
Rear Wheels: Swivel wheels. May be swivel-locked
Foot Rest (removable)
Front Wheels: Each wheel may be braked.
Control panel: Contains all the buttons, softkeys and the
alphanumeric keyboard used to operate the system.
USB Port
Probe cable hooks: Located on each side in the front and
rear of system
Front Handle
Console swivel operating handle: Situated on the right
side under the control panel
Console lifting operating handle: Situated on the left
side under the control panel
Probe ports: Three RS-type Probe sockets
Pencil probe socket
ECG connector socket: Also supporting the external ECG
input
Large probe socket: (Available on Vivid S6 only)
Supporting the TEE probes only
RS-Socket locking latch
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Getting started
Control panel
The following pictures illustrate the layout of the
Vivid S5/Vivid S6 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.
1. Power status LEDs and light-sensor
7. Speakers
2. On/off button
8. Softmenu 4-way Rocker
3. Softmenu keys and rotaries
9. Alphanumeric Function keys
4. Alphanumeric Keyboard
10. Speaker volume rotary
5. 2D-gain and active-gain rotaries
11. Scan-mode keys
6. TGC sliders
12. Trackball and related keys
13. Freeze keys
Figure 2-11: Vivid S5/Vivid S6 Control Panel
Note: Above figure is Vivid S6.
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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 white: 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
Key
Description
Turns the unit ON and OFF.
Sets the unit to Standby.
Navigation keys
The following buttons on the top left of the control panel are
used for navigating different screens and 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
Displays the Archiving opening page. Enables
the user to perform the following functions
("Starting an examination", page 95):
• Create a new patient record
• Edit the current patient’s information
• Browse the Patient List to search for patient
records
• End the current examination
Displays the Select Probe and Application dialog
box that enables the users to select the desired
probe and application preset for the current
examination ("Selecting a Probe and an
Application", page 100)("Probes", page 553).
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Getting started
Key
Description
Enters Stress Echo mode (optional). The
Protocol screen is displayed showing the default
stress protocol for the current probe.
Displays the Measurement worksheet where the
user may edit or delete measurements, change
averaging etc. ("Worksheet", page 366).
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 ("Review images in archive",
page 441).
Displays the examination report.
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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 ("Scanning Modes", page 147).
Note
Key
Description
Displays the 2D live acquisition mode that is the
default scanning screen for the unit ("2D-Mode",
page 150).
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 ("M-Mode", page 161).
Displays the examination screen in Color Flow
Mapping mode. Used to display color-coded blood
flow information ("Color Mode", page 167).
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 ("PW and CW Doppler", page 174).
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 ("PW and
CW Doppler", page 174).
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
("Tissue Velocity Imaging (TVI)", page 180).
Note: TVI is optional on Vivid S5. The TVI button is
always installed even if option is not installed.
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Getting started
Note
Key
Description
Depending on the options installed on the scanner,
this key will bring up the softkey menu for selection
of additional optional scanning modes, such as
AMM, TVI, DTI, TSI, SRI, SI, etc.
The Quantitative Analysis option will also appear (if
installed) as a softkey button named Q Analysis.
Note: Some functions are available only on
Vivid S6.
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
Gain rotary
Controls the total gain of the gray scale images
in 2D Mode.
CTO (Continuous Tissue Optimization) - while in
2D live scan mode, to optimize the uniformity
and brightness of the tissue continuously in
real-time, press the rotary knob.
ATO (Automatic tissue optimization) - while in 2D
Freeze mode, press the rotary knob to optimize
2D image automatically.
Active mode
rotary
Controls the total gain of other activated modes,
such as, M-Mode, Color, PW, or CW Doppler
modes.
In combined mode, switches between the mode
specific assignable controls without having to
exit each mode in order to control it.
TGC
74
Six sliding keys that compensate for
depth-related attenuation in an image. The upper
slider corresponds to the smallest depth.
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Getting started
Controls
Description
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 unltrasound beam angle
on linear probes. The steering angles are fixed
for each linear probe. This key has no effect with
sector imaging probes.
Zoom
Controls image magnification. Press to activate
"HR-Zoom" mode. Rotate clockwise to activate
"Display-zoom" mode and increase zoom factor.
Rotate counterclockwise to decrease and turn off
zoom ("Zoom", page 122).
Auto
While in 2D it activates CTO (Continuous Tissue
Optimization) or ATO - Automatic Tissue
Optimization to optimize 2D image automatically
("Automatic Tissue Optimization (ATO)",
page 154).
While in CW or PW Doppler it activates ASO Automatic Spectrum Optimization to optimize the
Doppler spectrum.
Flex
This key can be configured to function as any
button on the keyboard ("Flex Keys
configuration", page 606) with the exception of
alphanumeric and soft-menu sections.
Note: There are two trackball buttons which can
also be configured by the user ("Flex Keys
configuration", page 606).
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Freeze keys
The freeze keys are used to freeze images and cine loops in all
modes for on-line analysis.
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.
Display Format Key
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.
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.
Same arrows are used while reviewing images
from clipboard, the active frame may be stepped
forward or backwards to review the next or
previous image.
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Store Button
Key
Description
Store
Stores the currently active imaging window to
disk. The stored information depends on the
configuration of the current application.
Stored images are shown on the clipboard.
Measurement controls
The following keys are used to take measurements and
perform calculations.
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
("Measurement and Analysis", page 255).
Activates measurement tools (unassigned
measurement)("Measurement and Analysis",
page 255).
Print and Record Control
Key
Description
Record
This button exists on some systems, but has no
functionality.
P1
Prints the current imaging screen content to a
selected (configurable) printer ("Printing",
page 597). The PRINT key can also be
configured for alternative storing of images
("Additional outputs", page 639).
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Key
Description
P2
Prints the current imaging screen content to a
printer assigned to a second port (configurable).
The default factory configuration is set to
"Secondary Capture" ("Additional outputs",
page 639).
Trackball operation
The Trackball area consists of the trackball and five
surrounding keys. Three of these have the very same function
(the SET function) for ergonomic reasons.
Key
Description
Trackball
Used for navigation and together with the
surrounding keys, to move, select or activate
objects on the screen.
Trackball
Button
Controls the trackball assignments between the
mode-specific options. By pressing TRACKBALL,
the trackball function will cycle through the
possible assignments, which are indicated in the
lower right corner of the screen ("Trackball
assignment", page 108).
Set
Depending on the situation (Figure 3-3):
• Performs the selected control or highlighted
menu item.
• Toggles between the Trackball functions within
the active group.
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Key
Description
Update/Menu
In Freeze, activates menu with additional options
and controls not available from the assignable
keys.
In live mode, toggles between 2D imaging and
live time-motion imaging (Doppler/M-Mode).
Trackball
Bottom
Buttons
The two un-named buttons on the lower side of
the trackball are configured by default to have
identical functionality as the trackball's SET
button.
Each of these buttons may be configured by the
user in the same way as the Flex button ("Flex
Keys configuration", page 606).
Assignable keys and rotary knobs (soft keys)
The functions of the assignable keys and rotaries vary
according to the mode and/or module in which the user is
working.
Key
Description
Soft Rotaries
Four assignable rotary knobs, whose
mode-specific functions vary according to the
scan mode and position that is currently active.
These assignable rotaries are used both as
rotary-control knobs and as on/off toggles for
different controls on the menu The assigned
functions are indicated above the rotary on the
LCD display (Chapter 4, "Scanning Modes",
page 147).
Assignable
Buttons
Four assignable buttons, whose mode-specific
functions vary according to the scan mode and
position that is currently active. These
assignable buttons are used as on/off toggles for
different controls on the menu. The assigned
functions are indicated above the button on the
LCD display (Chapter 4, "Scanning Modes",
page 147).
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The soft menu rocker
Key
Description
Soft Menu
Rocker
A 4-way rocker used to access mode-specific
menus, select a menu option and adjust
option-related values (Chapter 4, "Scanning
Modes", page 147).
• The vertical arrows are used to select the menu
options.
• The horizontal arrows are used to adjust the
values.
The Alphanumeric Function keys
Key
Description
Help
Displays the on-line version of the user manual.
Config/Diag
Displays the configuration dialog box, allowing
user configuration of various settings on the
scanner.
Diagnostics of the system is activated by
pressing Shift > CONFIG.
80
Eject/Spooler
Press to Eject a device like MOD, DVD, CD or
memory card. Press Shift+Eject to display and
control the DICOM spooler. This function is
similar to the Alt+S shortcut.
LCD
To activate LCD adjustments controlled by
softkeys.
Biopsy
Displays the biopsy path marker.
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Key
Description
Bodymark
Displays the available body marks for the current
application.
Page Erase
Erases all previously-typed annotations (and
body marks).
Physio
Provides access to controls for ECG trace. The
ECG controls appear on the soft-menu.
Arrow
Displays an arrow that can be used to point at a
specific structure in the image.
Text
Enables text annotation to be inserted on the
image. The annotations can be typed or selected
from a (configurable) menu.
Playback
Not in use
Delete
Can be used to delete text during text
annotation.
List of shortcuts on alphanumeric keyboard
Key
Description
Alt+E
Allows to eject a device like MOD, CD or memory
card.
Alt+L
Allows to adjust intensity of keyboard backlight.
Alt+P
Allows to view and control printer spooler.
Alt+S
Allows to view and control DICOM spooler.
("DICOM spooler", page 495) 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.
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82
Key
Description
Alt+D
Allows to comment and save logfiles for
diagnostics ("Adding Problem description",
page 663).
Alt+B
Allows to insert a "bookmark" into the system
failure log ("Adding bookmarks", page 663)
Shift+Config
Allows to run various diagnostics.
Fn (function)
key + PgUp or
PgDn
Allows to view clipboard images sequentially
forward or backwards.
Alt + Help
Activates the “Front-panel Simulator” for the use
of system-diagnostics. Do not activate this
function. It is to be used only by a service
representative.
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The Scanning screen
1. Current patient ID data
16. Watermark area for screen calibration
2. Date & time of original image
17. Soft menu control button
3. Institution
18. Tracknall assignment
4. Operator ID
19. Rotary soft-menu control
5. Application & Temperature indicator for TEE
probe
20. Soft menu toggle button
6. Probe
22. Loop icon
7. Mechanical & Thermal Index
23. Service and iLinq, Caps on/off
8. Current date & time indicators
24. Clipboard
9. Heart rate
25. ECG trace and Heart-rate
10. Parameter window - all modes
26. Depth scale
11. Greyscale/Color bar
27. Focus marker
12. Soft menu window
28. TEE Scan plane indicator
13. Clipboard navigator
29. Probe orientation marker
14. Cine progress bar
30. Measurement result table (measurement mode)
15. Current menu name
31. Logo
21. Clipboard image number
Figure 2-12: The scanning screen
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The scanning screen is divided in several areas as follows:
The title bar
From the left:
The patient
information
displayed on the
Title bar is
configurable
("Patient Info",
page 608).
Patient Information
Displays 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
("Creating a new Patient record or starting an examination from
an existing patient record", page 95).
Institution name
The institution name is entered from the configuration package
("System", page 649).
Operator ID
Identification code of the operator ("Users", page 653).
Date and time
Displays the current date and time or for a retrieved image, the
date and time at which it was stored.
Probe and Application
Displays the currently selected probe and application or for
retrieved image the probe and application that were used
("Selecting a Probe and an Application", page 100)("Probe
Integration", page 567).
Live scanning related information
Displays, 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)
Archive Information
Displays 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
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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 (Chapter 4, "Scanning Modes",
page 147)("Using the Soft Menu Rocker", page 107).
Clipboard
Displays the thumbnail images representing the acquired data
during the current examination.
The status bar
Consists of four information fields as follows:
Service "Insite Express Connection" (ExC) icon
Enable access to the GE Healthcare on-line service center.
Connectivity status icon
Displays the network status: Connected or disconnected.
Prompt/status field
Displays system messages or prompts the user for actions.
Trackball assignments fields
Displays 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.
Three-Pedal Footswitch operation
The 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 ("Application", page 609).
The standard footswitch is not for use in the operating room.
WARNING
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To connect the footswitch
•
Connect the footswitch to the USB input on the External
connector (Figure 2-6).
Connecting and disconnecting probes
The connector panel situated in the front of the Vivid S6 has
three imaging probe ports type RS, one imaging probe port
type OR, and one pencil probe port.
The connector panel situated in the front of the Vivid S5 has
three imaging probe ports type RS and one pencil probe port.
Handle the probes gently while connecting and disconnecting.
CAUTION
WARNING
Do NOT touch the patient and any of the connectors on the
ultrasound unit simultaneously, including ultrasound probe
connectors.
To connect a probe (Small connector - type
RS)
1.
2.
3.
4.
5.
CAUTION
86
Hold the probe connector vertically with the cable pointing
upward.
Push the connector locking handle to the right-most
position.
Align the connector with the probe port and carefully push
into place.
Push the connector locking handle to the left-most position.
Position the probe cable so that it is not resting on the floor.
Take the following precautions with the probe cables:
• Keep free from the wheels.
• Do not bend the cables
• Do not cross cables between probes
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Figure 2-13: RS Probe Connection Locking Lever
CAUTION
Fault conditions can result in electric shock hazard. Do not touch
the surface of probe connectors which are exposed when the
probe is removed. Do not touch the patient when connecting or
disconnection a probe.
Probe connector formats
The RS-type probe-connectors supplied with the
Vivid S5/Vivid S6 may appear in three different formats (format
A, B or C) (Figure 2-14). Some other GE systems may be using
probes with RS-type connector having format D.
Use only RS-type probes with A, B or C connector formats.
Avoid using Format D as this connector is difficult to connect
properly into the system’s socket. Forcing the connector may
create pressure on the connector thus impacting system
reliability.
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Format A
Format B
Format C
Format D
Figure 2-14: Probe connector formats
To connect a probe (Large connector - type
OR)
1.
2.
3.
4.
Hold the probe connector vertically with the cable pointing
upward.
Turn the connector locking handle to the horizontal
position.
Align the connector with the probe port and carefully push
into place.
Rotate the locking handle to the full vertical position to lock
in place.
Cable Handling
Take the following precaution with probe cables:
•
Do not bend the cable acutely.
Deactivating the Probe
Press the FREEZE key to deactivate the probe. When
deactivating the probe, the probe is automatically placed in
Standby mode.
Disconnecting the Probe
Probes can be disconnected at any time. It is recommended
that the probe should not be active when being disconnected.
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To disconnect a probe (Small connector - type RS):
1. Freeze the image by pressing FREEZE.
2. Press the connector locking lever towards the left to unlock
the connector.
3. Pull the probe and connector straight out of the probe port.
4. Carefully slide the probe and connector away form the
probe port and around the right side of the keyboard.
5. Ensure the cable is free.
6. Be sure that the probe head is clean before placing the
probe in its storage case.
To disconnect a probe (Large connector - type OR):
1. Rotate the lock handle counter-clockwise to the horizontal
position to unlock the connector.
2. Pull the connector straight out of the probe port.
Transporting Probes
When transporting a probe a long distance, store it in its
carrying case.
Storing Probes
It is recommended that all probes be stored in the carrying
case provided.
•
First place the probe connector into the carrying case
•
Carefully wind the cable into the carrying case.
•
Carefully place the probe head into the carrying case.
DO NOT use excessive force or impact the probe face.
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Adjusting the Display Monitor
Image Adjustment
Adjusting the monitor's contrast and brightness is one of the
most important factors for proper image quality. If these
controls are set incorrectly, the Gain, TGC, Dynamic Range
and even Power Output may have to be changed more often
than necessary to compensate.
On Vivid S6 it is recommended to activate the automatic
screen-adjustment feature for best results. When the screen
auto-adjustment is not active, the LCD screen controls may
need periodic adjustment due to changes in ambient light. On
the bottom right corner of the screen you should be able to see
a faint dark, yet visible, letter V which is called "Watermark"
(Figure 2-12, item 22). If the watermark is not visible it is
because the screen is adjusted too dark relative to the
surrounding bright ambient light conditions. In this situation the
screen brightness should be adjusted.
Note: For best results make sure the watermark is always
visible.
Using LCD adjustment Soft menu Controls
When pressing the LCD button on the alphanumeric keyboard,
a special soft-key menu will appear. This menu contains
various screen controls which allow the user to optimize the
screen setting.
Note: On the LCD monitor, the brightness adjustment comes
before contrast.
Brightness Rotary
This is the main control to adjust screen brightness to
compensate for different ambient light.
When soft-rotary is rotated the brightness adjustment tool
appears at bottom of screen (Figure 2-15).
Figure 2-15: Brightness control
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In a totally dark room it is recommended to set brightness down
all the way (all rectangles are empty).
Make sure the
watermark is visible
at all time.
When ambient light becomes brighter and watermark becomes
less visible, increase the brightness till watermark is visible
again.
Contrast Rotary
This control is used to adjust screen contrast.
When soft-rotary is rotated the Contrast adjustment tool
appears at bottom of screen (Figure 2-16).
Figure 2-16: Contrast control
Make sure the
watermark is visible
at all time.
In a totally dark room it is recommended to lower the contrast
somewhat. In a well-lit or semi-lit room it is recommended to
set contrast to its maximal setting.
Blue Tint Rotary
This control is used to adjust blue-tint or color-temperature of
the white colors.
When soft-rotary is rotated the Blue-tint adjustment tool
appears at bottom of screen (Figure 2-17).
Figure 2-17: Blue tint control
This may be adjusted to suite your preference.
External screen button
Activate this button when connecting the system to an external
display. It will allow you to optimize Contrast / Brightness and
blue-tint to suit the particular external display.
When the button is de-activated, the previous settings that
were optimized for the internal display will be restored.
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Test pattern
When adjusting an external display or any peripheral hard-copy
device, you may turn this function ON to generate a
screen-calibration pattern.
Using Automatic Brightness adjustment
On Vivid S6 it is possible to set up the Automatic screen
adjust feature. This will attempt to maintain a well-adjusted
screen under all ambient light conditions by using a special
built-in light-sensor.
Auto-sensor button
In case Brightness
setting is
re-adjusted
manually the Auto
sensor feature will
be turned off.
When this button is turned ON, the system will monitor and
automatically adjust screen's brightness when ambient light
conditions have changed.
It is recommended to leave the Auto-Sensor ON by default for
the duration of the system's operation.
Auto Adjust button
When this button is depressed the system will perform a
one-time screen adjustment, based on the current ambient
light.
Position Adjustment
The monitor position can be adjusted for easy viewing.
•
The monitor can be rotated around its central pivot point.
•
The monitor can be tilted for the optimum viewing angle.
•
The monitor can be flipped forward to a horizontal position
for screen-protection, improved visibility and reduced
height while moving or transporting the system.
Do NOT place objects on the monitor.
CAUTION
To swivel the LCD monitor
Grab the left and right sides of the LCD monitor frame and
swivel the monitor to the desired position.
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To tilt the LCD monitor
Grab the top side of the LCD monitor frame and pull or push to
tilt the monitor to the desired position.
To reduce system's height, or if more visibility is required during
transportation, fold the LCD monitor forward to a horizontal
position, it will lock horizontally in place.
To fold the LCD monitor Horizontally
Pull out the spring-loaded locking knob to release the display's
locking mechanism (Figure 2-18), pull and lower the display
towards you. When fully horizontal release the knob.
To unfold the LCD monitor
Lift the display and pivot it to a vertical position. Adjust the tilt of
the display to the desired position.
CAUTION
Before folding the LCD monitor, please make sure that the gel
bottle is placed with the dispenser tip down into gel holder or
moved sideways in order not touch the monitor's faceplate.
Figure 2-18: Monitor position adjustment
Control Panel adjustment
The system Control panel can be freely adjusted to swivel or
move up/down. There are two brake handles located under the
control panel.
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To swivel the control panel left or right
1. Pull and hold the left brake handle, located under the
control panel.
The control panel can now be freely rotated left or right.
2. When reaching the desired swivel angle, release the
swivel-brake handle.
The control panel will remain at the set angle.
Note: The LCD monitor will swivel together with the
control-panel. In addition the LCD may be swiveled
independently of the control-panel.
To move the control panel up or down
1. Pull and hold the right-hand handle, located under the
control panel.
The control panel can now be freely adjusted up or down.
2. When reaching the desired height, release the
height-adjust handle.
The control panel will remain at the set height.
Note: When the control panel is lowered it moves towards the
operator. When panel is raised it also moves away from the
operator.
Note: When preparing the system to be moved, pull the left
handle and bring the control panel to a center position. Swivel it
slightly till a locking click is heard.
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Starting an examination
Beginning an exam consists of three steps:
•
Creating a new patient record or starting a new examination
from an existing patient record (below).
•
Selecting Probe and Application ("Selecting a Probe and an
Application", page 100).
•
Start scanning.
Creating a new Patient record or
starting an examination from an
existing patient record
Starting an examination
1.
Press PATIENT.
The Patient Handling screen is displayed.
Figure 2-19: The Patient Handling Screen
2.
Operator ID
creation is described
later in this manual
("Users",
page 653).
Press CREATE NEW PATIENT.
If the unit is password protected a Log In window will
appear asking for operator ID and password (Figure 2-20).
Note: In case the password is not known, press
Emergency. This allows you to scan with the system,
without accessing long-term archiving of the exam.
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1. Data stored only for
the duration of the
current examination
2. Select the operator
Figure 2-20: The Operator login window
3.
4.
Press Log on when completed.
The Search/Create Patient window is displayed
(Figure 2-21).
Type the patient Last Name, and/or ID.
Do NOT use '\' or '^' in patient information fields, as these
characters might cause problems with some DICOM devices.
CAUTION
The unit can be
configured to
automatically
generate a patient
ID ("Formats",
page 642).
To restrain the
search to special
category of patient
record, press More
and use the
searching filters.
The automatic
search tool
displaying
matching patient
information in the
Patient list can be
turned off
("Formats",
page 642).
96
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:
•
Trackball to the actual patient and double-click the
Trackball SET key (or press SET once and then Select
patient).
The unit is ready for scanning or the Patient information
window is displayed (Figure 2-22) depending on system
configuration ("Formats", page 642).
If the Patient name is not on the patient record list:
•
Press Create Patient.
The unit is ready for scanning or the Patient information
window is displayed (Figure 2-22) depending on system
configuration ("Formats", page 642).
If the unit is configured to display the Patient information
window, follow the steps below:
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1.
Press EXAM. LIST to
display the previous
examinations and
diagnosis
information for the
selected patient.
Enter additional
patient information
if required.
2.
Enter additional patient information if required.
Select between cardiac, vascular etc. to enter application
specific patient info, which is displayed when the button
More is depressed (Figure 2-22).
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 (Figure 2-23).
1. Press one of the headings to sort the list
accordingly.
4. Dataflow menu
5. Advanced search tool: The system can be
configured to display the Advanced search tool
as default ("Other configuration settings",
page 645).
3. Expended Patient record displaying belonging
examinations.
2. Select the column heading border and drag to
adjust column width.
Figure 2-21: The Search/Create Patient window
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1. The date format is configurable ("System",
page 649).
3. The Address field is configurable ("Formats",
page 642).
2. The window can be configured to display the
expanded patient info as default ("Formats",
page 642).
4. Select patient information category.
Figure 2-22: The Patient Information window
1. The patient information on the scanning screen is configurable ("Imaging", page 606).
Figure 2-23: The Patient information on the scanning screen
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Using Other Patient ID
The Vivid S5/Vivid S6 system supports an additional field for
Patient ID number referred to as "Other Patient ID". This is an
optional data field and may be accessed via the Patient List
screen and clicking the "More" button. The rules applicable to
the "Patient ID" data and the "Patient ID" filter also apply to the
"Other Patient ID" field.
The "Other Patient ID" field is part of the DICOM protocol and if
used, will appear on the patient demographic data viewed on
DICOM viewers.
Ending an Examination
1.
2.
3.
Press PATIENT.
The Patient Handling screen is displayed.
Select End Exam on the Patient Handling Screen
(Figure 2-19).
If the images on the clipboard were not previously stored a
prompt window is displayed where the user can choose to
store all, none or a selection of the images saved to the
clipboard.
Select:
• All: to store all images and end the exam
• None: to end the exam without storing any images
• Select: to select the images to store from the Review
screen and end the exam.
Connectivity on the Vivid S5/Vivid S6
ultrasound unit
Connectivity setup
is detailed later in
this manual
("Connectivity",
page 446).
The connectivity on the Vivid S5/Vivid S6 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.
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Selecting a Probe and an Application
The combination
Probe-Application
may be user-defined
("Application",
page 609).
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 application
1.
2.
3.
To select a probe
with the default
application, press
SET twice on the
actual probe.
4.
5.
Press PROBE on the control panel.
A list of the connected probes is displayed.
Trackball to the desired probe.
Press SET.
An Application menu for the selected probe is displayed.
Trackball to the desired application.
Press SET to launch the application.
Make sure that the probe and application names displayed on the
screen correspond to the actual probe and application selection.
CAUTION
100
Check that the correct TI category is displayed ("Thermal Index",
page 24). TIB must be displayed when a fetal application is
selected.
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Basic scanning operations
Chapter 3
Basic scanning operations
This chapter describes basic operations related to scanning.
Some operations described in this chapter are fully described
in the respective chapters throughout the manual.
This chapter includes the following information:
• Assignable keys and Soft Menu Rocker ..................................... .. 103
• Using the Assignable Keys Soft Menu ..................................... 104
• Using the Soft Menu Rocker .................................................... 107
• Trackball operation ....................................................................... .. 108
• Trackball assignment ............................................................... 108
• The system menu ..................................................................... 109
• Cineloop operation ....................................................................... .. 110
• Cineloop overview .................................................................... 110
• Cineloop controls ..................................................................... 111
• Using cineloop .......................................................................... 112
• Storing images and cineloops ..................................................... .. 113
• To store a single image ............................................................ 113
• To store a cineloop ................................................................... 113
• Removable Media .......................................................................... .. 114
• Intended use ............................................................................ 114
• Supported removable media .................................................... 115
• Zoom .............................................................................................. .. 122
• To Magnify an image (Display zoom) ....................................... 122
• Performing measurements .......................................................... .. 123
• To perform measurements ....................................................... 123
• Physiological ECG/Respiratory traces ....................................... .. 124
• Connecting the internal ECG ................................................... 125
• Physio controls ......................................................................... 134
• Displaying the ECG trace ......................................................... 135
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• Adjusting the display of the ECG trace ..................................... 136
• Displaying the Respiratory trace ...............................................136
• Annotations ................................................................................... ... 138
• To insert an annotation .............................................................138
• To edit annotation ..................................................................... 141
• To erase annotation .................................................................. 141
• Configuration of the pre-defined annotation list ........................ 142
• Bodymarks ................................................................................ 144
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Assignable keys and Soft Menu Rocker
1. Active mode & status
2. Filling gauge (progress bar)
3. Selected control shows highlighted
frame
4. Cine-buffer control gauge
Figure 3-1: A: the 4-Way Rocker; B: Soft Menu; C: the assignable
keys on the control panel.
To toggle between
modes in combined
mode, press ACTIVE
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 with 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
controls parameters associated with the active mode.
Switching the active mode will change the key and rotary
assignments accordingly.
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Using the Assignable Keys Soft Menu
The bottom of the display screen contains a graphics area of
soft-menu with assignable keys and rotaries. This area of the
screen is designed to match a parallel set of physical buttons
(the assignable keys and rotaries (Figure 3-1), located on the
upper portion of the control panel. An example of a soft-menu is
shown in below.
Figure 3-2: The Assignable Keys and Soft Menu
The soft-menu provides access and user control of different
system parameters.
The contents of the soft-menu is different for every system
mode. This provides access to the relevant settings in each of
the different modes.
There are several different control key elements in the
soft-menu area, as follows:
Variable Single parameter rotary knob
In this example, the “Baseline” parameter can be increased by
rotating the corresponding rotary knob clockwise. The same
parameter can be decreased by rotating the same rotary knob
counterclockwise. Upon rotating the knob the arch on the
graphics changes its length to reflect the change in the value of
the controlled parameter.
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An alternative method for modifying the parameter associated
with this button is to click with the mouse pointer on the
relevant side of the rotary graphics on screen.
Variable Dual parameter button
In this example the rotary knob has access to either “Frame
Rate” or “Low Vel. Reject” parameters.
When the “Frame Rate” upper label is highlighted, the
parameter “Frame Rate” can be increased by turning the
rotary clockwise and decreased by turning the rotary
counterclockwise.
When pressing the rotary knob, the bottom label (“Low vel.
Reject” in this example) will be highlighted. In this case, from
now on, turning the assignable rotary knob will either increase
or decrease respectively the value of the lower (highlighted)
parameter.
At this point, pressing the rotary knob will, again, associate the
rotary with the upper labeled parameter.
An alternative method for modifying one of the parameters
associated with this rotary is to click with the mouse pointer on
the relevant side of the assignable rotary graphic.
On/Off Toggle button
In this example the active green indicator indicates that the
“Simultan.” setting is set ON.
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The user can press the matching upper button to toggle the
“Simultan.” function ON or OFF.
The lower button functions slightly differently, it has no green
indicator.
The button indicates "Left / Right" control. The light-colored font
changes location upon each button press, indicating if "left" or
"right" status is currently active.
Alternatively, the user can click with the mouse pointer on the
relevant button graphic instead of pressing the actual button.
Soft Menu rocker button
The circular button on the bottom-right area of the screen acts
as a soft-menu rocker button. It has access to a different type
of soft-menu which pops up on the right portion of the screen.
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Using the Soft Menu Rocker
The Soft menu Rocker on the control panel enables the
adjustment of controls mapped in the Soft menu Window
(Figure 3-1).
The first row of the soft menu indicates the name of the active
mode and its status (freeze/live). The following rows list the
mode-specific controls.
The relative setting of each control is indicated by a gauge bar
filling the cell as the control value increases. The number
appearing on each of the gauge bars indicates the value
associated with the relevant control.
To select a control from the menu
1.
2.
Press any part of the 4-way rocker to display the soft menu.
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 values
Note: when soft
menu is not
accessed for a
defined period of
time it will time-out
and disappear from
the display. The
timeout can be
configured
("System",
page 649).
•
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 operation
Different 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 SET keys (identical): depending on the situation,
the SET 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 various
functions form a pop-up menu (Figure 3-3).
Trackball assignment
The trackball has a multi-mode function. The functions
available from the trackball are mode dependent. The available
trackball functions for the active mode are displayed on the
right side of the Status line (Figure 3-3).
To change trackball assignment
•
108
Press TRACKBALL in the Trackball area until the desired
function is selected highlighted.
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The system menu
The system menu enables a quick access to image related
functions (Figure 3-3).
1. Trackball key: select trackball assignment from the functions available in the Status line.
2. Set key: perform the selected control or highlighted menu item
3. Update Menu key: select the operation to perform from the pop-up System menu.
(Menu contents may change. Figure shows a typical menu)
Figure 3-3: The Trackball area
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Cineloop operation
When no ECG is
connected, a cine
gauge is displayed
indicating the
current 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
1. ECG
4. Right marker
2. Left marker
5. Heart rate or Cine speed (in replay)
3. Current frame
6. Cine frame number values
Figure 3-4: The cineloop controls display
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Cineloop controls
Cineloop assignable softkey controls
Left / Right Marker
Move the left and right markers to expand or trim the cineloop
boundaries.
Cycle select
Selects the heart cycle to be played back.
Number of cycle
Controls the number of heart cycles to be included in the loop.
Select All
Select all heart cycles.
First cycle / Last cycle
Selects the first or last heart cycle to be played back.
Cineloop
Starts cineloop acquisition.
Cineloop Freeze Control
2D Freeze
Toggles between replay and freeze modes.
Cineloop trackball controls
Scroll
When the scan mode is frozen, trackball to move the current
marker and review the images
Cine speed
In cine replay mode, move the trackball left or right to adjust the
speed of the cineloop playback.
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Using cineloop
Selection of a cineloop
1.
2.
3.
4.
To jump directly to
the first or to the
last heart beat press
the softkeys FIRST
CYCLE or LAST
CYCLE.
5.
6.
Press FREEZE.
The left and right markers on the ECG trace are displayed
on either side of the last detected heart cycle.
Press the 2D FREEZE button to un-freeze the cineloop and
let it run between the default setting of left and right borders.
To modify setting of the left or right borders, press the
CINELOOP softkey.
The selected heart beat is played back.
Press on the softkey CYCLE SELECT to move from heart beat
to heart beat to select the heart cycle of interest.
Press on the softkey NUM CYCLES to increase or decrease
the number of heart beats to be played back.
Adjust LEFT MARKER and RIGHT MARKER softkeys to trim or
expand the cineloop boundaries.
Adjustment of cineloop playback
1.
2.
If in freeze mode, press the softkey 2D FREEZE to start
cineloop replay.
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
(Figure 3-4).
To view a cineloop frame by frame
1.
2.
112
If not in freeze mode, press the 2D FREEZE button to freeze
the cineloop.
Use the Trackball to scroll through the cineloop frame by
frame.
Or
Use the Speed/Frame softkey button.
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Storing images and cineloops
Images stored on
the clipboard
during the
scanning session
are for immediate
purposes. At the
end of the
examination, the
data should be
archived in the
patient archiving
system
("Archiving",
page 417).
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 (Stress option) 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. ("Imaging",
page 606)("Application", page 609).
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 on the dataflow
configuration ("Dataflow", page 632).
To store a single image
1.
2.
Press FREEZE.
Press STORE to store the image digitally.
The thumbnail of the image is displayed on the clipboard
("Storing images and cineloops", page 420).
To store a cineloop
While in scanning mode, press the STORE button to store the
last heart-cycle loop. It is possible to configure this function in
several ways. Cineloops may be stored directly or after
preview, depending on how the system is configured.
While in cine-loop preview mode press STORE to store the
selected loop.
Cineloop length and loop selection is adjustable in several
ways. The procedure for cineloop storage is described later in
this manual ("Storing images and cineloops", page 420).
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Removable Media
Intended use
Removable media can be used for the following purposes:
•
Long-term image storage: the final destination of the
images, after they are moved out of the system harddisk by
using the Disk Management feature ("Disk Management",
page 483).
•
Backup of patient database and system configuration
presets ("Data Backup and Restore", page 490)
•
Patient archive sneaker-net: copy a set of patient records
between a scanner and EchoPAC PC using the
Import/Export feature ("Export/Import patient
records/examinations", page 470) with a removable media.
•
DICOM export to copy a set of patient records to a third
party DICOM review station.
•
MPEGVue export: review exported images on a Windows
computer ("Export/Import patient records/examinations",
page 470).
•
Excel export: exports demographics, measurements and
reporting data from the unit to a third party reporting
application using a removable media ("Export/Import
patient records/examinations", page 470).
•
Copy of system configuration presets between to units
using the Backup/Restore feature ("Data Backup and
Restore", page 490).
•
Save images as JPEG or AVI for review on a regular
computer.
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Supported removable media
The following removable media options can be used for data
storage:
•
5 1/4” Magneto Optical disk (from Sony only, 1.3, 2.3, 2.6,
5.4, 8.6 and 9.1 Gb)
•
USB Flash Card
•
USB external desktop hard drive (Iomega Ultramax)
(Option)
CAUTION
CAUTION
Use only shielded USB Flash cards that are verified for EMC
performance according to EN55011 Class A or B. The use of
other USB Flash cards may cause interference on the system
itself or on other electronic devices.
DO NOT USE devices containing embedded U3 technology
programs as these might interfere with the proper operation of
the Vivid S5/Vivid S6 system.
•
•
CD-R (CD-RW is not supported.)
DVD-R or DVD+R (use 8x or higher speed.)
Use only 24x or higher CD-R.
CAUTION
About removable media and long-term image
storage
We recommend running the Disk management feature with
MOD media or with USB HD (Iomega Ultramax) for long-term
image storage, because of the longevity and reliability of these
media. It is not recommended to use CD or DVD for long-term
storage, because of weaker performance in general when it
comes to longevity and reliability. However, Disk management
does not prevent the use of CD/DVD for long-term image
storage. If CD/DVD is used it is recommended to use Archival
Grade or Medical Grade CD/DVD.
No matter which media is used, it is always highly
recommended to take a backup of the media, which is the
responsibility of the customer.
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The system does not offer functionality for backing up images
saved on long-term storage media.
Iomega Ultramax desktop hard drive
The Iomega Ultramax desktop hard drive is an external
desktop hard drive, connected to Vivid S5/Vivid S6 via USB. It
is configured as RAID 1, so the content is mirrored (duplicated)
on two hard disk drives.
The intended use for Iomega Ultramax desktop hard drive is
for Disk Management.
Note: Connect only one USB storage device (like this Iomega
Ultramax desktop hard drive) to the Vivid S5/Vivid S6 at a time.
Note: When Disk Management has been performed, it is
recommended to back up the Patient Archive to a medical
grade DVD recordable disc.
CAUTION
If connected to Vivid S5/Vivid S6, the Iomega Ultramax unit must
not be placed inside the patient environment (refer to local
regulation and EN 60601-1-1).
1. Patient environment
Figure 3-5: Patient environment
Iomega Ultramax unit connection
1. Connect the Iomega Ultramax unit to Vivid S5/Vivid S6
using the USB cable provided with the unit. The USB cable
must be connected to the combined USB/eSATA (Duolink)
socket at the rear of the Iomega Ultramax unit (Figure 3-6).
Note: Do not use any of the other USB sockets (USB hub)
at the rear of the Iomega Ultramax unit.
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2.
3.
CAUTION
Connect the special power cord supplied with this option to
the DC IN connector on the rear of the Iomega Ultramax
unit (Figure 3-6, item 2).
Connect the other end of the same power cord to the
isolated AC outlet on the system (Figure 2-6, item 1).
To avoid leakage current above safety limits as prescribed by
IEC 60601-1 and to ensure continuity of earth protection, do not
connect Vivid S5/Vivid S6 and mains operated accessories to a
common multi-socket extension cord.
1. USB/eSATA (Duolink) connector
2. DC IN Power connector
3. On/Off switch
Figure 3-6: Iomega Ultramax unit, rear view
For further information on Iomega drive setup please see
Iomega Ultramax Desktop Hard Drive Installation Manual,
Part Number: 5401302-100.
Recommendation concerning CD and DVD
handling
To 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 disk surface
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has no visible scratches. If there are any scratches, do NOT
use the disk.
Writing on CD or DVD media
Use specifically recommended for writing on CD or DVD
media. Never use a solvent-based permanent marker on such
media. The following pens are recommended:
•
Dixon Ticonderoga "Redi Sharp Plus"
•
Sanford "Powermark"
•
TDK "CD Writer"
•
Smart and Friendly "CD Speed Marker"
Formatting removable media
MOD, CD-R, DVD+R, and DVD-R media must be formatted
before use, as described below.
Formatting may be done in two methods:
1. Formatting just prior to using the media ("Exporting patient
records/examinations", page 470).
2. Preparation well ahead of time as described in the following
section.
The formatting process will erase any data present on the disk.
CAUTION
Removable media
used during Disk
space management
or Backup do not
need to be
formatted; the
formatting process
is part of these
procedures.
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To Format a removable media
1. Insert the media into the drive.
2. Press CONFIG.
3. If required, log on to the system. The Configuration
package is opened.
4. Select the category Connectivity and select the sheet
Tools (Figure 3-7).
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Figure 3-7: The Tools Sheet
5.
6.
Select the removable media from the Media pop-up menu.
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, underscore (_) and
hyphen (-). 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 to continue.
11. Eject the media as described below.
Note: Removable media used during Disk space management,
Backup, Export or "Save-As..." do not need to be formatted in
advance as the formatting process is part of these procedures
if required.
Additional networking functions
Additional networking functions contained in this tab are
described below.
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Note: Before using any of these functions, verify that the
destination PC / Network has been set up with a shared folder
(remote path) with user permissions. Configuring the shared
folder for the first time will involve your GE field-service
engineer.
Save As PDF to network path
Save As PDF Network Path is used for saving Reports as
PDFs to a destination PC or network.
1. Under "Save As PDF Network Path", in the Remote Path
field, type the remote path. For example type: \\IP
ADDRESS\DIRECTORY, where directory is the name of
the shared folder in the destination PC.
2. Click Check to verify the connection.
Note: When clicking the Check button, you might momentarily
see a "failed" message that disappears if you click Check a
second time. The system will then confirm the setting.
Remote Path
1. Under "Setting for Remote Path used for Save As...", type
the remote path as follows:
\\IP ADDRESS\DIRECTORY
2. Click Check to verify the connection.
Configurable Remote Path User
It is possible to configure an additional user name and
password for all remote paths. These settings are only used if
the system fails to log on the default user and password.
•
Under Configurable Remote Path User, type the desired
user name and password as configured on the destination
PC (this is the password usually assigned by the local IT
person).
Ejecting removable media
Do not eject the CD
using the button on
the CD drive.
120
1.
Press the "Eject" button on top of the alphanumeric
keyboard, or use the shortcut ALT+E to eject the media.
The Eject device menu is displayed (Figure 3-8).
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Figure 3-8: The Eject device menu
2.
CAUTION
CAUTION
Select the relevant media.
The selected media is ejected.
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.
Removing USB devices while in standby mode: Introduce or
remove USB devices only while system is in full shut-down
mode, or while system is turned ON, using the proper Eject
command (ALT+E). Removing USB device while system is in
Standby may cause system failure.
Media corruption as result of AC power failure: While doing
any type of CD/DVD media-writing session, such as export,
backup, disk-management, save As etc. the system may issue
different error messages in case a writing-error has been
detected.
Note: The system does not notify the user whenever a USB
device has been disconnected. If a peripheral is not operating
correctly, please inspect the connection to verify that it is
hooked up properly.
In the special case where the AC power to the system is
interrupted in the midst of media-writing session, some error
messages may appear.
Note: A warning message might be misleading or might not be
given at all, but if the power was interrupted the DVD is likely to
be corrupted. Reconnect power to the DVD device and repeat
the export process to a new DVD media.
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Zoom
The Vivid S5/Vivid S6 supports two types of zoom: the display
zoom and the high resolution (HR) zoom.
•
The Display zoom (sometimes called "Read" zoom)
magnifies the image display in both frozen and live 2D,
M-Mode and combined modes.
•
The HR zoom (sometimes called "Write" 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.
To Magnify an image (Display zoom)
The Display zoom is
available in live and
replay.
1.
2.
3.
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.
Use the Trackball to position the zoom area over the
desired portion of the image.
To turn off the Display zoom, rotate the Zoom knob
counterclockwise, or press it twice.
Note: While in Display zoom, pressing the zoom knob once will
activate HR zoom, as explained below.
To activate the HR zoom
As a default setting,
the zoom area is
centered to the
cursor/color area if
present.
1.
2.
3.
4.
Press the Zoom knob.
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.
Use the Trackball to position the zoom area over the
desired portion of the image.
Increase size as desired by turning the zoom knob
clockwise.
To turn off the HR zoom, press the Zoom knob once, or
rotate it counter clockwise until zoom reference image
disappears.
Note: While zooming in any zoom method, pressing SET once
allows using the trackball to modify zoom ROI dimensions and
zoom magnification factor.
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Note: When the Zoom method is set to HR Zoom, the label
HiRes displays beneath the Zoom control window (Figure 3-9).
Figure 3-9: Zoom control window
Performing measurements
To perform measurements
•
•
Press MEASURE to enter the Measurement mode
("Measurement and Analysis", page 255).
Or
Press CALIPER to perform simple generic measurements.
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Physiological ECG/Respiratory traces
The Vivid S5/Vivid S6 contains a physiological module capable
of displaying the patient’s ECG trace and respiratory trace
(optional). The ECG trace is generated by monitoring the
patient, using 3 ECG electrodes, or by interfacing to an external
monitor.
The respiratory trace (optional) is generated by using ECG
electrodes to pass weak electric signals through the patient and
monitor changes in thoracic impedance.
In a different configuration, by using an additional External
Respiratory Interface, the respiratory trace is generated by
interfacing the system to an external respiration monitor.
The physiological module is an internally integrated part of the
Vivid S5/Vivid S6. The internal module consists of a single
connector, which can accept either an ECG electrodes
cable-set or an External-ECG cable, capable of handling
external ECG signals from other diagnostic ECG devices.
The scanned image that is displayed is synchronized with the
ECG and respiratory traces. In M-Mode or Doppler, the traces
are synchronized to that particular mode's sweep.
Note: The display of the patient's respiratory trace is provided
for synchronization (correlation) with the heart's ultrasound
image. It cannot be used for follow-up/monitoring the
respiratory functioning of the patient.
The operator can control the gain, the position and the sweep
rate of the traces using the softkeys on the control panel.
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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.
The use of respiratory monitoring might interfere with the proper
operation of impedance-based rate-responsive pacemakers.
When examining a patient with a pacemaker, it is required to turn
off the respiratory trace on the system. This will block off the
respiratory monitoring signals which might interfere with the
pacemaker.
EXCEPTION: When using an external respiratory monitor,
turning off the respiratory trace on the Vivid S5/Vivid S6 WILL
NOT block the operation of the external monitor.
Simultaneous use of two or more applied parts will cause
summation of patient leakage currents.
Connecting the internal ECG
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.
•
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.
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 (Table 3-1).
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Table 3-1: ECG Electrode Placement table
See note on optimal electrode placement on Table 3-2
AHA (USA)
IEC (Europe, Asia, ROW)
Black (LA)
p/n 412680-104
Yellow (L)
p/n 412680-106
White (RA)
p/n 412680-102
Red (R)
p/n 412680-108
Green (RL)
p/n 412680-103
Black (N)
p/n 412680-107
LL
Unassigned
F
Unassigned
V
Unassigned
C
Unassigned
Trunk cable
p/n 412931-001
Trunk cable
p/n 412931-002
Note: The ECG cables used on Vivid S5/Vivid S6 are not
compatible with the cables used on the Vivid 7 system. In case
the cable you are using has connector colors similar to those
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shown on Table 3-2 this cable is compatible with Vivid 7 but not
with Vivid S5/Vivid S6.
Table 3-2: ECG cable colors used on Vivid 7
AHA (USA)
IEC (Europe, Asia, ROW)
1.
2.
3.
1.
2.
3.
RA: White
LA: Black
LL: Red
R: Red
L: Yellow
F: Green
To connect the internal ECG
1.
2.
Connect the ECG trunk cable into the rectangular-shaped
socket marked ECG on the patient I/O panel. The patient
I/O panel is located in the front left of the ultrasound unit
(Figure 3-11).
Hook up the electrode cables to the electrodes, following
the appropriate convention (Table 3-1).
Optimal electrode placement
The graphics on the ECG connector describes an electrode
connection scheme that will provide the Lead I signal. This
signal is typically weak relative to the ECG waveform derived
from Lead II signal.
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For the ECG signal:
To receive the Lead II ECG signal, it is necessary to modify the
electrode placement (Table 3-3).
Table 3-3: Electrode placement for optimal Lead II ECG signal
• For AHA (USA) connectors: place the LA (black) electrode at the LL position under the
patient's left rib
• For IEC (Europe, Asia, ROW) connectors: place the L (yellow) electrode at the F
position under the patient's left rib
AHA Lead I
AHA Lead II
IEC Lead I
IEC Lead II
Optimizing electrodes location for the
Respiratory signal
1.
2.
128
When the electrode is placed on the right arm, the muscles
and arm's motion introduce artifact signals over the
respiratory signal.
When the electrodes are placed over the soft tissue of the
abdomen, the patient motion introduces artifact signals
over the respiratory signal.
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Due to the above it is mandatory to place the electrodes over
the ribcage as described in Figure 3-10.
Figure 3-10: Optimal Placement of electrodes for respiratory
Note: For proper Respiratory wave-form avoid using ECG
arm/leg clamps, as the electrodes need to be placed over the
torso as shown in Figure 3-10.
Connecting External ECG
A special External cable kit that can be ordered as
p/n H45021DE. The kit contains a 20-foot coax cable with
some additional connectors and adapters to allow interfacing
with various external ECG monitors. The type of adapter
should match the connector recommended by the ECG monitor
vendor.
1. ECG Connector port
2. CW pencil probe port
Figure 3-11: The Patient ECG Connector Port
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Connecting ECG electrodes for Pediatrics
It is possible to use pre-wired miniature disposable ECG
electrodes for pediatrics and neonatal use.
Note: The system does not support the internal respiratory
functionality while using pediatric-cardiology or OB
applications.
A special adapter is available allowing the connection of
pre-wired electrodes using a DIN 1.55 type connector into the
"MultiLink" ™ trunk ECG cable (Figure 3-12).
Figure 3-12: DIN 1.55 type connector
The electrodes should connect to their corresponding locations
as shown on Figure 3-13.
