Hd11 Reference Manual

HD11 Ultrasound System

User Reference 4535 611 65311 Rev A February 2005

Copyright © 2005 Koninklijke Philips Electronics N.V.

All rights reserved

Printed in USA

Manufactured by Philips Ultrasound 22100 Bothell-Everett Highway Bothell, WA 98021-8431 USA Telephone: +1 425-487-7000 or 800-426-2670 Fax: +1 425-485-6080 www.medical.philips.com

CE marking is for Council Directive 93/42/EEC. This product complies with the Medical Device Directive. European Union Representative Philips Medical Systems Nederland B.V. Corporate Quality and Regulatory Group Veenpluis 4 5684 PC Best The Netherlands Telephone: +31 40 27 64432 Fax: +31 40 27 62499 CAUTION

United States federal law restricts this device to sale by or on the order of a physician. This document and the information contained in it is proprietary and confidential information of Philips Medical Systems ("Philips") and may not be reproduced, copied in whole or in part, adapted, modified, disclosed to others, or disseminated without the prior written permission of the Philips Legal Department. This document is intended to be used by customers and is licensed to them as part of their Philips equipment purchase. Use of this document by unauthorized persons is strictly prohibited. Philips provides this document without warranty of any kind, implied or expressed, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Philips has taken care to ensure the accuracy of this document. However, Philips assumes no liability for errors or omissions and reserves the right to make changes without further notice to any products herein to improve reliability, function, or design. Philips may make improvements or changes in the products or programs described in this document at any time. This product may contain remanufactured parts equivalent to new in performance, or parts that have had incidental use. Color Power Angio, Cineloop, EnVisor, Hif Q, OmniPlane, SonoCT, and XRES are trademarks of Koninklijke Philips Electronics N.V. Non-Philips product names may be trademarks of their respective owners.

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Contents 1 Read This First . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Intended Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 About Your User Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 About Your Compact Disc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Upgrades and Updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Customer Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Ordering Supplies and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 2 Using Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Opening Help. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Help Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Resizing Help Panes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Finding Help Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Searching for Help Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Using Favorites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Printing Help Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 3 HD11 System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 System Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 System Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Clinical Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Imaging and Connectivity Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 System Layout and Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 On/Off Button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Video Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 HD11 User Reference 4535 611 65311

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CD and MOD Drives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Transducer Connector Panel and Cable Management . . . . . . . . . . . . . . . . . . . . .44 Physio (ECG) Panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Peripheral Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 4 Preparing Your System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Turning the System On and Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Setting the System Time and Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Positioning the Control Panel and Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Using the Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Using the Control Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 Connecting Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 Connecting Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 Connecting a Modem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Connecting to a Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 Moving the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Precautions for Moving the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Using the Removable Media Drives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 Loading and Ejecting CDs and MODs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Viewing a CD or an MOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Formatting an MOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Erasing a Disk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Recalibrating an Image in VCR Playback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 5 DICOM Networking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 DICOM Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Entering System DICOM Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 Changing or Setting the PC Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 Assigning DICOM Servers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71 4

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Automatic DICOM Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 Managing Networked Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Setting Up Automatic DICOM Export and Export Options. . . . . . . . . . . . . . . . .74 Changing the Image Format for DICOM Export. . . . . . . . . . . . . . . . . . . . . . . . . .76 Configuring Your Viewer Based on Study Description. . . . . . . . . . . . . . . . . . . . .79 Troubleshooting Automatic DICOM Export . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Setting Up Automatic Study Deletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Rescuing Stranded Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Automatic DICOM Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Setting Up Automatic DICOM Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Troubleshooting Automatic DICOM Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 Configuring a New DICOM Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 About Intelliprint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Changing DICOM Printer Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Canceling DICOM Jobs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 Modality Worklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89 About the Patient Selection Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89 Using Modality Worklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Setting Up Modality Worklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 Changing Modality Worklist Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92 Importing and Exporting in DICOM Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93 6 Customizing Your System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95 Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95 About Exam Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 Selecting a Preset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 Creating a Preset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 Modifying a Preset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 Deleting a Preset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Using Preset Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 HD11 User Reference 4535 611 65311