Figure 3-13: Electrode connections
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Connecting the external respiratory Interface
An External Respirator Interface is available for use on the
Vivid S5/Vivid S6 (Figure 3-14).
Label
3D picture of the device
1. USB interface cable
2. Label and serial no.
3. External monitor signals connector
Figure 3-14: The External Respirator Interface
The External Respirator Interface kit (ordered as p/n
H45031TF) includes:
•
External Respirator Interface
•
External monitor cable
•
Extra connector
•
Mounting ribbons (“Velcro™”)
The connection to the Respirator monitor is possible by using
the supplied external monitor cable or by assembling a
customized cable to match the monitors used in your clinic.
Details for preparing a customized interface cable: "Preparing
the customized interface cable", page 133.
Note: The external monitor cable supplied with this option is
compatible with a respiratory monitor with single-ended
positive output. When used with a single-ended negative output
monitor, the Respiratory invert softkey may be activated.
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Connecting an external respiratory monitor to the
Vivid S5/Vivid S6
An external respiratory monitor can be connected to the
Vivid S5/Vivid S6 system by using the External Respirator
Interface module. When connected, as explained below, the
respiratory signal arriving from the external monitor replaces
the respiratory signal picked-up by the internal ECG cable of
the Vivid S5/Vivid S6 system.
Notes:
•
While interfaced to en external respiratory monitor, the
ECG waveform can arrive either from the internal ECG
electrode-cable or from an external ECG monitor,
depending on the cable used.
•
While using an external ECG monitor, the system cannot
produce the respiratory signal by the internal ECG
electrode cable, so an external respiratory monitor should
be used.
Connecting the External Respirator Interface module to
the system
The External Respirator Interface module should be connected
to an external respiratory monitor using a special cable whose
details are described below.
The interface modulecan be connected to the system at any
time, using the USB interface cable. Once the module is
connected, the internal Respiratory signal is replaced by the
External Respirator signal. To ensure the module is connected,
press PHYSIO on the control panel and the More soft-key and
verify that the Ext. Resp soft-key is visible on the screen. The
amplitude of the External Respirator signal can be adjusted by
the soft-key Resp.Gain.
Disconnecting the module from the system
The External Respirator Interface module can be disconnected
from the system at any time.
Once the module is disconnected the External Respirator
signal is replaced by the internal Respiratory signal. To ensure
the internal Respiratory module is activated, press PHYSIO on
the control panel and the More soft-key, and verify that the Int.
Resp soft-key is visible.
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Mechanical mounting of the module on the system
The External Respirator Interface module is connected to the
system via the USB port located at the rear of the system.
It is recommended to attach the mounting ribbons ("Velcro™")
on the External Respirator Interface module and place the
module on the system as demonstrated in Figure 3-15.
Figure 3-15: Mounting the External Respirator Interface module
Preparing the customized interface cable
The interface cable should be connected to the connector
provided according to the pin-layout diagram below.
Figure 3-16: External Respiratory Interface pin layout diagram
The module has a maximum 2Vpp (Volt peak to peak) input
with a max frequency of 100 Hz. The inputs are differential.
There are three optional connections depending on the monitor
used:
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•
•
•
Option 1: Monitor with single-ended positive output (the
supplied cable is wired according to this wiring scheme):
Connect the "signal" lead to pin 2 on the connector.
Connect the ground shielding to pins 5 and 7 on the
connector.
Option 2: Monitor with single ended output Negative:
Connect the "signal" lead to pin 5 on the connector.
Connect the ground shielding to pins 2 and 7 on the
connector.
Option 3: Monitor with differential output:
Connect the positive "signal" lead to pin 2 on the
connector.
Connect the negative "signal" lead to pin 5 on the
connector.
Connect the ground shielding to pin 7 on the connector.
Physio controls
Physio softkey controls
Common controls
Horizontal 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.
ECG Controls
ECG Gain
Enables the user to change the amplitude of the ECG trace
displayed on the screen.
ECG Pos
Enables the user to move the position of the ECG trace on the
screen.
ECG
Turns the ECG trace on and off.
ECG Invert
Inverts the ECG trace upside down.
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QRS visible
Shows/hides the QRS marker on the ECG.
Respiratory Controls
Resp. Gain
Enables the user to change the amplitude of the respiratory
trace displayed on the screen.
Resp. Pos
Enables the user to move the position of the Respiratory trace
on the screen.
Int. Resp.
Turns the Respiratory trace ON and OFF while the system is
using the internal respiratory module.
When turned OFF the respiratory unit is deactivated and
respiratory signals are blocked from passing through the
patient’s body. ECG signals are not interrupted.
Ext. Resp.
Turns the Respiratory trace ON and OFF while the system is
using the External respiratory module.
When turned OFF the respiratory unit is deactivated but
respiratory signals generated by the external respiratory
module continue to pass through the patient’s body. ECG
signals are not interrupted.
Resp. Invert
Inverts the Respiratory trace upside down.
Displaying the ECG trace
To turn the ECG
display off, press
PHYSIO and press
the softkey ECG
Cardiac applications
The ECG is turned on by default in all cardiac applications.
Other applications
1.
2.
Press PHYSIO on the control panel to get access to the ECG
controls.
Press the softkey ECG to display the trace.
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Adjusting the display of the ECG trace
Adjusting the ECG trace sweep speed
1.
2.
Press PHYSIO on the control panel.
Adjust the softkey HORIZONTAL SWEEP to change the sweep
speed.
Adjusting the ECG trace amplitude
The ECG signal's
amplitude may vary
between patients
due to different skin
moisture and other
physiological
parameters.
1.
2.
Press PHYSIO on the control panel.
Adjust the softkey ECG GAIN to adjust the amplitude of the
trace.
Adjusting the ECG trace position
1.
2.
Press PHYSIO on the control panel.
Adjust the softkey ECG POSITION to move the trace
vertically.
Displaying the Respiratory trace
The following controls will only be available when the
respiratory option is installed.
Using the Internal Respiratory module
The Respiratory trace is turned OFF by default in all
applications.
1. Press PHYSIO on the control panel to get access to the ECG
controls.
2. Press the More softkey to enter the respiratory menu.
3. Press the Int Resp softkey to turn on the display of the
respiratory trace.
4. Adjust the softkey HORIZONTAL SWEEP to change the sweep
speed.
5. Adjust the softkey Resp Gain to adjust the amplitude of
respiratory trace.
6. Adjust the softkey Resp Pos to move the trace vertically.
7. Press Resp. Inv. to invert the polarity of the respiratory
waveform.
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Using External Respiratory module
All controls are identical to the ones of the internal module,
except for the Ext. Resp softkey which turns on or off the
respiratory trace arriving from the External Respiratory module.
Do not use the Vivid S5/Vivid S6 Ultrasound system ECG or
respiratory physio waveforms for diagnosis and monitoring.
CAUTION
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Annotations
Text 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.
CAUTION
Annotations (text, arrow or body mark) 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.
1. Select to display annotation for other
applications
2. Exit
3. Edit previous annotation
4. Pre-defined application-specific
annotations
Figure 3-17: The mode-specific annotation menu
To insert an annotation
Free text
While typing, use
BACKSPACE to
delete backward.
1.
2.
3.
138
Type the required text.
A suggested word corresponding to the entered characters
is displayed while typing. Press TAB to enter the suggested
word.
Trackball the text entered to the insertion position.
Press SET to add the annotation.
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Pre-defined annotation
Word selection from the Annotation menu
1. Press the alphanumeric key TEXT.
A list of application-specific pre-defined texts is displayed
(Figure 3-17).
To display a list from another application, select the
heading and choose another application.
2. Trackball to the required abbreviation.
3. Press SET.
4. Trackball to the position at which the annotation is to be
inserted.
5. Press SET to add the annotation.
1.
2.
3.
4.
5.
To draw an arrow
Press Arrow in the Annotation menu.
Trackball to the start position of the arrow to draw.
Press SET to anchor the arrow.
Trackball to the end position of the arrow to draw.
Press SET to fix the arrow.
Word selection from the Library
Pre-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.
1.
2.
3.
4.
5.
6.
7.
8.
Creating a Library
Press CONFIG.
In the Configuration package, select Meas/Text category.
In the Meas/Text category, select Customize.
The Customize sheet is displayed (Figure 3-18).
Select a pre-defined text in the Application pane.
Select Add in the desired section.
Repeat step 4 and 5 to populate the library.
To remove a pre-defined text from the library, select the
pre-defined text to remove and press Del, and press Save
(Figure 3-18, item 7)
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.
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9.
To exchange sections order, enter the sections to swap
next to Swap columns button and press Swap columns.
10. Customized text may be added to the Application pane by
the special window on the lower area of the Customize
sheet.
11. Press Save to store the library.
1. The Application pane
2. Library section
3. 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
Figure 3-18: The Customize sheet
1.
140
Using the Library
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.
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2.
3.
4.
To select a pre-defined text within a section, press ARROW
UP or ARROW DOWN until the desired word is selected.
To change section, Press LEFT ARROW until the desired
section is displayed in the Status bar.
To insert the selected pre-defined text, press RIGHT ARROW.
To edit annotation
1.
2.
3.
4.
5.
6.
Press the alphanumeric key TEXT.
Press Edit in the Annotation menu.
The pointer is changed to a cross marker.
Trackball to the annotation to edit.
Press SET.
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.
• BACKSPACE: deletes backward.
• DELETE: deletes the selected word.
Do the appropriate changes to the annotation.
Press SET to anchor the edited annotation.
To erase annotation
To erase all annotations on the screen in one operation, press
the alphanumeric key PAGE ERASE.
To erase annotation words one at a time, hit DELETE button on
the alphanumeric keyboard. Each button-press will delete a
single word in reversed order.
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Configuration of the pre-defined
annotation list
1.
2.
3.
Press CONFIG.
In the Configuration package, select Meas/Text category.
In the Meas/Text category select Annotation.
The Annotation sheet is displayed where the user can add,
delete or re-arrange the annotation text (Figure 3-19).
To re-arrange the annotation list
1.
2.
3.
4.
Trackball to the actual annotation text.
Press SET.
Press the relevant button (i.e. Delete, Move up or Move
down) to apply change.
Press save to store the new annotation list.
To add an annotation text
1.
2.
3.
4.
5.
142
Trackball to the text entry field (Figure 3-19).
Press SET to activate the text cursor.
Type the new annotation text.
Press add.
The new annotation text is added at the end of the list.
Press save to store the new annotation list.
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1. Rearrange list
2. Delete selected text
3. Reset to factory default
4. Add new text to the list
5. Enter new text
Figure 3-19: The Annotation Menu Configuration Dialog Box
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Bodymarks
Bodymarks 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 bodymark
1.
Press the alphanumeric key BODYMARK.
The Bodymark menu is displayed showing a selection of
bodymarks relative to the selected exam category.
1. Select and display bodymark list for
other applications
2. Exit bodymark menu
3. Erase bodymark
4. Bodymark list for the current
application
Figure 3-20: The Bodymark menu
2.
Trackball to the desired bodymark and press SET.
The bodymark with a probe marker is displayed on the
scanning screen.
1. Probe marker
Figure 3-21: The bodymark with probe marker
3.
4.
144
Using the trackball, adjust the position of the probe marker
and press SET.
Using the trackball, adjust the probe marker orientation and
press SET.
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Deleting a bodymark
1.
2.
Press the alphanumeric key BODYMARK.
The Bodymark menu is displayed
Select Erase.
When pressing PAGE ERASE on alphanumeric keyboard the
bodymark will be erased, provided it has been configured this
way.
To change the configuration
1. Press CONFIG.
2. In the Configuration package, select Meas/Text category.
3. In the Meas/Text category select Annotation (Figure 3-19).
4. Check or uncheck the "Delete on Page erase" option.
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Chapter 4
Scanning Modes
• Introduction ................................................................................... .. 149
• 2D-Mode ......................................................................................... .. 150
• 2D-Mode overview ................................................................... 150
• 2D-Mode controls ..................................................................... 152
• Using 2D .................................................................................. 158
• Optimizing 2D ........................................................................... 159
• M-Mode .......................................................................................... .. 161
• M-Mode overview ..................................................................... 161
• M-Mode controls ...................................................................... 162
• Using M-Mode .......................................................................... 164
• Optimizing M-Mode .................................................................. 166
• Color Mode .................................................................................... .. 167
• Color Mode overview ............................................................... 167
• Color M-Mode overview ........................................................... 168
• Color Mode controls ................................................................. 169
• Using Color Mode .................................................................... 172
• Optimizing Color Mode ............................................................. 173
• PW and CW Doppler ..................................................................... .. 174
• PW and CW Doppler overview ................................................. 174
• PW and CW Doppler controls .................................................. 175
• Using PW/CW Doppler modes ................................................. 177
• Optimizing PW/CW Doppler modes ......................................... 178
• Tissue Velocity Imaging (TVI) .................................................. 180
• Tissue Tracking ........................................................................ 184
• Strain rate ...................................................................................... .. 189
• Strain rate overview ................................................................. 189
• Strain rate controls ................................................................... 190
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• Using Strain rate ....................................................................... 192
• Optimizing Strain rate ............................................................... 192
• Strain ............................................................................................. ... 194
• Strain overview ......................................................................... 194
• Strain controls ...........................................................................195
• Using Strain .............................................................................. 197
• Optimizing Strain ...................................................................... 197
• Tissue Synchronization Imaging (TSI) ....................................... ... 199
• TSI overview ............................................................................. 199
• TSI controls ............................................................................... 200
• Using TSI ..................................................................................202
• Optimizing TSI .......................................................................... 203
• Additional scanning features ...................................................... ... 204
• LogiqView ................................................................................. 204
• Compound ................................................................................ 205
• B-Flow ....................................................................................... 206
• Blood flow imaging ....................................................................206
• Virtual Convex .......................................................................... 207
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Introduction
The Vivid S5/Vivid S6 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
•
Color Mode Imaging
•
Doppler Mode Imaging
•
Angio
•
Tissue Velocity Imaging
•
Tissue Tracking
•
Tissue Synchronization Imaging
•
BFlow
•
BFI (B-Flow Imaging)
•
Strain / Strain-Rate imaging
Note: Some optional scan-modes listed above are not
available on Vivid S5.
"Storing images
and cineloops",
page 420
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 DVD, CD, and
other various media, depending on available options.
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2D-Mode
2D-Mode overview
1. Focus marker
2. Probe orientation marker
3. Status window
4. Soft menu
Figure 4-1: The 2D screen (cardiac)
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1. Softkeys:
• Width
• Frequency
• Focus Pos
• Frame rate
• Up/Down R
• Left/Right R
• Cineloop (in Freeze, only)
• Dual focus
• B color maps
• Tilt
4. Soft menu
• Compress R
• Reject R
• Dynamic Range
• DDP R
• Speckle reduce R
• Contour
• Diff On/Off
• Power
2. Zoom
7. Gain
3. Depth
5. Freeze
6. 2D
Controls marked with R are also available in freeze and cine replay
Figure 4-2: The 2D controls on the front panel
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In combined mode,
press ACT. MODE to
toggle between
modes and access to
the mode specific
controls.
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:
•
M-Mode ("M-Mode", page 161)
•
Color Mode ("Color Mode", page 167)
•
CW or PW Doppler Mode ("PW and CW Doppler",
page 174)
•
Color and Doppler Modes (triplex)
2D-Mode controls
2D softkey controls
Width
Controls the size or angular width of the 2D image sector. A
smaller angle generally produces an image with a higher frame
rate.
Focus Pos
Changes the location of the focal point(s). A triangular focus
marker indicates the depth of the focal point.
Note: On convex and linear probes there are two additional
optional focus controls:
•
Focus number: Allows to control the number of focal point.
•
Focal Spread: Allows to control the distance among the
different focal points
Frame rate
Adjusts frame rate (FPS). 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.
Tilt
Enables 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. (Applicable only for cardiology applications).
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Frequency
On some low
frequencies, the
system switches
automatically to
second-harmonic
mode. The word
“Octave” appears
in the status
window.
Enables the adjustment of the probe's operating frequency.
The selected frequency is displayed in the status window. For
some probes/applications the lowest frequency settings will be
Octave imaging settings.
Note: While changing the Frequency value on display, the
operator actually selects different transmit patterns associated
with that value, which includes transmit pulse shape, frequency
and transmit sequence.
Octave
Enables quick switching over between Octave imaging and
corresponding fundamental frequencies, without rotating the
Frequency selection rotary knob.
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 focus
Activates Dual focus mode (optionally available in cardiology
applications only). To adjust the location of the Dual focus,
activate the FOCUS softkey.
B Color maps
Displays 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. Use the softkey rotary knob to highlight and activate
the desired map.
Compound
Compound is a process of combining three frames from
different steering angles into a single frame. The combined
single image has the benefits of reduced speckle noise,
reduced clutter, and continuity of specular reflectors. Therefore,
this technique can improve contrast resolution.
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When active, the focal marker indicators change shape ("Focal
Marker Shapes", page 160 - compound is available on Linear
array and on 4C-RS curved array probes).
Virtual Convex
Virtual Convex is designed to provide a wider field of view in
the far field, and is available on linear probes. While in
2D-mode, use the Virtual Convex soft-key to turn virtual
convex ON or OFF. When Virtual convex is turned on, you may
enter other scanning modes such as Color, Doppler or M-mode
and virtual convex will remain active on the 2D image.
Note: While Virtual Convex is turned on, the Zoom function will
always activate in "Display-zoom" mode only.
Cineloop (in Freeze only)
Allocates different cineloop control functions to the softkeys.
Gain
When 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.
Continuous Tissue Optimization (CTO)
CTO is intended to optimize the lateral and radial uniformity
(TGC), and brightness of the tissue continuously in real-time.
While in 2D live scanning, press the Auto button or the 2D
Gain rotary control to toggle CTO on or off. When activated,
CTO is displayed in the information window.
Automatic Tissue Optimization (ATO)
ATO provides an automatic optimization of the 2D image by
adjusting the gray scale curve. While in 2D Freeze, cineloop
mode or while image is recalled from archive, press the Auto
button or the 2D GAIN rotary to toggle ATO on or off. When
activated, ATO is displayed in the information window.
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Note: The user may change the default configuration of the
system to set ATO as default while selected during 2D live scan
("Flex Keys configuration", page 606).
Depth
Sets the maximum (far field) distance that will be imaged.
Decreasing the depth may allow higher frame rates.
2D Soft menu controls
Compress
Controls the amount of contrast in the 2D image. An index
number is displayed in the status window to indicate the
relative level of compression.
Reject
Adjust 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 Range
Enables 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.
Smart Depth
For every setting of scan-depth there is an optimal Frequency /
Transmit Pattern setting.
The Frequency/Transmit Pattern should be optimized to
produce both a clean signal, and maximal spatial resolution.
With Smart Depth turned ON, the system will optimize the
Frequency/Transmit Pattern to follow above guideline, and
automatically set optimal setting for the currently selected
depth.
The Frequency control value displayed on screen will be
modified to display the updated value with every change of
depth setting by the operator.
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The operator may change the Frequency control at any time to
any desired Frequency/Transmit Pattern.
If the depth setting is changed anytime after the user has
manually modified the frequency, the system will attempt to
optimize the Frequency/Transmit Pattern, taking into account
the different frequency-preference as set by the manual
modification by the user.
With Smart Depth turned OFF, the Frequency control setting
will remain unchanged even when depth setting is changed.
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.
Contour/Edge Enhance
Controls image processing related to the extent of edge
enhancement applied to an image.
Diff On/Off
Affects 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. (Applicable only for
cardiology applications).
Power
When power is
reduced, it reduces
the signal-to-noise
ratio, so that the
image 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.
Ultra Definition (UD) Clarity
This control is effective in Cardiology applications only. This
control reduces the unwanted effects of speckle in the
ultrasound image. Image speckle usually appears as a grainy
texture in otherwise uniform areas of tissue. Its appearance is
related to image system characteristics, rather than tissue
characteristics, so that changes in system settings, such as
probe type, frequency, depth, and others, can change the
appearance of the speckle.
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Too much speckle can impair image quality and make it difficult
to see the desired detail in the image. Likewise, too much
filtering of speckle can mask or obscure desired image detail.
Extra care must be taken to select the optimal Speckle
reduction level.
Ultra Definition (UD) Speckle Reduce
This control is used to reduce the amount of speckle in
non-cardiology applications.
Ultra Definition (UD) Adaptive reject
Conventional "Reject" function reduces noise by reducing low
gray levels. It does so by changing the gray-map of the whole
image. Noise is reduced but information in the myocardium
may also be lost.
"Adaptive reject" also reduces noise by reducing low gray
levels. The intensity reduction is done adaptively for each pixel
in the image and does not affect the gray-map. As a result,
pixels that are close to boundaries and tissue structures are
less affected than with conventional reject method.
Clear Vessel
This feature is available on linear probes while in live scanning
under the "Carotid" application. While scanning the common
carotid artery in a longitudinal scan, the "Clear Vessel" function
is designed to optimize the acquired image by automatically
adjusting the TGC of the system to remove noise artifacts
within the vessel without affecting surrounding tissue
structures.
1.
2.
3.
4.
Operation
Use the Carotid preset with a linear probe.
Make sure the "Clear Vessel" soft-key is turned ON.
The label CLR will appear on the upper right area of the
image.
Scan the common carotid artery longitudinally.
While in live scan, when the image of the carotid is
acquired, and the "Clear Vessel" function is active, it will
automatically optimize the image, in real-time, removing
some of the noise artifacts inside the vessel.
The label CLR appears in white whenever "Clear Vessel"
is active, and becomes dark-gray whenever "Clear Vessel"
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is not active, because scanning conditions do not allow
"Clear Vessel" to detect the vessel correctly (Figure 4-3).
Clear Vessel is active
Clear Vessel is ON but inactive
Clear Vessel is OFF
Figure 4-3: Clear Vessel indications
The “Clear Vessel” function may be turned OFF or ON at any
time by the user. When turned OFF, the CLR label totally
disappears from the screen.
Note: “Clear Vessel” can become active and functional only
while the image of the common carotid vessel occupies most of
the width of the image and is relatively linear throughout the
image. In case the vessel is curved or twisted the function will
become non-active and the CLR label will change to a
dark-gray color.
Note: When investigating anatomical structures of very low
echogenicity within the common carotid vessel the user may
turn off “Clear Vessel” in order to assure the visualization of all
reflected echoes, even if obscured by surrounding noise.
Note: In case the Carotid preset is being used while scanning
other anatomy, the CLR label might become active even
though the carotid is not included in the scan. This may
introduce a dark artifact over the tissue. In this case it is
recommended to turn off the Clear Vessel soft-key.
Using 2D
"Application",
page 609
158
The 2D-Mode is the system's default mode.
1. Press 2D on the control panel to access 2D mode.
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Check the Display's
brightness and
contrast setting
before adjusting the
unit imaging
controls
("Adjusting the
Display Monitor",
page 90).
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 2D
The 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.
•
Use UD Clarity (Cardiac) or UD Speckle reduce
(non-cardiac) to reduce image speckle. Extra care must be
taken to select the optimal Speckle reduction level, as too
much filtering of speckle can mask or obscure desired
image detail.
•
Use Adaptive reject (Cardiac) to reduce near field haze
and blood pol artifact without diluting tissue appearance of
moving structures.
•
Press Color maps and select a grey map from the menu on
screen.
Always use the minimum power required to obtain acceptable
images in accordance with applicable guidelines and policies.
WARNING
The Wide Aperture function may improve image quality by
increasing spatial resolution and signal-to-noise ratio. This
feature involves special processing which enables improved
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beam focus at large depth by increasing the number of probe's
elements involved in producing the ultrasound beam.
Wide aperture function can not be controlled manually by the
user When using linear or convex probes, the wide aperture
feature may turn on or off automatically, depending on various
scanning settings. In particular it turns on while placing the
focus marker at relatively large depth. Wide aperture
automatically turns off when focus is moved to a shallow
region.
Focal Marker Shapes
The focal marker shape changes to indicate different imaging
modes, as shown below:
•
: Standard focal marker.
•
: Wide Aperture is turned ON.
•
: Compound mode is ON.
•
160
: Coded Phased Inversion (CPI) mode is ON.
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M-Mode
M-Mode overview
1. Time motion cursor conventional M-Mode
2. Depth Scale
3. Focus Marker
4. Time Scale
Figure 4-4: The cardiac M-Mode screen (top/bottom)
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, or in the
optional modes: 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, and optional TVI, Tissue
Tracking, Strain rate and Strain modes.
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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
("Color M-Mode overview", page 168).
Note: 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.
M-Mode controls
M-Mode softkey controls
Horizontal sweep
Adjusts 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
frequencies, the
system switches
automatically to
second-harmonic
mode. The word
“Octave” appears
in the status
window.
Frequency
Enables the adjustment of the probe's operating frequency.
The selected frequency is displayed in the status window. For
some probes/applications the lowest frequency settings will be
Octave imaging settings.
Note: While changing the Frequency value on display, the
operator actually selects different transmit patterns associated
with that value, which includes transmit pulse shape, frequency
and transmit sequence.
Octave
Enables quick switching over between Octave imaging and
corresponding fundamental frequencies, without rotating the
Frequency selection rotary knob.
Focus Pos
Changes the location of the focal point(s). A triangular focus
marker indicates the depth of the focal point.
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Up/Down
Flips the M-Mode display 180 degrees.
Color maps
Displays 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. Use the trackball to point to a color map and press
SET to activate the desired map.
AMM
Anatomical M-Mode (option) is only available for cardiac
applications ("Anatomical M-Mode", page 165).
Compress
Controls the amount of contrast in the image. An index number
is displayed in the status window to indicate the relative level of
compression.
Reject
Adjust 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.
M-Mode Soft menu controls
Power
When power is
reduced, it reduces
the signal-to-noise
ratio, so that the
image, spectrum or
color scan 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.
Dynamic Range
Enables 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.
Contour/Edge Enhance
Controls image processing related to the extent of edge
enhancement applied to an image.
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Using M-Mode
Conventional M-Mode (greyscale)
1.
2.
Gain, Frequency,
Focus, Dynamic
Range and
Compression affect
also the 2D image.
3.
4.
5.
While in 2D-Mode press cursor on the control panel.
Use the trackball to position the cursor over the required
area of the image.
Press M - the M-mode sweep will start to sweep.
Adjust horizontal sweep, Gain, Frequency, Focus, Dynamic
Range, compression and Contour to optimize the display if
necessary.
Press FREEZE to stop imaging.
OR
1. While in 2D-Mode press M on the control panel. The
M-mode sweep will start to sweep.
2. Use the trackball to position the cursor over the required
area of the 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.
Conventional Color M-Mode
1.
2.
3.
4.
While in Color Mode press cursor on the control panel.
Use the trackball to position the cursor over the required
area of the image.
Press M - the Color M-mode sweep will start to sweep.
Press FREEZE to stop imaging.
OR
1. While in Color Mode press M on the control panel. The
Color M-mode sweep will start to sweep.
2. Use the trackball to position the cursor over the required
area of the 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.
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Anatomical M-Mode
Anatomical M-Mode is only available for cardiac applications.
Anatomical
M-Mode can also be
used with
previously acquired
digitally stored 2D
images.
The Trackball
softkey Pos
(Position) is
activated.
The Trackball
softkey Angle is
activated.
The Trackball
softkey Pos is
activated.
The M-Mode area of
the display updates
as the M-Mode
signal is
constructed.
1.
2.
Enter live M-mode.
Press the AMM softkey to enter Live Anatomical M-mode.
Continue to step 4 below.
OR
While in 2D-Live or 2D-Freeze modes, press ALT button and
press the AMM softkey
Y
OR
1. From the 2D Live, press FREEZE.
2. Press M to access the Freeze Anatomical M-Mode.
R over the required
3. Use the trackball to position the cursor
area of the image.
4.
Press SET to allow free rotation
A of the solid full-length cursor
line throughout the 2D image.
Rotate the solid cursor line to the desired direction.
Press SET twice and reposition the intersection point to the
desired position along
N the cursor line.
Repeat steps 4. and 5. to change the angle of the solid
I
cursor line if necessary.
5.
6.
7.
8.
Press TRACKBALL to activate scrolling control on the
trackball.
Use the trackball to scroll through the data acquired at that
location. The M-Mode display will vary accordingly.
M
9.
Curved Anatomical M-Mode
Curved Anatomical
M-Mode can also be
used with
previously acquired
L
digitally stored 2D
images.
1.
2.
3.
I
From the 2D or M-Mode view press ALT.
The alternative modes appear on the softkey display.
Press CURVED AMM.
Use the trackball to position the starting point of the time
motion curve.
E
R
P
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The time motion
curve can be edited
by following the
curve back to the
desired point and
redrawn as desired.
Following the curve
back to the starting
point will delete the
time motion curve.
4.
5.
6.
7.
Press SET to anchor the starting point of the time motion
curve.
Use the trackball to position the second point of the time
motion curve.
Press SET to anchor the second point of the time motion
curve.
Repeat step 5. and 6. up to seven times to draw a complete
time motion curve.
Optimizing M-Mode
"Application",
page 609
Except for
Contour, all the
controls listed in
the optimizing
M-Mode section
will also affect the
2D image.
166
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.
•
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 Mode overview
1. Probe orientation marker
2. Color bar
3. Color sector marker
4. Status window
5. Soft menu
Figure 4-5: The Color Mode screen
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Color M-Mode overview
1. Time motion cursors
2. Color bar
3. Focus marker
4. Flow sector marker
5. Time scale
6. Status window
7. Soft menu
Figure 4-6: The Color M-Mode screen (top/bottom display)
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Color Mode controls
Color Mode softkey controls
Horizontal sweep (Color M-Mode only)
Adjusts the horizontal refresh rate of the M-Mode area of the
display.
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. Baseline is available in both Live and Freeze.
Frame rate
Controls the Frame-rate by changing line density. When
adjusting frame rate, there is a trade off between spatial and
temporal resolution.
LVR (Low Velocity Rejection)
Color data produced
by very low flow
may cause
interference.
LVR, also called Wall motion filter, enables the extent of low
velocity removal to be adjusted.
Invert
Enables the color scheme assigned to positive and negative
velocities to be inverted. Invert is available in live and cine
replay.
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). Variance is available in live and cine
replay.
Simultaneous
Enables simultaneous display of 2D and Color mode,
side-by-side.
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Color maps
Displays a menu of color map options. Use the softkey rotary
knob to point to a color map and activate the desired color map.
Each color map is assigning different color hues to different
velocities.
Cineloop (in Freeze, Color 2D mode only)
Allocates different cineloop control functions to the softkeys.
Tissue priority
Emphasize 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.
Color-Mode Soft menu controls
Sample volume
Adjusts 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.
DDP (Data Dependant Processing)
Performs temporal processing, which reduces random noise
without affecting the motion of significant tissue structures.
Frequency
Enables 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.
Note: While changing the Frequency value on display, the
operator actually selects different transmit patterns associated
with that value, which includes transmit pulse shape, frequency
and transmit sequence.
Smart Depth
For best sensitivity in color-mode, the Color
Frequency/Transmit Pattern used should be optimized as a
function of the location of the color-ROI.
When ROI is set to a deep region in the body it is
recommended to decrease the Color Frequency value setting
in order to improve reception of the Doppler signals.
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When ROI is position in a shallow region, it is recommended to
increase the Color Frequency value setting in order to increase
the spatial resolution of the color image.
With Smart Depth turned ON, the system optimizes the Color
Frequency/Transmit Pattern using the above guideline, and
automatically sets an optimal setting to correspond with the
current location of Color-ROI. The associated Frequency value
displayed on screen changes accordingly.
The operator may change the Frequency control at any time to
any desired setting, overriding any automatic settings.
With Smart Depth turned OFF, the Frequency control setting
remains unchanged even while ROI depth setting is changed.
Lateral Averaging (Color 2D only)
Smoothes 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 Averaging
Use Averaging
controls with
caution so as not to
obscure significant
diagnostic
information
Smooths 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.
When power is
reduced, it reduces
the signal-to-noise
ratio, so that the
image 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.
Power
Trackball controls
ROI (Region Of Interest) size
When the trackball command Size is selected ("Trackball
operation", page 108), the height and width of the color area (or
ROI) is adjusted from the trackball.
ROI (Region Of Interest) position
When the trackball command Pos (position) is selected
("Trackball operation", page 108), the position of the color area
(or ROI) is adjusted with the trackball.
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Using Color Mode
Color 2D
The softkey controls
of the trackball are
displayed in the
trackball status bar
in the bottom right
corner of the screen.
1.
2.
3.
4.
5.
6.
From an optimized 2D image press COLOR.
Use the trackball to position the ROI frame over the area
to be examined.
Press SET. The instruction Size should be highlighted in the
trackball status bar. If not, press SET again to select Size.
NOTE: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
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.
Press SET when the desired size is obtained, to allow
repositioning of the ROI if desired.
Press FREEZE to stop imaging.
Color M-Mode
The softkey controls
of the trackball are
displayed in the
trackball status bar.
1.
2.
3.
4.
5.
172
From M-Mode press COLOR, or from Color-Mode press M.
Use the trackball to position the color area in the M-Mode
display.
Press the SET button. The instruction Size should be
highlighted in the trackball status bar. If not, press SET
again to select Size.
NOTE: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
Use the trackball to adjust the dimension of the color area.
To enlarge the color area, move the trackball up
To narrow the color area, move the trackball down.
Press SET when the desired size is obtained.
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Optimizing Color Mode
"Application",
page 609
The scale value may
affect FPS, Low
Velocity Reject, and
Sample Volume.
Frequency setting
may affect FPS, SV
and Low Velocity
Reject.
The Power setting
affects all other
operating modes.
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.
•
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
•
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.
•
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.
Use all noise reduction controls with care. Excessive
application may obscure low level diagnostic information.
CAUTION
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PW and CW Doppler
PW and CW Doppler overview
1. Sample volume (PW only)
2. Angle correction marker
3. Velocity scale
4. Low velocity reject
5. Nyquist velocity
6. Doppler baseline
7. Frequency scale (optional)("Overview", page 605)
8. Status window
9. Soft menu
Figure 4-7: The PW/CW Doppler Mode screen
Note: 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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PW and CW Doppler controls
PW and CW Doppler softkey controls
Horizontal sweep
Adjusts the horizontal refresh rate of the Doppler area of the
display. Horizontal sweep is available in live and cine replay.
Baseline
Enables 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
settings.
Scale
Enables 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 reject
Enables 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.
Occasionally, high
audio volume may
cause interruptions
or horizontal tonal
noise in CW
display, in such a
case lower the audio
gain.
Audio Vol.
If the Doppler mode
is combined with
Color mode, the
color map will be
also inverted.
Invert
Enables the loudspeaker volume control.
Enables the Doppler spectrum to be flipped 180 degrees, so
that negative velocities are displayed above the baseline and
positive velocities below the baseline. Invert in PW is available
in live and cine replay; invert in CW is available only in live
mode.
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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.
D Color maps
Displays a drop down menu of different Doppler colorization
maps. Use the softkey rotary knob to select the desired map
and activate the map.
PW/CW Doppler Soft menu controls
Quick angle and Angle correction
In non-cardiac
applications, Angle
correction is
controlled 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.
Sample volume
In 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.
Compress
Enables 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.
Reject
Enables 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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Frequency
Adjusts 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.
Power
When power is
reduced, it reduces
the signal-to-noise
ratio, so that the
image 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.
Using PW/CW Doppler modes
Controls and
operations for PW
and CW mode are
the same unless
otherwise noted.
There are two ways to start PW/CW Doppler:
Alternative 1
1.
2.
Sample Volume
adjustment may
affect the Scale,
Frame rate and LV
rej. settings.
3.
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.
Use the trackball to position the Doppler cursor line and in
PW the sample volume location over the area of interest.
In PW, with the Soft menu rocker key, adjust the sample
Volume (SV):
To enlarge the SV, press the Right arrow of the rocker
To narrow the SV, press the Left arrow of the rocker.
Alternative 2
1.
2.
3.
Press CURSOR on the control panel. A cursor line is
displayed on the 2D image.
With the trackball adjust the position of the cursor line.
Press PW or CW.
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Optimizing PW/CW Doppler modes
"Application",
page 609
Frequency and
Frame rate settings
may affect the Low
Velocity Reject.
The Doppler Power
setting affects only
Doppler operating
modes.
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.
•
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.
•
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).
Use all noise reduction controls with care. Excessive
application may obscure low level diagnostic information.
CAUTION
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.
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When Zoom is
active while in PW
or CW modes, use
the Depth rocker
button to adjust the
zoom magnification
factor
•
Use Angle correction to steer the ultrasound beam to the
blood flow to be measured (Not typically required during
cardiac studies).
Using ASO
Press the "Auto" button while in PW or CW modes. This will
activate the ASO function. Automatic Spectrum Optimization
(ASO) is used to automatically adjust baseline and scale of
current PW/CW spectrum to optimize the spectral display. It will
avoid the display of a folded spectrum and stretch the spectrum
vertically as large as possible.
ASO optimization is not continuous but performed
instantaneously each time the button is pressed.
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Tissue Velocity Imaging (TVI)
TVI overview
1. TVI sector marker
2. Status window
3. Soft menu
Figure 4-8: The TVI Mode screen
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.
TVI controls
TVI softkey controls
2D width
Controls the angular width of the 2D image sector.
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Lower scale value
allows greater depth
and lower Nyquist
limit.
Scale
Adjusts 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).
Baseline
Adjusts the color map to emphasize tissue motion either toward
or away from the probe. Baseline is available in both Live and
Freeze.
Frame rate
Controls the line density. When adjusting frame rate, there is a
trade off between spatial and temporal resolution.
Invert
Enables the color scheme assigned to positive and negative
tissue velocities to be inverted. Invert is available in live and
cine replay.
TSI
Starts TSI mode ("Tissue Synchronization Imaging (TSI)",
page 199).
Simultaneous
Enables simultaneous display of 2D image and 2D image with
TVI color.
TVI visible
Turns TVI display on/off. When TVI display is turned off the TVI
acquisition is still in turned on and raw-data is still acquired but
remains hidden from the display.
Cineloop (in Freeze only)
Starts cineloop acquisition.
Color maps
Displays a menu of color map options. Use the softkey rotary
knob to select and activate a desired color map. Each color
map is assigning different color hues to different velocities.
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Q-Analysis (in Freeze only)
Starts the Quantitative analysis application (Chapter 8,
"Quantitative Analysis", page 389).
Alternative softkey controls
Press ALT to access the following modes:
•
Tissue Synchronization Imaging ("Tissue Synchronization
Imaging (TSI)", page 199)
•
Tissue Tracking ("Tissue Tracking", page 184)
•
Curved Anatomical M-Mode ("Curved Anatomical
M-Mode", page 165)
•
Strain rate ("Strain rate", page 189)
•
Strain ("Strain", page 194)
TVI Soft menu controls
Compress
Controls the amount of color compression. The color bar is
adjusted accordingly.
Tilt
Enables 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. Tilting of the 2D image will tilt the TVI ROI
along with it.
Threshold
Controls the level of greyscale intensity that is used as a
threshold for color.
Transparency
Controls the degree of transparency of the TVI color.
Frequency
Enables the adjustment of the transmission frequency to
control the sensitivity or the level of penetration.
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Lateral Averaging
Use Averaging
controls with
caution so as not to
obscure significant
diagnostic
information
When power is
reduced, it reduces
the signal-to-noise
ratio, so that the
image may appear
noisier.
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 Averaging
Smooths 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.
Power
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 level permitted by regulatory
standards. The Thermal Index (TI) and the Mechanical Index
(MI) are displayed on the screen.
Using TVI
1.
2.
3.
The softkey controls
of the trackball are
displayed in the
trackball status bar
in the bottom right
corner of the screen.
4.
5.
Select the desired probe.
While in 2D mode press TVI on the control panel, then select
TVI soft-key.
Note: The keyboard on your Vivid S5 has the TVI button
even when the TVI option is not installed. Pressing this
button when the option is not installed will activate a
prompt that indicates option is not available.
Use the trackball to position the ROI frame over the area
to be examined.
Press SET. The instruction Size should be highlighted in the
trackball status bar. If not, press SET again to select Size.
Note: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
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 TVI
"Application",
page 609
The use of preset gives optimum performance with minimum
adjustment. If necessary, the following controls can be adjusted
to further optimize the TVI display:
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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
softkeys on the control panel.
PW will be
optimized for
Tissue Velocities
when activated
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.
Tissue Tracking
Tissue Tracking overview
1. Color sector marker
2. Tissue Tracking color bar
3. Status window
4. Soft menu
5. Track start and track end markers
6. Tracking start and end from R-peak
Figure 4-9: The Tissue Tracking Mode screen
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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.
Tissue Tracking controls
Tissue Tracking softkey controls
Tracking start
The time after ECG R-peak when the integration should start.
Tracking end
The time after tracking start when the integration should end.
Tracking scale
Controls the color cut-off value of max displacement displayed.
The chosen values is shown on the color bar when the softkey
is activated.
Frame rate
Controls the line density. When adjusting frame rate, there is a
trade off between spatial and temporal resolution.
Invert
Enables the color scheme assigned to positive and negative
tissue velocities to be inverted. Invert is available in live and
cine replay.
TSI
Starts TSI mode ("Tissue Synchronization Imaging (TSI)",
page 199).
Simultaneous
Enables simultaneous display of 2D image and 2D image with
Tissue Tracking color.
Cineloop (in Freeze only)
Starts cineloop acquisition.
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Color maps
Displays a menu of color map options. Use the softkey rotary
knob to select and activate a desired color map.
Q-Analysis (in Freeze only)
Starts the Quantitative analysis application (Chapter 8,
"Quantitative Analysis", page 389).
Alternative softkey controls
Press ALT to access the following modes:
•
Tissue Synchronization Imaging ("Tissue Synchronization
Imaging (TSI)", page 199)
•
Tissue Tracking ("Tissue Tracking", page 184)
•
Curved Anatomical M-Mode ("Curved Anatomical
M-Mode", page 165)
•
Strain rate ("Strain rate", page 189)
•
Strain ("Strain", page 194)
Tissue Tracking Soft menu controls
2D width
Controls the angular width of the 2D image sector.
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.
Threshold
Controls the level of greyscale intensity that is used as a
threshold for color.
Transparency
Controls the degree of transparency of the Tissue Tracking
color.
Frequency
Enables the adjustment of the transmission frequency to
control the sensitivity or the level of penetration.
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Use Averaging
controls with
caution so as not to
obscure significant
diagnostic
information
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.
Radial Averaging
Smooths 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.
Power
Controls the amount of acoustic power applied. When power is
reduced the signal to noise ratio is reduced, so that the image
may become noisier.
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 displayed on the top left corner.
Using Tissue Tracking
1.
2.
3.
4.
The softkey controls
of the trackball are
displayed in the
trackball status bar
in the bottom right
corner of the screen.
5.
6.
From 2D or TVI Modes, press ALT on the control panel and
select the TISSUE TRACKING softkey.
Adjust TRACKING START (softkey) close to the R-peak.
Adjust TRACKING END (softkey) near the T-wave.
Use the trackball to position the ROI frame over the area
to be examined.
Press SET. The instruction Size should be highlighted in the
trackball status bar. If not, press SET again to select Size.
Note: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
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 8,
"Quantitative Analysis", page 389.
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•
•
•
•
188
The main use of Tissue Tracking is to map positive systolic
displacements. This means that TRACKING START and
TRACKING END softkeys 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 softkey. 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
the apex).
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Strain rate
Strain rate overview
1. Color sector marker
2. Status window
3. Soft menu
4. Strain sample size
Figure 4-10: The Strain rate mode screen
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.
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Strain rate controls
Strain rate softkey controls
2D width
Controls the angular width of the 2D image sector.
SRI scale
Defines the scale for the color coding of the strain rate.
Frame rate
Controls the line density. When adjusting frame rate, there is a
trade off between spatial and temporal resolution.
Invert
Enables the color scheme assigned to strain rate to be
inverted. Invert is available in live and cine replay.
TSI
Starts TSI mode ("Tissue Synchronization Imaging (TSI)",
page 199).
Simultaneous
Enables simultaneous display of 2D image and 2D image with
Strain rate color.
Color maps
Displays a menu of color map options. Use the trackball to
point a color map and press SET to activate a desired color
map.
Q-analysis (in Freeze only)
Starts the Quantitative analysis application (Chapter 8,
"Quantitative Analysis", page 389).
Cineloop (in Freeze only)
Starts cineloop acquisition.
Alternative softkey controls
Press ALT to access to the following modes:
•
Curved Anatomical M-Mode ("Curved Anatomical
M-Mode", page 165)
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•
•
•
•
Tissue Synchronization Imaging ("Tissue Synchronization
Imaging (TSI)", page 199)
Tissue Tracking ("Tissue Tracking", page 184)
Strain rate ("Strain rate", page 189)
Strain ("Strain", page 194)
Strain rate Soft menu controls
Strain length
Determines the strain sample volume size. There is a trade-off
between noise and spatial resolution controlled by the Strain
length. To minimize noise the Strain length should be
maximized. A value of 12mm is typical for adult cardiac patients
("Optimizing Strain rate", page 192).
SRI Reject
Adjust the cut-off level of the low Strain rate to be discarded
when generating the color image. Rejected values are
displayed in green.
Compress
Controls the amount of color compression. The color bar is
adjusted accordingly.
Transparency
Controls the degree of transparency of the strain rate color.
Threshold
Controls the level of greyscale intensity that is used as
threshold for color.
Frequency
Enables the adjustment of the transmission frequency to
control the sensitivity or the level of penetration.
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.
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Use Averaging
controls with
caution so as not to
obscure significant
diagnostic
information.
Radial Averaging
Smooths 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.
Power
Controls the amount of acoustic power applied. When power is
reduced the signal to noise ratio is reduced, so that the image
may become noisier.
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 displayed on the top left corner.
Using Strain rate
1.
2.
The softkey controls
of the trackball are
displayed in the
trackball status bar
in the bottom right
corner of the screen.
3.
4.
From TVI Mode, press ALT on the control panel and press
STRAIN RATE.
Use the trackball to position the ROI frame over the area
to be examined.
Press SET. The instruction Size should be highlighted in the
trackball status bar. If not, press SET again to select Size.
Note: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
Use the trackball to adjust the dimensions of the ROI.
Optimizing Strain rate
•
•
•
192
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 8,
"Quantitative Analysis", page 389.
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).
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•
•
•
There is a trade-off between noise and spatial resolution
controlled by the Strain length. To minimize noise the
Strain length should be maximized. A value of 12mm is
typical for adult cardiac patients.
The maximum Strain rate that is color-coded can be
adjusted using the SRI SCALE softkey. 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.
Low strain rates may be masked out with a green color
using the SRI Reject control.
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Strain
Strain overview
1. Color sector marker
2. Strain color bar
3. Status window
4. Soft menu
5. Strain start and end markers
6. Strain start and end from R-peak and Strain sample size
Figure 4-11: The Strain mode screen
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.
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Strain controls
Strain softkey controls
Strain start
The 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 end
The 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 scale
Defines the scale for the color coding of the tissue deformation.
Frame rate
Controls the line density. When adjusting frame rate, there is a
trade-off between spatial and temporal resolution.
Invert
Enables the color scheme assigned to shortening and
elongation tissue deformation to be inverted. Invert is available
in live and cine replay.
TSI
Starts TSI mode ("Tissue Synchronization Imaging (TSI)",
page 199).
Simultaneous
Enables simultaneous display of 2D image and 2D image with
Strain color.
Color maps
Displays a menu of color map options. Use the trackball to
point a color map and press SET to activate a desired color
map.
Q-analysis (in Freeze only)
Starts the Quantitative analysis application (Chapter 8,
"Quantitative Analysis", page 389).
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Cineloop (in Freeze only)
Starts cineloop acquisition.
2D width (More menu)
Controls the angular width of the 2D image sector.
Alternative softkey controls
Press ALT to access to the following modes:
•
Curved Anatomical M-Mode ("Curved Anatomical
M-Mode", page 165)
•
Tissue Synchronization Imaging ("Tissue Synchronization
Imaging (TSI)", page 199)
•
Tissue Tracking ("Tissue Tracking", page 184)
•
Strain rate ("Strain rate", page 189)
•
Strain ("Strain", page 194)
Strain Soft menu controls
Strain length
Determines the strain sample volume size. There is a trade-off
between noise and spatial resolution controlled by the Strain
length. To minimize noise the Strain length should be
maximized. A value of 12mm is typical for adult cardiac patients
("Optimizing Strain", page 197).
Strain Reject
Adjust the cut-off level of the low tissue velocity to be discarded
when generating the color image. Rejected values are
uncolored.
Threshold
Controls the level of greyscale intensity that is used as
threshold for color.
Transparency
Control the degree of transparency of the strain color.
Frequency
Enables the adjustment of the transmission frequency to
control the sensitivity or the level of penetration.
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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.
Use Averaging
controls with
caution so as not to
obscure significant
diagnostic
information.
Radial Averaging
Smooths 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.
Power
Controls the amount of acoustic power applied. When power is
reduced the signal to noise ratio is reduced, so that the image
may become noisier.
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 displayed on the top left corner.
Using Strain
1.
2.
3.
4.
The softkey controls
of the trackball are
displayed in the
trackball status bar
in the bottom right
corner of the screen.
5.
6.
From TVI Mode, press ALT on the control panel and press
STRAIN.
Adjust STRAIN START close to the R-peak.
Adjust STRAIN END near the T-wave.
Use the trackball to position the ROI frame over the area
to be examined.
Press SET. The instruction Size should be highlighted in the
trackball status bar. If not, press SET again to select Size.
Note: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
Use the trackball to adjust the dimensions of the ROI.
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
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•
•
•
•
198
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 softkey. 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).
Low strain values may be masked out with a different color
using the Strain Reject control.
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Tissue Synchronization Imaging (TSI)
TSI overview
1. TSI start/end and TSI Cut-off
2. TSI start and end markers
3. QRS marker
4. TSI color bar
5. Status window
6. Soft menu
Figure 4-12: The TSI mode screen
TSI calculates and color-codes the time from onset of QRS to a
detected event, typically the time to peak systolic velocity.
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TSI controls
TSI softkey controls
Invert
Invert 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.
Frame rate
Controls the line density. When adjusting frame rate, there is a
trade-off between spatial and temporal resolution.
TSI
Starts/stops TSI Mode.
TSI Start
This rotary allows manual adjustment of TSI starting point.
TSI End
This rotary allows manual adjustment of TSI ending point.
Note: While in Freeze, press MORE to see the TSI Start / End
controls.
Q-analysis (in Freeze only)
Starts the Quantitative analysis application (Chapter 8,
"Quantitative Analysis", page 389).
Simultaneous
Enables simultaneous display of 2D image and 2D image with
TSI color.
Cineloop (in Freeze only)
Starts cineloop acquisition.
Color maps
Displays a menu of color map options. Use the softkey rotary
knob to select and activate a desired color map.
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Alternative softkey controls
Press ALT to access to the following modes:
•
Curved Anatomical M-Mode ("Curved Anatomical
M-Mode", page 165)
•
Tissue Synchronization Imaging ("Tissue Synchronization
Imaging (TSI)", page 199)
•
Tissue Tracking ("Tissue Tracking", page 184)
•
Strain rate ("Strain rate", page 189)
•
Strain ("Strain", page 194)
Physio softkey control
Press PHYSIO and MORE twice to access to the following
control:
QRS visible
Shows/hides the QRS marker on the ECG.
TSI Soft menu controls
TSI Cut-off
Controls 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.
Threshold
Controls the level of greyscale intensity that is used as
threshold for color.
Transparency
Control the degree of transparency of the TSI color.
Frequency
Enables the adjustment of the transmission frequency to
control the sensitivity or the level of penetration.
Power
Controls the amount of acoustic power applied. When power is
reduced the signal to noise ratio is also 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 displayed on the top left corner.
Using TSI
CAUTION
TSI requires correct QRS detection to function properly.
Therefore always check that the yellow circle markers on the
ECG are positioned correctly on each QRS complex before
proceeding with the analysis.
1.
2.
3.
4.
The softkey controls
of the trackball are
displayed in the
trackball status bar
in the bottom right
corner of the screen.
5.
6.
Ideally, perform the AVO and AVC Event Timing
measurements prior to starting TSI ("Event timing
measurements", page 277).
From TVI, or Tissue Tracking mode, select TSI.
Optionally adjust THRESHOLD.
Use the trackball to position the ROI frame over the area
to be examined.
Press SET. The instruction Size should be highlighted in the
trackball status bar. If not, press SET again to select Size.
Note: If the trackball control Pointer is selected, press
TRACKBALL to be able to select between Position and Size
controls.
Use the trackball to adjust the dimensions of the ROI.
TSI markers adjustments
The default TSI markers settings are:
•
TSI start: The time of the Event Timing measurement
Aortic Valve Opening (AVO). (If no AVO measurement is
available, 60 ms from the detected QRS is used.)
•
TSI end: The time of the Event Timing measurement Aortic
Valve Closure (AVC). (If no AVC measurement is available,
an estimated time of end systole + 200 ms. is used.)
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
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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. Press MORE and adjust TSI START and TSI END.
To store the modified marker 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 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 and ensure that both LV
walls and opposing walls are in the view.
Activate TSI from an optimized TVI display.
Low time to peak values may be masked out with a different
color using the TSI Cutoff control.
Optimize 2D gain for clean chamber
CTO or ATO can be used
Clean ECG trace
Acquire one or more complete heart cycles
Default TSI start and end times are suggested
When analyzing TEE images where systolic velocities are
negative, the detection mode may be changed to "Time to
peak negative velocity" using the Invert control.
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Additional scanning features
LogiqView
LogiqView 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.
Examples include scanning of vascular structures and
connective tissues in the arms and legs.
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.
Note: LogiqView is available only when Compound (below) is
turned off.
Using LogiqView
1.
2.
3.
4.
5.
6.
7.
8.
204
Perform a detailed examination of the anatomy/pathology.
Optimize parameters for tissue texture and visible window
prior to activating LogiqView.
Press the assigned key LOGIQVIEW.
To start acquiring the image, press 2D FREEZE. 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.
If required, press 2D FREEZE again to restart the acquisition.
To complete the scan, press FREEZE.
Adjust the assigned rotary LOGIQVIEW ROTATE to rotate
the acquisition.
Perform measurements.
Press IMG STORE.
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Note: Measurement error is within 5% of the distance you
measured for all linear probes.
Hint: When you scan, scan slowly and in a uniform motion
lengthwise, end-to-end (with or against the probe orientation
marker). LOGIQView acquires images via leading edge vectors
(and does not acquire slices, as in CINE). The image is being
stored as you perform the scan and you can watch the
LOGIQView as it is being acquired.
Uniform Motion
The quality and usefulness of LOGIQView images is affected
by transducer motion. Incorrect technique can contribute to
image distortion.
Guidance and precautions for uniform motion:
•
Continuous contact is required throughout the length of the
extended image. DO NOT lift the transducer from the skin
surface.
•
Always keep the transducer perpendicular to the skin
surface. DO NOT rock the transducer.
•
Keep the motion within the same scan plane, if possible.
DO NOT slide the transducer laterally.
•
Lateral turning (change in direction to follow anatomical
structure) can be accommodated with slower motion. DO
NOT make abrupt changes in direction.
•
The system accommodates a reasonable range of motion
velocity. DO NOT make abrupt changes in speed of motion.
Deeper scans generally require reduced speed.
Compound
Compound is a process of combining several frames from
different steering angles into a single frame. The 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 and 4C-RS curved probes in
2D live mode, or in the 2D image while in Color mode.
Compound is on by default.
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Using compound
•
Press the COMPOUND assigned key.
A compounded image is produced.
Note: Images that were acquired in compound mode are
sent to the EchoPac PC in DICOM-preview format rather
than in "raw-data" format.
B-Flow
B-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-Flow
1.
2.
While in Color flow, press the assigned key B-FLOW.
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 imaging
Blood 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.
Using blood flow imaging
1.
2.
206
While in Color flow, press the assigned key BFI.
Adjust Flow speckle. Increased Flow speckle enhances
hemodynamics.
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3.
Adjust the soft menu control BFI GAIN. Increased gain
enhances hemodynamic ("Optimizing Color Mode",
page 173).
Virtual Convex
Virtual Convex is designed to provide a wider field of view in
the far field, and is available on linear probes. While in
2D-mode, use the Virtual Convex soft-key to turn virtual
convex ON or OFF. When Virtual convex is turned on, you may
enter other scanning modes such as Color, Doppler or M-mode
and virtual convex will remain active on the 2D image.
Note: While Virtual Convex is turned on, the Zoom function will
always activate in "Display-zoom" mode only.
Note: Images that were acquired in compound mode are sent
to the EchoPac PC in DICOM-preview format rather than in
"raw-data" format.
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Chapter 5
Stress Echo
• Introduction ................................................................................... .. 210
• Selection of a stress test protocol template .............................. .. 211
• Image acquisition .......................................................................... .. 212
• Starting acquisition ................................................................... 213
• Continuous capture mode ........................................................ 217
• Analysis .................................................................................... 225
• Quantitative TVI Stress echo analysis ........................................ .. 230
• Accessing QTVI Stress analysis tools ...................................... 231
• Vpeak measurement ................................................................ 232
• Tissue Tracking ........................................................................ 235
• Quantitative analysis ................................................................ 235
• References ............................................................................... 236
• Editing/creating a template .......................................................... .. 237
• Entering the Template editor screen ........................................ 237
• Template editor screen overview ............................................. 238
• Editing/Creating a template ...................................................... 241
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Introduction
The Vivid S5/Vivid S6 ultrasound unit provides an integrated
stress echo package option, 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.
A stress echo examination consists of three steps:
•
Selection of a stress test protocol template ("Selection of a
stress test protocol template", page 211)
•
Image acquisition ("Image acquisition", page 212)
•
Stress analysis ("Analysis", page 225)
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Selection of a stress test protocol template
1.
"Editing/creating a
template", page 237
2.
3.
4.
5.
Press PROTOCOL to enter the stress echo mode.
The Protocol screen is displayed (Figure 5-1) showing the
default stress protocol for the current probe.
To use the current template:
Turn freeze off to initiate scanning.
To use another template:
Press the softkey TEMPLATE.
The template list is displayed.
Trackball to the desired template.
Press SET.
Turn freeze off to initiate scanning using the new template.
1. Projection selection
2. Level
3. Current acquisition
4. Projection
5. Group of views
Figure 5-1: The Protocol screen
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Image acquisition
Images 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 (Figure 5-2). 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.
1. Current view label
2. Template matrix
3. Current view (Green cell)
4. Timers
Figure 5-2: The stress mode acquisition screen
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Starting acquisition
"Timers", page 216
1.
2.
Smart Stress is
turned on by
default in factory
templates.
3.
"Editing/creating a
template", page 237
"Editing/creating a
template", page 237
4.
CAUTION
Turn freeze off to initiate scanning.
Perform a scan that conforms with the view that is
highlighted in the template matrix on the Clipboard window.
If the selected template has the option Smart Stress
turned on (this option is available only on Vivid S6) ("Smart
Stress:", page 240), 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.
Press STORE.
• 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 ("Cineloop operation",
page 110). 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.
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 (Figure 5-3).
Repeat previous steps until all required views are
completed.
If using DICOM Server dataflow for stress-echo acquisition,
images should not be saved to permanent archive before the
complete protocol exam is acquired.
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 (Figure 5-9).
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1. Current acquisition loop
2. Corresponding reference loop
Figure 5-3: 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 PROTO.IN/OUT
soft-key button.
2. Acquire the desired images outside the protocol.
3. Press the 2D mode button.
4. Press PROTO.IN/OUT soft-key button 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
be acquired in the template matrix, as images are stored.
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However, the order of scanning may be changed manually as
follows:
Manual selection of a view during acquisition
1. 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 image
1.
2.
3.
4.
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.
Turn freeze off to initiate scanning.
Scan and save the selected loop as explained in the
previous section.
Select in the dialog window if you want to Replace or Keep
the existing loop.
• Replace: the original image is deleted from the
examination and replaced by the acquired image.
• Keep: the original image is replaced by the acquired
image, but it is not deleted from the examination.
Note: When selecting Keep, both the new and the old
image will be associated with the current protocol cell and
you may later perform Wall Motion Scoring for this level in
the protocol using either the new or the old image. The
new image may be opened from the protocol, while the old
image may be opened manually from the clipboard.
After storage the system automatically highlights the next
available view to be acquired.
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Moving an acquired image
An Image can be moved from one cell to another during
acquisition. There are two ways to move images:
Procedure 1
1. When in the Protocol screen, press MORE (softkey menu).
2. Press the softkey MOVE IMAGES.
3. Trackball to the image to move (source cell).
4. Press SET.
5. Trackball to the destination cell.
6. Press SET.
The image is moved from the source cell to the destination
cell.
Procedure 2
1. In the Protocol screen, trackball to the cell containing the
image to move (source cell).
2. Press and hold down SET.
3. With the SET key still depressed, trackball to the destination
cell.
4. Release the SET key.
The image is moved from the source cell to the destination
cell.
Stored images
cannot 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 (Figure 5-4).
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1. Timers display
Figure 5-4: 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
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 ("Editing/creating
a template", page 237).
Continuous capture mode
Continuous 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
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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 ("Editing/creating a template",
page 237).
The buffer bar
When entering a level with Continuous capture enabled, a
Buffer bar is displayed in the Info window (Figure 5-5). 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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1. Scanner's state
2. Capture session
3. Pause session
4. Buffer gauge
5. Percentage of filled buffer
Figure 5-5: 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 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
(Figure 5-5).
2. Press 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.
The unit enters Freeze mode automatically once the buffer is
full and the captured loops are displayed in the Continuous
capture selection screen (below).
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Running Continuous capture
1.
The application
Exercise should be
used in order to get
maximum
continuous capture
buffer.
The Exercise
protocol template is
automatically
selected when the
application
Exercise is active.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Using Store all to
save the entire loop
may take up to 15
seconds on LocalArch-IntHD and
several minutes on
LocalArch-MOD.
13.
14.
220
Do all your pre-stress acquisitions in the Cardiac
application.
Press PROTOCOL to enter the stress echo mode.
The Protocol screen is displayed (Figure 5-1).
Press Template.
The template list is displayed.
Select the template Exercise 2x4.
Press Begin/Cont.
Acquire the resting loops in all four views.
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.
Note: Make sure the system is set to Exercise preset
before starting peak-stress acquisition.
When the patient is back on the bed, press STORE or 2D
FREEZE. The Continuous capture acquisition is started.
Acquire all your views.
The memory buffer gauge increases (Figure 5-5). When
memory filling exceeds 90%, the percent number turns
red.
Press FREEZE to finish.
Press the SELECT CYCLE softkey.
The Continuous capture selection screen is displayed
(Figure 5-6).
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.
Assign the cineloops to the four views ("Assigning and
storing the loops", page 223).
A dialogue window is displayed asking whether the entire
Continuous capture acquisition should be saved or not.
Press Delete to discard the loop
OR
Press Select later if you want to reselect any loops (open
the capture again from the Protocol screen).
OR
Press Store all to keep the entire loop.
Perform Analysis and scoring ("Analysis", page 225).
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Continuous capture with additional image acquisition
After acquiring Continuous capture, additional images can be
stored to the clipboard before the patient's heart rate decreases
toward recovery level. These additional images may be
acquired with other scanning modes (using the same probe
and application), before doing image assignment to the views:
1. Perform Continuous capture as described above (steps 1
to 10).
2. Press PROTOCOL twice on the control panel. Live scanning
is activated.
If the buffer is not filled up: press PROTO.IN/OUT on the
softkey menu. Live scanning is activated outside the stress
protocol.
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. Color flow,
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 ("Assigning and storing
the loops", page 223).
A dialogue window is displayed asking whether the entire
Continuous capture acquisition should be saved or not.
7. Press Delete to discard the loop
OR
Press Select later if you want to reselect any loops (open
the capture again from the Protocol screen).
OR
Press Store all to keep the entire acquisition.
The normal procedure is to discard the acquisition. The
loop is very big and will take a lot of disk space.
8. Perform Analysis and scoring ("Analysis", page 225).
Postponed image assignment
The assignment of the cineloops to the views can be done on a
later stage on a stored Continuous capture acquisition.
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1.
The continuous
capture loop is very
big, and ending the
exam may take
several minutes if
storing through a
slow network or
storing to a
removable media.
2.
3.
4.
5.
6.
7.
8.
9.
Perform Continuous capture ("Running Continuous
capture", page 220, steps 1 to 11).
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.
Re-open the examination if necessary.
Press PROTOCOL.
The Protocol screen is displayed.
Press on the Continuous capture thumbnail on the lower
left corner of the Protocol screen.
The Continuous capture selection screen is displayed.
Assign the cineloops to the views ("Assigning and storing
the loops", page 223).
Press Done when finished.
Perform Analysis and scoring ("Analysis", page 225).
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
images
OR
• 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
screen
•
Press RESTART CAPTURE.
The recording in memory is deleted and the Continuous
capture is started again.
Resume Continuous capture
•
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 (Figure 5-6).
1. Rotate CHANGE PAGE softkey to display other
pages.
2. Cycle number and total number of cycles
4. Red bar: pause session
5. Grey gauge: position of the highlighted loop
within the buffer area
3. Highlighted loop
Figure 5-6: The Continuous capture selection screen
Assigning a cineloop to a view
1. 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 SET.
A pop-up menu is displayed with the view names of the
template (Figure 5-7).
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The views that are
already assigned are
tick marked
(Figure 5-7).
3.
4.
5.
6.
7.
Saving the entire
acquisition may
take a few seconds
on the local hard
disk and several
minutes on a
removable media.
Trackball to the required view name.
Press SET.
The name of the view is displayed above the timers in the
loop window.
Repeat steps 1 through 4 to assign loops to the other views
of the level.
Press the softkey DONE when completed.
A dialogue window is displayed asking whether the entire
Continuous capture acquisition should be saved or not.
Press Delete to discard the acquisition.
OR
Press Store all to keep the entire acquisition.
The normal procedure is to discard the acquisition. The
acquisition is very big and will take a lot of disk space.
1. Assigned loop
2. Highlighted loop
3. Views pop-up menu
4. Highlighted views
5. Already assigned view
Figure 5-7: Loop assignment in Continuous capture
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Analysis
Analysis 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 5-9). The heart cycle loops in the display are
synchronized to enable comparison. Each loop in the quad
screen can be magnified, using the "Crop Images" function
("Crop images", page 607) or the zoom control ("Zoom",
page 122).
Image selection for analysis
Images can be selected manually or from a pre-defined group
in the Protocol screen.
Selection of images from a group
If groups of images have been defined in the protocol template
("Adding a group", page 243), the user can select a group of
images for analysis and sequentially analyze all images from
all groups from within the analysis screen (Figure 5-9).
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 SET to open images in the Analyze screen ("Scoring
acquired loops", page 228).
Note: Pressing ANALYZE (while no images are selected in
Protocol screen) automatically opens the first group of images
in the analysis screen.
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1. Select a Projection
2. Select an image
3. Select and open an Image group
Figure 5-8: Image selection from the Protocol screen
Manual selection of images in the Analysis screen
1. When currently in protocol analysis in the Stress analysis
quad screen (Figure 5-9), hold down SHIFT while performing
steps 2 to 4.
2. Trackball to the first image to select in the Template matrix.
3. Press SET.
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 screen
1. In a stress examination, press PROTOCOL.
A preview of the acquisitions is displayed.
2. Trackball to the first image to select.
3. Press SET.
The frame of the selected loop is highlighted.
4. Repeat steps 2 and 3 to select other images.
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Alternative: Double
click on the last
selected image to
open images.
5.
Press ANALYZE to open images in the Analyze screen
("Scoring acquired loops", page 228).
1. Selected loop (highlighted frame)
4. Change page or enter next image group
2. Highlighted segment name
5. Exit Wall motion scoring
3. Wall segment diagrams
6. displayed loops (highlighted frames)
Figure 5-9: The stress echo analysis screen (Quad screen)
Wall motion scoring
Wall motion scoring is used to evaluate wall motion in each
cardiac segment. The left ventricle myocardium is divided into
a number of segments (e.g. 16 or 18), and each segment is
assigned a score based on visual evaluation/"eye-balling". The
wall motion scoring results are linked to the stress level of the
image being evaluated. This means that for instance when
scoring a short axis projection and a long axis projection from
the same stress level, then common segments with the same
scoring value will be shown in the respective scoring diagrams.
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CAUTION
The wall motion scoring result is assigned to the stress level of
the image, but will not be updated if the image is moved to
another stress level in the protocol at a later time. Images should
be correctly placed in the protocol when performing wall motion
scoring.
Note: The number of segments (WMS segment model), the
range of scoring values (WMS scoring legend) and the initial
scoring value (WMS initial scoring) may be configured in
Config/Meas Text/Advanced under the Cardiac M&A category.
Scoring acquired loops
1.
To edit a score,
select it and choose
a new score.
Alternative: Press
the arrow heads at
the bottom of the
scoring diagram
(Figure 5-9)
2.
3.
4.
5.
6.
7.
228
After image selection ("Image selection for analysis",
page 225), press ANALYZE.
The Stress Echo Analysis screen is displayed (Figure 5-9).
Trackball to a segment in one of the scoring diagrams and
press SET.
The Score pop-up list is displayed (Figure 5-10).
Trackball to a score.
Press SET.
The score is displayed in the relevant segment area in the
diagram (Figure 5-10).
Repeat steps 1 through 3 to score relevant segments.
Rotate the softkey CHANGE PAGE to display next group of
images.
Repeat steps 1 through 3 to score relevant segments on the
new loops.
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1. Selected segment
2. Selected score
1. Scored segment
Figure 5-10: Segment scoring
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Quantitative TVI Stress echo analysis
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.
The Vivid S6 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.
Velocity
measurements in
mid and basal
segments of the
myocard will
contain
contributions from
the apical region of
the myocard. E.g. if
measured value in a
mid segment is
below the cutoff
value for this
segment then this
might relate to a
reduced function in
the mid or apical
region.
230
QTVI Stress is based on the assessment of peak velocity at
peak Dobutamine stress ("References", page 236). 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
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), (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
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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% ("References", page 236).
Three different analysis tools based on TVI data are available:
•
"Vpeak measurement", page 232: 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
("References", page 236).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", page 235: enables visualization of the
systolic contraction of the heart by color-coding the
myocardial displacement through the systole.
•
"Quantitative analysis", page 235: enables further
quantitative analysis based on multiple tissue velocity
traces.
The quantitative analysis is described in Chapter 8,
"Quantitative Analysis", page 389.
Note: QTVI analysis is not available on the Vivid S5. The Q
Analysis option is available on Vivid S5.
Note: On Vivid S6 systems, while activating the QTVI Stress
tools, the Smart Stress functionality is not operational even
though the flag remains turned ON. It operates as the regular
Stress package.
Accessing QTVI Stress analysis tools
The three QTVI Stress analysis tools are entered by pressing a
dedicated button on the scoring diagram (Figure 5-11) of the
selected view. Only views with TVI data acquired will display
QTVI Stress tools buttons on the respective diagrams.
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1. Vpeak measurement (V-peak measurement is displayed in views from peak levels and only after
scoring.)
2. Tissue Tracking
3. Quantitative analysis
Figure 5-11: QTVI Stress tools buttons
Vpeak measurement
This 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 ("References", page 236) to confirm the wall motion
scoring.
QTVI Stress can be used only in conjunction with wall motion
scoring analysis, as a guiding tool.
CAUTION
232
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 measurement
1.
2.
"V-peak
measurement
interpretation",
page 234
3.
4.
Perform segment scoring ("Scoring acquired loops",
page 228).
When performing scoring a view from a peak level, the
Vpeak measurement button (V) is displayed in the
corresponding diagram.
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
(Figure 5-12).
• 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.
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 (Figure 5-12).
Use the SEGMENT SELECT softkey to analyze the other
segments in the peak view,
Or
Select another scoring bullet in the diagram in one of the
peak views.
To turn off the Vpeak measurement tool
1.
2.
Trackball to one of the V button in the peak view scoring
diagrams.
Press SET in the trackball area.
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1. Threshold for current segment (green)
4. Vpeak threshold for current segment
2. Sampling point
5. Color-coded tissue velocity
3. Current segment
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%
Figure 5-12: Vpeak QTVI Stress display
V-peak measurement interpretation
The systolic Vpeak in the tissue velocity profile is automatically
detected and highlighted by a vertical bar (Figure 5-12). The
automatically detected Vpeak should be visually verified by the
user. In addition Vpeak thresholds are displayed as
color-coded horizontal lines (Figure 5-12). 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 ("References", page 236). The
result is highlighted by a color-coding of the thresholds lines,
the color-coding in the 2D image and the scoring bullet
(Figure 5-12).
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Tissue Tracking
Tissue 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 Tracking
1.
2.
3.
4.
Trackball to a loop with TVI data (usually an apical view at
peak level).
Press SET on the control panel.
Trackball to the corresponding Wall segment diagram.
Press T on the Wall segment diagram field (Figure 5-11).
The Tissue Tracking color overlay is displayed in the
Acquisition window.
Figure 5-13: Tissue Tracking display
Quantitative analysis
Quantitative analysis enables further analysis based on
multiple tissue velocity traces. Quantitative analysis is
performed using the Quantitative analysis package (Chapter 8,
"Quantitative Analysis", page 389).
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To start quantitative analysis
1.
2.
3.
4.
Trackball to a loop with TVI data (usually an apical view at
peak level).
Press SET on the control panel.
Trackball to the corresponding Wall segment diagram.
Press Q on the Wall segment diagram field to launch the
Quantitative analysis package (Chapter 8, "Quantitative
Analysis", page 389).
References
1.
236
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 template
The 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 ("Adding/deleting
levels and projections", page 241)
•
Assigning new labels to levels and projections ("Assigning
new labels to levels and projections", page 242)
•
Defining level options ("Configuring levels", page 242)
•
Defining new groups ("Adding a group", page 243)
Templates are edited/created from the Template editor screen.
Entering the Template editor screen
1.
2.
3.
4.
Press PROTOCOL to enter the stress echo mode.
Press the softkey TEMPLATE.
The Template pop-up menu is displayed.
Trackball to Template Editor.
Press SET.
The Template editor screen is displayed (Figure 5-14).
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Template editor screen overview
Figure 5-14: The Template editor screen
Template
Parameter
Description
Template:
• Select a pre-defined template from the
pop-up menu. The Protocol template
preview (below) is updated accordingly.
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Protocol template preview
Parameter
Description
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 SET in the actual
label field and type a new name.
• Q Stress acquisition: enables TVI data
acquisition for QTVI Stress analysis.
Template settings
Parameter
Description
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 ("Preview and
storage of a cineloop", page 421).
• 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
Parameter
Description
Grid size:
• Enter the number of levels and projections
for the selected template.
Timers:
•
: starts T1 and T2 timers automatically
Auto-start analysis:
•
: displays the Stress Echo Analysis
screen when the last acquisition is
performed.
Smart Stress:
Smart Stress option is available for Vivid S6
only.
•
: 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 ("Show
reference", page 239), 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
Parameter
Description
Pre-defined groups:
• Shows the image groups created.
• New group: creates a new image group.
Select the desired images on the template
preview ("Adding a group", page 243).
• Update group: edits a selected group after
new loop selection on the template preview
("Updating an existing group", page 243).
• Delete group: deletes selected group
("Deleting a group", page 243).
Editing/Creating a template
Selecting a base template to edit
1.
2.
Determine the
required number of
projections and
levels you need and
select the most
appropriate
foundation
template.
3.
4.
Factory templates
cannot be changed.
1.
Trackball to the Template pop-up menu on the upper left
corner of the Template editor screen.
Press SET on the arrow.
The Template pop-up menu is displayed.
Trackball to the base template to edit.
Press SET.
The selected template is displayed in the Protocol
template preview field, showing the levels and projections
and their labels.
Adding/deleting levels and projections
2.
Enter the number of levels and projections in the Grid size
field (Figure 5-14).
The new grid size is displayed in the Protocol template
preview field.
Press New Template to create a new template.
Or
Press Save Template to update the base template.
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The timers can also
be started or
stopped at any time
during stress
examination using
the softkeys T1 and
T2 on the control
panel.
Display timer(s)
•
Check the box(es) to display timer(s) as specified
(Figure 5-14).
Start analysis automatically
•
Check Auto start analysis to display the Stress Echo
Analysis screen when the last acquisition is performed.
Smart stress
Check Smart stress to store a subset of the image acquisition
settings (e.g., geometry, 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.
Assigning new labels to levels and projections
1.
2.
In the Protocol template preview field, Trackball to the Label
field that is to be changed.
Select the Label pop-up menu and press SET on the desired
pre-defined label.
Or
• If the Label field is empty:
Press SET and enter the label or projection name.
• If the Label field has a name to be changed:
Press SET 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:
•
Enter the desired number in the Cycles field.
Up to four cycles/cineloop can be stored.
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Continuous capture
•
Check Continuous capture if continuous image
acquisition throughout the level is desired.
When Continuous capture is selected, preview of cineloop
and reference display (below) during acquisition are not
possible.
Preview of store
•
Check Preview of store if review and adjustment of
cineloops before storage is desired.
Show reference
•
Check Show reference if the display of the corresponding
reference loop is desired during acquisition (dual screen
mode).
Adding a group
1.
2.
3.
4.
In the Protocol template preview field select the cells to be
part of the group.
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.
Enter the group name.
Press OK.
The new group is displayed in the Pre-defined group field.
Updating an existing group
A selected group is
highlighted by a
yellow frame.
1.
2.
3.
In the Pre-defined group field, select the group to edit.
The selected cell are highlighted in the Protocol template
preview field.
Either select (a) new cell(s) to add to the group or deselect
(an) existing cell(s) to remove from the group.
Press Update group in the Pre-defined group field.
The display in the Protocol template preview field is
updated accordingly.
Deleting a group
A selected group is
highlighted by a
yellow frame.
1.
2.
In the Pre-defined group field, select the group to delete.
Press Delete group.
The group is removed from the list in the Pre-defined
group field.
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Chapter 6
Contrast Imaging
• Introduction ................................................................................... .. 246
• Cardiac imaging ....................................................................... 246
• Non-cardiac imaging ................................................................ 247
• Data acquisition ............................................................................ .. 247
• Left Ventricular Contrast Imaging ............................................. 247
• LV Contrast overview ................................................................... .. 248
• LV Contrast controls ................................................................. 248
• Using LV Contrast .................................................................... 250
• Optimizing LV Contrast ............................................................ 251
• Vascular Contrast Imaging .......................................................... .. 252
• Abdominal Contrast Imaging ....................................................... .. 253
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Contrast Imaging
Introduction
Vivid S5/Vivid S6 supports:
•
Left Ventricular Contrast imaging: Optimized for
endocardial border detection and assessment of wall
motion and wall thickening ("Left Ventricular Contrast
Imaging", page 247).
•
Vascular Contrast imaging: optimized to visualize
contrast in larger vessels ("Vascular Contrast Imaging",
page 252).
•
Abdominal Contrast imaging: optimized to visualize
contrast in liver and kidney ("Abdominal Contrast Imaging",
page 253).
Appropriate training
WARNING
Only physicians or echo technicians who have received
appropriate training can use the Contrast applications.
Always read and follow carefully the manufacturer instructions
on the contrast agent label.
WARNING
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
The only contrast acquisition application available for cardiac
imaging is Left Ventricular Contrast imaging. The LV
Contrast (LVO) application is optimized for endocardial border
detection and assessment of wall motion and wall thickening.
This application requires the LVO Contrast option to be
enabled.
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Non-cardiac imaging
The following non-cardiac contrast acquisition applications are
available.
•
Vascular Contrast imaging: optimized to visualize
contrast in larger vessels, e.g. carotid artery. Requires the
Vascular/Abdominal Contrast option enabled.
•
Abdominal Contrast imaging: optimized to visualize
contrast in abdominal organs, e.g. liver and kidneys.
Requires the Vascular/Abdominal Contrast option enabled.
WARNING
Abdominal and Vascular Contrast applications are for research
purposes only. Diagnosis must not be based on results achieved
by contrast analysis alone.
Misdiagnosis based on image artifacts
WARNING
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.
Data acquisition
Left Ventricular Contrast Imaging
The Left Ventricular (LV) Contrast application has an optimized
system preset for Left ventricular opacification, optimal
resolution of endocardial borders delineationand for optimal
assessment of wall motion.
The LV Contrast application may help to identify LV thrombus
and evaluate wall motion.
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LV Contrast overview
1. Status window
2. Soft menu
Figure 6-1: The LV Contrast acquisition screen
LV Contrast controls
LV Contrast softkey controls
Width
Controls the size and angular width of the image sector. A
smaller angle generally produces a scan with a higher frame
rate.
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.
Frequency
Enables 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 (Coded
Phase inversion - multi-pulse).
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Ultra Definition (UD) Clarity
This control reduces the unwanted effects of speckle in the
ultrasound image ("Ultra Definition (UD) Clarity", page 156).
Focus Pos.
Changes 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 rate
Lower frame rate
gives better spatial
resolution.
Controls the line density.
Up/Down
Enables the 2D image to be flipped 180 degrees.
Left/Right
Enables 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 maps
Displays a 2D maps menu to optimized 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.
LV Contrast Soft menu controls
Power
Controls the amount of acoustic power applied to the
transmitted pulse.
Too high Power
level will destroy
the contrast agent.
Compress
Controls the degree of image contrast.
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Reject
Controls the Echo rejection level. When increased, low level
echoes are rejected and appear darker in the 2D image.
Dynamic Range
Controls the image contrast. A high dynamic range setting
gives a softer image. Decreasing the dynamic range will
provide a more black and white image.
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.
Contour
Controls the image processing related to the extent of edge
enhancement applied.
The Diff control
decreases the frame
rate and the number
of focal zones when
turned on.
Diff on/off
Affects the level of reverberation in the image. The
reverberation in the image is reduced when Diff control is
turned on.
DDP (Data Dependant Processing)
Performs temporal processing, which reduces random noise
without affecting the motion of significant tissue structures.
Using LV Contrast
The LV Contrast application works with the 3S-RS, M4S-RS
(Vivid S6 only) 5S-RS, 6T-RS, and 6Tc-RS probes.
1. Press PROBE on the control panel.
A list of the connected probes is displayed.
The Application menu for the selected probe is listed.
2. Trackball to LV Contrast application.
3. Press SET to launch the application.
4. Perform the acquisition.
Always read and follow carefully the manufacturer instructions
on the contrast agent label.
WARNING
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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
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
Too high Power setting will destroy the contrast agent in the LV
cavity.
CAUTION
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Vascular Contrast Imaging
Vascular 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 8L-RS and
9L-RS probes.
The application uses Coded Phase Inversion (CPI) (greyscale)
to maximize the contrast detection and visualization.
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.
WARNING
Abdominal and Vascular Contrast applications are for research
purposes 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.
Note: the Vascular Contrast application requires the
Vascular/Abdominal Contrast option enabled.
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Abdominal Contrast Imaging
Abdominal Contrast is intended for visualization of ultrasound
contrast agents in abdominal organs (e.g. liver or kidney).
The Abdominal Contrast application works with the 4C-RS
probe.
The application uses Coded Phase Inversion (CPI) (greyscale)
to maximize the contrast detection and visualization.
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.
WARNING
Abdominal and Vascular Contrast applications are for research
purposes 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.
Note: The Abdominal Contrast application requires the
Vascular/Abdominal Contrast option enabled.
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Chapter 7
Measurement and Analysis
• Introduction ................................................................................... .. 258
• About Measurement results display ......................................... 259
• The Assign and Measure modality .............................................. .. 260
• Starting the Assign and Measure modality ............................... 260
• Entering a study and performing measurements ..................... 261
• Measure and Assign modality ..................................................... .. 263
• Starting the Measure and Assign modality ............................... 263
• Post-measurement assignment labels ..................................... 264
• Cardiac measurements ................................................................ .. 267
• 2D Measurements .................................................................... 267
• M-Mode Measurements ........................................................... 271
• Doppler Measurements ............................................................ 274
• TSI Measurements ................................................................... 278
• Automated Function Imaging ................................................... 285
• AutoEF Measurements ............................................................ 305
• Vascular measurements ............................................................... .. 314
• B-Mode measurements ............................................................ 314
• Intima-Media Thickness ........................................................... 315
• M-Mode Measurements ........................................................... 320
• Doppler measurements ............................................................ 321
• Pediatric Calculations .................................................................. .. 325
• Overview .................................................................................. 325
• Hip Dysplasia Calculation ........................................................ 326
• Making Hip Dysplasia Measurement ........................................ 327
• Performing an OB exam ............................................................... .. 329
• Patient entry ............................................................................. 329
• Selecting probe and OB application ......................................... 332
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• OB Measurements and calculations ........................................... ... 335
• Introduction ............................................................................... 335
• B-Mode measurements ............................................................ 336
• M-Mode measurements ............................................................ 342
• Doppler Mode Measurements .................................................. 342
• OB parameter configuration ........................................................ ... 346
• Configuring OB M&A according to geographical regions ......... 346
• Measurement package configuration ......................................... ... 351
• Measurement package configuration - example ....................... 351
• User-defined formulas ................................................................. ... 356
• User-defined formula - example ...............................................356
• About units ................................................................................ 362
• Measurement result table ............................................................ ... 364
• Minimizing the Measurement result table .................................364
• Moving the Measurement result table ....................................... 364
• Deleting measurements ............................................................ 365
• Worksheet ..................................................................................... ... 366
• Overview ................................................................................... 366
• Using Worksheet ...................................................................... 367
• OB worksheet ............................................................................... ... 369
• Patient data ............................................................................... 370
• Measurement information ......................................................... 370
• Calculation information .............................................................371
• OB graphs ..................................................................................... ... 372
• Overview ................................................................................... 372
• Fetal Growth Curve Graph ........................................................ 373
• Fetal Trending ...........................................................................377
• Fetal Growth Bar Graph ............................................................ 378
• OB-Multigestational ...................................................................... ... 379
• Multiple Fetus ...........................................................................379
• GYN Measurements ...................................................................... ... 383
• Introduction ............................................................................... 383
• To Start a Gynecology Exam .................................................... 383
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• B-Mode Measurements ................................................................. .. 384
• Uterus length, width, and height ............................................... 384
• Ovary length, width, and height ................................................ 385
• Follicle measurements length, width, and height ..................... 386
• Endometrium thickness (Endo) ................................................ 386
• M-Mode Measurements ................................................................ .. 387
• Doppler Mode Measurements ...................................................... .. 387
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Introduction
A study is a set of
related
measurements, or
measurements that
are logically
grouped together.
The measurements
in a study are
sometimes used in a
formula to calculate
new parameters
(e.g. biplane volume
with EF, SV and
CO).
The Vivid S5/Vivid S6 Ultrasound unit provides functionality for
two measurement conventions:
•
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. You must select desired folder, Dimension,
Volumes, area, etc. 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 studies and their parameters are user-configurable. The
user can create its own studies containing the relevant
measurements only ("Measure Text", page 614).
•
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.
Only assigned measurements will be saved. Measurements
without assignment will be lost when scanning is resumed.
CAUTION
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About Measurement results display
Be aware of the following:
•
Measurement results display
By default the system always displays absolute values for
parameters measured in Doppler. This means that values
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 parameters
For 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 modality
In this measurement modality, the user selects a study
consisting in a set of related pre-labelled measurements.
Starting the Assign and Measure
modality
1.
Press MEASURE on the control panel.
The Measurement Menu is displayed in the Parameters
window (Figure 7-2).
The trackball cursor is in the parameter window, ready for
measurement selection.
1. Active application
2. Study
3. Selected study
4. Opened study
5. Measurements related to the
area study for the cardiac
application
Figure 7-1: Example of a measurement study
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Entering a study and performing
measurements
Note: When
entering the
Measurement mode
for the first time, the
Caliper tool is
selected by default.
1.
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 (Figure 7-2).
When re-entering
the Measurement
mode, the first
measurement in the
actual study that
has not been
performed is
selected by default.
2.
Select any required study (other than Generic study which
is reserved for the Measure and Assign modality).
Within the selected study, select the required parameter
which you intend to measure.
Perform the measurement. The parameter’s name and
measured value will appear in the result window.
3.
4.
To perform a measurement from another study
1.
2.
3.
4.
5.
Trackball to the required study.
Press SET 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.
Trackball to the measurement to perform.
Press SET on the trackball area to activate the
measurement tool.
The cursor is moved back to the scanning window.
Perform the measurement.
Completed measurements are marked with a check mark
(Figure 7-2).
When the measurement operation is completed the next
measurement on the list is automatically selected.
To skip a measurement in a study
1.
2.
Trackball to the desired measurement
Press SET to activate the measurement tool.
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1. Performed measurement
2. Next measurement is
automatically selected
Figure 7-2: Display of a performed measurement (example)
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Measure and Assign modality
In this measurement modality, the user performs a
measurement and assign a label.
Only assigned measurements will be saved.
CAUTION
Starting the Measure and Assign
modality
Alternative: Press
CALIPER on the
control panel and
select the
measurement tool
from the softkeys.
1.
2.
3.
1.
Press MEASURE on the control panel.
The Measurement Menu is displayed in the Parameters
window (Figure 7-3).
Select the Generic study if not already selected, and
trackball to the required measurement tool.
Press SET on the trackball area to activate the
measurement tool.
The cursor is moved back to the scanning window, ready
for measurement.
Measurement tools
Figure 7-3: The 2D Mode Measurement tools (Cardiac application)
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Post-measurement assignment labels
Each 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.
The selection of a
measurement
without pre-defined
labels will not
display the
Parameter label
menu.
2.
3.
4.
Trackball to the actual measurement in the Measurement
result table (Figure 7-4).
Press SET.
A Parameter label menu is displayed.
Trackball through the Parameter label menu to highlight the
required label.
Press SET to assign the highlighted parameter label to the
measurement.
The assigned measurements may be reviewed in the
Worksheet ("Worksheet", page 366). Up to five assigned
measurements with the same label can be stored in the patient
archive.
Only assigned measurements will be saved. Measurements
without assignment will be lost when scanning is resumed.
CAUTION
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1. Parameter Label menu
2. Selected label
Assignment
3. Assigned measurement
Figure 7-4: Measurement assignment
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To assign a user-defined parameter label
1. Trackball to the actual measurement in the Measurement
result table (Figure 7-4).
2. Press SET.
A Parameter label menu is displayed.
3. Trackball to User and press SET.
The Enter new parameter window is displayed.
Figure 7-5: The Enter new parameter window
4.
5.
266
Type a name for the parameter label.
Press OK.
The user defined parameter label is assigned to the
selected measurement.
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Cardiac measurements
2D Measurements
2D Length measurements
Alternative: Press
CALIPER on the
control panel and
press CALIPER
softkey.
See the Status bar
to get the next step
to perform.
The measurement
display color on the
2D image changes
from green to blue
after completion of
the measurement.
1.
2.
3.
4.
5.
6.
7.
Generate the 2D image.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Select Caliper in the Measurement Menu (Figure 7-1).
Trackball the cursor to the start point of the measurement.
Press SET to anchor the start point of the measurement.
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 SET to anchor the end point of the measurement.
The measurement result is displayed in the Measurement
result table.
9. Assign a label to the measurement ("Post-measurement
assignment labels", page 264).
10. Repeat steps 5 through 8 to make additional length
measurements.
2D length measurement ratio
The measurements
displayed on the 2D
image and the
corresponding
results are
numbered.
1.
2.
3.
Generate the 2D image.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Alternative: Press
CALIPER and DIST
RATIO softkey.
4.
5.
Select Dist. ratio in the Measurement Menu (Figure 7-1).
Perform two length measurements as described in steps 5
through 8 in the section above.
The measurement results including the ratio (%) of the two
measured lengths are displayed in the Measurement result
table.
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Editing 2D Length measurements
1.
2.
3.
4.
Trackball the cursor to one of the anchor points of the
measurement to modify.
Double-click the SET key to select the anchor point.
The selected marker turns green and is unanchored.
With the Trackball, reposition the marker.
Press SET to anchor.
2D Area measurements
Alternative: Press
CALIPER and AREA
softkey.
See the Status bar
to get the next step
to perform.
The measurement
display color on the
2D image changes
from green to blue
after completion of
the measurement.
The measurements
displayed on the 2D
image and the
corresponding
results are
numbered.
Alternative: Press
CALIPER, MORE
softkey and AREA
RATIO.
See the Status bar
to get the next step
to perform.
268
1.
2.
3.
4.
5.
6.
7.
Generate the 2D image.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Select Area (trace) in the Measurement Menu (Figure 7-1).
Trackball the cursor to the start point of the measurement.
Press SET to anchor the start point of the measurement.
Trace the area (planetary) with the Trackball.
The area and circumference fields are displayed in the
Measurement result table.
8. Press SET to complete the measurement.
The current measurement results are instantly updated
and displayed in the Measurement result table.
9. Assign a label to the measurement ("Post-measurement
assignment labels", page 264).
10. Repeat steps 5 through 8 to make additional area
measurements.
2D area measurement ratio
1.
2.
3.
4.
5.
Generate the 2D image.
Press FREEZEto stop the cineloop.
Press MEASURE on the Control Panel.
Select Area ratio in the Measurement Menu (Figure 7-1).
Perform two area measurements as described in steps 5
through 8 in the section above.
The measurement results including the ratio (%) of the two
measured areas are displayed in the Measurement result
table.
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Editing 2D Area measurements
1.
2.
3.
4.
Trackball the cursor to the anchor point of the area
measurement to modify.
Press SET twice (Double-click) to select the anchor point.
The selected marker turns green and is unanchored.
With the Trackball, reposition the marker.
Press the SET to anchor.
2D Volume measurements
For measurement
formulae, refer to
the Reference
Manual.
Alternative: Press
CALIPER and
VOLUME softkey.
See the Status bar
to get the next step
to perform.
The measurement
display color on the
2D image changes
from green to blue
after completion of
the measurement.
The measurements described in this section enable volume
measurement in a defined zone. The measurements tool
generates results by two methods:
•
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.
3. Press MEASURE on the Control Panel.
4. Select Volume in the Measurement Menu (Figure 7-1).
5. Trackball the cursor to the start point where a volume is to
be measured.
6. Press SET to anchor the start point of the measurement.
7. Trackball the cursor to draw the length. Use the trackball to
outline the area of interest.
8. Press SET to anchor the second point. A third caliper will
appear, marking the length of the ROI.
9. If required, drag the cursor with the Trackball to modify the
length marker.
The current area, circumference and Area/Length Volume
(Va-l) values are displayed in the Measurement result table
(Figure 7-1) and are instantaneously updated when
moving the cursor.
10. Press SET to complete the measurement.
The measurement results including Vmod (Simpson) are
displayed in the Measurement result table (Figure 7-1).
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The measurements
displayed on the 2D
image and the
corresponding
results are
numbered.
11. Assign a label to the measurement ("Post-measurement
assignment labels", page 264).
12. Repeat steps 5 through 10 to make additional volume
measurements.
2D Depth measurements
The measurements described in this section enable depth
measurement from the probe to a selected point.
Note: This measurement is disabled in the factory default
configuration. For details about on how to enable it through
configuration menu: "Measurement package configuration",
page 351.
See the Status bar
to get the next step
to perform.
The measurements
displayed on the 2D
image and the
corresponding
results are
numbered.
270
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 softkey 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.
6. Press SET to anchor the point.
The depth value (cm) is displayed in the Measurement
result table.
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M-Mode Measurements
In 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 measurements
Alternative: Press
CALIPER on the
control panel and
press CALIPER
softkey.
See the Status bar
to get the next step
to perform.
The measurement
display color on the
M-Mode changes
from green to blue
after completion of
the measurement.
The measurements
displayed on the
M-Mode image and
the corresponding
results are
numbered.
1.
2.
3.
4.
5.
6.
7.
Generate the M-Mode image.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Select caliper in the Measurement Menu.
Trackball the cursor to the start point of the measurement.
Press SET to anchor the start point of the measurement.
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 SET to anchor the end point of the measurement.
The measurement result is displayed in the Measurement
result table.
9. Assign a label to the measurement ("Post-measurement
assignment labels", page 264).
10. Repeat steps 5 through 8 to make additional length
measurements.
Editing M-Mode Length measurements
1.
2.
3.
4.
Trackball the cursor to one of the anchor points of the
measurement to modify.
Press SET twice (double-click).
The selected marker turns green and is unanchored.
With the Trackball, reposition the marker to a new position.
Press SET.
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Ao/LA study
Alternative: Press
CALIPER on the
control panel and
press the AO/LA
softkey.
See the Status bar
to get the next step
to perform.
The current value is
updated while
moving the cursor.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Generate the M-Mode image.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Select Ao/LA in the Measurement Menu.
Trackball the cursor along the time axis to the required point
to start measurement of Aorta root diameter.
Press SET.
The starting point for the measurement is anchored.
Trackball to the end point of the measurement.
Press SET.
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.
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)
•
FS (Fractional Shortening)
To perform LV study
1. Generate the M-Mode image.
2. Press FREEZE to stop the cineloop.
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Alternative: Press
CALIPER on the
control panel and
press the LV STUDY
softkey.
3.
4.
5.
6.