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Removing the Preset Name from the Display . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99 Installing Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 Assigning Option Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102 System Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102 Changing System Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Adjusting the Monitor Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 Selecting the Type of Dual Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 About Security Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107 Changing the Background Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Changing the Image Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Activating Body Markers During Dual Imaging and Freeze . . . . . . . . . . . . . . . . .109 Mode Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 Changing the M-mode Format and the Doppler Settings . . . . . . . . . . . . . . . . . .110 Turning Adaptive Doppler On or Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Controlling Spectral and M-mode Trace Scrolling . . . . . . . . . . . . . . . . . . . . . . .111 Changing the Spectral Trace Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Changing the Autotrace Evaluation Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Changing the Default Tissue Doppler Setting . . . . . . . . . . . . . . . . . . . . . . . . . . .113 Controlling Cursor Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 Turning the M-mode Reference Line On or Off . . . . . . . . . . . . . . . . . . . . . . . . .114 Label Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 Measurements and Analysis Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 Specifying the Measurement Circumference Method . . . . . . . . . . . . . . . . . . . . .115 Defaulting to Doppler Auto Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116 Specifying the Measurement Caliper Connection . . . . . . . . . . . . . . . . . . . . . . . .116 Choosing Quick Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Changing High Q Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Changing the Position of the Measurements Results Box. . . . . . . . . . . . . . . . . .118 6

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Customizing the Measurements and Calculations Menus . . . . . . . . . . . . . . . . . .119 Analysis and Reports Application Package/Group List . . . . . . . . . . . . . . . . . . . .120 Obstetrics Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 Creating a User-Defined Calculation by Using a Formula . . . . . . . . . . . . . . . . .121 Creating a User-Defined Calculation by Using a Table . . . . . . . . . . . . . . . . . . . .122 Editing a User-Defined Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 Deleting a User-Defined Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124 Selecting Fetal Growth Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125 Setting Fetal Weight Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125 Acquisition Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Specifying Acquisition Preferences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Setting the Duration of a Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 Specifying the Disk Full Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128 3D/4D Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128 Optical Disk, CD, and Peripherals Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129 About Backup and Restore Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 Backing Up Presets and Settings to a CD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 Restoring Presets and Settings from a CD . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 Assigning Record Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 Setting the VCR Record Time Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 About the Foot Switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 Configuring the Foot Switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 Installing Peripheral Software Drivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Setting the VCR Display for Record Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136 Using the VCR Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136 Language Input Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Changing the Input Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Selecting the Name Representation for the Top Border . . . . . . . . . . . . . . . . . .138 Entering Japanese Characters in the Patient Identification Window . . . . . . . . .138 HD11 User Reference 4535 611 65311

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Displaying the Input Method Editor Status Window. . . . . . . . . . . . . . . . . . . . . .139 Physio (ECG) and Stress Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139 Connecting the ECG Cable and Attaching the ECG Leads. . . . . . . . . . . . . . . . .140 Using Physio Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Changing Physio Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Triggering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142 Setting the Trigger Type in Doppler Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . .142 Changing Triggering Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143 Using Triggering Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143 7 Performing a Basic Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 8 Imaging Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 General Imaging Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149 Beginning an Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150 Acquiring an Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Printing in Live Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Resizing and Repositioning an Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 Moving a Reference Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 2D Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Using 2D Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Fusion Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154 Fusion Icons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154 Using 2D Soft Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155 M-mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156 M-mode Zoom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156 Using M-mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157 Using M-mode Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157 About the M-mode Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158 About M-mode Trace Scrolling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158 About Color M-mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 8

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Using Color M-mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 PW Doppler Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160 Using Doppler Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160 Using PW Doppler Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161 Repositioning the PW Sample Volume Gate . . . . . . . . . . . . . . . . . . . . . . . . . . . .162 Changing Doppler Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163 Turning Intelligent Doppler On or Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163 About High Pulse Repetition Frequency Doppler Mode . . . . . . . . . . . . . . . . . .163 About Nonimaging Doppler. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 Optimizing Doppler Trace Settings with Doppler iSCAN Intelligent Optimization 164 About Duplex and Triplex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 Using Duplex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 Using Triplex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166 Using Duplex Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166 Using Triplex Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 CW Doppler Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 Using CW Doppler Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 About Spectral Trace Scrolling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168 About the Spectral Trace Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169 Tissue Doppler Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169 Using Tissue Doppler Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Color Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 Using Color Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 Resizing and Repositioning an Angio, a Color, an ROI, or a Zoom Box . . . . . .171 Using Color Suppress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 About Color Compare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Using Color Compare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Using Color Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173 HD11 User Reference 4535 611 65311