7.
8.
Press MEASURE on the Control Panel.
Select LV study in the Measurement Menu.
Trackball the cursor along the time axis to the required point
to start measurement of IVSd.
Press SET. The starting point for the measurement is
anchored.
Trackball to the end point of the measurement.
Press SET. 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 SET. 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 SET. The LVPWd measurement end point is
anchored and the value is displayed in the Measurement
result table.
3. Repeat steps 5 through 8 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.
Alternative: Press
CALIPER on the
control panel and
press the RV STUDY
softkey.
The current value is
updated while
moving the cursor.
To perform RV study
1. Generate the M-Mode image.
2. Press FREEZE to stop the cineloop.
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 SET. The starting point for the measurement is
anchored.
7. Trackball to the end point of the measurement.
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8.
9.
Press SET. 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.
Repeat steps 5 through 8 to measure RVIDs.
Both the RVIDd and RVIDs values are displayed in the
Measurement result table.
Doppler Measurements
For measurement
formulae, refer to
the Reference
Manual.
The following measurements may be calculated on Doppler
mode spectra:
•
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 measurements
Alternative: Press
CALIPER on the
control panel and
press the POINT
CALIPER softkey.
The measurement
display on the
spectrum and the
corresponding
results are
numbered.
Alternative: Press
CALIPER on the
control panel and
press the CALIPER
softkey.
274
1.
2.
3.
4.
5.
6.
Generate the spectrum to be measured.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Select Point in the Measurement Menu.
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.
Press SET to anchor the point.
The velocity (m/s) and pressure (mmHg) values are
displayed in the Measurement result table.
Velocity and Pressure caliper measurements
1.
2.
3.
4.
5.
6.
Generate the spectrum to be measured.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Select Caliper in the Measurement Menu.
Trackball the cursor to the start point of the measurement.
Press SET to anchor the start point of the measurement.
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7.
The measurement
display color on the
spectrum changes
from green to red
after completion of
the measurement.
The measurement
display on the
spectrum and the
corresponding
result are
numbered.
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.
8. Press SET 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
anchor point position
• Time difference (dT) between anchored points position
9. Assign a label to the measurement ("Post-measurement
assignment labels", page 264).
10. Repeat steps 5 through 8 to make additional
measurements.
Manual Doppler trace measurements
Adjust Compress
and reject controls
to optimize the
Doppler signal.
1.
2.
3.
Generate the spectrum to be measured.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Alternative: Press
CALIPER on the
control panel and
press the MANUAL
TRACE softkey
4.
Select Trace in the Measurement Menu.
A vertical green cursor is displayed on the spectrum.
Trackball the cursor to the start point on the left side of the
trace.
Press SET to anchor the start point of the measurement.
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.
Press SET 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)
Trackball the cursor to the start point of the next heart beat.
The measurement
display color on
spectrum changes
from green to red
after completion of
the measurement.
5.
6.
7.
8.
9.
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10. Press the SET to anchor the next heart beat starting point.
The heart rate (BPM) is displayed in the Measurement
result table.
Automatic Doppler trace measurements
Adjust Compress
and reject controls
to optimize the
Doppler signal.
1.
2.
3.
Alternative: Press
CALIPER on the
control panel and
press the AUTO
TRACE softkey.
4.
Generate the spectrum to be measured.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
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 SET to anchor the start point of the measurement.
7. Trackball to the end trace position.
8. Press SET 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 SET to anchor the next heart beat starting point.
The heart rate (BPM) is displayed in the Measurement
result table.
MV E/A ratio
Adjust Compress
and reject controls
to optimize the
Doppler signal.
1.
2.
3.
Generate the spectrum to be measured.
Press FREEZE to stop the cineloop.
Press MEASURE on the Control Panel.
Alternative: Press
CALIPER on the
control panel and
press the MV E/A
RATIO softkey.
4.
5.
6.
7.
8.
9.
10.
Select MV E/A ratio in the Measurement Menu.
Trackball the cursor to the peak of the E wave.
Press SET to anchor the point.
Drag cursor to baseline to mark dT.
Press SET on the trackball area to anchor the second point.
Trackball the cursor to the peak of A wave.
Press SET 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.
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Measurements on protocol images
When performing measurements on images acquired in a
protocol, the measurement results will be associated with the
protocol level of the image. Average values will be calculated
for each protocol level.
For example you may measure LVOT Diam for images
acquired outside protocol and for images on each level of an
Exercise 2x4 protocol, leading to the following results in
worksheet:
Parameter
CAUTION
Value
Method
M1
M2
LVOT Diam
1.0 cm
Avg.
1.1
0.9
LVOT Diam, Rest
1.1 cm
Avg.
1.0
1.2
LVOT Diam, Peak
1.2 cm
Avg.
1.2
Measurement results associated with a stress level will not be
updated if the image is moved to another stress level at a later
time. Images should be correctly placed in the protocol when
performing measurements.
Event timing measurements
Event timing enables the time measurement for opening and
closure of the Aorta and Mitral valves, as referred to the
automatically detected QRS marker, which normally is on the
rising slope of the R-wave.
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.
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4.
5.
6.
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
Trackball the cursor to the corresponding point on the
spectrum for the selected measurement.
Press SET to anchor the point.
The event timing measurement (ms) is displayed in the
Measurement result table.
When an event timing measurement is performed, the
QRS markers are displayed on the ECG trace and correct
QRS marker position should be verified before the Event
Timing measurements are performed.
TSI Measurements
Each sample in the TSI image represents the time to the
maximum velocity within the chosen TSI search interval from
TSI Start to TSI End. The TSI search interval can be configured
("TSI controls", page 201).
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.
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 measurement
1.
2.
278
Acquire a TSI apical loop.
Press MEASURE.
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3.
4.
5.
In the Measurement menu, select Generic and Time to
peak (Figure 7-6).
The TSI loop freezes at the TSI end frame.
Place a point in the middle of a basal or mid-level
myocardial segment in the TSI image.
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 (page 284).
Figure 7-6: TSI Generic Time to peak measurement screen
Segment Time to peak measurements
1.
2.
Acquire TSI loops from all three apical views.
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 (Figure 7-7).
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3.
4.
5.
280
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.
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
Select TSI Bull’s eye report in the Measurement menu.
The measurements are displayed in a color coded bull’s
eye diagram together with a list of the calculated TSI
indexes.
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Figure 7-7: 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
(Figure 7-8).
2. Press SET 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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1. TSI ROI
2. TSI trace
3. TSI Time to peak marker
Figure 7-8: TSI trace
Time to peak measurement in Q Analysis
1.
2.
3.
4.
5.
282
From a TSI apical loop, press Q Analysis.
Place a sample area in a myocardial segment. A velocity
trace is displayed in the Analysis window (Figure 7-9).
Press MEASURE.
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.
In the Analysis window, measure the time from the yellow
QRS marker to the peak velocity of the velocity trace.
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1. Time measurement tool
2. Sample area
3. QRS marker
4. Time to peak measurement
Figure 7-9: 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.
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CAUTION
284
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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Automated Function Imaging
Automated Function Imaging (AFI) is a decision support tool for
regional assessment of the LV systolic function. AFI is a tool
derived from the 2D Strain, which tracks and calculates the
myocardial tissue deformation based on feature tracking on 2D
grey scale loops.
AFI is used to compute local and global tissue deformations in
the myocardium.
The purpose of AFI is to provide the user with a decision
support tool when reporting myocardial function.
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 (Figure 7-10).
The result is presented as a Bulls-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, Average Global Strain for the whole
LV, and the Aortic Valve Closure time used in the analysis are
stored to the worksheet.
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APLAX
4-Ch
2-Ch
Step
Acquired views
Defining a ROI
Tracking validation
AVC timing adjustment
Parametric image result
Review screen
Trace and Bulls-Eye result
Figure 7-10: AFI workflow
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Acquisition
1.
2.
3.
Create an exam, connect the ECG device and make sure
to obtain a stable ECG trace.
Acquire 2D grey scale cineloops of an Apical long axis
(APLAX) view, an Apical 4 chamber view and an Apical 2
chamber view.
Store the loop (must store).
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 high frame rate is recommended for high heart
rate.
•
The scanner should be configured to store at least 100 ms
before and after each heart cycle,
- or •
The scanner should be configured to store 3 loops or more.
•
If the stored loop contains 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 AFI
1.
2.
Open an APLAX view and press MEASURE.
In the Measurement menu, select AFI. The View selection
menu is displayed (Figure 7-11).
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Figure 7-11: Measurement and View selection menus
3.
Select APLAX.
The AFI application is started. A ROI can be defined.
Note: 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.
AFI on the APLAX view
Defining a ROI
When 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.
To define a ROI, place three points at the endocardial border;
two annular points at the base and one at the apex
(Figure 7-12). 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. Should you wish to turn it off use the
YOYO soft button.
Note: In case the Yo-yo function is not running place the
trackball pointer in the vicinity of the contour trace to activate it.
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Figure 7-12: Defining a ROI
After placing the apex point the ROI is displayed (Figure 7-13)
Note: Correct ROI definition is important for accurate
measurements. 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.
Figure 7-13: ROI Generation
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You may adjust the shape of the ROI by moving the cursor over
the inner ROI border, select an anchor point (red circle), press
and hold SET button and move the red mark to a new location
(Figure 7-14). The shape of the ROI is updated accordingly.
Figure 7-14: Selected anchor point on the inner ROI border
Note: System may be configured so that data processing is
started automatically if the cursor is not moved for a few
seconds (Figure 7-15).
If the ROI needs to be adjusted make sure to make the changes
immediately after the ROI is displayed.
CAUTION
Note: The auto processing function is configurable (from
Config/Meas-Text/Advanced/AFI/AutoEF auto processing).
Figure 7-15: AFI auto processing configuration
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Softmenu
Select Frame - Prior to the placement of the 3 points you may
select a different frame from the default one. Marked by a blue
vertical bar over the ECG trace.
YOYO - When turned ON the image will loop through some of
the neighboring frames to allow improved visualization of the
anatomy.
Left and Right Marker - Allows to correct the placement of the
yellow markers over the ECG trace and define the R-R interval
correctly.
Redraw - Allows to go back to previous screen and re-position
the three points.
ROI Width - May be adjusted to include more or less of the
myocardial tissue that needs to be assessed by AFI.
Process - Starts the speckle analysis of the tissue within the
selected ROI.
Quick Tips
Correct 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 (below).
Base
1.
2.
Correct
Wrong
Correct position of
the base points.
The ROI extends
into the aortic tract.
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Apex
1.
2.
2.
292
Wrong
Correct
Wrong
Correct position of
the Apex point.
The apex point is
placed too high. The
ROI is extending
beyond the
epicardium.
Apex
1.
Correct
Correct position of
the Apex point.
The upper right
border of the ROI is
way too much into
the chamber cavity.
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Bulges
1.
2.
Correct
Wrong
Correct
Wrong
Correct ROI
ROI should not be
bulging or follow the
papillary muscle
("ROI Adjustment",
page 296).
General
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.
Processing
After the processing has been completed, the following screen
appears.
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1. Display Quick Tips on tracking quality assessment
2. The ROI divided in segments
3. The Scoring table
•
: acceptable tracking
•
: unacceptable tracking
4. Bulls-Eye icon:
• Segments with yellow border: segments being analyzed.
• Green segments: segments already analyzed.
• Black segments: segments not analyzed.
Figure 7-16: Tracking Validation screen
Softmenu
Speed - Allows to slow down the loop play-back speed.
Syst YOYO - When turned ON the image will loop over the
systolic portion of the heart cycle.
Recalc - Allows to go back to previous screen in order to
manually correct the ROI.
Approve - Press Approve once the tracking quality has been
validated.
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The ROI is divided into segments. The tracking quality for each
segment is automatically evaluated and summarized in the
Scoring table (Figure 7-62).
Tracking Validation
The tracking for each segment must be visually controlled and
validated. Poor tracking quality could result from a variety of
causes. Select Quick tips (Figure 7-62) 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).
•
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).
To validate the Tracking:
1. Inspect each segment and make sure that the center line is
moving together with the underlying 2D image.
Note: 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 unacceptable (
).
If the tracking needs to be improved for some segments,
the user can modify the ROI ("ROI Adjustment",
page 296). 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, or Approve
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softkey. The user is asked to confirm or adjust the AVC
timing setting ("Timing Validation", page 296).
ROI Adjustment
1. Press RECALC.
2. The following adjustments can be done:
• Adjust ROI WIDTH.
• Press Redraw 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.
Press the Process softkey, or allow data processing to start
automatically if the cursor is not moved for a few seconds
(configurable).
The Tracking validation screen is displayed for tracking
validation.
Timing Validation
Timing 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 tool) 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 Adjustment
Note: This procedure is available in the APLAX view only.
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1.
2.
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.
A message appears.
To keep the current AVC setting, press SET. To change the
AVC setting, use the trackball to display another frame and
press SET.
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.
The Parametric systolic strain APLAX view is displayed
(Figure 7-17).
Figure 7-17: Parametric systolic strain APLAX view
Note: The image will not be saved unless Store is pressed.
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Press Quad softkey to display a quad screen (Figure 7-18)
showing:
•
2D image with the ROI
•
2D image with Peak systolic strain parametric data
•
Segmental curves with peak marker
•
Curved M-Mode image with strain parametric data
•
ECG trace and "QuickTip" help
Figure 7-18: Quad screen for the APLAX view
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
(Figure 7-11).
•
Define a ROI ("Defining a ROI", page 288).
•
Tracking Validation ("Tracking Validation", page 295).
Note: the AVC timing setting defined in the APLAX view is used
by the system when running AFI on the other apical views.
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Figure 7-19: 4-ch and 2-ch Parametric systolic strain images
Results
For the APLAX and apical 4-chamber views the following
results are available:
•
Single screen (Figure 7-17) displaying a 2D image with
strain parametric data.
•
Quad screen (Figure 7-18) displaying:
• 2D image with the ROI
• 2D image with Peak systolic strain parametric data
• Curved M-Mode image with strain data
• Segmental curves
• ECG trace and "QuickTip" help
CAUTION
If auto-AVC is used as AVC timing calculation method when
running AFI ("AVC Timing Adjustment", page 296), 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 therefore preliminary values. Only final
strain values should be reported.
If you enter Quad screen again after all three loops have been
processed, the strain values will be correct.
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When performing AFI on all three apical views the following
results are also available:
•
Review screen (Figure 7-21) displaying:
• 3 processed apical views
• Bulls-Eye with different user-selectable presentations
("Bulls-Eye presentation", page 300).
•
BE+Traces screen (Figure 7-22) displaying:
• Segmental curves for each three Apical views
• Bulls-Eye with different user-selectable presentations
("Bulls-Eye presentation", page 300).
•
Single Bulls-Eye screen (Figure 7-23) displaying:
• Bulls-Eye with different user-selectable presentations
("Bulls-Eye presentation", page 300).
•
Global Strain (GS) values for all three apical views.
In a given view the Global Strain (GS), also called Global
Longitudinal Peak Strain (GLPS), is defined as the
percentage of maximal contraction over the whole cardiac
cycle of the entire myocardial wall relative to its end
diastolic length.
•
Averaged global Peak strain value from all three apical view
data.
•
AVC measurement (either automatic, event timing
measurement or manual ("AVC Timing Adjustment",
page 296).
•
APLAX heart-rate
Bulls-Eye presentation
The Bulls-Eye in the different screens displays the Peak
Systolic strain presentation. It shows the segmental Peak
systolic strain (PSS) color coding (different shades of blue-red)
with segmental Peak systolic strain values and other
calculations.
Note: The Bulls-Eye can be configured to display either 18 or
17 segments (from Config/Meas-Text/Advanced/ AFI Segment
model)(Figure 7-15).
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 Bulls-Eye (from
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Config/Meas-Text/Advanced/AFI PSS/PSI Mode)
(Figure 7-15).
Changing the Bull's Eye map
The Bull's Eye is presented with a color coding map whose
colors are associated with different ranges of PSS or PSI
values.
1.
2.
To change a color-coding map:
Press the BE Map rotary softkey.
A list of color maps appears (Figure 7-20).
Select one of two available PSS color maps,
- or Select a PSI color map, in which case the segmental
values change from PSS to PSI values.
Figure 7-20: Selecting a color map
Getting Results
When approving the tracking in the Apical 2-chamber the
Review screen with three Apical views and Bulls-Eye is
displayed (Figure 7-21). Select Bulls-Eye only to display the
Single Bulls-Eye screen (Figure 7-23).
Figure 7-21: Review Screen
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Figure 7-22: BE+Traces Screen
Figure 7-23: Single Bulls-Eye screen
To save a snapshot, press STORE. To save the results exit AFI
and answer Yes to the prompt Do you want to store?. Once the
results are saved, the measurements are available in the
Worksheet and can be used in the report.
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If the tracking quality of a segment was scored as Not
acceptable (
), the colorimetric display on the Bulls-Eye
is greyed (Figure 7-24).
1. Segment with tracking quality scored as Not acceptable (
).
Figure 7-24: Colorimetric display
Peak detection
The peak systolic strain detection for each segment can be
verified and eventually manually changed.
To adjust the peak detection:
1. Press BE+Traces.
The Bulls-Eye and Traces screen is displayed
(Figure 7-22) showing:
• Trace plots for all three loops
• Bulls-Eye with Peak systolic strain values
2. To change the peak marker position on a curve:
• Press Set on the peak marker (square point) on one of
the curves, move the peak marker to a new position and
press the Set key again to fix the point.
- OR • Place the cursor on a segment in the Bulls-Eye. The
corresponding curve is highlighted.
3. Click on the segment to select the corresponding peak
marker and move it to a new position.
The position of the AVC marker can also be checked in the
Bulls-Eye and Traces screen. If needed, the APLAX view
should be reprocessed to change the AVC time.
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About the Results
Be 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 the report and the review page
the Single Bulls-Eye screen must be saved.
•
All results shown (curves and colors) 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 (
).
•
If the tracking quality was scored as Not acceptable
(
) in more than one segment, the Global peak strain
value is not calculated.
Figure 7-25: Worksheet results AFI
Note: Do not disable any sub-measurement of AFI using
Config. tab, as this will disable the whole set of AFI
measurements.
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Reprocessing data
The data from one or several views from a saved AFI analysis
may be reprocessed. When reprocessing a AFI analysis new
result screens are created.
1. Double-click on the Bulls-Eye thumbnail.
A quad screen is displayed showing the three apical views
and the Bulls-Eye diagram.
2. Select the view to reprocess and perform the analysis
("Acquisition", page 287).
AutoEF Measurements
Automated Ejection Fraction (AutoEF) is a semi-automatic
measurement-tool used for measurement of the global EF
(Ejection fraction). The AutoEF tool is utilized as optional
decision support tool in the system.
The AutoEF tool is derived from 2D speckle tracking algorithm,
which tracks and calculates the myocardial tissue deformation
based on feature tracking on 2D grey scale loops.
AutoEF is performed on either one or both apical 4-chamber or
2-chamber views, in any order.
The result is presented as Ejection Fraction value for each view
and average Ejection Fraction for the whole LV are stored to
the worksheet.
Note: AutoEF tool is intended for adult cardiology and is not
intended to be used in pediatrics cardiology. AutoEF tool is
therefore only available when using the following probes:
M4S-RS (on Vivid S6 only), 3S-RS, 5S-RS.
Acquisition
1.
2.
Create an exam, connect the ECG device and make sure
to obtain a stable ECG trace.
Acquire 2D grey scale cineloops of an Apical 4 chamber
view and an Apical 2 chamber view.
• The frame rate should be between 35 and 100 frames
per second. A higher frame rate is recommended for
high heart rate.
• The scanner should be configured to store at least
100 ms before and after each heart cycle.
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• 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.
Note: The AutoEF processed image runs slower than the
original speed of the heart-rate. To see the loop in correct
playback speed exit AutoEF.
Starting AutoEF
1.
2.
Open any one of the stored views and press MEASURE.
In the Measurement menu, select AutoEF. The View
selection menu is displayed (Figure 7-26).
Figure 7-26: Measurement and View selection menus
3.
4.
Select the name of the current view: 4-ch or 2-ch. A ROI
can be defined.
Place 3 points, 2 on the basal area and one on the apex
according to the guidance.
Tracing the endocardial border
When selecting a view to analyze, the system automatically
displays a frame where the endocardial border is usually
clearly visible. To use another frame, adjust SELECT FRAME.
To trace the endocardial border, place three points at the
endocardial border; two annular points at the base and one at
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the apex. Follow the indications displayed on the screen when
placing the three points.
After placing the third point on the Apex an endocardial border
will automatically be traced (Figure 7-27).
Note: Correct border tracing is important for an accurate EF
measurement. The system has an adaptive border tracing
function: using the endocardial three points as a guide, the
system will analyze the image and automatically adapt the
border tracing to an optimal position.
Note: the Yo-yo function is turned on to help finding correct
location for the points.
Editing the endocardial border tracing
1. If required, use the Left/Right Edge Shift softkey controls
to delineate separately the left or right portions of the
endocardial border visually as best as possible.
2. If required, move the trackball cursor over the border trace,
select an anchor point (red circle), press SET and correct
the trace by dragging the anchor point to a new location
(Figure 7-28). The shape of the border trace will update
accordingly.
3. In case you wish to start over, press Redraw and
re-position the 3 points defining the basal and apex points.
Figure 7-27: Defining a ROI
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1. Place the trackball cursor over the desired point.
2. Selected point is marked by a red circle.
3. Click over the red circle, it will turn to a square.
4. Move the square to re-align the border trace
Figure 7-28: Selected anchor point on the inner border trace
Press the Process soft-button when ready.
Note: Data processing is configured by default to start
automatically if the cursor is not moved for a few seconds. If the
trace needs to be adjusted make sure to make the changes
immediately after the ROI is displayed.
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Figure 7-29: EF Results Screen
Figure 7-30: EF Results Screen - Alternative dual screen mode
EF Results screen
When processing is complete the screen is generated
(Figure 7-29).
Note: The bi-plane results (BiP) will only appear on screen
(Figure 7-29) after measuring both 2-Ch and 4-Ch views.
The AutoEF
processed image
runs slower than
the original loopspeed. In order to
see the loop in
correct playback
speed exit autoEF.
The running loop is shown on the left. A green dotted line
marks the inner border of the chamber. In case of poor
tracking, the system will automatically display parts of the
border in red.
The system will automatically pick the frames with the maximal
area (ED) and minimal area (ES) and place them on the right
area of the display.
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The End Diastolic volume (EDV) and end Systolic Volume
(ESV) is calculated and shown above each frame.
The resulting EF calculation is displayed on top of the screen.
Tracking Validation
The tracking must be visually controlled and validated. If the
tracking results are visually correct press the red Approve
button. The button turns green and is labeled Approved. The
calculated values will be stored and later appear in the
worksheet.
If tracking needs correction there are several options:
•
If required, press Layout softkey to enlarge the ES and ED
frames and position them side-by-side (Figure 7-30).
•
You may manually select a different ED frame or ES frame
using the ED frame or ES frame softkeys.
•
You may edit any misaligned point on either ED or ES
frames. This is done by:
a. Placing the trackball cursor over the desired point.
b. Clicking over the red circle, it will turn to a square.
c. Pressing SET. The ESV, EDV and EF will be
recalculated accordingly.
d. Moving the square to re-align the border trace
(Figure 7-31) by:
Figure 7-31: Border Trace Edit
•
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In case these results are incorrect you may go back to the
previous step by pressing the Recalc soft-button and
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•
editing the endocardial border ("Tracing the endocardial
border", page 306).
In case editing the endocardial border is too difficult you
may start all over again by pressing Redraw and retrace
the border ("Tracing the endocardial border", page 306).
Possible causes of poor tracking
Poor tracking quality could result from a variety of causes. The
common causes for bad tracking are:
•
Erroneous placement of the basal points when defining the
border. If the basal points are placed too far from the
annular region, the border segments at the annular base
will not move together with the underlying 2D image
throughout the entire heart beat.
•
Erroneous placement of the apex point when defining the
border. The point should be placed so that the resulting
border trace covers mainly the endocardium. If the apex
point is placed too high, the border trace will mainly cover
the epicardium resulting in poor tracking.
•
Too much clutter. Images with too much static clutter will
result in poor tracking.
Results
For each of the views, a results screen containing the EF
calculation, appears (Figure 7-29) with a small mini-report
appearing in the results window on the right side (Figure 7-32).
Figure 7-32: Mini Report
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The results are summarized in the worksheet and in the report
(Figure 7-33 and Figure 7-34).
To exit the AutoEF package:
Press Measure to exit AutoEF.
Whenever pressing Worksheet , Patient, or 2D the system
closes the AutoEF package.
Before AutoEF closes a prompt appears: Do you want to store
the loop? Click Yes to store the loop or No to discard it.
Note: Do not disable any sub-measurement of AutoEF using
Config. tab, as this will disable the whole set of AutoEF
measurements.
Do not delete individual AutoEF measurements from the
worksheet. Always delete a full set.
CAUTION
Figure 7-33: Results in worksheet
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Figure 7-34: Results in the Report template
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Vascular measurements
B-Mode measurements
The following instructions assume that you first scan the patient
and press FREEZE.
% Stenosis
% Stenosis by diameter
1. 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 area
1. 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, then select select
Generic.
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
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axial view. One measurement is usually made in the sagittal
plane and two measurements in the axial plane.
When doing volume calculation from one or two distance
measurements, make one or two distance measurements
and press MENU.
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 diameter
1. 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.
Using Split-screen measurements
When using dual-screen format with a linear array probe, and
both sides are set to the same scan-depth, the images are
displayed in split-screen mode. This mode allows the user to
match two views into one large view. In this case it is possible
to measure across from one side to the other.
Note: In case the "virtual-convex" mode is turned on it will nor
be possible to measure across the screen. You will need to turn
off the "virtual-convex" mode.
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 7-35). IMT can be
measured both on the posterior and the anterior walls of the
vessel.
The IMT measurement is available with linear probes only.
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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
1. Vessel lumen
3. Lumen-Intima boundary
2. Vessel wall
4. Media-Adventitia boundary
5. Multiple IMT measurements
Figure 7-35: IMT measurement (Posterior wall)
IMT Measurement Protocol
The IMT measurement is based on the placement of an ROI
(region of interest) tool to define an area of the vessel where
the IMT will automatically be measured.
There are two methods to position the IMT ROI:
•
Arbitrary: Place the ROI at an arbitrary location selected by
the user. The ROI length is also arbitrarily defined by the
user.
•
Protocol defined: Place an ROI with predefined length at
a predefined distance (offset) from some vertical marker.
Both ROI offset and length are predefined by the user
according to the user's protocol.
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At any time, the users may select if they wish to measure IMT
by the protocol or by the arbitrary method.
IMT Measurement procedure
The 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 7-36).
Figure 7-36: IMT Measurement menu (Right Common Carotid
Posterior IMT measurement tool)
6.
7.
Turn the Protocol soft-key OFF or ON depending on your
requirement to operate the tool arbitrarily or by a fixed
protocol.
If Protocol is turned OFF place the cursor in the artery
closer to the posterior wall and press SET to anchor the start
of the search region (Figure 7-37, left).
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8.
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 7-37, left).
9. In case Protocol is set to ON place the vertical cursor on
some anatomical reference point on the bifurcation.
10. Press SET. This will anchor a vertical cursor on the
anatomical reference point, and an ROI box will appear on
the right, at a pre-defined offset distance. The length of the
ROI box is a fixed length.
11. Move the ROI box up or down to cover the posterior wall of
the carotid vessel.
Press SET to anchor the point. For the posterior wall the
contour detector searches for the leading edges of the
intima and adventitia layers. The detected contours are
drawn in the image (Figure 7-37, 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.
1. Measurement segment
2. IMT trace
Figure 7-37: IMT Measurement segment and traces
12. 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.
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IMT Measurement Protocol setting
When the IMT Protocol soft-button is turned ON two special
controls will appear: "Offset" and "Length", controlling the IMT
ROI with predefined length and predefined distance (offset)
from the vertical marker.
The user may modify the offset or length while performing the
exam, in case these are not set to optimal dimensions.
To modify Protocol defaults
1. Set the Protocol button ON or OFF.
2. In case Protocol is ON: adjust the Offset and Length
values.
3. Press the Store default soft-key to store the status of
"protocol" button ON or OFF and the current settings of
Offset and Length, to be used in the future exams.
4. The default settings may be defined differently for the CCA
and the ICA.
Note: When adjusting the offset for the ICA, the offset
values are negative, as the ROI is located to the left of the
vertical reference marker.
IMT trace approval
Since the IMT measurements are done semiautomatically, the
operator has to approve the detection by visual inspection
before storing the results in worksheet and report.
•
If the traces fit both layers of the intima-media walls,
approve the measurement by selecting Transfer in the
Measurement menu.
Once transferred, the calculations can be viewed in the
worksheet and report.
Measurements that are not approved will not be saved.
CAUTION
CAUTION
Any image adjustments (e.g. Gain or zoom) on approved
(transferred) measurements will unassign the measurements.
Press Transfer to approve the measurements again.
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M-Mode Measurements
The following instructions assume that you first scan the patient
and press FREEZE.
% Stenosis
1.
2.
3.
4.
Press MEASURE on the control panel.
Select % Stenosis in the Measurement menu.
Make a distance measurement of the inner area of the
blood vessel.
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.
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Doppler measurements
The 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
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 calculation
1. Press MEASURE.
The Vascular measurement menu is displayed
(Figure 7-38).
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 7-38).
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.
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6.
Press Save as default to set the selected calculations to be
default when a new study or exam is started.
1. Selected vessel
5. Trace parameters
2. Vessel location parameters
3. Manual/auto calculation controls
6. Selected measurements and calculation to
appear in the Measurement result table.
4. Other vessels
7. Assign measurement and calculation
Figure 7-38: Vascular measurement menu (example)
Using Auto vascular calculation
1. 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:
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• CYCLE SELECT: change the selected cycle.
• 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 SET to anchor the marker to its new
location.
To undo the
assignment, press
Cancel transfer.
Assigning auto calculations
1. In the Vascular Measurement menu (Figure 7-38), 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.
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 7-38).
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 SET to
anchor the caliper.
3. Position the second caliper at the end point and press SET
to anchor the caliper and complete the measurement.
The acceleration and/or the acceleration time is displayed
in the Measurement result table.
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Heart rate
Heart rate is calculated by selecting two identical points over
two heart cycles.
1. Select HR.
2. Position the caliper at a recognizable point in the first cycle
and press SET to anchor the caliper.
3. Position the second caliper at the identical point in the
second cycle and press SET 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 SET to complete the measurement.
The selected measurement is displayed in the
Measurement result table.
Pulsatility index (PI)
1.
2.
3.
1.
2.
3.
With Auto trace on
Select PI.
Position the caliper at the beginning of the wave form and
press SET to anchor the caliper.
Position the second caliper at end diastole and press SET.
A trace is displayed between the two calipers and PS, ED,
MD, TAMAX, PI and RI are displayed in the Measurement
result table.
With Manual trace on
Select PI.
Position the caliper at the beginning of the wave form and
press SET to anchor the caliper.
Using the trackball, draw the trace to the end diastole and
press SET.
The trace is displayed and PS, ED, MD, TAMAX, PI and RI
are displayed in the Measurement result table.
Peak systole/End diastole (PS/ED) and End diastole/Peak
systole (ED/PS) ratio
1. Select PS/ED or ED/PS.
2. Position the caliper at Peak systole or End systole and
press SET to anchor the caliper.
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3.
Position the second caliper at End diastole or Peak systole
and press SET 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 SET to anchor
the caliper.
3. Position the second caliper at end diastole and press SET.
The Peak systole, End diastole and RI are displayed in the
Measurement result table.
TAMAX/TAMEAN/Volume Flow
1.
2.
3.
1.
2.
3.
With Auto trace on
Select TAMAX, TAMEAN or Volume Flow.
Position the caliper at the start point and press SET to
anchor the caliper.
Position the second caliper at the end point and press SET
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 on
Select TAMAX, TAMEAN or Volume Flow.
Position the caliper at the start point and press SET to
anchor the caliper.
Using the trackball, draw the trace to the end point and
press SET.
The trace is displayed and the corresponding
measurements are displayed in the Measurement result
table.
Pediatric Calculations
Overview
Pediatrics measurements offer two different types of
measurement studies:
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•
•
Generic. The Generic Calculations study is common to all
applications ("Starting the Assign and Measure modality",
page 260).
Pediatric Hip (PedHip).
This section describes Pediatrics 2D-Mode measurements.
Figure 7-39: Pediatrics B-Mode Measurement Top/Sub Menu
The following generic measurements are common to other
exam applications ("2D Measurements", page 267):
•
%Stenosis
•
Volume
•
Angle
•
A/B Ratio
Hip Dysplasia Calculation
The HIP calculation assists in assessing the development of
the infant hip. In this calculation, three straight lines are
superimposed on the image and aligned with the anatomical
features. The two angles are computed, displayed, and can be
used by the physician in making a diagnosis.
The three lines are:
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1.
2.
3.
The baseline connects the osseous acetabulum convexity
to the point where the joint capsule and the perichondrium
unite with the iliac bone.
The inclination line connects the osseous convexity to
labrum acetabulare.
The Acetabulum roof line connects the lower edge of the
osilium to the osseous convexity.
The α (Alpha) angle is the supplement of the angle between 1
and 3. It characterizes the osseous convexity. The ß (Beta)
angle is the angle between lines 1 and 2. It characterizes the
bone supplementing additional roofing by the cartilaginous
convexity.
Making Hip Dysplasia Measurement
To make a Hip Dysplasia measurement:
1. From the Top/Sub Menu, select either the right or left side
(orientation) and then select HIP. A horizontal dotted line
displays.
2. To place the baseline, move the Trackball. Position the
crosshairs edge at the osseous convexity of the ilium.
3. To rotate or change inclination, adjust the Ellipse control or
Hip Rotate.
4. To fix the baseline, press SET. The system displays a
second dotted line at an angle.
5. To place the line along the inclination line of the osseous
convexity to labrum acetabulare, move the Trackball.
6. To rotate or change inclination, adjust the Ellipse control or
Hip Rotate.
7. To fix the second measurement line, press SET. The system
displays a third dotted line at an angle.
8. To place the caliper along the acetabular roof line, move the
Trackball.
9. To rotate or change inclination, adjust the Ellipse control or
Hip Rotate.
10. To fix the third measurement line and complete
measurement, press SET.
The system displays the hip measurements (α and ß) in
the Results window.
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Alpha HIP
The Alpha HIP measurement measures the angle between the
iliac baseline and the bony roof line. To make an Alpha HIP
measurement:
1. From the Top/Sub Menu, select either the right or left side
(orientation) and then select Alpha HIP.
A horizontal dotted line displays.
2. To place the baseline, move the Trackball. Position the
crosshairs edge at the osseous convexity of the ilium.
3. To rotate or change inclination, adjust the Ellipse control or
Hip Rotate.
4. To fix the baseline, press SET.
The system displays a second dotted line at an angle.
5. To place the caliper along the acetabular roof line, move the
Trackball.
6. To rotate or change inclination, adjust the Ellipse control or
Hip Rotate.
7. To fix the second measurement line, press SET.
The system displays the alpha hip measurement (α) in the
Results window.
d:D Ratio Measurement
The d:D Ratio measurement measures the percentage of the
femoral head coverage under the bony roof. To make this
measurement:
1. From the Top/Sub Menu, select either the right or left side
(orientation) and then select d:D Ratio.
A horizontal dotted line displays.
2. Use the Trackball to place the baseline along the ilium.
Position the crosshairs edge at the osseous convexity of
the ilium.
3. Use the Ellipse control to adjust or change inclination or
Hip Rotate.
4. Press SET to fix the baseline.
5. The system displays a circle representing the femoral head.
Use the Trackball to position the circle.
6. Use the Ellipse control to size the femoral head
circumference.
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7.
Press SET to fix the femoral head circumference.
The system displays the d:D ratio for the femoral head in
the Results window.
Performing an OB exam
Patient entry
1.
2.
3.
4.
5.
6.
7.
Enter a New Patient or a New Exam for an existing patient
by following the procedure "Starting an examination",
page 95.
Note: Use "Other ID" if relevant ("Using Other Patient ID",
page 99).
When the Search/Create Patient screen appears, the
Category field should be preset to Obstetrics. Change it if
required.
Enter or validate the patient's Last name, First name, ID
and birth-date or age.
Click the Create Patient softkey
To add an additional patient information click Patient.
Select Current Patient Information.
The Patient Information screen appears (Figure 7-40).
Use the fields in this screen to enter various data
(Table 7-1)
After entering data click the Begin Exam softkey to
continue with the exam and get a scanning screen.
Alternatively, click 2D Mode to continue scanning.
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Figure 7-40: The Patient Information window
Table 7-1: Obstetric fields
330
Field
Description
LMP
Last Menstrual Period; enter the date that the
patient started her last menstrual period, in
dd/mm/yyyy format. You must enter 2 digits for
the day or the month. When you type the month
and day, the system fills in the / (slash) and the
digits 20 as the first digits of the year.
EDD by LMP
Estimated Delivery Date by LMP; the system fills
in the date after you enter the LMP.
GA by LMP
Gestational Age by LMP; the system fills in the
age after you enter the LMP.
EDD
If you click on the EDD by LMP button it will
change into EDD. When you fill in the EDD
(Estimated Delivery Date) the system calculates
and fills in the LMP and the GA by EDD field.
GA
If you click on the GA by LMP button it will
change into GA. When you fill in the GA
(Gestational Age) the system calculates and fills
in the LMP and the EDD by GA field.
Fetus number
Number of fetuses; default is 1; possible values
are 1-4.
Gravida
Number of pregnancies.
Para
Number of births.
AB
Number of abortions.
Ectopic
Number of ectopic pregnancies.
Accession #
Exam number used with hospital information
system (DICOM). This is a tracking number from
the worklist.
Ref. Doc
The physician who requested the exam. Choose
from the list or type the name.
Diagn.
Physician
The physician who diagnoses the exam. Choose
from the list or type the name.
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Table 7-1: Obstetric fields
Field
Description
ExamDate
Defaults to today's date. May be edited by user.
Note 1: After entering the LMP, the system will automatically
calculate and display the EDD by LMP and the GA by LMP
values.
Note 2: If you prefer to enter the EDD instead of LMP, click on
the EDD button just to the left of the EDD field, and type in the
EDD. The system will automatically calculate and display the
LMP and the GA by EDD values
Note 3: If you prefer to enter the estimated GA instead of LMP,
click on the GA button just to the left of the GA field, and type in
the GA. The system will automatically calculate and display the
LMP and the EDD by GA value.
To exit the Patient Data Entry screen and return to the Scan
screen, you can use one of the following methods:
•
Press ESC on the keyboard.
•
Select PATIENT or FREEZE on the control panel.
•
Select 2D-MODE on the control panel.
The Scan screen appears.
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Setting patient information on the image
Title-bar
In case you wish to display some OB data on the
image-header, such as LMP or GA, the system can be
configured to display this information.
1. Select CONFIG > Imaging > Global.
2. Select Title Bar Line 1 or Line 2 to select the relevant
information to appear on the screen.
Figure 7-41: Setting patient information on the image title bar
Selecting probe and OB application
Select probe and application ("Starting an examination",
page 95).
•
For a first-trimester OB exam select OB1.
•
For a second / third trimester OB exam select OB2/3.
The following presets are available in addition:
•
OB General
•
Fetal Heart
•
OB/GYN Vessel
Note: The selection of the OB preset will not only optimize the
imaging but will also bring up the proper M&A package for that
particular application.
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Note: The system does not support the internal respiratory
functionality while using OB applications ("Physiological
ECG/Respiratory traces", page 124).
The parameter contents of each of the applications are
configurable by the operator. Following are the factory presets
for each of the applications.
OB1 application
The measurements available by default for OB1 are:
GS (Hellman)
CRL (Hadlock)
BPD (Hadlock)
FL (Hadlock)
OB2/3 application
The measurements available by default for OB2/3 are:
AC (Hadlock)
HC (Hadlock)
BPD (Hadlock)
FL (Hadlock)
OB - general application
The measurements available by default for OB-General are:
AC (Hadlock)
HC (Hadlock)
BPD (Hadlock)
FL (Hadlock)
GS (Hellman)
CRL (Hadlock)
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Figure 7-42: OB general application measurements
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OB Measurements and calculations
Introduction
Comment: Measurements and calculations derived from
ultrasound images are intended to supplement other clinical
procedures available to the attending physician. The accuracy
of measurements is not only determined by the system
accuracy, but also by use of proper medical protocols by the
user. When appropriate, be sure to note any protocols
associated with a particular measurement or calculation.
Formulas and databases used within the system software that
are associated with specific investigators are so noted. Be sure
to refer to the original article describing the investigator's
recommended clinical procedures.
Note: When you make measurements, you can select the
calculation before you make the measurement or after you
make it. If you select the calculation before you make the
measurement, the Results Window shows the estimated fetal
age as you make the measurement. If you select the
calculation after you make the measurement, the estimated
fetal age is displayed after you complete the measurement.
The measurements steps in this section tell you to select the
calculation before you make the measurement.
The following pages describe how to make OB measurements
and calculations. The measurements are organized by mode,
and within mode are listed in alphabetical order.
Out of range: If the system indicates that a measurement is
out of range (OOR), it means one of the following:
•
The measurement is out of the normal range based on the
gestational age that is calculated from the LMP. The system
determines OOR from the ultrasound age compared to the
gestational age. The gestational age is calculated from the
last menstrual period or the estimated delivery date.
•
The measurement is outside of the range for the data used
in the calculation. That means that the measurement is
either less than or more than the range of measurements
used to determine fetal age based on the measurement.
Note: Calculation formulas are listed in the Reference Manual.
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B-Mode measurements
This section describes all B-Mode measurements that you
typically find in OB studies. Additional OB measurements follow
the typical ones.
Single diameter parameter measurement
Table 7-2: Single diameter parameters
Parameter
Full name
BPD
biparietal diameter
OFD
occipitofrontal diameter
TAD
transverse abdominal diameter
TCD
transverse cerebellar diameter
ThD
thorax transverse diameter
To measure one of the Single-diameter parameters shown in
Table 7-2 above, perform one distance measurement by
completing the following procedure:
1. Press MEASURE. Use the trackball to select the required
measurement parameter on the right-hand pull-down
menu. Alternatively, use the soft-keys to select the required
measurement parameter.
2. To position the active caliper at the first point, move the
Trackball. To fix the first point, press SET.
The system fixes the first caliper and a second active
caliper becomes available.
3. To position the second active caliper at the end point, move
the Trackball. A dotted line connects the measurement
points.
4. When the second caliper is moved, the measurement-box
displays the current value of the measured parameter and
the corresponding age, in weeks +days.
5. To complete the measurement, press SET. A checkmark will
appear by the measured parameter. The second caliper is
anchored, and a third caliper is available for further
measurements.
The system displays the selected Parameter diameter in
the Results Window.
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Editing 2D Length measurements
1. While the measurement is on the screen, trackball the
cursor to one of the anchor points of the measurement to
modify.
2. Double-click the SET key to select the anchor point.
The selected marker turns green and is unanchored.
3. Reposition the marker using the Trackball.
4. Press SET to anchor.
Deleting a 2D Length measurements
1. While the measurement is on the screen, Trackball the
cursor to one of the anchor points of the measurement.
The selected marker turns green.
2. Press Delete on the alphanumeric keyboard.
Single Length parameter measurement
Table 7-3: Single length parameters
Parameter
Full name
CRL
crown rump length
FL
femur length
Tt
foot length
HL
humerus length
SL
spinal length
tibia
tibia length
Ulna
ulna length
To measure one of the Single-length parameters shown in
Table 7-3 above, follow the procedure "Single diameter
parameter measurement", page 336.
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Circumference parameter measurement
Table 7-4: Circumference parameters
Parameter
Full name
AC
Abdominal Circumference
HC
Head Circumference
When selecting one of the Circumference parameters shown
in Table 7-4 above, the system will automatically provide an
Ellipse tool to perform the measurement.
To measure circumference using the Ellipse tool
1. Select the Circumference parameter.
An active caliper appears.
2. To position the active caliper, move the Trackball.
3. To fix the start point, press SET.
The system fixes the first caliper and provides a second
active caliper.
4. To position the second caliper, move the Trackball.
An ellipse with an initial circle shape appears.
5. Position the second caliper so as to measure the major axis
of the elliptical measured body.
6. When ready press SET.
A third caliper will appear along the second axis of the
ellipse.
7. Use the trackball to control the length of the minor axis of
the ellipse.
8. Press SET to anchor the third caliper.
The system displays the parameter's circumference and
estimated age in the Results Window.
Editing Ellipse measurements
1. While the measurement is on the screen, trackball the
cursor to one of the anchor points of the ellipse to modify it.
2. When color changes to green, double-click the SET key to
select the anchor point.
The selected marker is unanchored and can be moved.
3. With the Trackball, reposition the caliper.
The ellipse will rotate or stretch along with the motion of
the caliper
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4.
Press SET to anchor.
Figure 7-43: Editing ellipse measurements
Deleting the ellipse measurements
1. While the ellipse measurement is on the screen, Trackball
the cursor to one of the anchor points of the measurement.
The selected marker turns green.
2. Press Delete on the alphanumeric keyboard.
Gestational Sac
To calculate the gestational sac, you need to make diameter
measurements in three orthogonal directions. These may be
done either sequentially or simultaneously in two scan planes.
Measuring GS on two scan planes
To display two scan planes, press the 1/2/4 key once. Get an
image in each scan plane and press FREEZE.
1. Activate M&A and select GS (Hellman).
An active caliper appears.
• To position the active caliper at the start point, move the
Trackball.
• To fix the start point, press SET.
The system fixes the first caliper and displays a second
active caliper.
• To position the second active caliper at the end point,
move the Trackball.
A dotted line connects the measurement points.
• To complete the measurement, press SET.
The system displays the distance value in the Results
Window and displays an active caliper.
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2.
To make the second and third distance measurement,
repeat step 1.
After you complete the third distance measurement, the
system displays the gestational sac measurement in the
Results Window. It displays the three diameters d1, d2
and d3. In addition, it shows the average diameter GS and
the corresponding estimated age.
Figure 7-44: Gestational sac measurement
Measuring GS sequentially
1. Scan and freeze an image of GS that you would like to
measure (use full screen).
2. Activate M&A and select GS (Hellman).
3. Measure the two diameters of the GS (as explained above).
The measurements will display on screen as d1 and d2.
4. Scan again to produce a view of a plane which is orthogonal
to the previous plane.
5. Activate M&A and select GS (Hellman).
6. Measure the GS diameter; this will be marked as d3.
After you complete the third distance measurement, the
system displays the gestational sac measurement in the
Results Window. It displays the three diameters d1, d2
and d3. In addition it shows the average diameter GS and
the corresponding estimated age.
Amniotic Fluid Index (AFI)
To calculate the amniotic fluid index, you make
measurements of the four quadrants of the uterine cavity. The
system adds these four measurements together to calculate
the Amniotic Fluid Index.
Note: The four quadrants can be measured with distance
(caliper) or circumference (circle) measurements. Press the
appropriate AFI quadrant Top/Sub Menu key to toggle between
caliper and circle.
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1.
2.
3.
4.
5.
6.
Select OB-2/3, then AFI(Moore) located just under it.
The first distance measurement, AFI-Q1, is already
selected.
Make a standard distance measurement for the first
quadrant:
• To position the active caliper at the start point, move the
Trackball.
• To fix the start point, press SET.
The system fixes the first caliper and displays a second
active caliper.
• To position the second active caliper at the end point,
move the Trackball.
A dotted line connects the measurement points.
• To complete the measurement, press SET.
The system displays the distance value in the Results
Window.
When the measurement of the first quadrant is completed,
unfreeze and move to the second quadrant.
After you obtain the image, press FREEZE and then
MEASURE.
The system prompts you to continue with the AFI
measurements. Make sure that the next quadrant has
been selected.
Perform a standard distance measurement for the second,
third, and fourth quadrants (step 2 above).
When all four quadrants have been measured, the system
calculates the AFI total and displays it in the Results
Window.
Note: If the fluid in a pocket is zero, set the second caliper on
top of the first one to give it a zero value.
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Figure 7-45: Amniotic Fluid Index
Estimated Fetal Weight (EFW)
To measure estimated fetal weight, you make several OB
measurements. These measurements can vary, based on how
your system is set up. Measurements can include biparietal
diameter, fetal trunk area, femur length, antero-postero trunk
diameter and transverse trunk diameter, abdominal
circumference, head circumference and spinal length.
•
Activate the Worksheet.
The calculation for EFW will appear under 2D
Calculations label as soon as the required measurements
have been made.
Note: For a description of any of the required measurements,
refer to that measurement.
M-Mode measurements
There are no special tools for OB other than the general
M-Mode measurement tools found under all applications.
Doppler Mode Measurements
You can use Doppler mode to study fetal blood flow in the
heart, umbilical cord, placenta, and middle cerebral arteries.
OB/GYN Doppler mode also allows you to study uterine and
ovarian blood flow.
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The OB/GYN vessel study includes the following vessels:
•
Aorta
•
Desc. Aorta
•
Middle Cerebral Artery (MCA) (right and left)
•
Ovarian (right and left)
•
Placenta
•
Umbilical
•
Uterine (right and left)
For each of these studies, you can make any of the following
measurements:
•
Peak Systole (PS)
•
End Diastole (ED)
•
Minimum Diastole (MD)
•
Resistive Index (RI)
•
PS/ED Ratio
•
ED/PS Ratio
•
Acceleration
•
AT
•
TAMAX
•
Pulsatility Index (PI)
•
Heart Rate
•
Volume Flow
•
TAMEAN
•
PV
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Figure 7-46: Doppler Mode Measurements
To select OB/GYN vessel measurements
OB/GYN Vessel measurements use the auto sequence
feature. With this feature, when you select a folder for the
vessel you want to measure, the system automatically starts
the first measurement. It then continues with each of the other
measurements in that study.
1. Select the folder for the vessel you want to measure.
The system shows all the measurements for that vessel.
The caliper for the first measurement is automatically
displayed.
2. Make the measurement.
After you complete each measurement, the system starts
the next measurement. After the last measurement is
complete, the system returns to the first measurement.
Your system is set up to show the measurements that you
usually make for each vessel. To make a measurement that is
not shown for the selected vessel:
1. Select the folder for the vessel you want to measure.
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2.
3.
Select Show All.
The system displays all possible vessel measurements.
Select the desired measurement.
Detailed explanations about making the different
measurements and using the different tools are provided in the
Doppler M&A section of the Vascular package ("Doppler
measurements", page 321).
The following pages describe the steps to make each specific
measurement in the OB/GYN Vessel study.
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OB parameter configuration
Configuring OB M&A according to
geographical regions
Different countries use different sets of OB charts. The system
supports OB charts from USA, Europe, Osaka, Tokyo, and
ASUM.
1. Press CONFIG.
2. Select MEAS/TEXT.
3. Select the Advanced tab.
4. Set the M&A category to Obstetrics.
5. Locate the parameter OB Type in the upper pane and click
on the region.
A menu opens listing the region names.
Figure 7-47: Region name menu
USA
OB-1
Folder contents
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OB-2/3
Folder contents
OB-General
Folder contents
Europe
OB-1
Folder contents
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OB-2/3
Folder contents
Osaka
Osaka
Folder contents
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Tokyo/Shinozuka
Folder contents
JSUM
Folder contents
EFW (Osaka)
Folder contents
EFW (Tokyo)
Folder contents
EFW1 (S)
Folder contents
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EFW2 (S)
Folder contents
EFW3 (S)
Folder contents
EFW (JSUM)
Folder contents
ASUM
ASUM 2001
Folder contents
ASUM
Folder contents
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Measurement package configuration
A 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 example
Calculation 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 and select the category Meas/Text.
The Measurement menu sheet is displayed (Figure 7-48).
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.
A list of all available measurements for the selected folder
is displayed in the Measurement menu sheet.
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4.
5.
6.
Check the box in front of AV Diam.
The AV Diam measurement is displayed in the folder
Dimension in the Measurement menu.
For the AV VTI measurement, check Doppler in the
Measurement menu sheet and select the folder Aortic in
the Measurement menu.
Check the box in front of AV Trace.
The AV Trace measurement is displayed in the folder
Aortic in 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.
Figure 7-48: Configuration of the Measurement menu
Configuration of the Measurement result table
If AV CO calculation is not displayed in the Measurement result
table, follow the following procedure:
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1.
2.
3.
4.
Press CONFIG and select the category Meas/Text.
The Measurement menu sheet is displayed.
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.
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.
Check the box in front of AV CO.
The AV CO calculation will be displayed in the
Measurement result table.
Normal values
Normal 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, Pediatry etc.)
Normal values are displayed in the report.
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To define a Normal value
1. Measurement category
2. Selected measurement
3. Parameters
4. Press to define Normal value
Figure 7-49: Adding Normal value
1.
2.
3.
354
Press CONFIG and select the Config category
Measure/Text.
The Measurement menu sheet is displayed (Figure 7-49).
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.
Select
in the Normal value column.
The Normal value window is displayed.
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Figure 7-50: The Normal value window
4.
5.
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.
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
("Normal values", page 353). Measurements outside the
Normal value are highlighted in the Report.
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User-defined formulas
User-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.
GE Medical Systems does not take any responsibility for the
correctness of the user-defined functions.
CAUTION
User-defined formula - example
The 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-AVET)/AVET.
Creation of a user-defined folder
1. Select the appropriate scanning mode.
2. Create a folder in the Measurement menu.
Figure 7-51: The Measurement menu sheet
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1.
2.
3.
4.
Press CONFIG and select the category Meas/Text.
MCO and AVET are Doppler measurements, select
Doppler in the Measurement menu sheet.
Select Add folder.
Give the folder a name (e.g. “My Folder”).
Adding measurements
1. Select the user-defined folder.
2. Press Add measurement.
Figure 7-52: The Measurement menu sheet
1.
2.
Select the user-defined folder (e.g. “My Folder”) in the
Measurement menu.
Press Add Measurement in the Measurement menu
sheet.
The Add measure window is displayed.
Figure 7-53: The Add measure window
3.
MCO and AVET are measurements that already exist on
the system, check Use copy of and select MCO from the
drop down menu.
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4.
5.
Select OK to add the MCO measurement.
Repeat steps 2 to 4 to add the AVET measurement.
Creation of the formula
1. Select the last measurement.
2. Double click and enter the formula name.
3. Select “=” to create the formula.
Figure 7-54: The Measurement menu sheet
The formula for this example is as follow:
My LIMP = (MCO-AVET)/AVET
1. In the user-defined folder (e.g. ”My folder”), select the last
measurement created (e.g. AVET).
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.
358
Select
.
The Edit formula window is displayed.
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Figure 7-55: The Edit formula window
5.
6.
Select “(“ from the Operators drop-down menu.
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
AVET [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
AVET [My Folder, AVET].
The Formula line should display: ({MCO}-{AVET})/{AVET}.
No units are necessary since the formula is a ratio ("About
units", page 362).
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. Select the appropriate scanning mode.
2. Select the appropriate folder.
3. Press Add measurement.
Figure 7-56: The Measurement menu sheet
1.
2.
3.
4.
Press CONFIG and select the category Meas/Text.
In the Measurement menu sheet, select the appropriate
scanning mode for the measurement to be created (e.g.
2D).
Select the appropriate folder in the Measurement menu
(e.g. Dimension).
Press Add Measurement in the Measurement menu
sheet.
The Add measure window is displayed.
Figure 7-57: The Add measure window
5.
360
Check Blank and press OK.
The Measurement menu sheet is updated.
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1. Enter a name for the measurement.
2. Select the appropriate measurement tool.
3. Double click and enter the formula name.
Figure 7-58: The Measurement menu sheet
6.
7.
8.
In the Measurement menu sheet, enter the name for the
measurement (e.g. My Distance).
Select the appropriate measurement tool in the drop-down
menu, next to Tool (e.g. 2D Caliper).
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 ("About units", page 362).
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About units
Be aware of the following:
•
All units are calculated in SI units (table below).
•
If no unit is specified in the Edit formula window when
defining a formula, the displayed value will be in SI unit.
To define a different unit
1.
2.
362
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).
The output of a formula must always be in an SI unit (table
below). Conversion to the specified display unit is then
done automatically.
Example: a 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.
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Calculation
SI
Alternative unit
Time
s
Ratio
%
Frequency
bpm
Angle
rad
deg - grad
Distance
m
cm - dm - cm - mm - inch - feet - pixels
Velocity
m/s
dm/s - cm/s - mm/s - inch/s
Acceleration
m/s2
dm/s2 - cm/s2 - mm/s2 - inch/s2
Area
m2
dm2 - cm2 - cm^2 - mm2 - inch2
Volume
m3
dm3 - cm3 - l - dl - cl - gallon - quart
Volume flow
m3/s
dm3/s - cm3/s - l/s - dl/s - cl/s - ml/s - m3/min dm3/min - cm3/min - l/min - L/min - dl/min - cl/min
- ml/min - ml/m2
Pressure
mmHg*
Pa - kPa - bar - torr - atm - psi
Pressure/time
mmHg/s
Mass
kg
Other
ms - msec - min - h
g - ounce - pound
mmHG - Date - WeekDay - Day - NoUnit l/minm2 - g/m2 - cm/m2
* 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.
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Measurement result table
The 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.
2.
Repeat step 1 to
enlarge the
Measurement
result table.
Alternative: Use
the Move Calc
Win softkey located
under More to
move the
Measurement
result table from
corner to corner on
the Acquisition
window.
Trackball to the symbol
on the heading of the
Measurement result table (Figure 7-59).
Press SET.
The Measurement result table is minimized to the heading
bar.
Moving the Measurement result table
1.
2.
3.
4.
Trackball to the symbol
on the heading of the
Measurement result table (Figure 7-59).
Press SET to grab the table.
Trackball the Measurement result table to a new position.
Press SET to anchor the table.
1. Minimize/maximize table
2. Move table
Figure 7-59: Measurement result table display tools
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Deleting measurements
1.
2.
Trackball to the measurement to delete in the
Measurement result table and press SET.
A menu is displayed.
Select Delete Measurement.
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Worksheet
The 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
1. Measurement type
4. Measured / calculated values
2. Measurement parameter
5. Value type
3. Value: Averaging, Max, Min or Last
6. Measurement type selection
Figure 7-60: The Worksheet screen (Cardiac)
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Using Worksheet
•
Press WORKSHEET on the control panel and select the
measurement type (Figure 7-60).
To scroll through pages
•
Select PAGE DOWN or PAGE UP.
To select the type of value
1.
2.
Trackball to the relevant cell in the Method column.
Press SET.
A pop-up menu is displayed showing the different options
available (Figure 7-61).
1. Average of the measurements taken
2. Maximum measurement
3. Minimum measurement.
4. Last measurement that was taken
Figure 7-61: The Calculation method options list.
3.
4.
Trackball to the required option.
Press SET.
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.
When excluded the
measurement
display turns grey.
To exclude a measurement
1. Trackball to the measurement value to exclude.
2. Press UPDATE MENU.
The Worksheet menu is displayed.
3. Trackball to Exclude Value.
4. Press SET.
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To include a measurement
1. Trackball to the measurement value to include.
2. Press UPDATE MENU.
The Worksheet menu is displayed.
3. Trackball to Include Value.
4. Press SET.
Manually changing a value
Individual measured values can be manually changed using
the alphanumeric keyboard.
An asterisk
indicates that the
value has been
manually altered.
The calculation
type is changed to
Edit.
To manually change a value
1. Trackball to the value that is to be changed.
2. Press SET.
3. Use the alphanumeric keyboard to enter the required value.
To restore automatic calculation
1. Trackball to the relevant cell in the Method column.
2. Press SET.
A pop-up menu is displayed showing the different
calculation options available (Figure 7-61).
3. Press SET.
The value is re-calculated according the method selected.
Deleting measurement parameter
1.
2.
3.
4.
368
Trackball to the measurement parameter to delete.
Press UPDATE MENU.
The Worksheet menu is displayed.
Trackball to Delete Value.
Press SET.
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OB worksheet
The OB Worksheet lists patient information, and all
measurement and calculation data.
•
To view the OB Worksheet press Worksheet.
1. Patient data
2. Measurement information
3. Calculation information
Figure 7-62: The OB worksheet
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Patient data
The Patient data section, at the top of the worksheet, lists
information from the Patient Data Entry screen.
You can select the following fields:
•
FetusNo - if this is a multi-gestational patient, you can
select the fetus in this field. You can also adjust the Fetus
selection to change the fetus.
•
CUA/AUA - select the ultrasound age calculation method:
• Composite Ultrasound Age (CUA) - regression
calculation
• Average Ultrasound Age (AUA) - an arithmetic average
You can select the method in this field, or adjust the Select
CUA/AUA soft-key control.
You can enter information in the following fields:
•
FetusPos - type information about the fetus position.
•
PLAC - type information about the placenta.
Measurement information
This section lists the results of all measurements.
•
CUA or AUA - If this field is checked, the system uses the
measurement to calculate the ultrasound age.
•
Value - The measured value. If more than one
measurement was made for an item, the system uses the
specified method (average, maximum, minimum, or last) to
determine this value.
•
m1-m3 - Up to three measurement values for each item. If
you make more than three measurements, the worksheet
uses the last three.
•
Method - When there is more than one measurement for an
item, this specifies the method used to calculate the
measurement value listed in the Value column. Choices are
average, maximum, minimum, or last.
To change the method:
• Move the Trackball to the Method field.
• Press SET.
• Move the Trackball to select from the list.
• Press SET.
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•
•
AGE - The fetal age for this measurement.
Range - The typical range of fetal age for this
measurement.
Calculation information
This section of the worksheet provides calculation choices and
lists calculation results.
•
EFW - lists the parameters used to calculate EFW. This is
followed by the calculation result.
To change which parameters are used:
• Select this field, or press Select EFW.
• Select the desired parameters.
•
EFW GP - lists the source used to calculate EFW-GP
(growth percentile). This is followed by the growth
percentile.
To change the source:
• Select this field, or press Select GP.
• Select the desired source.
The remaining calculation information shows ratios for several
measurements, and the Cephalic Index (CI).
The worksheet shows if any of the ratios are out of range
(OOR). Out of range indicates one of the following:
•
The measurement is out of the normal range based on the
gestational age that is calculated from the LMP. The system
determines OOR from the ultrasound age compared to the
gestational age. The gestational age is calculated from the
last menstrual period or the estimated delivery date.
•
The measurement is outside of the range for the data used
in the calculation. That means that the measurement is
either less than or more than the range of measurements
used to determine fetal age based on the measurement.
Information about how to use the worksheet can be found
earlier in this chapter ("Worksheet", page 366).
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OB graphs
Overview
OB 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 plot all
fetuses and compare the growth on the graphs.
Vivid S5/Vivid S6 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 graphs
1.
2.
372
Press Worksheet.
Press the Graph soft-key button
The Fetal growth curve graph is displayed (Figure 7-63).
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Figure 7-63: Fetal Growth Curve Graph
Fetal Growth Curve Graph
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
•
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.
The legend at the bottom of the graph shows the symbols and
colors that indicate data for fetal trending (Past and Present)
and multiple gestation (Fetus).
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To select the measurement
To select which measurement you want to display on the Fetal
Growth Curve Graph, do one of the following:
•
To select a specific measurement:
• On the graph display, move the Trackball under the
<Measurement Type> field and press SET.
The system displays a list of measurements
(Figure 7-64).
• Move the Trackball to select the desired measurement
and press SET.
The system displays the Fetal Growth Curve Graph for
the selected measurement.
•
To scroll through all Fetal Growth Curve Graphs, adjust the
Graph Change control.
Figure 7-64: Fetal growth measurement type
To select the age to use
To plot the fetus age, the system allows you to use the
gestational age (GA) from the LMP, or to use the composite
ultrasound age (CUA). To select, adjust the Select GA control.
The information in the left column changes between CUA and
GA (EDD), and the data may change.
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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 a single or four graphs
You can view either a single Fetal Growth Curve Graph or you
can view four graphs at the same time. To select each view,
press Single or Quad on softkey button.
Figure 7-65: Fetal Growth Curve Graph: Quad View
The measurement values are displayed at the bottom of the
graph.
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To change measurements in quad view
When you view four graphs simultaneously, you can select
which four you want to see. To change each graph in quad
view:
1. On the graph display, use the Trackball to move the cursor
to the small box that is upper left of each graph, then press
SET.
The system displays a list of measurements.
2. Move the Trackball to select the desired measurement and
press SET.
The system displays the Fetal Growth Curve Graph for the
selected measurement.
To scroll through all Fetal Growth Curve Graphs, adjust the
Graph Change control.
Figure 7-66: Changing a chart in quad view
To edit patient data
When you are working with graphs, you can change or enter
the following patient data.
•
GA (LMP) - this field is computed using the LMP date on
the Patient Data Entry screen. To change this field:
Note: You can only change this field on the Fetal Growth
Curve Graph in single view.
• Move the Trackball to the field, which is left of the graph.
To select the field press SET.
The system displays a window with the GA weeks and
days.
• To select each field, move the Trackball to the field and
press SET.
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• Type the correct weeks or days.
• Select OK.
The system makes the following changes:
•
GA (LMP) is now GA (GA) and shows the age you entered.
•
In the Patient Data section, the GA changes.
•
In the Patient Data section, the EDD (LMP) changes to
EDD (GA) and shows an updated date, using the GA you
entered. In addition, the LMP is erased.
•
FetusPos - type information about the fetus position.
•
PLAC - type information about the placenta.
Note: To return from a graph to the scan display press
Worksheet or Freeze.
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 then Plot Both.
The system automatically finds the data from previous
ultrasound exams, and displays it on the graph with the
present data.
Figure 7-67: Fetal Trending
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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.
To view the Fetal Growth Bar Graph:
1. Press Worksheet.
2. Select Graph.
3. Select Bar.
Figure 7-68: Fetal Growth Bar Graph
Graph description:
•
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.
You cannot do fetal trending or view multiple gestation data on
the bar graph.
Note: To return to the graphs, press the Worksheet and the
Graph soft-key; or press the "More" and the Graph soft-key.
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OB-Multigestational
Multiple Fetus
Vivid S5/Vivid S6 allows you to measure and report multiple
fetus development. The system can report a maximum of four
fetuses.
To define the number of fetuses
If more than one fetus is imaged during the exam, enter the
number of fetuses in the Patient Information Entry page.
1. Press PATIENT.
2. Select Current Patient Information.
The Patient Information window appears.
3. Type the number of fetuses into the Fetus No. field (1-4).
4. Press the Begin Exam softkey to continue with the exam
and get a scanning screen.
Note: You may also press the 2D mode button to continue
with the scanning.
To identify each fetus
For measurements, calculations, and worksheet displays, the
system labels each fetus A, B, C, or D. Each fetus is identified
by a letter and the total number of fetuses. For example, fetus
A/3 is fetus A from a total of 3.
When scanning, you can enter information about the fetus
position and placenta location. You can enter the information in
the Patient Data section of the worksheets and the graphs.
You can type up to 23 characters in the FetusPos and PLAC
fields.
Each fetus may have different description in these fields.
Figure 7-69: OB Worksheet - Patient Data section
To select a fetus
During measurements and calculations, to change between
fetuses, do one of the following:
•
Adjust the Fetus selection.
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•
Move the Trackball to the Summary Window and select
the fetus.
Figure 7-70: Summary Window: Multiple fetus
You can change between fetuses at any time during the exam.
Note: After you change to the next fetus, any measurements
you make are recorded and reported to that fetus. If you have
any active measurement or calculation that is not completed
when you change the fetus, the system cancels the
measurement or calculation.
To compare multiple fetus data on a
worksheet
With multiple fetuses, you can list and compare measurements
of the fetuses on the worksheet.
•
Select Worksheet Display.
•
Select Fetus Compare.
The system lists the measurement results for each fetus
on the Worksheet.
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Figure 7-71: Worksheet Display with Fetus Compare
To view multiple fetuses data on graphs
You can view multiple gestation data on fetal growth curve
graphs. After you have made measurements for each fetus,
select Graph Display.
•
To view the graph for each fetus, do one of the following:
• Adjust the Fetus selection.
• In the Patient Data section, move the Trackball to
highlight the FetusNo field. Then, in the list of fetuses,
move the Trackball to select the fetus you want, and
press SET.
•
To display data for multiple fetuses on the same graph,
select Fetus Compare.
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Figure 7-72: Fetal Growth Curve Graph: Fetus Compare
The legend at the bottom of the graph shows the symbols and
colors that represent each fetus.
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GYN Measurements
Introduction
The Gynecology exam category includes the following three
studies:
•
Generic: This study is common to all exam categories, and
is part of the Measure and Assign Modality ("Starting the
Measure and Assign modality", page 263).
•
General Gynecology: This study includes uterine, ovarian,
ovarian follicle, and endometrium measurements.
•
OB/GYN Vessel: This study includes the following vessels:
uterine, ovarian, umbilical, middle cerebral artery, aorta,
placenta, and descending aorta.
Note: The calculation formulas are listed in the Advanced
Reference Manual.
To Start a Gynecology Exam
To begin a gynecology exam, you enter patient data or, if the
patient data from a previous exam is saved in the system, find
the patient information.
Details about how to start an exam can be found earlier in this
chapter ("Performing an OB exam", page 329).
After you complete the patient information, you can begin the
scan.
1. To change from the Patient Data Entry screen to the Scan
screen, do one of the following:
• On the keyboard, press Esc.
• On the Control Panel, select PATIENT or FREEZE.
• On the Control Panel, press the B-MODE key.
The system displays the Scan screen.
2. On the Control Panel, press MEASURE.
The default Gynecology study is displayed on the Top/Sub
Menu.
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B-Mode Measurements
In B-Mode, you make the measurements in the General
Gynecology study. These measurements include:
•
Uterine length, width, and height
•
Ovarian length, width, and height
•
Ovarian follicle
•
Endometrium thickness
Uterus length, width, and height
Each of these is a standard distance measurement. Typically,
length and height are measured on the saggital plane while the
width is measured on the axial/transverse plane.
To measure uterus length, width, or height:
1. Scan the patient in the appropriate scan plane.
2. Select the UV folder, then select UV L, UV H, or UV W.
An active caliper displays.
3. Perform a standard distance measurement:
• To position the active caliper at the start point, move the
Trackball.
• To fix the start point, press SET.
The system fixes the first caliper and displays a second
active caliper.
• To position the second active caliper at the end point,
move the Trackball.
A dotted line connects the measurement points.
• To complete the measurement, press SET.
The system displays the distance value in the Results
window. After the first and second measurement, the
system displays an active caliper for the next
measurement.
4. To make the second and third distance measurement,
repeat steps 2-3 above.
After you complete the third distance measurement, the
system displays the Ut-Vol (uterine volume) in the Results
Window, together with the three dimensions: Ut-L, Ut-H,
Ut-W.
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Ovary length, width, and height
You can measure the length, width, and height of the left and
right ovaries. Each measurement is a typical distance
measurement made in the appropriate scan plane.
Typically, length and height are measured on the saggital plane
while the width is measured on the axial/transverse plane.
To measure ovarian length, width, or height:
1. Scan the patient's right or left ovary in the appropriate
plane.
2. Select the OV folder, then select left or right side.
3. Select length, width or height: OV L, OV W, or OV H.
4. Perform a standard distance measurement:
• To position the active caliper at the start point, move the
Trackball.
• To fix the start point, press SET.
The system fixes the first caliper and displays a second
active caliper.
• To position the second active caliper at the end point,
move the Trackball.
A dotted line connects the measurement points.
• To complete the measurement, press SET.
The system displays the distance value in the Results
window. After the first and second measurement, the
system displays an active caliper for the next
measurement.
5. To make the second and third distance measurements,
repeat steps 3-4 above.
After you complete the length, width, and height
measurements, the system displays the ovarian volume in the
Results window. The results are:
•
Right side: Rt Ov-L, Rt Ov-H, Rt Ov-W, Rt Ov Vol
Or:
•
Left side: Lt Ov-L, Lt Ov-H, Lt Ov-W, Lt Ov Vol
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Follicle measurements length, width,
and height
You can make left and right ovary follicle volume
measurements from three distances.
1. Select the right or left side by clicking Rt or Lt.
2. Select Follicle.
An active caliper displays.
3. Measure the 3 dimensions length, width, height of the
follicle as follows:
4. Make the first distance measurement:
• To position the active caliper at the start point, move the
Trackball.
• To fix the start point, press SET.
The system fixes the first caliper and displays a second
active caliper.
• To position the second active caliper at the end point,
move the Trackball.
A dotted line connects the measurement points.
• To complete the measurement, press SET.
The system displays the distance value in the Results
Window. After the first and second measurement, the
system displays an active caliper.
5. To make the second and third distance measurements,
repeat step 4 above.
The three distances will display in the Results Window.
After the third measurement, the system displays the
follicle volume calculation including previous
measurements in the Results window.
Endometrium thickness (Endo)
To measure the endometrium thickness, make one distance
measurement.
1. Select Endo.
An active caliper displays.
2. To position the active caliper at the start point, move the
Trackball.
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3.
4.
5.
To fix the start point, press SET.
The system fixes the first caliper and displays a second
active caliper.
To position the second active caliper at the end point, move
the Trackball.
A dotted line connects the measurement points.
To complete the measurement, press SET.
The system displays the endometrium thickness in the
Results window.
M-Mode Measurements
M-Mode measurements for the Gynecology exam are identical
to M-Mode measurements for the Obstetrics exam. These
measurements include % stenosis, A/B ratio, and heart rate
("M-Mode Measurements", page 320).
Doppler Mode Measurements
Doppler measurements for the Gynecology exam are identical
to Doppler measurements for the Obstetrics exam. These
measurements include the following vessels: uterine, ovarian,
umbilical, middle cerebral artery, aorta, placenta, and
descending aorta. For each vessel, you can make any of the
following measurements: peak systole, minimum diastole, end
diastole, heart rate, TAMAX, pulsatility index, resistive index,
acceleration, PS/ED, ED/PS, and acceleration time ("Doppler
measurements", page 321).
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Chapter 8
Quantitative Analysis
• Introduction ................................................................................... .. 391
• Accessing the Quantitative analysis package ........................... .. 392
• Quantitative Analysis window ..................................................... .. 393
• Overview .................................................................................. 393
• Generation of a trace .................................................................... .. 400
• About the sample area ............................................................. 400
• To generate a trace .................................................................. 400
• Manual tracking of the sample area (dynamic anchored sample
area) ........................................................................................ 401
• Zooming in the Analysis window .............................................. 402
• Deletion of a trace ......................................................................... .. 403
• To delete all traces ................................................................... 403
• To delete one specific trace ..................................................... 403
• Saving/retrieving Quantitative analysis ...................................... .. 403
• Frame disabling ............................................................................ .. 404
• Disabling frames ...................................................................... 404
• Re-enabling all frames ............................................................. 404
• Optimizing sample area ................................................................ .. 406
• Reshaping a sample area ........................................................ 406
• Labelling a sample area ........................................................... 407
• Optimizing the trace display ........................................................ .. 408
• Optimizing the Y-axis ............................................................... 408
• Trace smoothing ...................................................................... 409
• Switching modes or traces .......................................................... .. 411
• To switch mode ........................................................................ 411
• To switch trace ......................................................................... 411
• Cine compound ............................................................................. .. 412
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• Curved Anatomical M-Mode (CAMM) .......................................... ... 413
• Introduction ............................................................................... 413
• Using CAMM ............................................................................. 413
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Introduction
The quantitative analysis software package is designed for
analysis of TVI, Tissue Tracking, Strain and Strain rate 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
Note: Strain and Strain Rate modes are options available on
Vivid S6 only.
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Accessing the Quantitative analysis package
In replay mode
1.
2.
Open an examination and recall a TVI or contrast loop.
Press the softkey Q ANALYSIS.
The Quantitative Analysis screen is displayed (Figure 8-1).
In live
1.
2.
392
Press FREEZE.
Note: if in 2D mode outside a contrast application, press
ALT and MORE softkey.
Press the softkey Q ANALYSIS.
The Quantitative Analysis screen is displayed (Figure 8-1).
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Quantitative Analysis window
Overview
7
1. Color cineloop window
2. Tissue cineloop window
5. Time at cursor position and velocity at cursor
position
3. Analysis window
6. Trackball Assignments
4. Sample Area
7. Sample area tools
Figure 8-1: The Quantitative analysis window (here with TVI data)
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The color cineloop window
Displays TVI, Tissue Tracking, Strain, Strain
rate or Angio color-coded data.
Sample area (1):
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.
The cineloop windows system menu
This 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.
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.
• Delete anchorc: remove anchoring from a
dynamic sample area ("About the sample
area", page 400)("Manual tracking of the
sample area (dynamic anchored sample
area)", page 401).
• 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.
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The Tissue cineloop window
Displays 2D data
Sample area (1):
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:
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: creates a sample area based on
freehand drawing.
•
: creates a sample area with a
pre-defined circular/elliptic configurable
shape ("Reshaping a sample area",
page 406)
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The analysis window
TVI:
6
Displays velocity trace
-2.3
1
5
4
1.
2.
3.
4.
5.
6.
Y axis: velocity scale (cm/s)
X axis: Time (s)
ECG
Time at cursor position
Velocity at cursor position
Velocity at frame marker position
(color coded)
Tissue Tracking:
Displays tissue displacement trace
2
3
1.
2.
3.
4.
5.
6.
Y axis: displacement scale (mm)
X axis: time (s)
ECG with Tracking start and Tracking
end markers
Time at cursor position
Displacement at cursor position
Displacement at frame marker
position (color coded)
Strain rate:
Displays Strain rate trace (rate of deformation
(s-1))
1.
2.
3.
4.
5.
6.
396
Y axis: s-1
X axis: time (s)
ECG
Time at cursor position
Strain rate at cursor position
Strain rate at frame marker position
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Strain:
6
Displays Strain trace (extent of tissue
deformation (%))
-2.3
1
5
4
1.
2.
3.
4.
5.
6.
Y axis: percent displacement
X axis: time (s)
ECG with Strain start and Strain end
markers
Time at cursor position
% deformation at cursor position
% deformation at frame marker
position (color coded)
2
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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).
a)
With contrast data only.
b)
Shown only in zoom mode.
• 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.
• 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 trace
Up to eight traces can be generated.
About the sample area
The free sample area
disappears when the
QA cursor is moved
over a static
anchored frame.
The sample area can be in three different states:
•
Free sample area: freely moving sample area (QA cursor)
before anchoring.
•
Static sample area: the free sample area is anchored by
pressing SET on the Trackball area.
•
Dynamic anchored sample area: the sample area is
anchored in two or more frames ("Manual tracking of the
sample area (dynamic anchored sample area)", page 401).
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 trace and
sample area are
color-coded. First
generated trace is
yellow, second
green...etc.
The shape of the pre-defined sample area is configurable
("Reshaping a sample area", page 406).
1. If the Trackball assignment is not on QA, press TRACKBALL
until QA is highlighted.
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 SET 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 cursor
In 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 area
1.
2.
3.
4.
Select the Pencil button
.
Trackball to one of the Cineloop windows.
The trackball cursor is changed to a cross.
Press and hold down the SET button while drawing a
sample area with the trackball.
Release the SET 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)
In the original
frame and this
particular frame the
sample area is
marked with an
anchor.
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 SET.
The sample area is unanchored.
6. Drag the sample area to the corresponding anatomical
location in the new frame.
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 area
1.
In these frames the
sample area is
marked with an
anchor.
2.
3.
4.
5.
6.
7.
Press TRACKBALL until the Scroll trackball assignment is
selected.
Using the trackball, browse through the cineloop to display
one of the frames where the sample area was anchored.
Press TRACKBALL until the QA trackball assignment is
selected.
Trackball to the sample area to move, in one of the
Cineloop windows.
Press SET.
The sample area is unanchored.
Drag the sample area to a new location.
Press SET to anchor the sample area to the new location.
Zooming in the Analysis window
1.
2.
In the Analysis window, press and hold down the SET key
while dragging the trackball cursor to define the zooming
area.
Release the SET key.
The selected area is displayed in the Analysis window.
To unzoom
1.
2.
3.
402
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
Trackball to Unzoom.
Press SET.
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Deletion of a trace
The user can delete all traces at once or one at a time.
To delete all traces
1.
2.
3.
4.
If necessary, press TRACKBALL until the QA trackball
assignment is selected.
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
Trackball to Delete all traces.
Press SET.
To delete one specific trace
1.
2.
3.
4.
5.
If necessary, press TRACKBALL until the QA trackball
assignment is selected.
Trackball to the sample area to delete.
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
Trackball to Delete trace.
Press SET to perform deletion.
Saving/retrieving Quantitative analysis
1.
2.
Press IMAGE STORE to save the quantitative analysis
session.
To recall the Quantitative analysis session, select the icon
on the clipboard, and press the assigned key Q ANALYSIS.
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Frame disabling
Frame disabling excludes the actual frame from the cineloop
display. Frame disabling is available only with contrast data.
Disabling frames
To re-enable a
frame: Press
SELECT on the
corresponding
frame marker.
1.
2.
Trackball to the frame marker of the frame to disable
beneath the Analysis window (Figure 8-2).
Press SET to disable the frame.
The frame marker turns red.
disabling successive frames at a time
To re-enable
successive frames:
press and hold
down the SELECT
key while dragging
the cursor over the
frame markers.
1.
Press and hold down SET 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 (Figure 8-2).
3. Press UPDATE MENU.
The System menu is displayed.
4. Trackball to ECG triggering.
5. Press SET.
All frames in all heart cycles are disabled except for the
selected and corresponding frames in the other heart
cycles.
Re-enabling all frames
1.
2.
3.
404
Trackball the cursor to the Frame marker axis.
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
Trackball to Enable all frames.
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4.
Press SET.
All previously disabled frames are re-enabled.
1. Analysis window
2. Frame marker axis
3. Enabled frame (green marker)
4. Disabled frame (red marker)
5. ECG
6. Current frame
Figure 8-2: Frame disabling
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Optimizing sample area
The sample area can be reshaped and labelled.
Reshaping a sample area
There are two ways of modifying a sample area: either from the
Update menu or by selecting the SAMPLE SHAPE softkey.
Reshaping a sample area from the Update
menu
1.
2.
3.
4.
5.
If necessary, press TRACKBALL until the QA trackball
assignment is selected.
Trackball to the sample area to reshape.
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
Trackball to Set Sample area shape.
Press SET.
A Dialogue window is displayed where the user can adjust
the height, the width and the angle of the sample area
(Figure 8-3).
Figure 8-3: The sample area reshaping window
6.
7.
406
Drag the sliders to adjust the shape of the sample area as
desired.
Press OK to return to the Quantitative analysis window and
use the settings for the current analysis only.
OR
Press 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 softkeys
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 softkey.
The Sample shape softkey controls are displayed.
2. Adjust the size and angle of the sample area using the
softkey rotaries.
3. If desired press the softkey SET DEFAULT to keep the
settings as default.
Labelling a sample area
The 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
panel.
The System menu is displayed.
4. Trackball to Label Sample area....
5. Press SET.
A Dialogue window with a free text field is displayed
(Figure 8-4).
6. Type a name for the sample area.
7. Press OK to return to the Quantitative analysis screen.
1. Free text
Figure 8-4: The sample area labelling window
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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 function
1. 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
panel.
The System menu is displayed.
4. Trackball to Vertical auto-scaling.
5. Press SET.
The Vertical autoscaling menu is displayed.
Figure 8-5: The Vertical Auto-scaling menu
6.
7.
408
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.
Press SET.
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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 unit
1. 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
panel.
The System menu is displayed.
4. Trackball to Vertical unit.
5. Press SET.
The Vertical unit menu is displayed.
Figure 8-6: The Vertical unit menu
6.
7.
Trackball to the desired option.
Press SET.
Trace smoothing
The 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.
2.
3.
If necessary, press TRACKBALL until the QA trackball
assignment is selected.
Trackball to the Analysis window.
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
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4.
5.
410
Select Smoothing.
The Smoothing menu is displayed.
Select a smoothing filter.
The trace display is updated.
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Switching modes or traces
The user can toggle between TVI, Tissue Tracking, Strain rate
or Strain modes to access to the mode specific controls (soft
menu and softkey) or display alternative traces from within a
selected mode.
To switch mode
1.
2.
Press MORE.
Select the desired mode (TVI, Tissue Tracking, Strain rate
or Strain.
The Soft menu and softkeys are updated accordingly.
To switch trace
1.
2.
3.
4.
5.
If necessary, press TRACKBALL until the QA trackball
assignment is selected.
Trackball to the Analysis window.
Press UPDATE MENU in the trackball area on the control
panel.
The System menu is displayed.
Trackball to Analysis signal.
Press SET.
The Analysis signal menu is displayed.
Figure 8-7: The Analysis signal menu
6.
7.
Trackball to the desired trace.
Press SET.
The Analysis window is updated with the selected trace.
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Cine compound
Cine 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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Curved Anatomical M-Mode (CAMM)
Introduction
M-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 CAMM
1.
2.
3.
4.
To edit a path under
construction,
trackball
backward and
retrace the path.
5.
6.
Rotate HORIZ.
SWEEP and scroll
through the
cineloop to optimize
the display to the
portion of interest.
Press the CAMM softkey.
In one of the Cineloop windows, trackball to the region from
where to start the sampling path.
Press SET to anchor the first point of the path.
Trackball to the location for the next anchoring point of the
path.
Press SET 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.
To end the trace press SET twice (double clicking).
The color-coded display of the corresponding data
calculated along the path is shown in the Analysis window
(Figure 8-8).
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1
2
3
3
4
1. Cineloop window
3. Path anchor point
2. Analysis window
4. Time scale
Figure 8-8: The curved anatomical M-Mode display (here TVI data)
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Optimizing Curved Anatomical M-Mode
Edition of the curve
The drawn Curved Anatomical M-Mode path can be edited by
moving the anchor points.
To move an anchor point
1.
2.
3.
Trackball to anchor point to move.
Press SET.
Trackball the anchor point to a new position.
4.
Press SET to anchor the point to its new location.
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Chapter 9
Archiving
• Introduction ................................................................................... .. 419
• Storing images and cineloops ..................................................... .. 420
• Storing an image ...................................................................... 421
• Storing a cineloop .................................................................... 421
• Saving images and cineloops to a standard format ................. 422
• MPEGVue/eVue ....................................................................... 424
• Retrieving and editing archived information .............................. .. 428
• Locating a patient record .......................................................... 428
• Selecting a patient record and editing data in the archive ....... 434
• Deleting archived information ................................................... 438
• Moving examinations ............................................................... 440
• Review images in archive ............................................................ .. 442
• Review the images from a selected examination ..................... 442
• Select images from the Image list screen ................................ 443
• Connectivity .................................................................................. .. 447
• The dataflow concept ............................................................... 447
• Stand-alone scanner scenario ................................................. 450
• A stand-alone scanner and a stand-alone EchoPAC PC
environment ............................................................................ 451
• A scanner and EchoPAC PC in a direct connect environment 454
• A scanner and EchoPAC PC in a network environment .......... 458
• A scanner and a DICOM server in a network ........................... 460
• Export/Import patient records/examinations ............................. .. 470
• Exporting patient records/examinations ................................... 470
• Importing patient records/examinations ................................... 479
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• Disk Management ......................................................................... ... 483
• Configuring the Disk management function .............................. 484
• Running the Disk management function ................................... 487
• Data Backup and Restore ......................................................... 490
• DICOM spooler .............................................................................. ... 498
• Starting the DICOM spooler ......................................................498
• Database import from Vivid 3 or Vivid 4 ..................................... ... 501
• Transfer Procedure ................................................................... 501
• Installing the Vivid 3/4 Data Viewer .......................................... 504
• Using the Vivid 3/4 Data Viewer ...............................................507
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Introduction
During an examination, the operator stores data, images and
cineloops for immediate purposes. The Vivid S5/Vivid S6
ultrasound unit includes an integrated patient archiving system
for data and image storage.
Do not use the internal hard drive for long-term image storage.
CAUTION
The Vivid S5/Vivid S6 ultrasound unit enables also storing of
data and images to external databases (Image Vault, Magneto
Optical (MO) disk, CD-R or DVD-R). The patient and image
archives are set by the selected dataflow. Details about
available dataflows and default dataflow selection are provided
later in this manual ("Dataflow", page 632).
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Storing images and cineloops
DICOM 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
(Figure 9-1). When an image is stored, all the additional
information that is displayed is saved with it (i.e. probe and
application selected, image setting, annotations or
measurements, etc.).
The image archive is set by the dataflow selected. Details
about available dataflows and default dataflow selection are
provided later in this manual ("Dataflow", page 632).
Do not use the internal hard drive for long-term image storage.
CAUTION
External storage media or network-based server solution 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 ("Starting the DICOM spooler",
page 498) when reconnecting the unit. Resend all jobs that are
failed or on hold.
In addition, stored images and cineloops can be saved to a
removable media in the standard formats JPEG, AVI (cineloop),
MPEG and DICOM ("Saving images and cineloops to a
standard format", page 422).
1. Single image stored
2. Cineloop stored Scrolling tool
3. Scrolling tool
4. Serial number of image
Figure 9-1: The Clipboard on the scanning screen
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Storing an image
Images 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. A serial number appears on each thumbnail,
start from “1” in chronological order (Figure 9-1).
Storing a cineloop
A 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 cineloop
1.
2.
3.
4.
While scanning in any mode, press FREEZE.
Press the softkey CINELOOP.
Determine the best cineloop to store using the softkeys
("Cineloop operation", page 110).
Press STORE.
The cineloop is stored and a thumbnail is displayed on the
clipboard. The "loop" icon appears on the thumbnail image
indicating that the image stored is a loop (Figure 9-1). A
serial number appears on each thumbnail, starting from “1”
in chronological order.
Note: Cineloop storage can be configured to store heart cycles
with additional time before and after the R-wave ("The Global
setup sheet", page 606).
Direct storage of a cineloop
Depending on whether the system has been configured to
enable or disable the Preview Loop before store function
("Imaging", page 606), the following procedures enable the
cineloop to be stored directly.
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Storing cineloop without preview
The function Preview Loop before store is disabled
("Imaging", page 606).
•
While scanning, press STORE.
The last valid cineloop is stored in the archive and a
thumbnail is displayed on the clipboard.
Scanning resumes immediately.
Storing cineloop with preview
The function Preview Loop before store is enabled
("Imaging", page 606).
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 softkeys ("Cineloop operation", page 110).
3. Press STORE to save the cineloop.
A thumbnail is displayed on the clipboard.
Saving images and cineloops to a
standard format
Images and cineloops can be saved to a removable media or a
shared network folder in the following standard formats:
•
Still images: JPEG, MPEG, DICOM and RawDICOM (Raw
data + DICOM), and HDF
•
Cineloops: AVI, MPEG, DICOM and RawDICOM (Raw
data + DICOM), and HDF
Images can also be stored as MPEG format on a CD-R using
the Export function ("MPEGVue/eVue", page 424).
Procedure:
1.
2.
422
In live: press FREEZE.
In replay: select an image thumbnail on the clipboard.
Press UPDATE/MENU on the control panel.
The System menu is displayed.
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Figure 9-2: The System menu
3.
4.
Trackball to Save as.
Press SET.
The Save as menu is displayed.
Figure 9-3: The Save as menu
5.
6.
7.
Select the desired removable media from the Save in
archive pull-down menu.
Enter a file name in the File name field.
If the image or cineloop is saved as DICOM or RawDICOM
the file name is automatically generated to follow the
DICOM standard.
Select between:
• Store image only: saves the image or cineloop only.
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• 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.
• Quad view: saves all images or cineloop when in quad
view.
Quad view is not available when storing RawDICOM.
8. Select the image compression type (JPEG or RIe) or no
compression.
9. Enter in the desired Image quality (between 10 and 100).
A high quality setting will give a lower compression.
10. 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.
• HDF: saves the image or cineloop in HDF (Hierarchical
Data Format). HDF is a portable data format for
exchange of scientific numerical and graphical data.
More information about HDF format at:
http://hdf.ncsa.uiuc.edu
A tool for viewing HDF files can be downloaded from:
http://hdf.ncsa.uiuc.edu/hdf-java-html/hdfview/
11. Press Save.
A file is saved in the selected archive.
MPEGVue/eVue
MPEGVue/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.
MPGEGVue Viewer is intended for secondary review and patient
consultation.
CAUTION
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Note: MPEGVue is optionally available on both Vivid S5 and
Vivid S6, while eVue is available for Vivid S6 only.
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.
Creating an MPEG exam using the Export
function (MPEGVue)
("Exporting patient records/examinations", page 470).
Creating a MPEGVue exam usingan eVue dataflow
The dataflow must be configured before first time use as
follows:
1. Press CONFIG 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.
Make sure that the option Hidden is unchecked.
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Figure 9-4: The Dataflow Sheet
4.
Select the eVue device in the Selected devices pane and
press Properties.
The eVue properties window is displayed.
Figure 9-5: The eVue properties window
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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.
5.
6.
7.
1.
2.
3.
Select a removable media or a network volume remote path
as the destination in the Destination pull-down menu.
Check the options as required.
Select OK and press CONFIG.
To create an MPEG exam using an eVue dataflow
Press ARCHIVE.
The Search/Create patient window is displayed.
Select the dataflow Local Archive - Int. HD/eVue or
Remote Archive - Remote HD/eVue.
Perform an exam.
When saving an image, it is stored as raw data to the local
machine, an MPEG copy is created and stored to the
destination set during the configuration of the dataflow.
Reading an 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 reading
MPEG exams on a computer.
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Archiving
Retrieving and editing archived information
Locating a patient record
Operator ID
creation is described
later in this manual
("Users",
page 653).
1.
Press PATIENT on control panel.
If the unit is password protected a Log In window
(Figure 9-6) will appear asking for user ID, and password.
1. Select the operator
Figure 9-6: The Operator login window
The unit can be
configured to
automatically
generate a patient
ID ("Formats",
page 642)
2.
Press Log on when completed.
The Archive entry screen is displayed (Figure 9-7).
Figure 9-7: Archive entry screen
3.
4.
428
Click the Create New Patient button.
The Search/Create patient window is displayed
(Figure 9-8).
Type the patient Last Name, and/or ID.
Note: Use "Other ID" if relevant ("Using Other Patient ID",
page 99).
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Do NOT use '\' or '^' in patient information fields, as these
characters might cause problems with some DICOM devices.
CAUTION
The automatic
searching tool
displaying
matching patient
information in the
Patient list can be
turned off
("Formats",
page 642)
5.
6.
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.
Trackball to the actual patient and press the Trackball SET
key.
The patient record is highlighted.
Press SELECT PATIENT
Or
Press [+] in front of the actual patient record and select the
desired examination.
The Examination List window for the actual patient is
displayed (Figure 9-10).
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1. Press one of the headings to sort the list
accordingly.
4. Select the column heading border and drag to
adjust column width
2. Select new archive and other pre-defined
services
5. Expended Patient record displaying belonging
examinations
3. Extended menu
The Search/Create patient window may be slightly different depending on the Dataflow selected
Figure 9-8: The Search/Create Patient window
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Advanced search
The list of searching
filters may vary
depending on the
Dataflow selected
To restrict 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 filter
Echolab
Diagnostic code
Born between
Examination date between
Current date
Images: patient records with examinations with images
Stress examinations: patient records with stress echo examinations
No Report: Patient record with examination(s) without stored
reports
Category: displays only patient records for the selected category
Diagnosis Physician
The unit can be
configured to
display the
Advanced search
tool as default
("Formats",
page 642)
Searching with filter:
1. Trackball to the More button in the Search/Create Patient
window.
2. Press SET on the control panel.
The Search/Create Patient window is extended displaying
the searching filters (Figure 9-9).
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.
Note: Use Other ID if relevant ("Using Other Patient ID",
page 99).
Note: It is not possible to search for patients via the Age field
as this field is inactive. To search for a patient by age, use the
Date of Birth field ("Other configuration settings", page 645).
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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 9-9).
2. Press SET on the control panel.
The patient list is sorted in ascending order according to
the field selected.
3. Press SET once more.
The patient list is sorted in descending order according to
the field selected.
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1. Press one of the headings to sort the list
accordingly.
4. Select the column heading border and drag to
adjust column width
2. Select new archive and other pre-defined
services
5. Expended Patient record displaying belonging
examinations
3. The system can be configured to display the
Advanced search tool as default ("Formats",
page 642)
The Search/Create patient window may be slightly different depending on the Dataflow selected.
Figure 9-9: The extended Search/Create Patient window
Printing the patient list
1.
2.
In the Search/Create patient window, select More to display
the additional menu.
Select Print Patients.
The displayed patient list is printed.
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Selecting a patient record and editing
data in the archive
After locating the patient in the database ("Locating a patient
record", page 428), the user must select the patient record, to
be able to review and edit archived data.
Selecting a patient record from the patient list
1.
2.
In the Search/Create patient window, trackball to the actual
patient and press the Trackball SET key.
The patient record is highlighted.
Press SELECT PATIENT.