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Color Power Angio (CPA) Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173 Using Color Power Angio Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174 Using Color Power Angio Suppress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174 Using Color Power Angio Compare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175 Using Color Power Angio (CPA) Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . .175 3D/4D Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176 About 3D Volume Data Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176 About Acoustic Artifacts in 3D Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177 About 3D Freehand and Motorized Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . .178 Activating 3D/4D Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179 About Working in 3D Preview Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180 Acquiring a Freehand 3D Data Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180 Acquiring a Motorized 3D Data Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181 Using 3D Preview and Acquisition Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . .182 3D Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183 Using 3D Render Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183 About the 3D Render Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184 About 3D/4D Display Layouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185 Editing the ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187 Making Measurements on 2D MPR Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 Using Slice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 Changing the Orientation of the Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 Changing the View Direction of the Rendered 3D Image . . . . . . . . . . . . . . . . .189 Swiveling a 3D Volume. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190 Using Swivel Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192 About Editing 3D Volumes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192 Zooming and Magnifying Images in 3D/4D . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194 Using Render Controls Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195 Using Image Controls Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195 10

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About 3D/4D Render Mode Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196 About 3D/4D Vision Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197 Changing the Vision Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 Modifying a Render Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 4D Imaging Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199 Using 4D Soft Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200 Acquiring 4D Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200 Reviewing 4D and Fetal STIC Images. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201 Saving 4D and Fetal STIC Loops, Images, and Volumes . . . . . . . . . . . . . . . . . . .202 Using Volume Cine Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202 Fetal STIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203 Using Fetal STIC Soft Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 About the Fetal Heart Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205 9 Imaging Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207 Biopsy Guides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207 Turning the Biopsy Guide On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .208 About the Biopsy Guide Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209 Contrast Harmonic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210 Using Contrast Harmonic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210 Using Contrast Harmonic Imaging Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . .211 Adjusting Settings for Contrast Harmonic Imaging . . . . . . . . . . . . . . . . . . . . . . .212 About Contrast Harmonic Imaging Principles . . . . . . . . . . . . . . . . . . . . . . . . . . .214 About Acoustic Artifacts in Contrast Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . .215 Dual Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 About Single Buffer and Two Buffer Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . .216 About The Active Buffer Indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217 Using Two Buffer and Two Buffer Dual Imaging . . . . . . . . . . . . . . . . . . . . . . . . .218 Using Single Buffer Dual Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .218 Using Quick Review in Dual Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 HD11 User Reference 4535 611 65311

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iSCAN Intelligent Optimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220 About 2D iSCAN Intelligent Optimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220 Using 2D iSCAN Intelligent Optimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221 Adjusting the Default 2D iSCAN Gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221 Panoramic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222 About the Accuracy of Panoramic Images. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222 Acquiring a Panoramic Data Set. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223 Using Panoramic Preview and Acquisition Soft Keys . . . . . . . . . . . . . . . . . . . . .224 Exiting Panoramic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224 Panoramic Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224 Using Panoramic Render Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224 Moving a Panoramic Image Around the Display . . . . . . . . . . . . . . . . . . . . . . . . .225 Magnifying Panoramic Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226 Performing Measurements on a Panoramic Image . . . . . . . . . . . . . . . . . . . . . . .226 Placing a Title Above a Panoramic Image. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227 Placing a Label on a Panoramic Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228 Saving Panoramic Images and Data Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228 Quick Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229 Using Quick Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229 Using Quick Review Soft Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230 Playing Back a Quick Review Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230 SonoCT Real-time Compound Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .231 About SonoCT Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .231 Using SonoCT Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232 Tissue Harmonic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232 Using Tissue Harmonic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233 Trapezoidal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233 Using Trapezoidal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234 XRES Adaptive Image Processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234 12

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Zoom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235 Using Zoom During Live Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235 Magnifying Live and Frozen Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236 Using Color or Color Power Angio Zoom. . . . . . . . . . . . . . . . . . . . . . . . . . . . .236 Using M-mode Zoom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237 10 Imaging Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239 Imaging Tips for 2D Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239 I need to increase the penetration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239 I need to improve the resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240 I want the image to be less soft, hazy, or gray. . . . . . . . . . . . . . . . . . . . . . . . . . .240 I want the image to be less contrasty or grainy. . . . . . . . . . . . . . . . . . . . . . . . . .241 I need to be able to see the soft tissue.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241 I want the fluid-filled structures to have fewer echoes. . . . . . . . . . . . . . . . . . . .242 Imaging Tips for M-mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242 I want to reduce noise in the M-mode trace. . . . . . . . . . . . . . . . . . . . . . . . . . . .242 I want to increase the size of the M-mode trace. . . . . . . . . . . . . . . . . . . . . . . . .243 Imaging Tips for PW Doppler Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243 I want the Doppler to be more sensitive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243 I need to be able to see a Doppler signal that is audible, but not visible. . . . . .244 I need to unwrap an aliased spectrum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244 I want to reduce artifacts and noise in the spectrum.. . . . . . . . . . . . . . . . . . . . .244 I want the 2D reference image to be updated. . . . . . . . . . . . . . . . . . . . . . . . . . .245 I want to display low-velocity signals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245 Imaging Tips for CW Doppler Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245 I want the Doppler to be more sensitive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .246 I need to be able to see a Doppler signal that is audible, but not visible. . . . . .246 I want to reduce artifacts and noise in the spectrum.. . . . . . . . . . . . . . . . . . . . .247 I want the 2D reference image to be updated. . . . . . . . . . . . . . . . . . . . . . . . . . .247 I want to display low-velocity signals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247 HD11 User Reference 4535 611 65311