The Examination List window is displayed showing
previous examinations and diagnosis information related
to the selected patient (Figure 9-10).
1. The information displayed in the Patient list is
configurable ("Formats", page 642).
3. Select the column heading border and drag to
adjust column width
2. Insert pre-defined text in the Comment field
4. Enter the diagnostic code
Figure 9-10: The Examination list window
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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.
CAUTION
Use the Arrow keys
to move text
marker.
The user is responsible for patient demographic data, diagnostic
information or any other patient related information entered in
the database.
Text edition
1. In the Examination list window (Figure 9-10), trackball to
the required field.
2. Press SET.
3. Using the alphanumeric keyboard, edit the information.
4. Press PATIENT on the control panel to quit the archive.
Inserting pre-defined text input
1. In the Examination list window, trackball to Insert Text over
the actual field.
2. Press SET.
The Insert text window is displayed (Figure 9-11).
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.
Figure 9-11: The Insert text window
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Creating, editing and deleting text input
These features are described later in this manual ("The
Comment texts sheet", page 629).
Diagnosis code
Entering a Diagnosis code
1. In the Examination list window, select Code (Figure 9-10).
The Entered Code window is displayed.
2. Select Add.
The Code list window is displayed.
3. Double-click the code to enter.
The selected code is displayed in the Examination list
window.
1. The Entered Code window
2. The Code list window
Figure 9-12: Entering Diagnosis codes
Deleting an entered Diagnosis code
1. In the Examination list window, select Code (Figure 9-10).
The Entered Code window is displayed.
2. In the Entered Code window, select the code to delete and
press Delete.
Creating a Diagnosis code
1. In the Examination list window, select Code (Figure 9-10)
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.
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More information is provided later in this manual ("The
diagnostic codes sheet", page 628).
Editing Demographic details
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.
Note: Patient ID may also refer to patient's "other ID" ("Using
Other Patient ID", page 99).
1.
2.
3.
4.
5.
Press the PATIENT button on the control panel.
Select Patient Details.
The Patient information window is displayed.
Trackball to the field to edit.
Press SET on the control panel.
Using the alphanumeric keyboard, edit the information.
Do NOT use '\' or '^' in patient information fields, as these
characters might cause problems with some DICOM devices.
CAUTION
Alternative: Press
any active scanning
mode key.
6.
Press the EXAM LIST softkey to go back to the Examination
list window. OR
Press PATIENT on the control panel to quit the archive.
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Deleting archived information
Only user logged in
with full operator
rights can delete
patient records
("Users",
page 653).
To delete a patient record
1.
2.
3.
4.
5.
6.
7.
Press PATIENT on the Front panel.
Select Patient List.
The Search/Create Patient window is displayed
(Figure 9-8).
Type the patient Last Name, and/or ID.
Trackball to the actual patient record.
Press SET to highlight the patient record to delete.
Press Delete in the Search/Create Patient window.
A dialogue box is displayed asking for confirmation of the
deletion (Figure 9-13).
Trackball to OK and press SET on the control panel.
Figure 9-13: Delete patient record confirmation prompt
To delete an examination
1.
2.
3.
4.
5.
6.
7.
438
Press PATIENT on the Front panel.
Select Patient List.
The Search/Create Patient window is displayed
(Figure 9-8).
Type the patient Last Name, and/or ID depending on
system configuration.
Trackball to the actual patient record and double-click the
Trackball SET key (or press SET once and SELECT PATIENT)
to select the patient.
The Examination list window is displayed.
Trackball to the examination to delete.
Press the trackball SET key.
Press More in the Examination list window (Figure 9-10).
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8.
9.
Press Del Exam to delete the examination.
A warning message is displayed asking the user to confirm
the action to perform (Figure 9-14).
Trackball to OK and press SET to delete the selected
examination.
Trackball to Cancel and press SET to abort deletion.
Figure 9-14: Delete Examination prompt
To delete an image
1.
2.
Repeat steps 9 and
10 to delete several
images.
Press PATIENT on the Front panel.
Select Patient List.
The Search/Create Patient window is displayed.
3. Type the patient Last Name, and/or ID.
4. Trackball to the required patient to highlight the record.
5. Press the trackball SET button.
The Examination list window is displayed.
6. Trackball to the actual examination in the Examination list
window.
7. Press the trackball SET button.
8. Press REVIEW.
The images for the selected examination are displayed on
the Review screen (Figure 9-17).
9. Trackball to the image to delete.
10. Press SET on the control panel.
11. Press Delete.
A pop-up dialog box is displayed asking for confirmation of
the deletion.
12. Trackball to OK and press SET on the control panel.
The image is deleted.
To delete an image from the clipboard
1.
If in live, press FREEZE.
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2.
3.
4.
5.
6.
Press TRACKBALL until the Pointer tool is selected.
Move the pointer over and select the image to delete in the
clipboard.
Press the Update/Menu button.
Select Delete clipboard cell from the Update menu.
A pop-up dialog box is displayed asking for confirmation of
the deletion.
Trackball to OK and press SET on the control panel.
The image is deleted.
Moving examinations
An 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.
When moving an examination, verify that the target patient
record is correct.
CAUTION
1.
2.
3.
4.
440
In the Search/Create Patient window press [+] in front of
the patient record containing the examination(s) to move
(Figure 9-8).
Select the examination to move.
Press the More soft button in the lower, right-hand corner
of the Search/Create Patient window.
Press the Move Exam soft button.
The Move exam window is displayed.
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Figure 9-15: The Move exam window
5.
6.
Search and select the target patient record.
Press Move Exam.
A warning message is displayed asking the user to confirm
the action to perform (Figure 9-16).
Make sure that the patient record selected is correct.
CAUTION
Figure 9-16: Moving examination prompt
7.
8.
Trackball to OK and press SET.
An information window is displayed to confirm the
operation.
Press OK.
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Review images in archive
There 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
examination
1.
2.
3.
In the Examination list window (Figure 9-10), trackball to
the actual examination.
Press SET on the control panel to highlight the examination.
Press REVIEW on the control panel.
The stored images for the selected examination are
displayed in the Review screen (Figure 9-17).
To analyze images:
1.
2.
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Press SET on the images to analyze.
Press ANALYZE.
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1. Page number
3. Selection tools
2. Selected image (bold frame)
Figure 9-17: The Review screen
Select images from the Image list
screen
The 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.
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1.
2.
In the Examination list window (Figure 9-10), press Image
list.
The Image list screen is displayed (Figure 9-20) showing
thumbnails of stored images for the actual patient sorted
by examination.
If the images are stored on a removable media that is not
mounted, the image thumbnail is replaced by a symbol.
Press SET 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 9-18: The Restore images window
3.
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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.
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4.
Press OK.
The Insert media window is displayed.
Figure 9-19: The Insert media window
5.
6.
Insert the required media.
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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1. Examination
2. Examination date and archive location
3. Selected image
4. Preview of selected image
5. Defined groups
Figure 9-20: The Image list screen
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Connectivity
This section describes the communication and connection
options for the Vivid S5/Vivid S6 ultrasound unit with other
devices in the hospital information system. This section covers
the procedures for configuration and optimal data management
from a Vivid S5/Vivid S6 in the following scenarios:
•
A stand-alone Vivid S5/Vivid S6 ("Stand-alone scanner
scenario", page 450).
•
A Vivid S5/Vivid S6 and one or several EchoPAC PC
workstations in a sneaker net environment ("A stand-alone
scanner and a stand-alone EchoPAC PC environment",
page 451).
•
A Vivid S5/Vivid S6 and an EchoPAC PC workstations in a
direct connect environment ("A scanner and EchoPAC PC
in a direct connect environment", page 454).
•
A Vivid S5/Vivid S6 and a DICOM server in a network ("A
scanner and a DICOM server in a network", page 460).
•
A Vivid S5/Vivid S6 and one or more PC stations in
MPEGvue or eVue environment.
The dataflow concept
Communication between the Vivid S5/Vivid S6 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 S5/Vivid S6 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.
Dataflow examples
A complete list and description of supported dataflows is
provided later in this manual ("Dataflow", page 632).
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Stand-alone scanner
The figure below illustrates dataflow for a stand-alone scanner.
A: LocalArchive-Int.HD dataflow:
The local database is used for
patient archiving. Images are
stored to internal hard drive.
Figure 9-21: Stand-alone scanner dataflows
Scanner in a network
The figure below illustrates two different dataflows for a
scanner connected to a network.
B: 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).
C: 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 hard drive.
Figure 9-22: Scanner in a network dataflows (example)
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Dataflow selection
Select a dataflow from the Search/Create Patient window
("Creating a new Patient record or starting an examination from
an existing patient record", page 95) or configure the system
with a default dataflow from the Configuration management
package as described below.
Default dataflow selection
1. Press CONFIG and log on as administrator if required.
2. Select the Connectivity category and Dataflow subgroup.
The Dataflow sheet is displayed (Figure 9-23).
3. Select the desired dataflow in the Name pull-down menu
and check the option Default.
4. Press CONFIG to exit the Configuration management
package.
1. Select Connectivity category
2. Select Dataflow subgroup
3. Select a dataflow
4. Default option for the selected dataflow
Figure 9-23: Default dataflow setting
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Stand-alone scanner scenario
In this scenario images will most likely be reviewed from
images stored in the internal archive. If digital images are
stored, they should be stored on the scanner’s internal hard
drive.
Figure 9-24: Stand-alone scanner with LocalArchive-Int.HD dataflow
Data management
Data acquisition
•
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 hard drive.
Image review
The same dataflow is used for review on the system.
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A stand-alone scanner and a
stand-alone EchoPAC PC environment
In this scenario the EchoPAC PC (one or several) is used for
review of studies acquired on one or more Vivid S5/Vivid S6
without being connected via a private or a local area network.
Images can be stored on the scanner’s internal hard drive
(recommended), on a dedicated MOD, or on a CD/DVD.
Images stored on the internal hard drive
Vivid S5/Vivid S6: dataflow LocalArchive-IntHD
EXP: export from LocalArchive-Int.HD to Removable MOD Archive
IMP: import from Removable MOD Archive to LocalArchive-Int.HD
EchoPAC PC: dataflow LocalArchive-Int.HD
Figure 9-25: A stand alone scanner and a stand alone EchoPAC PC
environment with images stored on the scanner’s hard drive
In this configuration images are first stored on the scanner’s
hard drive and then exported from the scanner’s hard drive to a
MOD and finally imported from the MOD to the EchoPAC PC’s
internal hard drive.
Data management
•
Scanner’s dataflow configuration
Select the LocalArchive-Int.HD dataflow as default
dataflow.
The local database is used for patient archiving. Images
are stored to internal hard drive.
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•
1.
The MOD
dedicated to
Export/Import can
be reformatted and
reused.
2.
3.
Export from Vivid S5/Vivid S6
Export the data (images, demographics, measurements
and report) for the patient(s) to be reviewed on a blank
dedicated formatted MOD (or CD/DVD) ("Export/Import
patient records/examinations", page 470).
Export from LocalArchive-Int.HD to Removable MOD
Archive or to CD/DVD Archive.
Make sure that the option Copy images is checked.
Import on EchoPAC PC
Select the LocalArchive-Int.HD dataflow on the
EchoPAC PC (can be configured as default dataflow).
Import the data from the Export/import MOD (or CD/DVD)
to EchoPAC PC internal hard drive using the Import
function as described in the workstation user manual.
Import from Removable MOD Archive or CD/DVD
Archive to LocalArchive-Int.HD
Make sure that the option Copy images is checked.
Press Archive and select the patient to be reviewed.
Stand-alone scanner and a stand-alone DICOM workstation
In this scenario a DICOM workstation is used for review of
studies acquired on one a Vivid S5/Vivid S6 without being
connected via a private or a local area network.
Figure 9-26: A stand-alone scanner stand-alone DICOM workstation
Data management
1.
2.
452
Scanner's dataflow configuration
Select the LocalArchive-Int.HD dataflow as default
dataflow. The local database is used for patient archiving.
Images are stored to internal hard drive.
Export the data to the DICOM MOD (or CD/DVD) using the
following settings: export from LocalArchive-Int.HD to
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DICOM MOD or DICOM CD/DVD ("Export/Import patient
records/examinations", page 470).
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A scanner and EchoPAC PC in a direct
connect environment
In this scenario the data is transferred from the
Vivid S5/Vivid S6 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 hard drive. 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.
Vivid S5/Vivid S6: dataflow RemoteArch-RemoteHD
EchoPAC PC: dataflow LocalArchive-Int.HD
Figure 9-27: 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 S5/Vivid S6 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.
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Scanner’s TCP/IP settings
To 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 and log on as administrator.
2. Select the Connectivity category and TCP/IP subgroup.
The TCP-IP subgroup is displayed.
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 Image
Vault)
4. Save TCP/IP settings. The changes will be
effective after the system is rebooted.
Figure 9-28: 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
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4.
5.
In the Remote archive setup area enter:
• The IP address for the remote archive
• The name of the remote archive
Press Save settings and reboot the system.
Direct connect with online acquisition
Data management
•
1.
Scanner’s dataflow configuration
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 hard
drive of the EchoPAC PC. Patient demographics,
measurements and reports are transferred on the fly when
entering the information on the Vivid S5/Vivid S6.
Review on the EchoPAC PC workstation
Select the LocalArchive-Int.HD dataflow on the
EchoPAC PC (can be configured as default dataflow).
Do NOT open a study on the EchoPAC PC workstation before the
study is closed on the scanner.
CAUTION
2.
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Press Archive and select the patient to be reviewed.
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Direct connect with offline acquisition
Data management
•
•
Press Today to
display today’s
exams to ease the
search.
Scanner’s dataflow configuration for offline
acquisition
When offline, select the LocalArchive-IntHD dataflow.
The local database is used for patient archiving. Images
are stored to internal hard drive.
Export examinations done offline from the scanner to
EchoPAC PC
When reconnected, export the data (images,
demographics, measurements and report) for the
examination(s) done offline to EchoPAC PC
("Export/Import patient records/examinations", page 470).
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
environment
In this scenario the Vivid S5/Vivid S6 is configured to work with
an ImageVault 4.0 or an Image Vault 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
Data management
•
1.
Scanner’s dataflow configuration
Select the RemoteArch-RemoteHD dataflow as default
dataflow in the sublevel Dataflow in the subgroup
Connectivity of the Configuration management package
("Dataflow", page 632 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 S5/Vivid S6.
Review on the EchoPAC PC workstation
Select the RemoteArch-RemoteHD dataflow on the
EchoPAC PC (can be configured as default dataflow).
Do NOT open a study on the EchoPAC PC workstation before the
study is closed on the scanner.
CAUTION
2.
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Press Archive and select the patient to be reviewed.
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Network environment with offline acquisition
Data management
•
•
Press Today to
display today’s
exams to ease the
search.
Scanner’s dataflow configuration for offline
acquisition
When offline, select the LocalArchive-IntHD dataflow.
The local database is used for patient archiving. Images
are stored to internal hard drive.
Export examinations done offline from the scanner to
the server
When reconnected, export the data (images,
demographics, measurements and report) for the
examination(s) done offline to the server ("Export/Import
patient records/examinations", page 470).
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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Archiving
A scanner and a DICOM server in a
network
In this scenario the Vivid S5/Vivid S6 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 dataflow 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
hard drive 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 hard drive.
•
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.
Note: When the system is configured to "Direct Store" to a
DICOM Server, the data transfer rate may become very slow,
and images are held up in the spooler for a long time.
This happens only when the system is configured to include the
DICOM header and while system is in scanning mode.
To increase transfer rate, either:
•
Reconfigure system to exclude sending the DICOM header
- or -
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•
Freeze the scanning for a while. The data transfer rate will
increase to a higher speed, allowing the release of data
accumulated in the spooler.
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 ("Scanner’s
TCP/IP settings", page 455).
In addition, to work against the DICOM server the following
information has to be entered in the scanner:
•
The DICOM server IP address
•
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
1.
2.
3.
DICOM dataflow selection
Press CONFIG and log on as administrator.
Select the Connectivity category and Dataflow subgroup.
The Dataflow sheet is displayed.
Select the DICOM dataflow to configure in the Name
pull-down menu (Figure 9-29).
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Figure 9-29: The Dataflow sheet
DICOM devices configuration
Depending 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
press Properties (Figure 9-30).
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1. Select the DICOM device.
2. Press Properties.
Figure 9-30: Display of the DICOM device Properties window
The Properties window for the selected DICOM device is
displayed (Figure 9-31).
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Figure 9-31: DICOM worklist properties window
2.
464
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 9-32: 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 port
For 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 (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 SR
DICOM Structured Reporting (SR) is a standardized format for
medical results. Vivid S5/Vivid S6 and EchoPAC PC support
the specialized form for Adult Echo and Vascular Ultrasound
("Supplements 71 and 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 S5/Vivid S6 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 S5/Vivid S6
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 S5/Vivid S6 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 SR
DICOM SR must be activated for each DICOM device.
1. Press CONFIG 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 (Figure 9-29).
4. Select a DICOM storage device in the Selected devices
pane and press Properties.
The Properties window for the selected DICOM stogare
device is displayed.
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Figure 9-33: DICOM storage properties window
5.
6.
7.
Check the option DICOM SR.
Select OK.
Press CONFIG.
Adjusting the Search criteria
When 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 and log on as administrator.
2. Select the Connectivity category and Dataflow subgroup.
The Dataflow sheet is displayed (Figure 9-34).
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.
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6.
7.
8.
9.
Select a Search criteria from the Select tag pull-down
menu.
Enter a value if required or leave blank if not to be used.
This entry is case sensitive and must match exactly.
Press Add to list.
Press OK to close the Search criteria window.
1. The dataflow sheet
2. The Properties window for the Worklist device.
3. The Search criteria window
Figure 9-34: Adjusting the Search criteria
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Checking the connection to the DICOM server
1. 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 study
1.
2.
3.
4.
5.
6.
Online scanner
In the Search/Create patient window, select a DICOM
dataflow.
If a DICOM worklist dataflow is selected, enter a search
criteria and press QUERY. The patient list is updated.
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.
At the end of the study press END EXAM on the Control
panel. The save images dialogue window is displayed.
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.
Press F4 or ALT+S to display the DICOM spooler ("DICOM
spooler", page 498).
Offline scanner
When 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
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 ("DICOM spooler", page 498).
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Export/Import patient records/examinations
Patient records/examinations from the local archive on one
system (Vivid S5/Vivid S6 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 (Figure 9-36).
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).
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.
Exporting patient records/examinations
1.
2.
3.
4.
470
If exporting to a removable media, insert a removable
media in the drive.
Press PATIENT on the Front panel, then select Patient List.
The Search/Create Patient window is displayed
(Figure 9-8).
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.
Press Export in the Search/Create Patient window.
The Export dialogue window is displayed.
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Figure 9-35: The Export Dialogue window
5.
Select one of the following destinations from the
Destination drop-down menu:
Note: the exact contents of this menu depends on the
options and devices contained in the system.
• MOD Archive: exports raw and DICOM (if present) data
to a removable MOD.
• DICOM MOD525: export DICOM data only to a
removable MOD.
• CD/DVD Archive: exports raw and DICOM (if present)
data to a CD/DVD.
• Memstick Archive: exports raw and DICOM (if present)
data to a USB flash drive device.
• DICOM CD/DVD: export DICOM data only to a
CD/DVD-R/W.
• DICOM Memstick: export DICOM data only to a USB
flash drive device.
• 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 demographics, measurements and
reporting data to a spreadsheet. The export destination
must be configured (Figure 9-43).
• 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, and saved reports as CHM-files.
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6.
The export destination must be configured ("Export
Configuration", page 476).
Press OK.
Figure 9-36: The Export patient window
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.
Insert media and select Retry.
Figure 9-37: Insert media window
• The system is checking if the destination media is empty
and needs to be formatted. If yes an Information window
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is displayed asking the user whether or not to format the
media.
Figure 9-38: 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
"-". 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 9-39: Add files window
Select Yes.
The system is preparing the media to allow addition of
new files.
Note: If Eject is selected, the user is prompted to insert
another media. If No is selected, the Export Dialogue
window is displayed (Figure 9-35), where the user can
select another destination.
The Export patient window is displayed (Figure 9-36).
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7.
Press More to
display the
extended Export
patient window if
necessary.
8.
9.
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Search and Select the patient records/examinations to
export in the Patient list. All searching criteria can be used
to find the patient records to export.
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 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
records of patients born during a specific time period and
select the actual records.
Adjust the following settings (if available) as desired:
• Delete selected patient(s) after copy
• Copy images
Press Copy.
If one or more patient examination is already present in the
destination archive the Export/Import conflict window is
displayed (Figure 9-40). 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 9-40: The Export/Import conflict window
Do not eject the CD
using the button on
the CD drive.
Press OK to resume export.
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.
12. If exporting to a removable media, press Eject or ALT+E to
eject the disk.
The Eject device menu is displayed.
Figure 9-41: The Eject device menu
13. Select the relevant media.
The selected removable media is ejected.
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CAUTION
When exporting an exam to a DICOM CD or DVD, the following
fields are not included in the exported exam:
• Address
• Phone
• EchoLab
• B/P (blood pressure)
• Tape
• Coounter
• Comments field
Note: These fields remain intact in the system Archiving
database and will always export correctly when using the
raw-data export dataflow.
Export Configuration
The destination for Export of patient records to Excel and
MPEG must be configured prior to use (both are options). This
is done from the Dataflow sheet in the Configuration package.
To display the Dataflow sheet:
1. Press CONFIG and log on as administrator.
2. Select Connectivity category and Dataflow subgroup.
The Dataflow sheet is displayed (Figure 9-4).
3. Select the dataflow Misc Export in the Name pull-down
menu.
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Figure 9-42: The Dataflow Sheet
Configuring an Excel Export
1. Select the Excel storage device in the Selected devices
pane and press Properties.
The Excel properties window is displayed.
Figure 9-43: The Excel properties window
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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.
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.
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2.
3.
Select a removable media or a network volume remote path
as the destination in the Destination pull-down menu.
Select OK and press CONFIG.
Export to an eVue Configuration
1. Select the eVue device in the Selected devices pane and
press Properties.
The eVue properties window is displayed (Figure 9-5).
2. Select a removable media or a network volume remote path
as the destination in the Destination pull-down menu.
3. Check the options as required.
4. Select OK and press CONFIG.
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Importing patient records/examinations
1.
2.
3.
4.
Insert the removable media of the source archive in the
corresponding drive (MO drive or CD-ROM).
Press PATIENT on the Front panel, then select Patient List.
The Search/Create Patient window is displayed
(Figure 9-8).
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).
Press Import in the Search/Create Patient window.
The Import dialogue window is displayed (Figure 9-44).
Figure 9-44: The Import Dialogue window
5.
Select one of the following source archive from the Source
drop-down menu:
• MOD Archive: imports raw and DICOM data (if present)
from a MOD.
• DICOM MOD525: imports DICOM data only from a
MOD.
• CD/DVD Archive: imports raw and DICOM data (if
present) from a CD/DVD-R.
• Memstick Archive: imports raw and DICOM (if present)
data from a USB flash drive device.
• DICOM CD/DVD: imports DICOM data only from a
CD/DVD-R/W.
• DICOM Memstick: imports DICOM data only from a
USB flash drive device.
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6.
• Remote Import/Export Archive: imports raw and
DICOM (if present) data from an Echo server (network)
or EchoPAC PC (direct connect or network).
• Query retrieve: imports data from a DICOM server.
Press OK.
The Import patient window is displayed (Figure 9-45).
Figure 9-45: The Import patient window
7.
480
Search and select the patient records to import in the
Patient list. All searching criteria can be used to find the
patient records to import.
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
display the
extended Import
patient window if
necessary.
8.
9.
• 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.
Adjust the following settings as desired:
• Copy images
Press Copy.
If one or more patient examination is already present in the
destination archive the Export/Import conflict window is
displayed (Figure 9-40). 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 9-46: 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.
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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 Management
The 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 move or copy reports from the
oldest patient records (configurable). The Disk management
function has also an auto-purge feature that automatically
deletes images that have already been copied if the local hard
disk is approaching its capacity limit.
When moving or
copying files a copy
of the patient
archive is also
created on the
media.
Three different disk management scenarios are possible
depending on the system configuration:
•
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 is 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 is 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 are 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
function
Configuration of the Disk management system can only be
done by user with administration rights.
1. Press CONFIG.
If required, log on as administrator.
2. Select the Admin category.
3. In the Admin category, select the sheet Data Management.
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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
Figure 9-47: The Disk management sheet
Disk management schedule settings
•
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 is displayed.
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Disk management settings
1.
2.
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 are copied or moved. If None is
selected, all files are copied or moved.
Next to Operation, select one of the following options:
• Copy: the images and reports from the examinations
older than the specified setting defined in step 1 are
copied to the specified destination. After using this
setting, the files 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. After using this setting,
the files 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 settings
•
CAUTION
Next to Destination device, select a removable media,
USB hard disk, 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.
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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Running the Disk management function
The 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 ("Disk
management schedule settings", page 485), or if the local hard
drive is about to reach its capacity limit.
Manual start of disk management
1.
2.
Press PATIENT on the control panel, then select Patient list.
The Search/Create patient window is displayed.
Press More in the Search/Create patient window to display
additional menu options and select Disk management.
The Disk management welcome screen is displayed
(Figure 9-48). The Disk management operation will either
copy, remove or delete files from the local archives
depending on the Disk management configuration
("Configuring the Disk management function", page 484).
Make sure that the correct configuration is set.
Figure 9-48: The Disk management welcome screen
3.
Press Next.
The Storage size information window is displayed
(Figure 9-49). Verify the information displayed. If using
removable media, the operation may require several
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media as specified on the screen. Make sure to gather the
necessary number of disks.
Figure 9-49: The Storage size information window
The media does not
need to be
formatted.
488
4.
5.
Insert a removable media into the specified drive. The disk
does not need to be formatted.
Press Next.
The Copying files window is displayed (Figure 9-50).
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Figure 9-50: The copying files window
6.
7.
8.
The system automatically formats and labels new disks. If
the media contains backup or export data, a Warning
window is displayed.
Select one of the following options:
• 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.
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.
Press Next to continue.
The Summary window is displayed (Figure 9-51), showing
a list of the disks used.
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Figure 9-51: The summary window
• Select Print summary to print the list for archiving
purpose.
• Select Detailed summary to display the list of the
patient records copied.
9. Make sure that all media are physically labeled 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.
10. Press Done to complete the Disk management operation
and file the media.
Data Backup and Restore
The 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.
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To minimize accidental loss of data, perform backup of the
patient archive stored on the local hard drive at least once a
week.
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.
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 ("Disk
Management", page 483).
DO NOT use the local hard drive for long-term image storage.
CAUTION
The backup of the patient archive on the hard drive and the
system configuration is done from the configuration
management package ("Backup procedure", page 491).
Data from Backup/Restore disks may be restored to the local
hard drive using the Restore procedure ("Restore procedure",
page 495).
Only users with administration rights ("Users", page 653) have
access to the backup/Restore function.
Backup procedure
1.
2.
3.
Press PATIENT on the control panel, then select Patient list.
The Operator login window is displayed.
Select the operator with administration rights, enter the
password and press Log on.
The Search/Create patient window is displayed.
In the Search/Create patient, select the dataflow Local
Archive - Int. HD (Figure 9-52).
Figure 9-52: Dataflow selection for backup
4.
5.
Press CONFIG.
Select the category Admin.
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6.
Select the Backup sheet (Figure 9-53).
Figure 9-53: The Backup sheet
7.
To be able to select a
shared network
folder, the path (of
type:
\\server-name\sh
are-name) must be
entered once in the
Remote Path
field.
492
In the Backup sheet, select one of the following options:
• 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.
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
(Figure 9-54) prompting the user to insert a media.
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Figure 9-54: Insert media prompt
Insert the media and select OK.
• The system is checking if the media needs to be
formatted. If yes, a dialogue window is displayed
containing some auto-generated label, prompting the
user to enter a media label.
Figure 9-55: The Enter media label window
Type in a label for the media and select OK.
Note: Only the following characters and signs can be
used when labeling a media: A - Z, a - z, 0 - 9, "_" and
"-". Do not use more than 11 characters or signs. Do not
use space.
Note: If you select Eject you can perform the backup
using another removable media. If you select Cancel
the backup operation is stopped.
• 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.
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Figure 9-56: Replace backup prompt
• 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
(Figure 9-57), showing the current operation being
performed.
Figure 9-57: Backup progress windows
12. At the end of the process, the media is ejected and the
Backup completed window (Figure 9-58) is displayed.
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Figure 9-58: Backup completed window
Select OK.
The Backup result is displayed on the Backup sheet
(Figure 9-59).
Figure 9-59: 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.
Restore procedure
1.
2.
3.
Press CONFIG.
Select the category Admin.
Select the Restore sheet (Figure 9-60).
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Figure 9-60: The Restore sheet
4.
5.
6.
In the Restore sheet, select one of the following options:
• Patient archive: to restore the patient records.
• 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
(Figure 9-60).
Make sure that Restore from Source Device is selected.
Select the appropriate Source device.
The Restore procedure OVERWRITES the existing data on the
local hard drive. Make sure to select the correct device.
CAUTION
7.
8.
496
If restore is done from a backup on a removable media,
insert the media in the drive.
Select Restore now.
Depending on the selection, one or two Restore
confirmation windows are displayed (Figure 9-61):
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Figure 9-61: Restore confirmation windows
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 9-62).
Figure 9-62: Reboot system prompt
10. Select OK to reboot the system.
If connectivity configuration settings have been restored,
make sure to save the TCP/IP settings: select
Config/Connectivity/TCPIP and select Save settings. The
system needs to be restarted again.
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DICOM spooler
DICOM 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 a user
action.
•
the job is incomplete, waiting for more images.
•
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 spooler
•
On the alphanumeric keyboard, press and hold down the
ALT key and press S.
The DICOM spooler window is displayed (Figure 9-63).
The DICOM spooler window is automatically updated. Press
Refresh to update the information displayed at any time.
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Figure 9-63: The DICOM job spooler window
Deleting a job
Only non-active
jobs can be deleted.
1.
2.
3.
4.
Trackball to the job to delete in the DICOM job spooler
window.
Note: Several jobs can be selected.
Press SET.
Trackball to Delete.
Press SET.
Resending a job
Only jobs that
failed or are in hold
can be resent.
1.
2.
3.
4.
Trackball to the job to re-send in the DICOM job spooler
window.
Note: Several jobs can be selected.
Press SET.
Trackball to Resend.
Press SET.
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Sending a job to a new destination
Only jobs that
failed or are in hold
can be sent to a new
destination.
1.
2.
3.
4.
5.
6.
7.
Trackball to the job to send in the DICOM job spooler
window.
Press SET.
Trackball to Send to...
Press SET.
A dialogue window is displayed.
Select the new destination from the Destination popup
menu.
Trackball to Send.
Press SET.
Holding a job
1.
2.
3.
4.
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.
Press SET.
Trackball to Hold.
Press SET.
To undo hold, press Resend.
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Database import from Vivid 3 or Vivid 4
The Vivid 4/Vivid 4 Database Import option provides the
capability to import data from a Vivid 3 or Vivid 4 system with
software version BT02 or higher, into the Vivid S5/Vivid S6
system.
This feature allows the user to review examinations previously
acquired on a Vivid 3 or Vivid 4 system, on the
Vivid S5/Vivid S6 in DICOM format. In addition, the user may
review all measurements made on the Vivid 3/4 , using an
Excel viewer installed on a separate PC.
Note: The following procedure is valid for Vivid 3 or 4 of version
BT02 and upwards.
Transfer Procedure
This is a one-time procedure which will normally be performed
by your GE representative, during the system's installation.
CAUTION
CAUTION
The database imported from the Vivid 3 /4 into Vivid S5/Vivid S6
should only be imported during the installation, while the
Vivid S5/Vivid S6 archive is still empty. Importing the database at
a later stage is not possible without first erasing the whole
Vivid S5/Vivid S6 database.
Data must be imported only from the LATEST backup media. In
case you are not sure, it is advisable to perform another backup
from the Vivid 3/4.
Attempting to import data from any backup version other than
the latest, will make the Vivid S5/Vivid S6 database incomplete,
with missing exams.
1.
2.
3.
4.
5.
While in regular scanning mode, press PATIENT.
Log in as an Administrator.
Press Create New Patient/New Exam.
The Search/Create patient window is displayed.
Verify that the Patient list is empty.
From the Dataflow drop-down menu select No Archive
(Figure 9-64).
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Figure 9-64: Dataflow selection
6.
7.
Press ESC to close the window.
Press Config, then select Admin.
The Admin dialog window is displayed (Figure 9-65).
Figure 9-65: Config menu - Vivid 3/4 DB Import
8.
502
Select the V3\V4 DB Import tab.
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9.
Insert the media (CD/DVD or MOD) containing the LATEST
database backup from the Vivid 3 or Vivid 4, into the
Vivid S5/Vivid S6 system.
10. Select the appropriate import path from the drop-down
menu (Figure 9-66).
Figure 9-66: Config menu - Import Data from Removable Media
11. Click Import Vivid-3 Database to commence the import
process.
A progress bar is displayed. The import process may take
some time, depending on the size of the database being.
When the import process is complete, an "Import
Complete" message is displayed. The Import Vivid-3
Database button is disabled (appears grayed-out) and the
Vivid 3/Vivid 4 Database Import option is no longer
available.
12. Repeat steps 3 and 5 above for the Local Archive + Int.
HD dataflow.
Note: The user is now able to review the imported data on the
Vivid S5/Vivid S6 system. The images may be loaded at a later
stage in the normal review process, as described in this
manual.
Exporting the Excel database
It is possible to convert all of the patients' demographic data
and exam measurements to Excel format, which may be
exported to removable media and viewed on a PC. This
procedure is performed from the Admin dialog box.
1. Log in as an Administrator.
2. Press Config, then select Admin.
The Admin dialog window is displayed (Figure 9-65).
3. Select the V3\V4 DB Import tab.
4. Insert blank media into the appropriate media drive on the
Vivid S5/Vivid S6 system.
5. Click Generate Excel Database (Figure 9-67).
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Figure 9-67: Export Excel Data to Removable Media
6.
A progress bar is displayed during the export process. The
measurements and demographics database is generated
and compressed into a ZIP file.
When done, eject the media and label it accordingly.
Installing the Vivid 3/4 Data Viewer
The Vivid 3/4 Data Viewer installation consists of two
procedures: Extraction and Formatting.
Extraction
1.
2.
3.
4.
Insert the media created in the section above ("Exporting
the Excel database", page 503).
Browse to the media location, copy the database file
Patients.zip from the media, and paste it to a dedicated
path on the PC hard disk.
Right-click the Patients.zip file on the hard disk and select
Extract All... from the context menu.
The Extraction Wizard appears.
Click Next twice.
During the extraction process, a password prompt appears
(Figure 9-68).
Figure 9-68: Extraction password prompt
5.
6.
504
Type dolphin in the password field, then click OK.
The files are extracted into a new Patients folder, located
under the dedicated path on the hard disk.
Proceed to the following procedure - Formatting.
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Formatting
1.
Locate the file Master.xls under the Patients folder and
double click it (Figure 9-69).
Figure 9-69: Patients folder contents
While the Excel file opens, a macro prompt appears
(Figure 9-70).
Figure 9-70: Excel macro prompt
2.
3.
4.
Click Enable Macros.
The Start formatting V3/4 Data Viewer window appears
(Figure 9-71).
Select a language.
Type any password you wish to use into the password field.
This later provides privacy protection to your Vivid 3/4 Data
Viewer database.
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Figure 9-71: Start formatting V3/4 Data Viewer window
5.
Click Run.
Automatic formatting begins. When finished, the Progress
field on the bottom-right shows 100% and the Stop button
is grayed-out (Figure 9-72).
Figure 9-72: Formatting complete
Note: Depending on the database size, formatting may
take several hours. In case you need to stop the process
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6.
before it concludes, click Stop. Then, remove the
previously generated files and repeat the entire procedure.
Note: While formatting takes place, if prompted by
AutoSave, do not save Master.xls.
Press Exit.
All files, including Master.xls are closed.
Using the Vivid 3/4 Data Viewer
Opening the Data Viewer
1.
2.
Locate the file Vivid 3_4 Data Viewer.xls under the
Patients folder and double click it.
When prompted for a password, type in the password you
defined in step 4 of the previous procedure ("Formatting",
page 505).
The Data Viewer database opens in Excel (Figure 9-73).
Figure 9-73: Vivid 3/4 Data Viewer
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Using the Data Viewer
The Data Viewer Excel database contains several useful tabs.
The main tab is Index_patient, detailing demographic data of
each exam. Each row details one exam. The left-most Patient
Index column contains internal index numbers, each unique to
an exam.
To browse exam results:
1. Use the Last name, Patient ID or Exam date tab to identify
the patient or exam of interest.
2. Click records in blue font to jump to the corresponding
exam in the Index_patient tab.
3. Identify and locate the exam of interest in the
Index_patient tab.
4. Click the corresponding Patient Index number to see all of
the relevant measurements for that particular exam.
5. Click on same Patient Index to return to the main
Index_patient tab.
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Chapter 10
Report
• Introduction ................................................................................... .. 508
• Creating a report ........................................................................... .. 509
• Working with the report function ............................................... 509
• To print a report ........................................................................ 512
• To store a report ....................................................................... 512
• Retrieving an archived report ................................................... 513
• Deleting an archived report ...................................................... 513
• Structured Findings ...................................................................... .. 514
• Prerequisite .............................................................................. 514
• Starting Structured Findings ..................................................... 515
• Structured Findings structure ................................................... 515
• Using Structured Findings ........................................................ 517
• Structured Findings configuration ............................................ 520
• Direct report .................................................................................. .. 530
• Creating comments .................................................................. 530
• Creating pre-defined text inputs ............................................... 531
• Report designer ............................................................................ .. 532
• Accessing the Report designer ................................................ 532
• Report designer overview ........................................................ 532
• Designing a report template ..................................................... 535
• Saving the report template ....................................................... 546
• To exit the Report designer ...................................................... 546
• Report templates management ................................................... .. 547
• Configuration of the Template selection menu ......................... 548
• Export/Import of Report templates ........................................... 549
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Introduction
The Vivid S5/Vivid S6 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 be carefully reviewed before the report is saved. Use
the worksheet ("Worksheet", page 366) 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 report
Reports 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.
Note: "Other ID" does not appear as a separate item in the
system's Report templates. The user should generate a custom
report sheet if Other ID data is required to be recorded.
Working with the report function
•
Press REPORT.
The default template for the current examination, or the
template last used, is displayed (Figure 10-1). The
information entered during the examination in
automatically filled out (e.g. demographic, Diagnosis,
Comments etc.)
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1. Assigned keys
• Print
• Store
• Retrieve
• Template
MORE menu
• Insert Text
• Save as
• Delete
• Designer
Figure 10-1: The Report screen and assigned keys
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To choose another report template
1.
The Template
selection menu can
be configured to
display only the
templates of interest
("Configuration of
the Template
selection menu",
page 548).
2.
Press the softkey TEMPLATE.
The Template selection menu is displayed showing the
available report templates organized by application.
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.
Note: After selecting a different report template the selected
template becomes the default template which will be selected
next time
To change patient information
1.
2.
3.
4.
Trackball to heading of the information to change.
The trackball marker is changed to a hand with pointing
finger
.
Press SET on the Trackball area.
The original location of the data is displayed.
Change the information entered if required.
Press REPORT when completed.
Images in the report
•
•
•
•
To add an image to the report, place the pointer over an
image in the clipboard and double-click the SET key.
The image is inserted into the first free image container in
the report.
To move an image in the report, select and drag the image
to move it to a new image container.
To replace an image in the report, select and drag an
image from the clipboard over the image to replace in the
report.
To remove an image from the report, select and drag the
image to remove outside the report page.
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To print a report
Only members of the user group "Cardiologist" are allowed to
print a report ("Users", page 653).
•
Press PRINT.
The report is printed on the default printer. A status window
is displayed showing the printing process (Chapter 12,
"Peripherals", page 595).
Printing a report with the Ink-saving feature
When a report containing many images is printed it contains
many large areas with black background. When printing to an
ink-jet printer these black areas utilize a lot of ink and take
longer to print.
The report may be configured In order to eliminate these large
areas of black background while printing.
To configure the Ink-saving feature:
1. Press CONFIG and select the Report - Template tab
(Figure 10-26).
2. Set the Ink-Save checkmark.
All reports generated from now on will be printed with
images containing white background.
To store a report
Only members of the user group “Cardiologist” are allowed to
store a report ("Users", page 653).
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 (not available on EchoPAC PC).
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1.
2.
3.
4.
5.
Press MORE.
The additional controls are displayed (Figure 10-1).
Press SAVE AS.
The Save as dialogue window is displayed.
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>
Select PDF or CHM format from the Save as type pull down
menu.
Press SAVE.
Retrieving an archived report
1.
2.
3.
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.
Trackball to the report to retrieve.
Press SET.
Deleting an archived report
Only members of the user group “Cardiologist” are allowed to
store a report ("Users", page 653).
1. Press MORE.
The additional controls are displayed (Figure 10-1).
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 SET.
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Structured Findings
Structured 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.
Prerequisite
To 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 10-2).
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 10-2).
8. Select OK.
9. Save the Report template and exit the Report designer.
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Figure 10-2: The Archive information box
Starting Structured Findings
1.
2.
Press REPORT.
Make sure the current template has a Structured Findings
field and a Conclusion field defined or select another
template if necessary.
Press MORE and FINDINGS.
The Structured Findings window is displayed
(Figure 10-5).
Structured Findings structure
The diagnostic statements are organized in tab folders
(Figure 10-3). Each tab folder may contain:
•
Underlying tab folders that contain Tab sheets.
•
Tab sheets that contain diagnostic statements.
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1. Tab folder with underlying tab sheets
2. Tab sheet
Figure 10-3: Structured findings structure
There are three types of diagnostic statements (Figure 10-4):
•
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.
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1. Check box statement
2. Combo box statement
3. Statement group
Figure 10-4: Diagnostic statement types
Using Structured Findings
1.
2.
3.
Start Structured Findings ("Starting Structured Findings",
page 515).
Browse to the tab sheet containing the statements of
interest.
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 (Figure 10-5). The statement text in
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4.
518
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 ("Adding statements in the tab sheet",
page 523).
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 (Figure 10-5).
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 statements can be reordered using drag
and drop procedure in the Conclusion preview field. The
conclusion text in the preview field can be edited. This will
apply only for the current 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.
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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1. Statement inserted in the Conclusion and Findings field.
2. Statement inserted in the Findings field only.
3. Findings preview field
4. Conclusion preview field
5. Remove all selections.
6. Insert normal findings for the current tab sheet.
Figure 10-5: Structured Findings window
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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
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 configuration
Structured 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 screen
1.
2.
Press CONFIG and select the Report category.
Select the Structured Findings tab.
The Structured Findings configuration screen is displayed
(Figure 10-6).
Or from within Structured Findings:
•
Press UPDATE MENU on the control panel and select Config.
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1. Structured Findings structure tree:
•
•
•
tab folder
Combo box statement
tab sheet
Check box statement
Statement group
2. Tab or statement label
3. Findings text
4. Conclusion text
5. Codes for the selected statement
6. Move, create or delete statement.
7. Create folder, Combo box or statement groups
8. Enter a variable in statement or conclusion text
9. Hide selected tab or statement from the Structured Finding window
10. Set the selected statement as normal
11. Rest factory default findings
12. Export/import findings.
Figure 10-6: Structured Findings configuration screen
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Creation of a tab folder
The following procedure describes how to create a new top
level tab folder.
1. Configuration window
2. Structured findings window
Figure 10-7: New tab folder
1.
2.
3.
4.
522
In the Structured Findings configuration window
(Figure 10-6), select the Structured Findings tab folder.
Select Add.
A new entry is created in the Structured Findings tab
folder. The new entry is by default a tab sheet ( ).
Select Enable one more tab level to change the new entry
to a tab folder ( ).
A warning message is displayed. Select OK.
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.
Note: to enter several codes separate each code by a
space.
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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.
1. Configuration window
2. Structured findings window
Figure 10-8: New tab sheet
1.
2.
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 ( ).
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.
Note: to enter several codes separate each code by a
space.
Adding statements in the tab sheet
Check box statement
The following procedure describes how to create a check box
statement.
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1. Configuration window
2. Structured findings window
Figure 10-9: New check box statement
1.
2.
524
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 ( ).
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.
If required:
• Enter the appropriate codes.
Note: to enter several codes separate each code by a
space.
• Check Include findings in normal report to define the
statement as normal.
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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
("Using Structured Findings", page 517).
Combo box statement
The following procedure describes how to create a combo box
statement.
1. Configuration window
2. Structured findings window
Figure 10-10: New combo box statement
1.
2.
Create a new statement as described above. A check box
statement is created by default.
With the new statement selected, press Add.
A new underlying entry is created and the parent
statement is changed to a Combo box statement ( ).
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3.
4.
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.
• Enter a conclusion in the Conclusion text field (optional).
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 group
Statement 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 10-6), select the item to edit.
2. Make the required changes.
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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 (Figure 10-11).
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)
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 10-11: Insert parameter window
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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 10-6), select the item to copy.
2. Select Copy.
3. Select the item to contain the copy.
4. Select Paste.
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.
Deletion cannot be undone.
CAUTION
1.
2.
In the Structured Findings configuration window
(Figure 10-6), select the item to delete.
Select Delete.
The selected item is deleted.
Factory reset
All statements can be reset back to the factory default.
Factory reset cannot be undone.
CAUTION
1.
2.
528
Select Reset.
The Reset statements window is displayed.
Select:
• Yes to reset all statement to the factory default (No
undo).
• No to cancel the operation.
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Exporting/Importing statements
Diagnostic statements can be exported from one system and
imported on another system.
Exporting statements
1. In the Structured Findings configuration window
(Figure 10-6), select Export.
A browsing window is displayed.
2. Browse to a destination and select Save.
Importing statements
CAUTION
Importing statements will replace the current statements. If
necessary, backup the current statements by exporting them
before performing import.
1.
2.
In the Structured Findings configuration window
(Figure 10-6), select Import.
A browsing window is displayed.
Browse to a destination and select Open.
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Direct report
Direct 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 comments
1.
2.
3.
4.
5.
Press UPDATE MENU.
Select Direct report (Figure 10-12).
In the Direct report screen, select the comment type.
Type your comments in the Text field.
To add a measurement in the comment, double-click a
measurement in the Measurement overview field.
1. Open Direct report
2. Select the type of information
3. Create/insert pre-defined text
4. Text field
5. List of measurements completed
6. Exits the Direct report
Figure 10-12: The Direct report
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Inserting pre-defined text input
1.
2.
Select the insertion point in the Text field.
Select Insert text.
The Insert text window is displayed (Figure 10-13).
Figure 10-13: The Insert text window
3.
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.
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 inputs
This feature is described later in ths manual ("The Comment
texts sheet", page 629).
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Report designer
The 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 designer
1.
2.
Press REPORT on the Control panel.
The Report screen is displayed.
Press DESIGNER.
The Report designer screen is displayed with the selected
template in the Report template design area
(Figure 10-14).
Report designer overview
1. Menu bar
2. Report template design area
Figure 10-14: The Report designer screen
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The menu bar
Menu
File
Description
• 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
Edit
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• Delete: remove the selected object from the report
template.
• Undo: restore the previous state of the report template.
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Menu
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 information
Exam information
Site information
• Anatomical graphics: select and insert an
anatomicalgraphic (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
Preferences
534
Description
Description
• Page color: sets the default background color for the
template page.
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Designing a report template
Starting template designing
1.
2.
Start the Report designer ("Accessing the Report
designer", page 532).
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 background
1. Press Preferences and select Page Color.
The Color selection window is displayed.
2. Select the desired color.
3. Press OK.
Header and footer in the printed report
This function is described later in this chapter ("Inserting
header and footer", page 544).
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 table
1.
2.
3.
4.
Press the Left mouse button at the desired insertion point
in the Report template design area.
Press Insert and select Table.
The Container properties window is displayed
(Figure 10-15).
Adjust the parameters as desired.
Press OK.
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The table is displayed in the template.
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 10-15: The Table properties window
Inserting a logo
1.
2.
3.
Provide the hospital logo in JPEG or Bitmap format onto a
CD or MO disk.
Select the location where to insert the logo (a table cell or
directly in the report template).
Select Insert and Logo.
The Logo box is displayed.
Figure 10-16: The Logo box
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4.
5.
6.
Select a logo, or if not available, select Import logo.
Browse and select the logo and select OK.
Specify the appearance.
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 10-17: The Fixed text box
3.
4.
Enter the text and specify the appearance.
Select OK.
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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.
3. Select Insert and Archive information.
The Archive information box is displayed.
Figure 10-18: The Archive information box
4.
5.
6.
7.
538
If desired, enter a heading and select a heading link from
the pull-down menu.
Select the Information parameters to be displayed in the
first cell.
Select Box properties to change the font, alignment,
appearance, etc.
Select OK.
Select the next table cell and repeat steps 3 to 6 to enter the
remaining archive information.
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Inserting an image container
1.
2.
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.
Figure 10-19: The Ultrasound image box
3.
4.
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 Measurement box is displayed.
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Figure 10-20: The Measurements box
4.
5.
6.
7.
8.
9.
540
Enter a heading (e.g. 2D).
Using the Filter criteria, define the type of measurements to
be entered (e.g. Cardiac, 2D, measured and calculated).
Select Show normal value to display user-defined Normal
value next to the measurements in the Report ("Normal
values", page 353).
Note: References for the normal values can be displayed
in the report by checking Normal value references from
Insert -> Archive Info ("Inserting archive information",
page 538)
From the measurement list, select the measurement to
insert and press Add. Both single measurements or a folder
may be added.
The list of the inserted measurements is displayed in the
Selected measurement list on the right side.
Press OK.
Select the next table cell and repeat steps 3 to 8 to insert
several measurements.
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Inserting text fields
Text fields are:
•
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 10-21: The Text field box
3.
4.
Enter a heading.
From the Display field, select one of the following options:
• Referral reasons: displays the information entered in
the Direct report ("Direct report", page 530) or in the
Examination list window.
• Comments: displays the information entered in the
Direct report ("Direct report", page 530) or in the
Examination list window.
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5.
• Diagnosis: displays the information entered in the
Direct report ("Direct report", page 530) or in the
Examination list window.
• Free text 1-8: creates an empty free text container.
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 container
1. 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 10-22: The Wall motion scoring box (Cut planes)
3.
Adjust the parameters and select OK.
The scoring diagrams are inserted in the report template.
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Inserting Wall motion scoring diagrams container
1. Place the cursor right below the Wall motion scoring
diagrams container.
2. Select Insert, Wall motion analysis and select Score
table box.
The Score table box is displayed.
Figure 10-23: 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 container
1. 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 properties
1.
2.
Modifying the container’s specific properties
Move the Mouse cursor over the border of the container to
edit.
The mouse cursor is changed to a cross
.
Double-click on the Left mouse button.
The Container box is displayed.
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3.
Adjust the parameters specific to the selected container.
Note: Some information containers have additional
parameters that may be adjusted by selecting Box
properties.
Inserting a new page
1.
2.
3.
In the template, position the Mouse cursor at the insertion
point.
Press the Left mouse button.
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 10-24: The Page setup box
2.
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Adjust the printing orientation.
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3.
4.
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.
Select OK.
To check the display of the header and footer, select File
and Print preview.
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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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 name
1.
Press File and select Save as.
The Save as template window is displayed.
Figure 10-25: The Save as template window
2.
3.
Enter a name for the template.
Press OK.
The template is saved.
To exit the Report designer
1.
2.
546
Select File and Exit.
The Exit window is displayed.
In the Exit window, select one of the following:
• 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 management
This 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 and select the Report category.
The Report category sheet is displayed.
Figure 10-26: The Report template sheet
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Configuration of the Template selection
menu
The 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.
Inserting a template in the Templates
selection menu
1.
2.
3.
4.
Press CONFIG and select Report.
The Report template sheet is displayed (Figure 10-26)
In the Available templates field (left field), select the
template to insert in the Template selection menu.
Next to Section, select the appropriate application.
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 menu
1.
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 Available
template field will also insert the template in the Template
menu.
Sorting the templates in the Template
selection menu
548
1.
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.
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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 10-26).
2. Press Delete.
A Confirmation window is displayed.
3. Select Yes to delete the report template.
Export/Import of Report templates
User-defined report templates can be exported to a removable
media and imported from the removable media into another
system (Vivid S5/Vivid S6 / EchoPAC PC).
Export of Report templates
1.
2.
3.
Insert a removable media into the drive.
Press CONFIG and select Report.
The Report template sheet is displayed (Figure 10-26).
Select Export Templates.
The available user-defined templates are displayed in the
Export template dialogue window.
Figure 10-27: The Export template dialogue window
4.
5.
Select the template(s) to export. Multiple selection can be
done using SHIFT or CTRL key.
Select the desired removable media under Select target
device.
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6.
7.
8.
Press OK.
A Confirmation window is displayed.
Press OK.
The selected template(s) are exported to the removable
media.
Press ALT + E and select the media to eject.
Import of Report templates
1.
2.
3.
Insert the removable media with the report template(s) to
import.
Press CONFIG and select Report.
The Report template sheet is displayed (Figure 10-26).
Select Import Templates.
The Import template window is displayed.
Figure 10-28: The Import template window
4.
5.
6.
7.
Select the source device from the pull-down menu.
Press OK.
A Confirmation window is displayed.
Press OK.
The templates are imported into the system.
Press ALT + E and select the media to eject.
Setting transparent background
A special transparent background flag appears on bottom of
screen (Figure 10-26). Set a checkmark in order to save black
ink used for the black background of the images. All images
inserted to the template after setting this flag ON appear with
white background.
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Chapter 11
Probes
• Probe overview ............................................................................. .. 555
• Supported probes ..................................................................... 555
• Vivid S5 Probe/Application Overview ....................................... 560
• Vivid S6 Probe/Application Overview ....................................... 561
• Probe surface-temperature safety mechanisms ...................... 562
• Maximum probe temperature ................................................... 563
• Probe orientation ...................................................................... 564
• Probe labelling ......................................................................... 564
• Environmental Requirements ................................................... 565
• Probe Integration .......................................................................... .. 567
• Selecting probes ...................................................................... 567
• Connecting the probe ............................................................... 567
• Activating the probe ................................................................. 569
• Disconnecting the probe .......................................................... 570
• Care and Maintenance .................................................................. .. 571
• Planned maintenance .............................................................. 571
• Inspecting the probe ................................................................. 572
• Special handling instructions .................................................... 573
• Cleaning and disinfecting probes ............................................. 575
• Probe safety .................................................................................. .. 581
• Biopsy ............................................................................................ .. 582
• Precaution concerning the use of biopsy procedures .............. 582
• Preparing the Biopsy guide attachment ................................... 584
• Displaying the Guide zone ....................................................... 588
• Endocavitary Probe Biopsy Guide Assembly ........................... 590
• Biopsy needle path verification ................................................ 592
• Starting the biopsy procedure .................................................. 592
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Probes
• Cleaning, disinfection and disposal .......................................... 592
• Surgery/Intra-operative Use ........................................................ ... 593
• Preparing for Surgery/Intra-operative Procedures .................... 593
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Probe overview
The Vivid S5/Vivid S6 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-RS
2D mode
Cardiology
Frequency:
1.5–3.6 MHz
M-Mode
Coronary
Foot print:
18 x 24 mm
Color Flow
Transcranial
CW Doppler
Renal
PW Doppler
OB
Frequency:
1.5-3.6 MHz
Image
Abdomen
Fetal Heart
M4S-RS
(Vivid S6
only)
2D mode
Cardiology
M-Mode
Pediatric heart
Color Flow
Adult Cephalic
CW Doppler
Abdomen
PW Doppler
Renal
Fetal Heart
5S-RS
2D mode
Cardiology
Frequency:
2.0–5.0 MHz
M-Mode
Coronary
Foot print:
18 x 24 mm
Color Flow
Pediatric Heart
CW Doppler
Fetal Heart
PW Doppler
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Probes
Probe
Mode
6S-RS
2D mode
Cardiology
M-Mode
Pediatric Heart
Color Flow
Fetal Heart
CW Doppler
PW Doppler
Neonatal
cephalic
2D mode
7S-RS
Intended use
Technical data
Frequency:
2.7-8.0 MHz
Cardiology
Frequency:
3.5–8.0 MHz
M-Mode
Pediatric heart
Foot print:
15 x 21 mm
Color Flow
Coronary
CW Doppler
Neonatal head
Image
PW Doppler
10S-RS
2D mode
Cardiology
Frequency:
4.5–11.5 MHz
M-Mode
Pediatric heart
Foot print:
10 x 14 mm
Color Flow
Coronary
CW Doppler
Neonatal head
PW Doppler
Linear Array probes
Probe
Mode
8L-RS
2D mode
Intended use
M-Mode
Peripheral
vascular
Color Flow
Small parts
Technical data
Frequency:
4.0–13.0 MHz
Foot print:
14 x 48 mm
Frequency:
4.0–13.0 MHz
Foot print:
14 x 52 mm
Image
PW Doppler
9L-RS
M-Mode
Peripheral
vascular
Color Flow
Small parts
2D mode
PW Doppler
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Probe
12L-RS
Mode
Intended use
M-Mode
Peripheral
vascular
Color Flow
Small parts
2D mode
Technical data
Frequency:
6.0–13.0 MHz
Foot print:
14 x 48 mm
Image
PW Doppler
Curved Array (Convex) probes
Probe
Mode
4C-RS
2D mode
Abdomen
Frequency:
1.8–6.0 MHz
M-Mode
Fetal Heart
Foot print:
17 x 65 mm
Color Flow
Renal
FOV:
58 degrees
PW Doppler
OB
2D mode
Pediatrics
Abdomen
Frequency:
4.0-11.0 MHz
Foot print:
26 x 10 mm
Neonatal
Head
FOV:
133 degrees
8C-RS
M-Mode
Color Flow
PW Doppler
Intended use
Technical data
Image
Cartoid
Small parts
Cardiac
e8C-RS
2D mode
Endocavity
Frequency:
4.0-11.0 MHz
M-Mode
Fetal Heart
Foot print:
23 x 10 mm
Color Flow
Obstetrics
FOV:
133 degrees
PW Doppler
Pelvic
Doppler probes
Probe
Mode
Intended use
Technical data
2D-RS
(P2D)
CW Doppler
Cardiology
Frequency:
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Image
2.0 MHz
557
Probes
Probe
Mode
Intended use
Technical data
6D-RS
(P6D)
CW Doppler
Vascular
Frequency:
Image
6.0 MHz
Multiplane Transesophageal Phased Array
probe
Probe
Mode
Intended use
Technical data
6T-RS
2D mode
Frequency:
2.9–8.0 MHz
6T*
M-Mode
Transesophageal
Cardiology
Transesophageal
Cardiology
Frequency:
2.9-8.0 MHz
Transesophageal
Cardiology
Frequency:
4.0–10.0 MHz
Image
Color Flow
CW Doppler
PW Doppler
6Tc-RS
2D mode
M-Mode
Color Flow
CW Doppler
PW Doppler
9T-RS
2D mode
9T*
M-Mode
Color Flow
CW Doppler
PW Doppler
* Applicable only for Vivid S6.
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Intra Operative Probes
Probe
Mode
Intended use
Technical data
i12L-RS
2D mode
Intraoperative*
Frequency:
5.0-13.0 MHz
M-Mode
Thoracic
Vascular and
abdominal
Foot print:
14 x 33 mm
Color Flow
PW Doppler
Image
Pediatric
Small parts
Musculo-skeletal
Musculo-skeletal
Superficial
Peripheral
vascular
* Excluding direct contact with the heart
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Probes
Vivid S5 Probe/Application Overview
P6D
+
P2D
+
9T-RS
+
+
+
+
+
+
+
Contrast
Coronary
+
+
Excercise
+
+
Fetal Heart
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
HFR (High Frame Rate)
+
+
+
+
+
+
LEA
+
+
+
LEV
+
+
+
LV Contrast
+
LVO Stress
+
+
+
Musculoskeletal
+
Neo Head
+
Nerves
+
+
+
+
Obstetrics
+
+
+
+
+
+
+
+
+
Pelvic
+
Pharm Stress
+
Renal
+
Small Parts
+
+
+
+
+
+
+
+
Small Organs
Superficial
Transcranial
6Tc-RS
+
Carotid
Pediatric
6T-RS
+
+
Breast
Cardiac
+
e8C-RS
Aorto-Iliac
8C-RS
+
4C-RS
i12L-RS
12L-RS
9L-RS
8L-RS
10S-RS
7S-RS
6S-RS
5S-RS
Abdominal
3S-RS
Application
+
+
+
+
+
Thyroid
+
+
+
UEA
+
+
+
UEV
+
+
+
Vertebral
+
+
Note: Some of the above applications depend on the availability of certain options
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Vivid S6 Probe/Application Overview
P6D
+
P2D
+
9T
+
9T-RS
6Tc-RS
+
+
+
+
+
+
+
+
Contrast
Coronary
+
+
+
Excercise
+
+
+
Fetal Heart
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
HFR
+
+
+
+
+
+
+
+
LEA
LEV
LV Contrast
+
+
LVO Stress
+
+
+
+
+
+
+
+
+
+
Musculoskeletal
+
Neo Head
+
Nerves
+
+
+
+
Obstetrics
+
+
+
+
+
Pharm Stress
+
+
+
Renal
+
+
+
+
+
+
+
Pelvic
+
Small Parts
+
+
+
+
+
Small Organs
+
+
+
Superficial
Transcranial
6T
+
Carotid
Pediatric
6T-RS
+
e8C-RS
+
+
Breast
Cardiac
8C-RS
Aorto-Iliac
4C-RS
i12L-RS
12L-RS
9L-RS
8L-RS
10S-RS
7S-RS
+
6S-RS
+
5S-RS
M4S-RS
Abdominal
3S-RS
Application
+
+
+
+
+
+
Thyroid
+
+
+
UEA
+
+
+
UEV
+
+
+
Vertebral
+
+
Note: Some of the above applications depend on the availability of certain options
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Probes
Probe surface-temperature safety
mechanisms
The Vivid S5/Vivid S6 system has an Acoustic Power Control
(APC) mechanism to ensure that each probe/console
combination is set up and run within temperature limits given by
the harmonized safety standard IEC60601-2-37.
The APC setup is based upon an algorithmic predication for
each probe, application and system combination. The acoustic
power control mechanism is implemented in the system's
software, and is calibrated by laboratory measurements of
surface temperature on each probe type. APC input parameter
control is performed during setup of each new scan, and any
detected error in the input, and/or malfunction of APC, are
protected by software error handling that aborts setup and
prevents start of scanning.
The Vivid S5/Vivid S6 system also incorporates voltage
surveillance used by the ultrasound transmit circuitry and
probe. If the transmit voltage exceeds a set of expected values
over a time period, the transmit voltage will be set to zero and
the system will stop all scanning. This mechanism will protect
against illegal setup and/or probe defects. The voltage
monitoring is additional to the Acoustic Power Control.
These safety mechanisms are designed to ensure that the
surface temperature for each probe, supported by the
Vivid S5/Vivid S6 system is kept within values listed in
"Maximum probe temperature table" given below. No particular
user actions are required for the proper functioning of the
described safety mechanisms. The user should however make
sure that the proper probe and application is selected for the
intended exam, as listed in "Probe overview" section on page
555, and adhere to the principles of ALARA as described in the
AIUM document: "Medical Ultrasound Safety" which is included
in the Documentation CD shipped with the Vivid S5/Vivid S6
system.
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Maximum probe temperature
Probe
Max Temp
3S -RS
40.5
M4S-RS
42.8
5S-RS
40.8
6S-RS
39.5
7S-RS
37.7
10S-RS
36.1
8L-RS
41.0
9L-RS
40.4
12L-RS
36.6
i12L-RS
40.5
4C-RS
37.8
8C-RS
37.3
E8C-RS
40.7
6T/6T-RS
40.8
6Tc-RS
42.3
9T/9T-RS
42.1
P2D
35.3
P6D
36.0
Notes: Lens temperature measured under following conditions
per IEC 60601-2-37:
1. Thermocouple was placed at the geometric center of the
lens. Thermal phantom made with tissue-mimicking
material as referenced in IEC60601-2-37.
2. a: Thermal phantom at 23 +/- 3 °C for all probes.
b: Temperature rise is measured and added to 33 for
External-Use probes or 37 °C for Non External-Use
probes.
3. Probe placed upright in contact with above thermal
phantom.
4. Auto-freeze capability is disabled.
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Probes
5.
6.
Lens temperature is monitored until it reaches equilibrium
(temperature change rate of less than 0.06 °C per minute).
a: Measurement uncertainty for probes with temperature
sensor: 0.3 °C
b: Measurement uncertainty and probe variation for other
probes: 1.6 °C
Probe orientation
Some probes are provided with a green light (LED) orientation
marking near their head (Figure 11-1). 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.
1. LED
2. Notch
3. V-mark on screen: indicates the orientation of
the probe to the scan.
Figure 11-1: Orientation marking on probe and on screen
Probe labelling
Each probe is labelled with the following information:
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Probes
•
•
•
•
•
Name of distributor and manufacturer
Operating frequency
Model number
Probe serial number
Year of manufacture
The probe name is displayed on the probe housing.
1. CE mark
2. Probe name
Figure 11-2: Probe labelling (examples)
Environmental Requirements
Probes should be operated, stored, or transported within
specific temperature and humidity requirements (Table 2-1).
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Probes
Ensure that the probe face temperature does not exceed
normal operation temperature range ("Maximum probe
temperature", page 563).
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Probe Integration
This section covers:
•
Connecting the probe
•
Activating the probe
•
Disconnecting the probe
Selecting probes
Selecting a new
probe unfreezes the
image.
•
•
•
•
•
Only use approved probes.
All imaging probes with an RS-type connector can be
plugged into any of the probe RS ports.
Always start out with a probe that provides optimum focal
depths and penetration for the patient size and exam.
Begin the scanning session by choosing the correct
application and preset for the examination by selecting
Preset.
Begin the scan session using the default Power Output
setting for the probe and exam.
Connecting the probe
Probes can be connected at any time, whether the unit is on or
off.
Vivid S5: 3 type RS ports
Vivid S6: 3 type RS ports and one type OR
port to support TEE probes
Figure 11-3: Probe ports
Do not allow the probe head to hang freely. Impact to the probe
head may result in irreparable damage.
CAUTION
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Probes
CAUTION
Fault conditions can result in electric shock hazard. Do not touch
the surface of probe connectors which are exposed when the
probe is removed.
WARNING
Do NOT touch the patient and any of the connectors on the
ultrasound unit simultaneously, including ultrasound probe
connectors.
To connect a probe (small connector - type RS)
1.
2.
3.
4.
Hold the probe connector vertically with the cable pointing
upwards.
Push the connector locking handle to the right-most
position.
Align the connector with the probe port and carefully push
into place.
Push the connector locking handle to the left-most position.
To connect a probe (large connector - type OR)
1.
2.
3.
4.
CAUTION
568
Hold the probe connector vertically with the cable pointing
upwards.
Turn the connector locking handle horizontically.
Align the connector with the probe port and carefully push
into place.
Rotate the locking handle to the full vertical position to lock
in place.
Take the following precautions with the probe cables:
• Keep free from the wheels.
• Do not bend cable sharply.
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Probes
Activating the probe
When a probe is connected to the unit it is automatically
detected.
To select a probe and an application
1.
2.
3.
4.
Press PROBE on the control panel. A list of the connected
probes will pop up.
Trackball to the desired probe.
An application menu for the desired probe is then listed.
Trackball to the desired application
Press SET to launch the application.
Make sure that the probe and application names displayed on the
screen correspond to the actual probe and application selection.
CAUTION
Check that the correct TI category is displayed ("Thermal Index",
page 24). TIB must be displayed when a fetal application is
selected.
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Probes
Disconnecting the probe
Probes can be disconnected at any time. It is recommended
that the probe should not be active when being disconnected.
To disconnect a probe (small connector type RS)
1.
2.
3.
4.
5.
6.
Freeze the image by pressing FREEZE.
Press the connector locking lever towards the left to unlock
the connector.
Pull the probe and connector straight out of the probe port.
Carefully slide the probe and connector away form the
probe port and around the right side of the keyboard.
Ensure that the cable is free.
Verify that the probe head is clean before placing the probe
in its storage case.
To disconnect a probe (large connector type OR)
1.
2.
3.
570
Rotate the lock handle counter-clockwise to the horizontal
position to unlock the connector.
Pull the connector straight out of the probe port.
Verify that the probe head is clean before placing the probe
in its storage case.
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Probes
Care and Maintenance
This section covers:
•
Planned maintenance
•
Probe inspection
•
Probe cleaning
•
Probe disinfection
Planned maintenance
Improper handling can lead to early probe failure and electric
shock hazards.
CAUTION
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.
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
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Probes
Inspecting the probe
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.
After each use
1.
2.
Inspect the lens, the probe housing and the cable
(Figure 11-4).
Look for damage that might allow liquid into the probe.
Before each use
1.
2.
3.
Inspect the lens, the probe housing and the cable
(Figure 11-4).
Look for damage that might allow liquid into the probe.
Test the functionality of the probe.
1. Housing
2. Strain relief
3. Seal
4. Lens
Figure 11-4: Probe parts
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Special handling instructions
Using protective sheaths
CAUTION
Protective barriers may be required to minimize disease
transmission. Probe sheaths are available for use with all clinical
situations where infection is a concern. Use of legally marketed,
sterile probe sheaths is strongly recommended for intra-cavitary
and intra-operative procedures. Use of legally marketed, sterile,
pyrogen free probe sheaths is REQUIRED for neurological
intra-operative procedures.
Instructions
Custom made sheaths are available for each probe. Each
probe sheath kit consists of a flexible sheath used to cover the
probe and cable and elastic bands used to secure the sheath.
Sterile probe sheaths are supplied as part of biopsy kits for
those probes intended for use in biopsy procedures. In addition
to the sheath and elastic bands, there are associated
accessories for performing a biopsy procedure which are
included in the kit. Refer to the biopsy instructions for the
specific probes in the Discussion section of this chapter for
further information.
Reordering
To reorder sheaths, please contact your local distributor or the
appropriate support resource.
CAUTION
Devices containing latex may cause severe allergic reaction in
latex sensitive individuals. Refer to FDA's March 29, 1991
Medical Alert on latex products.
CAUTION
Do not use pre-lubricated condoms as a sheath. In some cases,
they may damage the probe. Lubricants in these condoms may
not be compatible with probe construction.
DO NOT use an expired probe sheath. Before using probe
sheaths, verify whether the term of validity has expired.
CAUTION
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Probes
Endocavitary Probe Handling Precautions
If the sterilization solution comes out of the endocavitary probe,
please follow the cautions below.
CAUTION
Sterilant Exposure to Patient (e.g., Cidex): Contact with a
sterilant to the patient's skin or mucous membrane may cause an
inflammation. If this happens, refer to the sterilant's instruction
manual.
Sterilant Exposure from Probe Handle to Patient (e.g., Cidex): DO
NOT allow the sterilant to contact the patient. Only immerse the
probe to its specified level. Ensure that no solution has entered
the probe's handle before scanning the patient. If sterilant comes
into contact with the patient, refer to the sterilant's instruction
manual.
Sterilant Exposure from Probe Connector to Patient (e.g., Cidex):
DO NOT allow the sterilant to contact the patient. Only immerse
the probe to its specified level. Ensure that no solution has
entered the probe's connector before scanning the paitent. If
sterilant comes into contact with the patient, refer the the
sterilant's instruction manual.
Endocavitary Probe Point of Contact: Refer to the sterilant's
instruction manual.
Probe handling and infection control
This information is intended to increase user awareness of the
risks of disease transmission associated with using this
equipment and provide guidance in making decisions directly
affecting the safety of the patient as well as the equipment user.
Diagnostic ultrasound systems utilize ultrasound energy that
must be coupled to the patient by direct physical contact.
Depending on the type of examination, this contact occurs with
a variety of tissues ranging from intact skin in a routine exam to
re-circulating blood in a surgical procedure. The level of risk of
infection varies greatly with the type of contact.
One of the most effective ways to prevent transmission
between patients is with single use or disposable devices.
However, ultrasound transducers are complex and expensive
devices that must be reused between patients. It is very
important, therefore, to minimize the risk of disease
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Probes
transmission by using barriers and through proper processing
between patients.
CAUTION
CAUTION
Risk of Infection: ALWAYS clean and disinfect the probe between
patients to the level appropriate for the type of examination and
use FDA-cleared probe sheaths where appropriate.
Adequate cleaning and disinfection are necessary to prevent
disease transmission. It is the responsibility of the equipment
user to verify and maintain the effectiveness of the infection
control procedures in use. Always use sterile, legally marketed
probe sheaths for intra-cavitary and intra-operative procedures.
For neurological intra-operative procedures, use of a legally
marketed, sterile, pyrogen free probe sheath is REQUIRED.
robes for neuro surgical use must not be sterilized with liquid
chemical sterilants because of the possibility of neuro toxic
residues remaining on the probe.
Cleaning and disinfecting probes
CAUTION
Transesophageal and intraoperative probes require a special
handling. Refer to the user documentation enclosed with these
probes.
CAUTION
You MUST disconnect the probe from the Vivid S5/Vivid S6 prior
to cleaning/disinfecting the probe. Failure to do so could damage
the system.
Cleaning probes
Cleaning procedure
1. 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.
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Probes
CAUTION
To minimize the risk of infection from blood-borne pathogens,
you must handle the probe and all disposables which have
contacted blood, other potentially infectious materials, mucous
membranes, and non-intact skin in accordance with infection
control procedures. You must wear protective gloves when
handling potentially infectious material. Use a face shield and
gown if there is a risk of splashing or splatter.
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 disinfection
•
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.
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High-level disinfection
High-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
endocavity (TV, TR, and TE) probes after contact with mucosal
membrane.
Follow the
manufacturer's
instructions for
storage, use and
disposal of the
disinfection
solution.
WARNING
1.
High-level disinfection procedure
Prepare the germicide solution according to the
manufacturer's instructions.
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).
2.
Place the cleaned dried probe in contact with the germicide
for the time duration specified by the manufacturer.
Do not immerse the probe in liquid beyond the level specified for
that probe (Figure 11-5).
WARNING
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.
3.
4.
Rinse the part of the probe which was in contact with the
germicide according to the germicide manufacturer's
instructions.
Wipe dry with a soft towel or air dry the probe.
CREUTZFELD-JACOB DISEASE
WARNING
Neurological use on patients with this disease must be avoided.
If a probe becomes contaminated, there is no adequate
disinfecting means.
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Probes
1. Fluid level
2. Contact face with patient environment
Figure 11-5: Probe immersion levels
CAUTION
After cleaning and disinfection, inspect the probe's lens, cable,
casing and connector. Look for any damage that would allow
liquid to enter the probe.
Also, inspect the probe functionality by live scan. If any damage
is found, do not use the probe until it has been inspected and
repaired/replaced by a GE service representative.
Table 11-1: Description of Pictogram on Care card
Pictogram
Description
"ATTENTION - Consult accompanying
documents" is intended to alert the user to refer
to the operator manual or other instructions
when complete information cannot be provided
on the label.
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Table 11-1: Description of Pictogram on Care card
Pictogram
Description
"CAUTION - Dangerous voltage" (the lightning
flash with arrowhead) is used to indicate electric
shock hazards.
Biohazard - Patient/user infection due to
contaminated equipment. Usage:
• Cleaning and care instructions
• Sheath and glove guidelines
Ultrasound probes are highly sensitive medical
instruments that can easily be damaged by
improper handling. Use care when handling
and protect from damage when not in use.
Do not immerse the probe into any liquid
beyond the level specified for that probe. Refer
to the user manual of the ultrasound system.
Since there is a possibility of having negative
effects on the probe, observe the specified
immersing time by the germicide manufacturer
strictly. Do not immerse the probe in liquid
chemical germicides more than the time
prescribed in the care card.
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Probes
CAUTION
In order for liquid chemical germicides to be effective, all visible
residue must be removed during the cleaning process.
Thoroughly clean the probe, as described earlier before
attempting disinfection.
You MUST disconnect the probe from the Vivid S5/Vivid S6 prior
to cleaning/disinfecting the probe. Failure to do so could damage
the system.
DO NOT soak probes in liquid chemical germicide for longer than
is stated by the germicide instructions for use. Extended soaking
may cause probe damage and early failure of the enclosure,
resulting in possible electric shock hazard.
1.
2.
CAUTION
Prepare the germicide solution according to the
manufacturer's instructions. Be sure to follow all
precautions for storage, use and disposal.
Place the cleaned and dried probe in contact with the
germicide for the time specified by the germicide
manufacturer. High-level disinfection is recommended for
surface probes and is required for endocavitary and
intraoperative probes (follow the germicide manufacturer's
recommended time).
Probes for neuro surgical intra-operative use must NOT be
sterilized with liquid chemical sterilants because of the
possibility of neuro toxic residues remaining on the probe.
Neurological procedures must be done with the use of legally
marketed, sterile, pyrogen free probe sheaths.
3.
After removing from the germicide, rinse the probe
following the germicide manufacturer's rinsing instructions.
Flush all visible germicide residue from the probe and allow
to air dry.
Coupling gels
Do not use gels (lubricants) that are not recommended. They
may damage the probe and void the warranty.
CAUTION
In order to assure optimal transmission of energy between the
patient and probe, a conductive gel or couplant must be applied
liberally to the patient where scanning will be performed.
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Do not apply gel to the eyes. If there is gel contact to the eye,
flush eye thoroughly with water.
WARNING
Coupling gels should not contain the following ingredients as
they are known to cause probe damage:
•
Methanol, ethanol, isopropanol, or any other alcohol-based
product
•
Mineral oil
•
Iodine
•
Lotions
•
Lanolin
•
Aloe Vera
•
Olive Oil
•
Methyl or Ethyl Parabens (para hydroxybenzoic acid)
•
Dimethylsilicone
Returning/shipping probes and repair parts
US Department of Transportation and GE Medical Systems
policy requires that equipment returned for service MUST be
clean and free of blood and other infectious substances.
When you return a probe or part for service (Field Engineer or
customer), you need to clean and disinfect the probe or part
prior to packing and shipping the equipment.
Ensure that you follow probe cleaning and disinfection
instructions provided in the Basic User Manual.
This ensures that employees in the transportation industry as
well as the people who receive the package are protected from
any risk.
Probe safety
WARNING
Ultrasound probes are highly sensitive medical instruments that
can easily be damaged by improper handling. Use care when
handling and protect from damage when not in use. DO NOT use
a damaged or defective probe. Failure to follow these
precautions can result in serious injury and equipment damage.
For a detailed description of the safety guidelines: "Probe
Safety", page 30.
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Biopsy
The Vivid S5/Vivid S6 supports biopsy capability for the 3S-RS,
M4S-RS (Vivid S6 only), 4C-RS, 8L-RS, 9L-RS, 12L-RS, and
e8C-RS 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 S5/Vivid S6 ultrasound
unit.
Precaution concerning the use of
biopsy procedures
Do not freeze the image during a biopsy procedure. The image
must be live to avoid a positioning error.
WARNING
CAUTION
CAUTION
582
Biopsy guidezones are intended to assist the user in determining
optimal probe placement and approximate the needle path.
However, actual needle movement is likely to deviate from the
guideline. Always monitor the relative positions of the biopsy
needle and the subject mass during the procedure.
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.
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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.
• Use protective barriers such as gloves and probe sheaths.
• 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.
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Preparing the Biopsy guide attachment
The 3S-RS, 4C-RS, 8L-RS, 9L-RS, and 12L-RS probes have
an optional biopsy kit specific for each probe. The biopsy kit
consists of:
•
One reusable non-sterile bracket
•
•
Five disposable, single-use 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
• Sterile gel
• One reusable needle guide
Instructions
In addition sterile Ultra-Pro IITM Needle guide kits can be
ordered as replacement kit.
Introduction to CIVCO's Needle Guidance
Systems
CIVCO's Needle Guidance Systems utilize a two-part system
consisting of a reusable biopsy bracket and a disposable
snap-on needle guide. The disposable needle guides snap
onto the biopsy bracket, providing a fixed path for visualizing
ultrasound-guided instrument placement procedures.
Applications include tissue biopsy, fluid aspirations and
catheter placement. Single-angle brackets offer imaging
professionals a fixed angle needle path during puncture
procedures. Multi-angle brackets offer professionals different
angles for needle placement. Once the desired angle has been
selected, a stainless steel pin locks the angle securely into
position. The pin is removable from the bracket for easy
reprocessing between patients. Brackets should be cleaned
and disinfected according to your CIVCO User's Guide.
The Ultra-Pro II™ allows for accurate placement for
ultrasound-guided biopsy and drainage procedures. The
needle guide directs instruments according to on-screen
system software guidelines. The Ultra-Pro II features a
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mechanism for quick-release detachment of the needle guide
from the transducer while maintaining secure needle
placement. The Ultra-Pro II includes disposable needle inserts
for 14 to 23 gauge instruments. 8.5 French gauge inserts also
available. Replacement kits include sterile needle guide,
transducer cover, gel packet and colored elastic bands. Biopsy
depth is indicated in centimeters.
WARNING
Read the following instructions and the user's guide for the
Ultra-Pro IITM Needle Guide kit before using the biopsy
equipment.
Bracket attachment procedure
1.
Identify the appropriate biopsy guide bracket (Figure 11-6).
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Probes
Probe
Bracket
Probe with Bracket
3S-RS
4C-RS
8L-RS
9L-RS
12L-RS
E8c-RS
Figure 11-6: Biopsy Guide Brackets
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2.
Orient the bracket so that the needle clip attachment is on
the same side as the probe orientation mark (notch or LED)
(Figure 11-7).
1. Needle clip attachment on the bracket
2. Bracket label
3. Probe label
4. Probe orientation mark (notch or LED)
5. Lever lock
Figure 11-7: Probe/bracket alignment
3.
4.
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.
3S probe: tighten the biopsy bracket to the probe by locking
the lever lock.
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Probes
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.
Displaying the Guide zone
1.
2.
3.
Select the desired probe with biopsy support.
Press BIOPSY on the alphanumeric keyboard.
If the needle multi-angle is supported, select the correct
angle from the Biopsy menu.
Figure 11-8: The Biopsy menu
The biopsy guide zone is displayed on the screen.
The biopsy guidezone represents a path of the needle. The
dots which make up the guidezones is the depth readout
where:
•
Yellow represent 1 cm increments.
•
Red represents 5 cm increments.
The display should be carefully monitored during a biopsy for
any needle deviation from the center line or guidezone.
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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.
Figure 11-9: Biopsy guide zone
The needle may vary from the center line or guidezone for
various reasons:
•
Needle barrel to needle clearance or strength
•
Bracket manufacturing tolerance
•
Needle deflection due to tissue resistance
•
Needle size chosen. Thinner needles may deflect more.
Failure to match the guidezone displayed to the guide may cause
the needle to track a path outside the zone.
DANGER
It is extremely important that when using the adjustable angle
biopsy guides, the angle displayed on the screen matches the
angle set on the guide, otherwise the needle will not follow the
displayed guidezone which could result in repeated biopsies or
patient injury.
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Probes
Endocavitary Probe Biopsy Guide
Assembly
Note: The reusable biopsy guide fits with 16G needle or
thinner.
E8C Preparation
To prepare the E8C for use:
1. Remove the probe from the box and carefully examine it for
any damage.
2. If the biopsy guide is to be attached, use the filling removal
tool to clean out the attachment area on the probe head.
a. Probe Head
b. Attachement
c. Filling Removal Tool
Figure 11-10: Attachment Filling Removal
3.
Clean, then disinfect the probe.
Note: Ensure that protective gloves are worn.
Installing the sheath
To install the sheath:
1. Remove the sheath from its package. Do not unroll the
sheath.
Note: Remember to rinse all sanitary probe sheaths of
powder before placing on the probe. Powder can degrade
the displayed image.
2. Place an adequate amount of ultrasound gel inside the
sheath tip (the gel is between the sheath inner surface and
the probe aperture).
Note: Ensure that only acoustic coupling gel is used for
this purpose.
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3.
4.
Place the sheath tip over the probe aperture and then pull
the sheath end toward the probe handle.
Inspect the sheath for nicks, cuts or tears.
a. Probe Handle
b. Sanitary Sheath
c. Probe Body
Figure 11-11: E8C Probe with Sheath
5.
Rub a finger over the tip of the probe to ensure all air
bubbles have been removed.
E8C Biopsy Guide Preparation
1.
CAUTION
If a biopsy is to be performed, snap the plastic biopsy guide
on to the probe over the sheath.
Patient injury or repeated biopsies may result. The needle
placement will not be as intended if the needle guide is not
properly seated and secure.
Figure 11-12: Civco Disposable Biopsy Guide (approx. 5° Angle)
2.
3.
Place an adequate amount of ultrasound gel on the
gel-filled sheath tip's outer surface.
Ensure the guide is properly seated and secure by pushing
forward on the needle insertion end of the guide until the
attachment node is firmly in place in its hole.
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Probes
Biopsy needle path verification
Perform 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 ("Bracket
attachment procedure", page 585).
2. Scan in a container filled with a glycerol solution (6% in
water).
3. Display the biopsy guide zone on the monitor ("Displaying
the Guide zone", page 588).
4. Ensure that the needle echo falls within the guide zone
markers.
Starting the biopsy procedure
Enabling color flow
would allow for
visualization of the
vascular structure
around the area to
be biopsied.
1.
2.
3.
Cleaning, disinfection and disposal
1.
2.
3.
592
Press BIOPSY.
Place sterile coupling gel on the scanning surface of the
probe/sheath.
Perform the biopsy.
Refer to the Ultra-Pro IITM Needle Guide user manual for
cleaning and disinfection of the bracket.
Perform cleaning and disinfection of the probe ("Cleaning
and disinfecting probes", page 575).
Dispose the sheath, bands and needle guide after use,
according to medical regulations for biohazardious waste.
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Surgery/Intra-operative Use
Preparing for Surgery/Intra-operative
Procedures
Preparing the transducer for intra-operative use follows the
same sterile procedure as for biopsy use except that no biopsy
attachments are used ("Preparing the Biopsy guide
attachment", page 584).
Sterile gel is applied to the transducer face and a sterile sheath
completely covers the transducer and cable which has first
undergone a thorough cleaning and high-level disinfection.
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.
CAUTION
Follow your
institutions
guidelines on post
surgery/intraoperat
ive procedures for
probe cleaning and
disinfection.
For surgery/intra-operative procedures, a sterile environment is
required. Therefore, both the operator and probe needs to be
sterile.
To ensure a sterile environment during the procedure, it is
recommended that this be a two-person job.
1. Perform a high level disinfection of the probe.
2. The scanner (surgeon, sonographer, etc.) should be sterile
and gloved.
3. Place an adequate amount of sterile coupling gel on the
face of the probe.
4. Place the proper sterile sheath over the probe and cord.
5. Depending on the type of procedure, use either sterile
water or sterile gel on the sheath cover.
Figure 11-13: Applying Sterile Sheath
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Chapter 12
Peripherals
• Introduction ................................................................................... .. 596
• Printing .......................................................................................... .. 597
• To print an image ..................................................................... 597
• Specifications for peripherals ..................................................... .. 597
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Peripherals
Introduction
This chapter provides information on peripherals that can
operate with the Vivid S5/Vivid S6 ultrasound unit, as follows:
•
Color Thermal Video Printer
•
Black & White Thermal Video Printer
Use only GE Medical Systems approved internal equipment
when replacing an internal peripheral.
CAUTION
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 must be verified.
All devices meeting IEC60950 must be kept outside of the patient
environment, as defined in IEC60601-1-1, unless it, according to
IEC60601-1-1, 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 UL60601-1 and IEC60601-1 standards for electrical leakage.
When using peripheral device, observe all warnings and
cautions given in peripheral operator manuals.
WARNING
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Printing
The Vivid S5/Vivid S6 ultrasound unit can support a color and a
black & white thermal video printer. The printer devices are
controlled from the PRINT key on the control panel.
The PRINT key can also be configured to perform alternative
storage (i.e. storage to DICOM media or secondary capture).
PRINT key configuration is described later in this manual
("Additional outputs", page 639).
To print an image
For details on the
Thermal video
printers operation,
consult the
manufacturer
operator manual
provided with the
printer.
•
Press PRINT on the Control panel.
The image displayed on the screen is printed on B&W or
Color printer, depending on the key assignment
configuration ("Additional outputs", page 639).
Specifications for peripherals
Please refer to the documentation accompanying the
peripherals.
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Chapter 13
Presets and System setup
• Introduction ................................................................................... .. 601
• Starting the Configuration package ............................................ .. 604
• To open the Configuration package ......................................... 604
• Overview ........................................................................................ .. 605
• Imaging .......................................................................................... .. 606
• The Global setup sheet ............................................................ 606
• Application ................................................................................ 609
• Application menu ...................................................................... 612
• Measure Text ................................................................................. .. 614
• The measurement menu sheet ................................................ 614
• Configuration of the Measurement menu ................................. 617
• The Advanced sheet ..................................................................... .. 619
• Parameter configuration ........................................................... 619
• The Modify Calculations sheet .................................................... .. 620
• Parameter configuration ........................................................... 620
• The OB table sheet .................................................................. 621
• Report ............................................................................................ .. 627
• The diagnostic codes sheet ..................................................... 628
• The Comment texts sheet ........................................................ 629
• Connectivity .................................................................................. .. 632
• Dataflow ................................................................................... 632
• Additional outputs ..................................................................... 639
• Tools ........................................................................................ 641
• Formats .................................................................................... 642
• TCP-IP ..................................................................................... 648
• System ........................................................................................... .. 649
• The system settings ................................................................. 649
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Presets and System setup
• About ............................................................................................. ... 651
• Administration .............................................................................. ... 652
• Users ........................................................................................ 653
• Unlock Patient ...........................................................................656
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Introduction
This chapter describes the configuration management package
of the Vivid S5/Vivid S6 ultrasound unit. The Vivid S5/Vivid S6
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 S5/Vivid S6
configuration package:
Category and sublevel
Description
access
Imaging
• Global
Refer to
page 606
Sets the cineloop controls and
display.
All
Sets the patient information
display.
Sets the scan information
displayed on the video record.
• Application
Configures the probe and
application specific settings.
All
• Application menu
Configures the Application
menu.
All
Measure / Text
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Category and sublevel
Description
access
• Measurement menu
• Advanced
• Modify calculations
Configures the Measurement
menu by selecting and defining
the sequence of the
measurements and calculation
to perform.
All
Refer to
Creates user-defined
measurements
Configures vascular Doppler
calculations to be performed.
• Annotation
• Customize
Configures the Annotation menu
and create pre-defined
annotation.
All
Report
page 627
• 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
• Structured findings
Enables the insertion of
pre-configured structured
diagnosis statements in the
patient report.
All
Connectivity
page 632
• Dataflow
Create new dataflows or
configure existing dataflows.
Admin
• Additional outputs
Configure the PRINT key.
All
• Tools
Formats removable media.
All
• Formats
Configures the Examination list
window display and other
options related to the patient
management.
All
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Category and sublevel
Description
access
• TCP-IP
Sets the Transmission
Protocol/Internet Protocol.
Admin
System
Refer to
page 649
• 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
Administration
page 651
page 652
• Disk management
Enables the management of the
hard disk space while
maintaining the patient database
on the system.
All
• 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
• System administration
Keeps track of all the options
implemented in the unit.
Admin
• Unlock patient
Unlock patient records that were
not properly finished.
Admin
Service
This sheet is for service staff
only. Deals with printer definition
and keyboard configuration.
Admin
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Starting the Configuration package
To access the Configuration package the user has to log on as
a specific user ("Users", page 653). This ensures user-specific
and user-defined settings and presets to be used.
The access to the entire configuration package is user
configuration dependent ("Users", page 653).
To open the Configuration package
1.
2.
Press CONFIG on the alphanumeric keyboard.
The Log In window is displayed asking for operator ID and
password (Figure 13-1).
Select Log on when completed.
The Setup dialogue window is displayed (Figure 13-2).
1. Select the operator
2. Type password
Figure 13-1: The Operator login window
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Overview
The 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.
Note: Whenever making any modifications of settings through
the different configuration screens and tabs, it is always
required to re-boot the system for the modifications to become
valid.
1. Sublevel tabs for the selected Setup
category.
2. Setup categories
3. Selected Setup category
Figure 13-2: The Setup dialogue window structure
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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 13-3: The Global setup sheet
Flex Keys configuration
There are 3 configurable buttons on the system which can be
assigned by the user. The Flex key and the two un-marked
buttons at the lower side of the trackball can be configured to
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function as any button on the keyboard with the exception of
alphanumeric and soft-menu sections.
Configuring the Flex key
Click the combo-box menu and select one of the configurable
buttons: Flex, Left-TB or Right-TB. On the second combo-box
select one of the functions on the list. The selected function will
be assigned to the selected configurable button.
Configuring one of the Flex keys while in the Global tab will
assign the selected function independent of any probe or
application selection.
Configuring one of the Flex keys while in the Application tab will
assign the selected function only for the selected preset
application.
Cineloop store
Parameter
Description
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
Parameter
Description
Crop images:
: In the Analysis screen, removes top and
bottom of the image when more than two
images have been selected.
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Doppler
Parameter
Description
Doppler:
• Show KHz scale: when selected, displays
the KHz scale on the left side of the Doppler
spectrum ("PW and CW Doppler",
page 174).
Patient Info
Parameter
Description
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 ("The Patient information on
the scanning screen", page 98).
• Anonymous patient: when checked,
no patient information is displayed on
the scanning screen's Title bar.
Scan Info
Parameter
Description
Scan Info:
• selects scan information on the video
record.
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Application
The 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 13-4: The Application setup sheet (example)
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The Probe/application configuration
parameters
Parameter
Description
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.
M&A Category/Study:
Selects particular M&A categories to be
associated with a specific probe and
preset.
Auto invert on steer:
In Color flow, the color bar is inverted
when steering the color flow sector angle.
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Parameter
Description
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. settings
Press Save to store the changes applied
to the current setting. Not applicable on
factory application settings.
Flex Button Functionality:
Defines the function of each of the three
Flex Keys.
• Select one of three Flex keys in upper
box.
• Define the functionality for the selected
key in the lower box.
Creating 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. Highlight the probe and press SET.
3. Trackball to Presets...
A pop-up window Enter new name: appears.
4. Enter a name for the new application.
5. Press Save.
To edit an application
1.
2.
3.
4.
Press APPLICATION, select the probe, and select the
application to edit.
Adjust the imaging parameters as desired.
Press APPLICATION.
Highlight the probe and press SET.
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5.
6.
Trackball to Presets...
A pop-up window Enter new name: appears, displaying the
current preset name.
Press Save to store the changes.
Applicable only on user-defined applications.
Application menu
The 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.
1. First menu level
3. Moving tools
2. Second menu level
Figure 13-5: The Application menu setup sheet (example)
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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 level
1. Trackball to the application to move.
2. Press SET.
3.
Press Default to
get factory setting.
4.
Press
.
The application is moved one step up.
Press
.
The application is moved one step down.
To move an application from one level to the other
1. Trackball to the application to move.
2. Press SET.
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.
To delete an application
1. Trackball to the application to delete.
2. Press SET.
3. Press Delete.
Applicable only to user-defined applications.
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Measure Text
The Measure/Text category deals with the following:
•
Configuration of the Measurement menu ("Configuration of
the Measurement menu", page 617)
•
Creation of user-defined measurements ("User-defined
formulas", page 356)
•
Configuration of Measurement tools ("The Advanced
sheet", page 619)
•
Configuration of the vascular Doppler calculation ("The
Modify Calculations sheet", page 620)
•
Configuration of the Annotation function ("Configuration of
the pre-defined annotation list", page 142)
The measurement menu sheet
The Measurement sheet enables the organization of the
Factory default Measurement menu and the creation of
user-defined Measurements.
1. Configuration window (see next pages for
details)
2. The measurement menu (displays updated
configuration)
Figure 13-6: The Measurement menu setup sheet
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Parameter
Description
Add measurement:
Create or select from the pop-up list a
measurement to be added to a folder
("Configuration of the Measurement
menu", page 352).
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.
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Parameter
Description
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.
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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
("Measurement package configuration", page 351).
Display of the Measurement categories
1.
2.
Press M&A categories in the Configuration window.
The M&A categories are displayed in a pop-up window
("M&A Categories:", page 615).
Check the categories to be displayed.
Uncheck the categories to hide.
To copy a Measurement category
1.
Factory
Measurement
categories cannot be
renamed.
Press M&A categories in the Configuration window.
The M&A categories are displayed in a pop-up window
("M&A Categories:", page 615).
2. Move the trackball marker over the M&A category name.
3. Press SET to highlight the category.
4. Press Create copy.
A copy of the selected measurement category is displayed
in the Measurement menu.
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 category
1.
2.
3.
4.
Trackball to the Measurement menu heading.
Press SET.
The measurement categories are displayed in a
sub-menu.