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Imaging Tips for Color Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248 I want the color to be more sensitive.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248 I want the color to have less noise, flashing, or fewer artifacts. . . . . . . . . . . . . .248 I want the color to be less speckled or fragmented.. . . . . . . . . . . . . . . . . . . . . .249 I need to improve the color filling.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249 I want to unwrap aliased signals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250 I need to increase the frame rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250 Imaging Tips for Color Power Angio Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251 I want the angio to be more sensitive.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251 I want the angio to have less noise, flashing, or fewer artifacts. . . . . . . . . . . . . .251 I need to improve the angio filling.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252 I need to improve the angio resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 I need to increase the frame rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 11 Stress Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Stress Echo Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256 Modifying a Stress Echo Preset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257 About Stress Echo Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257 About Stress Echo Acquisition Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258 About ECG Artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258 Minimizing ECG Artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259 Using a VCR During a Stress Echo Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260 Using the Timer During a Stress Echo Study. . . . . . . . . . . . . . . . . . . . . . . . . . . .260 Stress Echo Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261 Performing a Stress Echo Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261 Using Stress Echo Soft Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262 About the View Icon and the Stage-View Label . . . . . . . . . . . . . . . . . . . . . . . . .262 Acquiring Loops for a Single-Cycle or a Quad-Cycle Acquisition Stage. . . . . . .263 Acquiring Loops for a Multi-Cycle Acquisition Stage . . . . . . . . . . . . . . . . . . . . .264 Acquiring Images Outside of a Stress Echo Protocol . . . . . . . . . . . . . . . . . . . . .264 14

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Using the ROI Box in Stress Echo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .265 Moving the 2D Reference Line in Stress Echo . . . . . . . . . . . . . . . . . . . . . . . . . .265 Stopping and Resuming a Stress Echo Study . . . . . . . . . . . . . . . . . . . . . . . . . . . .266 Stress Echo Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267 Selecting the Preferred Stress Echo Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267 Relabeling Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .268 Viewing All the Stress Echo Loops for a View . . . . . . . . . . . . . . . . . . . . . . . . . .268 Playing Back Stress Echo Loops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269 Performing Wall Motion Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269 12 Annotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271 Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271 Placing a Label on the Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271 Typing a Label on the Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272 Modifying a Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272 Placing Arrows and Drawings on the Display . . . . . . . . . . . . . . . . . . . . . . . . . . .273 Moving or Deleting Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273 Using Annotation Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .274 Body Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275 Placing a Body Marker on the Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275 Moving a Body Marker or the Transducer Icon . . . . . . . . . . . . . . . . . . . . . . . . .276 Rotating or Specifying the Shape of the Transducer Icon . . . . . . . . . . . . . . . . . .277 Using Body Marker Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .277 Using Body Markers and Dual Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .278 13 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279 Analysis Setup and Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280 Configuring the Analysis Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280 About the Accuracy of Measurements and Calculations . . . . . . . . . . . . . . . . . . . . .281 About the Sources of Measurement Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281 HD11 User Reference 4535 611 65311

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About Measurement Primitives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283 About Volume Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .284 About PISA Measurements and Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .286 About Pulsatility Index and Resistivity Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .287 Doppler Trace Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288 About Doppler Auto Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289 Using Doppler Auto Trace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289 Using Doppler Auto Trace Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291 Using Multi-Cycle Doppler Auto Trace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291 Performing a Manual Doppler Trace Measurement . . . . . . . . . . . . . . . . . . . . . .292 Using High Q Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293 14 Measurements and Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Working with Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295 About Calipers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .296 Approving Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .296 Displaying Measurement Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297 Reactivating a Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297 Deleting a Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .298 Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .298 Performing Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299 Unlabeled Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299 Performing a 1-Point Depth or Velocity Measurement . . . . . . . . . . . . . . . . . . .299 Performing a 2-Point Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .300 Performing an Ellipse Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301 Performing a Trace Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302 Performing a Method of Discs Measurement or SPE Volume . . . . . . . . . . . . . .303 Quick Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304 Labeled Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .311 Performing a Labeled Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .311 16