Trackball to the measurement category of interest.
Press SET.
The measurement category is displayed.
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Moving an item in the Measurement menu
1.
2.
Trackball to the entry to move into the Measurement menu.
Press SET.
3.
Press
or
to move the selection up or down inside the
Measurement menu.
Deleting an item in the Measurement menu
Only user created
items can be
deleted.
1.
2.
Trackball to the entry to delete in the Measurement menu.
Press SET.
3.
Press
to delete the item.
Display/hide a folder or a measurement in the
Measurement menu
The 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:
•
Uncheck the actual folder or measurement in the Folder or
Measurement field in the Configuration window.
To display a hidden folder or measurement:
•
Check the actual folder or measurement in the Folder or
Measurement field in the Configuration window.
Creating a user-defined folder
1.
2.
3.
If the folder is to be inside another folder, select the actual
folder in the Measurement menu.
Press Add folder.
The Measurement menu is updated.
Select the new folder and Enter the folder name in the
Name text field.
Adding a measurement to a folder
The user can either add a pre-defined measurement or create
a new measurement with user-defined parameters to a folder
("Configuration of the Measurement menu", page 352).
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The Advanced sheet
The Advanced sheet enables further configuration of the
Measurement function. The settings are divided into application
specific parameters and global parameters.
Figure 13-7: The Advanced sheet
Parameter configuration
1.
When pointing at a
parameter an
explanation label is
displayed.
2.
3.
If configuring application specific parameters, select an
application from the M&A category pull-down menu.
Select the configuration value next to the parameter to
configure.
A pull-down menu is displayed (Figure 13-7).
Select a new value from the pull-down menu.
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The Modify Calculations sheet
The Modify Calculations sheet is used to configure the
calculations to be performed when doing a Doppler vascular
measurements.
Figure 13-8: The Modify Calculations sheet
Parameter configuration
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.
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The OB table sheet
The OB table sheet enables the creation and edition of
user-defined OB tables.
Figure 13-9: 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 ("The OB
table templates", page 623).
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7.
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).
Select Edit table.
The OB Table spreadsheet is displayed, showing the table
template selected.
Figure 13-10: 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
Measurement
result
Fetal growth
format:
MEAS
MEAN
SD
Unit:
mm
week
week
Table range:
1 SD
Graph range:
1 SD
Value:
[cm]
GA:
[#w#d]
Min:
[#w#d]
Max:
[#w#d]
Format:
AGE
MEAN
SD
Unit:
week
mm
week
Others are same as above
Template 2 (based on Tokyo)
Fetal age
Measurement
result
Fetal growth
Format:
MEAS
MEAN
SD
Unit:
mm
day
day
Table range:
1 SD
Graph range:
1 SD
Value:
[cm]
GA:
[#w#d]
SD:
[day (+/-)]
Format:
AGE
MEAN
SD
Unit:
day
mm
day
Others are same as above
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Template 3 (based on Osaka)
Fetal age
Measurement
result
Fetal growth
Format:
MEAS
MEAN
SD
Unit:
mm
day
mm
Table range:
1 SD
Graph range:
1 SD
Value:
[cm]
GA:
[#w#d]
SD:
[(mv-pv)/sd]
Format:
AGE
MEAN
SD
Unit:
day
mm
day
Others are same as above
Template 4 (based on several European tables)
Fetal age
Measurement
result
Fetal growth
Format:
MEAS
MEAN
SD
Unit:
mm
weekday
mm
Table range:
5%–95%
Graph range:
5%–95%
Value:
[cm]
GA:
[#w#d]
GP:
[%] Calculated by Fetal growth table. If Fetal
growth table is not edited, GP is not calculated.
Format:
AGE
MEAN
SD
Unit:
weekday
mm
day
Others are same as above
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Template 5 (based on several European tables)
Fetal age
Measurement
result
Fetal growth
Format:
MEAS
MEAN
SD
Unit:
mm
weekday
mm
Table range:
1 SD
Graph range:
5%–95%
Value:
[cm]
GA:
[#w#d]
GP:
[%] Calculated by Fetal growth table. If Fetal
growth table is not edited, GP is not calculated.
Format:
AGE
MEAN
SD
Unit:
weekday
mm
day
Others are same as above
Template 6 (based on several European tables)
Fetal age
Measurement
result
Fetal growth
Format:
MEAS
MIN
MEAN
SD
Unit:
mm
weekday
weekday
weekday
Table
range:
10%–90%
Graph
range:
10%–90%
Value:
[cm]
GA:
[#w#d]
GP:
[%] Calculated by Fetal growth table. If Fetal growth
table is not edited, GP is not calculated.
Format:
AGE
MIN
MEAN
SD
Unit:
weekday
mm
mm
mm
Others are same as above
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Template 7 (based on several European tables)
Fetal age
Measurement
result
Fetal growth
Format:
MEAS
MEAN
SD
Unit:
mm
weekday
mm
Table range:
1 SD
Graph range:
10%–90%
Value:
[cm]
GA:
[#w#d]
GP:
[%] Calculated by Fetal growth table. If Fetal
growth table is not edited, GP is not calculated.
Format:
AGE
MEAN
SD
Unit:
weekday
mm
mm
Others are same as above
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Report
The 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 ("Report templates management", page 548).
•
Diagnostic codes: enables the creation of pre-defined text
inputs to be used in the Diagnosis information field in the
Examination list window (Figure 9-10).
•
Comment texts: enables the creation of pre-defines text
inputs to be used in the Comment information field in the
Examination list window (Figure 9-10).
•
Structured findings: enables the insertion of
pre-configured structured diagnosis statements and
Billing/Accreditation codes in the patient report ("Structured
Findings", page 514).
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The diagnostic codes sheet
This sheet enables the creation (and deletion) of text inputs
that can be used when entering diagnostic codes in the
Examination list window (Figure 9-10).
1. List of text inputs
3. Text input display area (free text area)
2. Text input name
4. Create a text input
Figure 13-11: The Diagnostic codes sheet
Creating a diagnostic codes
1.
2.
3.
4.
5.
Select New text to create a new diagnostic code
(Figure 13-11).
In the Code field enter a name for the diagnostic code.
Trackball to the Text input display area.
Press SET.
Enter the text.
A diagnostic code can be added to an examination ("Diagnosis
code", page 435).
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Deleting a diagnostic code
1.
2.
3.
4.
In the Code list field, trackball to the diagnostic code to
delete (Figure 13-11).
Press SET.
Trackball to Delete.
Press SET.
The Comment texts sheet
This sheet enables the creation (and deletion) of text inputs
that can be used when entering comments in the Examination
list window (Figure 9-10) or in the Direct report.
Figure 13-12: 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 level
1. Select the first level.
2. Press New.
The Enter new text window is displayed.
Figure 13-13: The Enter new text window
3.
4.
Enter a title in the Text field.
Enter the pre-defined text in the Full text field.
Press OK.
Second and third level
1. 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 13-13).
4. Enter a title in the Text field.
Enter the pre-defined text in the Full text field.
5. Press OK.
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Editing a pre-defined text input
1.
2.
3.
Select the term to edit in one of the columns.
Press Edit.
The Edit text window is displayed.
Figure 13-14: The Edit text window
4.
5.
Edit the text in both the Text and Full text fields.
Press OK.
Deleting a pre-defined text input
1.
2.
3.
4.
Select the item to delete in one of the columns.
Press Delete.
A Confirmation window is displayed.
Press Yes.
The selected text input is deleted including the belonging
text inputs.
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Connectivity
This 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
Dataflow
Communication between the Vivid S5/Vivid S6 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. Input/output
devices cannot be added/removed to/from the pre-defined
dataflows. However the settings for the devices can be
adjusted.
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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1. Select a dataflow to edit
Factory defined dataflows cannot be edited.
2. Use selected dataflow as default
3. Store data directly to archive
5. Option for the search function. In the
Search/Create patient window select between
None, All patients and Today’s patient
6. Input/output devices assigned to the current
dataflow
4. Hide selected dataflow from the list of available
7. Adjust the settings for the selected assigned
dataflow
device
Figure 13-15: The sublevel Dataflow (example)
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Dataflows available
A set of pre-defined dataflows is available on the unit as listed
in the table below. Input/output devices cannot be
added/removed to/from the pre-defined dataflows. However the
settings for the devices can be adjusted ("Adjusting the
assigned devices", page 637).
Dataflow
Description
No Archive
Enables to perform an examination
without storing the data to the archive.
LocalArchive-Int.HD
Local archive internal hard drive
The local database is used for patient
archiving. Images are stored to
internal hard drive. The stored image
files will consist of raw data only,
together with a single-frame DICOM
preview image (no DICOM multi-frame
is stored).
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 ("DICOM
SR", page 463)
RemoteArch-RemoteHD
Remote archive remote hard drive
A remote database (either on
EchoPAC workstation or a server) is
used for patient archiving. Images are
stored to a network image volume
(either internal HD on EchoPAC
workstation or a 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.
Some of the measurements are stored
if DICOM SR is turned on ("DICOM
SR", page 463)
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WL-LA-DServ:
the local
database is not
searched, only
the DICOM
Modality
Worklist.
Dataflow
Description
Worklist/LocalArchive-DI
COMServer/Int.HD
Modality Worklist local archive
DICOM server and local hard drive
Search 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 hard drive.
Some of the measurements are stored
if DICOM SR is turned on ("DICOM
SR", page 463)
Worklist/RemoteArchiveDICOMServer/RemoteHD
Modality Worklist remote archive
DICOM server and remote hard drive
Search 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 ("DICOM
SR", page 463)
Worklist/Remote Archive
- Remote Storage
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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
a server.
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Dataflow
Description
DICOM MOD
Pure DICOM image format to/from a
DICOM Magneto Optical Disk
Read/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 ("DICOM
SR", page 463).
DICOM CD/DVD read
DICOM CD/DVD read
Read DICOM Media from the
CD/DVD-drive.
Read-only dataflow, no data can be
stored.
DICOM Server
DICOM server
Store pure DICOM images to a
DICOM device.
Some of the measurements are stored
if DICOM SR is turned on ("DICOM
SR", page 463).
DICOM Print
DICOM Print
Send images to a DICOM printer.
Query Retrieve
Query Retrieve
Retrieve images from a DICOM server
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LocalArchive-Int.HD/
eVue
The local database is used for patient
archiving. Images are stored to
internal hard drive and a MPEG exam
is created to the configured
destination.
RemoteArch-RemoteHD/
eVue
A remote database (either on
EchoPAC workstation or on Image
Vault) is used for patient archiving.
Images are stored to a network image
volume (either internal HD on
EchoPAC workstation or Image Vault
volume) and a MPEG exam is created
to the configured destination.
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To select the default dataflow
1.
2.
3.
Select the dataflow in the Name drop-down menu.
(Figure 13-15).
Check the Default box.
The dataflow will be selected by default when restarting
the unit.
Check the Direct Store box to have data stored
automatically to the archive (no buffer storage).
Adjusting the assigned devices
1.
2.
3.
Select the device in the Selected devices field.
Press Properties.
The Properties window is displayed.
Adjust the device specific parameters as desired (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
Allow raw data
Definition
: 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 Framerate
Select 25, 30 or Full from the pop-up menu. Full (original
acquisition) is default.
Compression
Select compression type or no compression.
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Image settings
Quality
Allow Multiframe
Connection settings
Retry
DICOM settings
Definition
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 cineloop storage.
Definition
Set maximum number of connection tentatives, time
interval between tentatives and time-out.
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 outputs
The 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).
1. Select between P1 and P2 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 ("Printing", page 597)
Figure 13-16: The sublevel Additional outputs (example)
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P1/P2 Print key configuration
1.
2.
3.
4.
In Button field select Print P1 or P2.
Select an output device in the available outputs field and
press the Right arrow button to assign the service to the
dataflow. The Properties window is displayed
Adjust the device specific parameters and select OK.
Some of the settings can be changed directly in the Image
to Produce field in the sublevel Additional outputs.
Adjust the image specific parameters (the table below).
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)
To remove a device, select the device in the Selected devices
field and press the Left arrow button.
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Tools
The Tools sublevel sheet deals with:
•
formatting of removable media (MO disk, CD-R, DVD-R).
•
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 13-17: The sublevel Tools
Remote path setting
The user can define a default remote path for a network shared
folder (\\server-name\share-name). The remote path can then
be selected as a destination archive for the following
operations:
•
Export traces function in Q-Analysis
•
Export of system error log file
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•
•
•
Export of report templates
Save as function for images
Save as function for reports
To define a remote path
1. Press Utility/Config on the Touch panel and log on as
administrator if required.
2. Select the Connectivity category and Tools subgroup. The
Tool sheet is displayed.
3. Enter a remote path of a shared folder on the network.
To check the connection, press Check.
Creation of a DICOM directory
1.
2.
Insert the media in the drive.
Select Repair DICOM DIR.
Wait for the display of the Information window indicating
that the process is completed.
Formats
The Formats sublevel enables configuration of the Examination
list window (Figure 9-10) and other tools related to patient
management, as described below.
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Figure 13-18: The sublevel Formats (example)
Configuration of the Examination list window
The user can configure the examination list displayed in the
Examination list window (Figure 9-10) by deleting, adding
columns and change the information type displayed in each
column.
To adjust column
width, select and
drag column
heading border.
Column configuration
1. Trackball to the column to edit.
2. Press the SET key in the trackball area.
A sub-menu is displayed (Figure 13-19).
3. Select the action to perform:
• Insert: creates a new column
• Delete: removes selected column
• select the desired information to be displayed in the
selected column.
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1. Insert new column to the left of
the selected column
2. Delete selected column
3. Select column heading
Figure 13-19: Configuration of the Examination list window
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Other configuration settings
Parameter
Description
Use free text addresses:
In the Patient information window ("The
Patient Information window", page 98),
: 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 ("The
Patient Information window", page 98), 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 ("The
Patient Information window", page 98),
: 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 ("The
Search/Create Patient window",
page 97)("The Search/Create Patient
window", page 429)("The extended
Search/Create Patient window", page 432),
: 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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Parameter
Description
Auto search for patient:
In the Search/Create Patient window ("The
Search/Create Patient window",
page 97)("The Search/Create Patient
window", page 429)("The extended
Search/Create Patient window", page 432),
: The system searches automatically
through the patient archive selected while
entering patient information.
: The system searches through the patient
archive after pressing SET.
Pre-defined text directly:
In the Examination list window ("The
Examination list window", page 433),
: the Insert text key launches pre-defined
text input.
: the Insert text key open the extended
text field.
Examination list on Archive button
When 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 ("The
Search/Create Patient window", page 97),
: 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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Parameter
Description
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-IP
This configuration category enables the user with
administration rights to set the Transmission Protocol/Internet
Protocol for the system and connected remote archive.
1. Computer name: device’s name of type VIVID_S5-00nnnn or
VIVID_S6-00nnnn 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 Image Vault)
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 ("Adding Problem description",
page 663).
Figure 13-20: The sublevel TCP/IP
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System
This 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 13-21: The System settings setup sheet
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Location
Parameter
Description
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.
Date and Time
Parameter
Description
Date and Time:
Changes done on the date or time format
will be effective only after rebooting the
system.
650
• 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, min, sec).
• 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: four digits must be typed when
entering the patient year of birth.
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Languages
Parameter
Description
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.
Units
Parameter
Description
Units:
Select the desired units (Metric or US) from
the pop-up menu.
About
The About sheet gives informations about the ultrasound unit
concerning:
•
software
•
hardware
•
Probes
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Administration
Only users with
administration
rights have access to
this setup category
("Users",
page 653).
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The Admin. category deals with the following:
•
Disk management: enables the management of the hard
disk space while maintaining the patient database on the
system ("Running the Disk management function",
page 484).
•
Backup: enables the backup procedures for local patient,
and report archives as well as system and user-defined
configuration ("Backup procedure", page 488).
•
Restore: enables data retrieving of patient and report
archives as well as system and user-defined configuration
(presets) from a backup ("Restore procedure", page 492).
•
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 ("Unlock Patient", page 656).
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Users
The 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 13-22: The Users setup sheet
Users are divided in groups with different rights. There are two
types of groups:
•
User groups: members of these groups (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
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the system. They are registered as references that can be
associated to a patient record.
Table 13-1: The User groups
Right (definition below)
Store report
+
+
Physician
+
+
Sonographer
+
+
Fellow
+
+
Sys Admin
+
+
Hosp admin
GE admin
Service
Print report
+
Admin
Create
Cardiologist
Group
Activated
with a
Dongle
+
+
+
+
+
The rights associated to the user groups are:
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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Creating a user or a referring member
1.
2.
3.
Press New
Enter the user’s information.
Select the type of user/referring member in Member of
Group(s).
To be able to login on the system, the group Operator MUST be
selected.
CAUTION
Editing an user configuration
1.
2.
3.
Select the actual user in the User list.
Make the desired changes.
Press CONFIG or any active scanning key to exit the
Configuration management package.
Deleting a user
1.
2.
Select the actual user in the User list.
Press Delete.
The user is removed from the User list.
Auto logon and auto Screenlock
Auto logon
•
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 logoff
•
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.
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Unlock Patient
If for any reason an examination is not properly finished, the
patient record is locked and cannot be opened again unless it
is unlocked.
Figure 13-23: The Unlock Patient sheet
To unlock patient records:
1.
2.
3.
4.
5.
6.
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Press CONFIG.
Select the category Admin.
In the Admin category, select the sheet Unlock patient.
In the Unlock patient sheet, select the patient records to
unlock
You can search for a specific patient record or a group of
patient record using the searching filters.
Select Unlock to unlock the selected patient record(s), or
select Unlock All to unlock all patient records.
A Confirmation window is displayed.
Select OK.
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Chapter 14
User maintenance
• System Care and Maintenance .................................................... .. 658
• Inspecting the system .............................................................. 658
• Cleaning the unit ...................................................................... 659
• Prevention of static electricity interference ............................... 662
• Using disposable hygienic control-panel cover ........................ 662
• System self-test ............................................................................ .. 663
• System malfunction .................................................................. 663
• Using InSite ExC ........................................................................... .. 667
• InSite ExC Functionalities ........................................................ 667
• Initiating a Request for Service (RFS) ...................................... 667
• Clinical Lifeline Mode ............................................................... 671
• Exiting InSite ExC .................................................................... 671
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System Care and Maintenance
Having been determined by GE Medical Systems engineers
that your Vivid S5/Vivid S6 system has no high-wearing
components likely to fail due to frequent use, no Periodic
Maintenance Inspections are mandatory. However, some
Customer Quality Assurance Programs may require additional
tasks and/or inspections to be performed at periods of
frequency different from those listed in this manual.
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.
Only trained persons are allowed to perform the safety
inspections mentioned above.
Technical descriptions are available on request.
To ensure that the Vivid S5/Vivid S6 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
If any defects are observed or malfunctions occur, DO NOT
operate the equipment, and inform a qualified service person.
CAUTION
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
To avoid electrical shock hazard, do not remove panels or
covers from the unit.
WARNING
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Virus Protection
To minimize virus vulnerability Vivid S5/Vivid S6 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 S5/Vivid S6. 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
third party technology used. Microsoft (and other) security
patches that addresses serious issues with Vivid S5/Vivid S6
will be made available to customers after GE verification of
those patches.
Cleaning the unit
General Cleaning
Frequent and diligent cleaning of the Vivid S5/Vivid S6
ultrasound unit reduces the risk of spreading infection from
person to person, and also helps to maintain a clean working
environment.
CAUTION
CAUTION
When performing Cleaning Procedures, to prevent the risk of
system damage, always observe the following precautions:
• Use only recommended cleaning materials and solutions.
• Do not use any solutions or products not listed in the
Vivid S5/Vivid S6 User Manual.
• Do not spray any liquid directly onto the Vivid S5/Vivid S6 covers,
LCD Display or keyboard!
• Do not allow any liquid to drip or seep into the system.
• Prior to cleaning, turn OFF power to the system.
After cleaning, please inspect the system including functionality
by live scan. If any defects are observed or malfunctions occur,
do not operate the equipment but inform a qualified service
person. Contact a Service Representative for information.
System Cabinet
On a weekly basis, moisten a soft, non-abrasive folded cloth or
sponge with a mild, general purpose, non-abrasive soap and
water solution. Do not use any solution containing abrasive
powder or strong chemicals such as acid or alkaline.
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Squeeze excess liquid from the cloth/sponge, them wipe down
the top, front, back and both sides of the unit. Do not spray
any liquid directly onto the unit!
1. Rinse the cloth/sponge with clean running water and wipe
the unit surfaces again.
2. Use a dry, soft, lint-free cloth to dry the unit surfaces.
3. Wait for the unit surfaces to dry completely.
Note: In the event that disinfection is required or any stubborn
stains remain, remove them with a soft, dust-free cloth on
which a small quantity of isopropyl rubbing alcohol has been
absorbed, as described below for cleaning the Keyboard.
LCD Display
On a weekly basis, gently wipe the LCD Display with a dry, soft,
lint-free non-abrasive folded cloth.
Note: In the event that you see a scratch-like mark on the LCD
Display, this may be a stain transferred from the Keyboard or
Trackball when the LCD Display Cover was pressed from the
outside. Proceed as follows:
Wipe or dust the stain gently with a soft, dry cloth. If the stain
remains, moisten a soft, lint-free cloth with water or a 50-50
mixture of isopropyl alcohol and water that does not contain
impurities. Wring out as much of the liquid as possible then
wipe the LCD Display again. Do not let any liquid drip into
the computer!
Be sure to dry the LCD Display before closing the cover.
Control Panel and Keyboard
Control Panel:
On a weekly basis, moisten a soft, non-abrasive folded cloth or
sponge with a mild, general purpose, non-abrasive soap and
water solution or general purpose disinfectant. Do not use any
solution containing abrasive powder or strong chemicals
such as acid or alkaline.
Squeeze excess liquid from the cloth/sponge, them wipe down
the Control Panel.
Do not spray any liquid directly onto the Control Panel!
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1.
2.
3.
Rinse the cloth/sponge with clean running water and wipe
the Control Panel again.
Use a dry, soft, lint-free cloth to dry the Control Panel.
Wait for the Control Panel surfaces to dry completely.
Keyboard:
Clean the keyboard as described (above) for cleaning the
Control Panel.
Note: In the event that disinfection is required or any stubborn
stains remain, absorb a small quantity of isopropyl rubbing
alcohol on a soft, dust-free cloth.
Wipe the surface of the keycaps with the cloth, making sure
that no liquid drips on or between the keys. Allow to dry.
Magneto Optical Disk (MOD)
Clean the drive head and media with the vendor-supplied
cleaning kit. Advised to repeat this often, to prevent future
problems. MOD disks must be stored away from dust and
cigarette smoke. Do not use alcohol or benzene to clean the
MOD cartridge.
DVD - CD-RW Drive
Clean the drive head and media with the vendor-supplied
cleaning kit. Advise the user to repeat this often, to prevent
future problems. CDs must be stored away from dust and
cigarette smoke. Do not use alcohol or benzene to clean the
CD drive.
Peripherals
Clean the peripherals in accordance with the respective
manufacturer's directions.
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Prevention of static electricity
interference
Interference 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.
Using disposable hygienic control-panel
cover
Figure 14-1: Disposable hygienic control-panel cover
A special disposable hygienic cover for the control panel
(Figure 14-1) can be ordered from GE healthcare.
The cover is a hygienic, non-sterile cover designed to protect
the control-panel area from contamination by dirt or fluids.
The user can operate all of the controls while the cover is
stretched over the whole control panel. The cover may be
replaced whenever necessary.
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System self-test
The Vivid S5/Vivid S6 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 malfunction
In 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.
Adding bookmarks
When a problem occurs during regular use of the system, press
ALT - B. This inserts a "bookmark" into the system failure logs,
and a confirmation message appears on a prompt line
(Figure 14-2). Bookmarks serve as time-stamps, indicating
where particular problems have occurred, while allowing the
user to continue working with minimum interruption. The
bookmark logfile assists service engineers in troubleshooting.
Figure 14-2: Bookmark message
Adding Problem description
1.
2.
3.
Press ALT - D on the alphanumeric keyboard.
The Problem description dialogue window is displayed
(Figure 14-3).
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.
Click Save to create a logfile.
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Figure 14-3: The Problem description dialogue window
Using advanced features
Extensive logging
In some cases you may be asked to activate the Extensive
Logging feature. This allows the system to record logging data
in a more detailed format.
To activate, click Extensive Logging (Figure 14-3) and select
the categories which require detailed analysis (Figure 14-4).
This generates a larger, more detailed log-file.
Note: extensive logfiles can grow considerably over time.
When the feature is not needed, turn it off in order to conserve
the size of the logfiles.
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Figure 14-4: Extensive Logging dialog
Advanced Options
Click Options (Figure 14-3) to open the Advanced Options
dialog (Figure 14-5). This dialog allows you to:
•
Control the size of logfiles
•
Specify some optional attachments to be added to the
logfiles
Setting Logfile ranges
By default, the logfiles may be very large as they are not limited
by time. In case you wish to limit the logfiles:
1. Select Export Logs Using (Figure 14-5).
2. Select Time Range.
3. Define the time range using the From and To fields.
Alternatively, select Bookmarks. This generates logfiles which
are limited to one hour before through one hour after the
selected bookmark.
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Figure 14-5: Advanced Options dialog
Setting Logfile attachments
On the lower area of the Advanced Options dialog
(Figure 14-5) you can select different items that you wish to
attach to logfiles.
Exporting the logfile
1.
2.
3.
666
Press ALT - D on the alphanumeric keyboard to display the
Problem description dialogue window again.
Select the destination where to export the logfile (MOD or
CD-R).
Press Save and Export.
A Zip file (named “logfile_<date>_<time>.zip”) is copied on
to the selected removable media.
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Using InSite ExC
InSite ExC is your direct link with a GE Online Service
Engineer, or Applications Support Engineer, or a Request for
Service. The system enables you to get online assistance
promptly, and monitor and follow up the status of your requests.
A Request for Service (RFS) can also be initiated by GE
service personnel.
You access Insite ExC via the InSite ExC link
the bottom left corner of the screen.
located at
InSite ExC Functionalities
•
•
•
•
•
Service Desktop: Utilities intended for service personnel
Request for Service: Opens a service call with GE Service
Connect to GE: Sets up a quick link with GE Technical
Support
Connect Clinical Lifeline: Gives GE service full access to
your system and enables Technical Support to establish a
remote control link with your system
Cancel
Initiating a Request for Service (RFS)
This option opens a service call with GE Service.
1.
Click the
icon at the bottom left corner of your screen.
The Insite-2 dialog box opens (Figure 14-6).
Figure 14-6: Insite-2 dialog box
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2.
Select Request for Service. The Contact Information
dialog box opens - (Figure 14-7 and Figure 14-8).
The items marked with a red asterisk are required fields
and the requested information must be typed in the
relevant fields.
Figure 14-7: Contact Information dialog box
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Figure 14-8: Contact Problem Description
3.
Note: Before clicking the "Send" button, verify that
"Checked Out" is displayed at the bottom left corner of the
screen. This indicates that the communications link is
active.
After you have completed filling in all the required
information, press Send to initiate the Request for Service.
The following request confirmation appears (Figure 14-9).
Figure 14-9: Request confirmation
4.
Select the Queue tab (Figure 14-10) to check the status of
your request.
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Figure 14-10: Screen showing status of requests in queue
5.
To identify which users have sent service requests, click the
Users tab (Figure 14-11).
Figure 14-11: Users tab
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Clinical Lifeline Mode
Using the Clinical Lifeline functionality is similar to the Request
for Service procedure:
1.
2.
Click the InSite ExC icon
at the bottom left corner of
the screen. The Insite 2 dialog box displays.
Select Connect Clinical Lifeline.
After a few moments the InSite ExC icon changes to a red
icon
indicating that you have authorized Service to
establish a remote control link with your system.
Note: In addition to contacting a technical / clinical support
person, selecting this mode also changes the service response
time from 10 minutes to 15 seconds so that your call can be
answered as quickly as possible, as well as enabling Disruptive
mode (where Technical Support can establish a remote control
link with your system).
Exiting InSite ExC
1.
2.
Click
at top right corner of the screen to exit InSite ExC.
After you have finished using InSite ExC, reboot the
system.
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User maintenance
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Index
Numerics
2D Soft menu controls............................................................................ 155
2D-Mode.......................................................................................... 150–160
Controls............................................................................................. 152
Optimizing ......................................................................................... 159
Overview ........................................................................................... 150
Using................................................................................................. 158
A
Active mode gain
Optimizing Color Mode ..................................................................... 173
Optimizing CW Doppler .................................................................... 178
Optimizing PW Doppler..................................................................... 178
adding malfunction description............................................................... 663
Advanced sheet............................................................................... 619, 620
AFI.......................................................................................................... 340
Alpha HIP ............................................................................................... 328
Amniotic Fluid Index ............................................................................... 340
Angle correction
CW Doppler ...................................................................................... 176
Optimizing CW Doppler .................................................................... 179
Optimizing PW Doppler..................................................................... 179
PW Doppler....................................................................................... 176
Annotations ..................................................................................... 138–145
Configure .......................................................................................... 142
Editing ............................................................................................... 141
Erasing.............................................................................................. 141
Inserting ............................................................................................ 138
Application
selecting............................................................................................ 100
Assignable keys ..................................................................................... 103
Audio Volume
PW/CW Doppler................................................................................ 175
AutoEF ................................................................................................... 305
AVI.......................................................................................................... 422
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Index
B
B Color maps
2D Mode ............................................................................................ 153
Baseline
Color Mode ........................................................................................ 169
CW Doppler ....................................................................................... 175
Optimizing Color Mode ...................................................................... 173
PW Doppler ....................................................................................... 175
TVI ..................................................................................................... 181
battery, internal ......................................................................................... 55
BFI .......................................................................................................... 207
B-Flow..................................................................................................... 207
Biopsy ..................................................................................................... 582
needle path........................................................................................ 592
Blood flow imaging..................................................................................207
B-Mode measurements....................................................................336, 384
Bodymark................................................................................................144
bookmark ................................................................................................663
C
CAMM ..................................................................................................... 413
Care and Maintenance.....................................................................658–662
Cine Compound
Strain ................................................................................................. 198
Strain rate .......................................................................................... 193
Tissue Tracking ..........................................................................188, 203
Cineloop........................................................................................... 110–113
Controls ............................................................................................. 111
Overview............................................................................................ 110
Saving as AVI .................................................................................... 422
Using ................................................................................................. 112
Circumference parameter ....................................................................... 338
CIVCO..................................................................................................... 584
Cleaning
Ultrasound unit ..................................................................................659
Color 2D
Using ................................................................................................. 172
Color maps
Color Mode ........................................................................................ 170
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CW Doppler ...................................................................................... 176
M-Mode............................................................................................. 163
Strain................................................................................................. 196
Strain rate ......................................................................................... 191
Tissue Synchronization Imaging ....................................................... 201
Tissue tracking.................................................................................. 186
TVI .................................................................................................... 181
Color M-Mode
Overview ........................................................................................... 168
Using................................................................................................. 172
Color Mode...................................................................................... 167–173
Controls............................................................................................. 169
Optimizing ......................................................................................... 173
Overview ........................................................................................... 167
using ................................................................................................. 172
Comments .............................................................................................. 434
Compound....................................................................................... 153, 206
Compress
2D ..................................................................................................... 155
CW Doppler ...................................................................................... 176
LV Contrast ....................................................................................... 249
M-Mode............................................................................................. 163
Optimizing CW Doppler .................................................................... 178
Optimizing M-Mode........................................................................... 166
Optimizing PW Doppler..................................................................... 178
PW Doppler....................................................................................... 176
Strain rate ......................................................................................... 192
TVI .................................................................................................... 182
Compund......................................................................................... 153, 206
Configurable Remote Path ..................................................................... 120
Configuration see System setup
Connecting peripherals ............................................................................ 56
Connecting the unit .................................................................................. 52
Connectivity
Buttons.............................................................................................. 639
Dataflow ............................................................................................ 632
Overview ........................................................................................... 632
Continuous capture ................................................................................ 217
Continuous Tissue Optimization............................................................. 154
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Index
Contour
2D ...................................................................................................... 156
LV Contrast........................................................................................ 250
M-Mode ............................................................................................. 163
Optimizing M-Mode ...........................................................................166
Contrast Imaging..............................................................................245–253
Abdominal Contrast Imaging .............................................................253
LV Contrast Imaging.......................................................................... 247
Vascular Contrast Imaging ................................................................ 252
Control panel........................................................................................70–81
Coupling gels .......................................................................................... 580
CTO ........................................................................................................ 154
CW Doppler .....................................................................................174–179
Controls ............................................................................................. 175
Optimizing.......................................................................................... 178
Overview............................................................................................ 174
Using ................................................................................................. 177
D
D Color maps
PW Doppler ....................................................................................... 176
d-D Ratio................................................................................................. 328
DDP
2D ...................................................................................................... 156
LV Contrast........................................................................................ 250
Optimizing 2D .................................................................................... 159
Delete
Examination....................................................................................... 437
Image................................................................................................. 438
Patient record .................................................................................... 437
Depth
2D ...................................................................................................... 155
Optimizing 2D .................................................................................... 159
Diagnosis code ....................................................................................... 435
Diagnosis information ............................................................................. 434
DICOM spooler ....................................................................................... 495
DICOM SR .............................................................................................. 463
DICOM verification..................................................................................641
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Diff On/Off
2D ..................................................................................................... 156
Diff on/off
LV Contrast ....................................................................................... 250
Direct report............................................................................................ 530
Disk Backup ........................................................................................... 487
Disk Management .................................................................................. 480
configuring ........................................................................................ 481
destination device ............................................................................. 483
manual start ...................................................................................... 484
running .............................................................................................. 484
schedule............................................................................................ 482
settings.............................................................................................. 483
Disk Restore........................................................................................... 487
Doppler measurements .......................................................................... 342
Doppler see PW or CW Doppler
Dual focus
2D ..................................................................................................... 153
Dynamic Range
LV Contrast ....................................................................................... 250
Dynamic range
2D ..................................................................................................... 155
M-Mode............................................................................................. 163
Optimizing M-Mode........................................................................... 166
Dysplasia................................................................................................ 326
E
ECG
Adjusting trace .................................................................................. 136
Connecting........................................................................................ 125
Controls............................................................................................. 134
Edge Enhance, M-Mode......................................................................... 163
EFW ....................................................................................................... 342
Ejection Fraction, automated.................................................................. 305
Emission declaration ................................................................................ 42
Estimated Fetal Weight .......................................................................... 342
Event timing............................................................................................ 277
eVue ....................................................................................................... 424
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Index
Examination
Starting ................................................................................................ 95
Export
Patient records ..................................................................................468
extensive logging .................................................................................... 664
External Respirator Interface .................................................................. 131
F
Fetal growth
bar graph ........................................................................................... 378
Fetal growth curve graph ........................................................................ 373
File Management .................................................................................... 480
Focus
2D ...................................................................................................... 152
LV Contrast........................................................................................ 249
M-Mode ............................................................................................. 162
Optimizing 2D .................................................................................... 159
Optimizing M-Mode ...........................................................................166
Follicle measurements ............................................................................ 386
footswitch ..................................................................................................85
Formatting
Removable media.............................................................................. 641
Frame rate
2D ...................................................................................................... 152
Optimizing CW Doppler ..................................................................... 178
Optimizing M-Mode ...........................................................................166
Optimizing PW Doppler ..................................................................... 178
Strain ................................................................................................. 196
Strain rate .......................................................................................... 191
Tissue Synchronization Imaging........................................................ 201
Tissue Tracking ................................................................................. 186
TVI ..................................................................................................... 181
Frequency
2D ...................................................................................................... 153
Color Mode ........................................................................................ 170
CW Doppler ....................................................................................... 177
LV Contrast........................................................................................ 248
M-Mode ............................................................................................. 162
Optimizing Color Mode ...................................................................... 173
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Optimizing CW Doppler .................................................................... 178
Optimizing M-Mode........................................................................... 166
Optimizing PW Doppler..................................................................... 178
PW Doppler....................................................................................... 177
Strain................................................................................................. 197
Strain rate ......................................................................................... 192
Tissue Synchronization Imaging ....................................................... 202
Tissue Tracking................................................................................. 187
TVI .................................................................................................... 182
G
Gain
2D ..................................................................................................... 154
Optimizing 2D ................................................................................... 159
Optimizing M-Mode........................................................................... 166
Gel.......................................................................................................... 580
Gestational Sac ...................................................................................... 339
GS .......................................................................................................... 339
GYN measurements............................................................................... 383
H
Hazard symbols........................................................................................ 14
Hip Dysplasia ......................................................................................... 326
Horizontal sweep
Color M-Mode ................................................................................... 169
CW Doppler ...................................................................................... 175
M-Mode............................................................................................. 162
Optimizing CW Doppler .................................................................... 178
Optimizing M-Mode........................................................................... 166
Optimizing PW Doppler..................................................................... 178
PW Doppler....................................................................................... 175
I
Images
Saving as JPEG................................................................................ 422
Import
Patient records.................................................................................. 477
Intima-Media Thickness ......................................................................... 315
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Index
Invert
2D ...................................................................................................... 153
Color Mode ........................................................................................ 169
CW Doppler ....................................................................................... 175
Optimizing Color Mode ...................................................................... 173
Optimizing CW Doppler ..................................................................... 178
Optimizing PW Doppler ..................................................................... 178
PW Doppler ....................................................................................... 175
Strain rate .......................................................................................... 191
Tissue Tracking ................................................................................. 186
TVI ..................................................................................................... 181
J
JPEG.......................................................................................................422
L
Language
Online manual ................................................................................... 651
System............................................................................................... 651
Lateral Averaging
Color Mode ........................................................................................ 171
Optimizing Color Mode ...................................................................... 173
Strain ................................................................................................. 198
Strain rate .......................................................................................... 192
Tissue Tracking ................................................................................. 187
TVI ..................................................................................................... 183
LCD monitor safety ................................................................................... 35
logfile.......................................................................................................665
exporting............................................................................................ 666
LogiqView ............................................................................................... 205
Low Velocity Reject see LVR
LPRF.......................................................................................................176
LVR
Color Mode ........................................................................................ 169
CW Doppler ....................................................................................... 175
Optimizing Color Mode ...................................................................... 173
Optimizing CW Doppler ..................................................................... 178
Optimizing PW Doppler ..................................................................... 178
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M
M&A........................................................................................................ 346
Magneto Optical Disk
Formatting......................................................................................... 641
Measurements
Configuration..................................................................................... 351
User-defined formulas....................................................................... 356
Measurements (Cardiac)................................................................. 255–364
2D ..................................................................................................... 267
Doppler ............................................................................................. 274
M-Mode............................................................................................. 271
TSI .................................................................................................... 278
Measurements (Vascular)
B-Mode ............................................................................................. 314
Doppler ............................................................................................. 321
M-Mode............................................................................................. 320
M-Mode ........................................................................................... 161–166
Anatomical M-Mode .......................................................................... 165
Controls............................................................................................. 162
Conventional M-Mode....................................................................... 164
Curved Anatomical M-Mode ............................................................. 165
Optimizing ......................................................................................... 166
Overview ........................................................................................... 161
Using................................................................................................. 164
Monitor
adjusting image................................................................................... 90
adjusting position ................................................................................ 92
Moving the unit ......................................................................................... 63
moving the unit ......................................................................................... 63
MPEG exams ......................................................................................... 424
MPEGVue/eVue ..................................................................................... 424
multiple fetus .......................................................................................... 379
N
Needle Guidance Systems..................................................................... 584
normal values ......................................................................................... 353
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Index
O
OB application.........................................................................................333
OB exam ................................................................................................. 329
OB graphs............................................................................................... 372
OB measurements ..................................................................................335
OB Multigestational................................................................................. 379
OB parameter configuration....................................................................346
OB table sheet ........................................................................................ 621
OB worksheet .........................................................................................369
On/Off ....................................................................................................... 59
Operation principles .................................................................................... 2
Ovary measurements.............................................................................. 385
P
Patient
Entering information ............................................................................ 95
Pediatric Calculations ............................................................................. 326
Phono
Adjusting trace................................................................................... 136
Controls ............................................................................................. 134
Physiological ECG/Respiratory traces .............................................124–136
Power
2D ...................................................................................................... 156
Color Mode ........................................................................................ 171
CW Doppler ....................................................................................... 177
LV Contrast........................................................................................ 249
M-Mode ............................................................................................. 163
Optimizing Color Mode ...................................................................... 173
PW Doppler ....................................................................................... 177
Strain rate .......................................................................................... 193
Tissue Synchronization Imaging.................................................198, 202
Tissue Tracking ................................................................................. 188
Probe-Application Overview
Vivid S5 ............................................................................................. 560
Vivid S6 ............................................................................................. 561
Probes
Activating ........................................................................................... 569
Care and Maintenance ...................................................................... 571
Cleaning ............................................................................................ 575
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Connecting................................................................................... 86, 567
connector formats ............................................................................... 87
Disconnecting ................................................................................... 570
Disconnecting and connecting ............................................................ 86
Disinfecting ....................................................................................... 577
Intra-operative use ............................................................................ 593
Labelling............................................................................................ 565
Orientation markers .......................................................................... 564
returning............................................................................................ 581
Safety................................................................................................ 581
Selecting ........................................................................................... 100
shipping............................................................................................. 581
special handling ................................................................................ 573
surgery use ....................................................................................... 593
Types ................................................................................................ 555
probes, selecting .................................................................................... 567
protective sheaths .................................................................................. 573
Pulse Pressure
Adjusting trace .................................................................................. 136
Pulse Pressure transducer
Controls............................................................................................. 134
PW Doppler ..................................................................................... 174–179
Controls............................................................................................. 175
Optimizing ......................................................................................... 178
Overview ........................................................................................... 174
Using................................................................................................. 177
Q
Quantitative Analysis.............................................................................. 389
Curved Anatomical M-Mode ............................................................. 413
Deletion of a trace............................................................................. 403
Frame disabling ................................................................................ 404
Labelling a sample area.................................................................... 407
Manual tracking................................................................................. 401
Optimizing Anatomical M-Mode ........................................................ 415
Optimizing sample area .................................................................... 406
Optimizing the trace display.............................................................. 408
Overview ........................................................................................... 393
Sample area...................................................................................... 400
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Index
Strain cursor ...................................................................................... 400
To generate a trace ...........................................................................400
Trace smoothing................................................................................ 409
R
Radial Averaging
Color Mode ........................................................................................ 171
Optimizing Color Mode ...................................................................... 173
Strain ................................................................................................. 198
Strain rate .......................................................................................... 193
Tissue Tracking ................................................................................. 187
TVI ..................................................................................................... 183
Referral reasons ..................................................................................... 434
Regulatory requirements............................................................................. 6
Reject
2D ...................................................................................................... 155
LV Contrast........................................................................................ 250
M-Mode ............................................................................................. 163
Optimizing 2D .................................................................................... 159
Optimizing M-Mode ...........................................................................166
Strain ................................................................................................. 197
Strain rate .......................................................................................... 192
Remote Path ........................................................................................... 120
Removable media
Ejecting.............................................................................................. 120
Flash Card ......................................................................................... 115
Formatting .........................................................................................641
Report ..............................................................................................507–551
Configuration of the Template selection menu .................................. 549
Creating ............................................................................................. 509
Deleting ............................................................................................. 513
Direct report....................................................................................... 530
Export/Import templates ....................................................................550
managing report images.................................................................... 511
Print ................................................................................................... 512
Retrieving .......................................................................................... 513
Save .................................................................................................. 512
Report designer ...................................................................................... 532
Designing a template......................................................................... 535
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Respiratory Trace, displaying................................................................. 136
ROI size
Color Mode ....................................................................................... 171
S
Safety .................................................................................................. 11–48
Biological hazard................................................................................. 34
Electrical hazard ................................................................................. 33
Equipment safety ................................................................................ 33
Explosion hazard ................................................................................ 33
Mechanical hazard.............................................................................. 30
Pacemaker hazard.............................................................................. 34
Patient safety ...................................................................................... 29
Personnel safety ................................................................................. 33
Sample volume
Color Mode ....................................................................................... 170
CW Doppler ...................................................................................... 176
Optimizing Color Mode ..................................................................... 173
Optimizing CW Doppler .................................................................... 178
Optimizing PW Doppler..................................................................... 178
PW Doppler....................................................................................... 176
save as PDF to network ......................................................................... 120
Scale
Color Mode ....................................................................................... 169
CW Doppler ...................................................................................... 175
PW Doppler....................................................................................... 175
Strain................................................................................................. 196
TVI .................................................................................................... 181
Scanning
Screen layout ...................................................................................... 83
starting .............................................................................................. 100
Simultaneous
Strain................................................................................................. 196
Strain rate ......................................................................................... 191
Tissue Synchronization Imaging ....................................................... 201
Tissue tracking.................................................................................. 186
TVI .................................................................................................... 181
Single length parameter ......................................................................... 337
Site requirements ..................................................................................... 51
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Index
Soft Menu Rocker ................................................................................... 103
using .................................................................................................. 107
Strain.......................................................................................................195
Controls ............................................................................................. 196
Optimizing.......................................................................................... 198
Overview............................................................................................ 195
Using ................................................................................................. 198
Strain cursor............................................................................................ 400
Strain rate ............................................................................................... 190
Controls ............................................................................................. 191
Optimizing.......................................................................................... 193
Overview............................................................................................ 190
Using ................................................................................................. 193
Stress Echo......................................................................................209–243
Acquisition .........................................................................................212
Analysis ............................................................................................. 225
Configuring levels .............................................................................. 242
Creating an image group ................................................................... 243
Deleting a group ................................................................................ 243
Editing template................................................................................. 237
Labelling a level................................................................................. 242
Labelling a projection......................................................................... 242
Scoring .............................................................................................. 228
Selecting a template .......................................................................... 211
Timers.........................................................................................216, 242
System
Controls affecting acoustic output ....................................................... 25
Switching On/Off.................................................................................. 59
System documentation ...............................................................................4
System setup ...................................................................................599–656
Application .........................................................................................609
Connectivity ................................................................................632–648
Examination list window ....................................................................642
Examination signoff ...........................................................................642
Imaging setup .................................................................................... 606
Language........................................................................................... 649
M&A................................................................................................... 614
Patient ID........................................................................................... 642
Patient information............................................................................. 608
Scan information................................................................................ 608
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Starting system setup ....................................................................... 604
Units.................................................................................................. 649
Unlock Patient................................................................................... 656
User configuration............................................................................. 653
T
TCP-IP.................................................................................................... 648
TGC see Time Gain Compensation ....................................................... 154
Threshold
Strain................................................................................................. 197
Strain rate ......................................................................................... 192
Tissue Synchronization Imaging ....................................................... 202
Tissue Tracking................................................................................. 187
TVI .................................................................................................... 182
Tilt
2D ..................................................................................................... 152
LV Contrast ................................................................................ 248, 250
Time Gain Compensation (TGC)
2D ..................................................................................................... 154
Optimizing 2D ................................................................................... 159
Optimizing M-Mode........................................................................... 166
Tissue priority
Color Mode ....................................................................................... 170
Optimizing Color Mode ..................................................................... 173
Tissue Synchronization Imaging ............................................................ 200
Controls............................................................................................. 201
Optimizing ......................................................................................... 204
Overview ........................................................................................... 200
Using................................................................................................. 203
Tissue Tracking ...................................................................................... 185
Controls............................................................................................. 186
Optimizing ......................................................................................... 188
Overview ........................................................................................... 185
Using................................................................................................. 188
Tissue Velocity Imaging see TVI
Trackball
Operation .......................................................................................... 108
Transparency
Strain................................................................................................. 197
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Index
Strain rate .......................................................................................... 192
Tissue Synchronization Imaging........................................................ 202
Tissue Tracking ................................................................................. 187
TVI ..................................................................................................... 182
TSI ...................................................................................................181, 186
TSI, see Tissue Synchronization Imaging
TVI .......................................................................................................... 180
Controls ............................................................................................. 180
Optimizing.......................................................................................... 184
Overview............................................................................................ 180
Using ................................................................................................. 183
U
UD....................................................................................................156, 249
Ultra Definition Clarity ......................................................................156, 249
Uterus measurements............................................................................. 384
V
Variance
Color Mode ........................................................................................ 169
Optimizing Color Mode ...................................................................... 173
Velocity range
Optimizing CW Doppler ..................................................................... 178
Optimizing PW Doppler ..................................................................... 178
Virtual Convex.........................................................................................208
Virus precaution ........................................................................................ 47
W
wheels....................................................................................................... 63
Width
2D ...................................................................................................... 152
LV Contrast........................................................................................ 248
Worksheet............................................................................................... 366
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