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Performing a Protocol Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 Entering a Measurement Value Manually . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 Using Labeled Measurement Soft Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 Assigning a Measurement Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313 Performing a Hip Angle Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313 Performing an IMT Trace Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315 Performing an IMT Linear Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315 Labeled Measurements by Exam Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316 Cardiac Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316 Cardiac Triggered Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325 Vascular Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .326 TCD Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .326 Carotid Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .330 UE Artery Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .336 UE Vein Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .340 LE Artery Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .341 LE Vein Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .347 IMT Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .348 General Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .348 Abdominal Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .349 Prostate Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .352 Thyroid Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .354 Breast Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .356 Testicular Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .357 Superficial Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .359 Pediatric Hip Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361 Obstetric Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .362 Gynecology Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .365 Musculoskeletal Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .368 HD11 User Reference 4535 611 65311

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Labeled Calculations by Exam Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .368 General Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .369 Prostate Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .371 Thyroid Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .374 Breast Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375 Testicular Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .376 Superficial Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .378 Hip Angle Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .380 Cardiac Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .380 Obstetric Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .386 Gynecology Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .389 Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .391 15 Patient Studies, Image Review, and Reports . . . . . . . . . . . . . . . . . . . . . . 399 Patient Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399 Creating Patient Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399 Creating a Patient Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399 Editing Patient Demographic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .400 Saving a Patient Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .400 Closing a Patient Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .401 Managing Patient Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .401 Restarting a Patient Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .401 Searching for a Patient Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .402 Searching for a Patient Folder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .403 Deleting a Patient Folder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .404 Deleting a Patient Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .404 Viewing a Previous Study for the Current Patient . . . . . . . . . . . . . . . . . . . . . . .405 Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .405 Working in Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .406 About Single Images, Thumbnails, and Full-Screen Images . . . . . . . . . . . . . . . . .406 18

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Deleting an Image in Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .407 Adding a Caption or a Flag to an Image. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .407 Viewing 3D or Panoramic Images in Image Review. . . . . . . . . . . . . . . . . . . . . . .407 Printing Images in Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408 About Reactivating Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .409 Reactivating an Image in Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .410 Using the Select Key in Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .410 Specifying the Image Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .411 Specifying the Image Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .411 Playing Back Loops in Image Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .412 Controlling the Playback of Loops in Image Review . . . . . . . . . . . . . . . . . . . . . .412 Viewing a Full-Screen Frame or Playing Back a Loop in Image Review . . . . . . .413 Playing Back More Than One Image in Image Review. . . . . . . . . . . . . . . . . . . . .414 Playing Back Images That You Select . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .414 Playing Back a Series of Sequential Images. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .415 Comparing Images from Two Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .415 Editing the Endpoints of a Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .416 Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .416 Report Work Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .417 Finalizing a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .418 Viewing Report Versions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .418 Printing a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .419 Saving a Report as a Series of Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .419 Adding an Image to a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .419 Manipulating Measurements in a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .420 Adding Patient Information to a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .421 Adding Interpretations to a Cardiac or a Vascular Report. . . . . . . . . . . . . . . . .421 Adding Visualizations and Observations to an Obstetric Report . . . . . . . . . . . .422 Adding Visualizations and Observations to a Gynecologic Report. . . . . . . . . . .423 HD11 User Reference 4535 611 65311

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Adding Comments to a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .425 Generating Obstetric Trending Graphs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .425 Formulas Used in Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .426 Importing and Exporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .427 Importing a Patient Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .428 Exporting the Current Patient Study in DICOM Format . . . . . . . . . . . . . . . . . .429 Exporting Patient Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430 About the Icons in the Search for Study Window . . . . . . . . . . . . . . . . . . . . . . .431 Setting the Brightness for an Automatic Export . . . . . . . . . . . . . . . . . . . . . . . . .432 Exporting an Image in PC Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .434 Exporting Images in PC Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .435 Exporting a Report in PC Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .435 Exporting Images and Reports from Patient Studies in PC Format . . . . . . . . . .436 Exporting Data to a Third-Party Application. . . . . . . . . . . . . . . . . . . . . . . . . . . .437 16 Clinical References for Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .439 A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .440 B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .444 C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .445 D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .446 E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .447 F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .453 G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .455 H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .475 I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .476 L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .476 M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479 O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .482 20

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P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .483 R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .485 S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .485 T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .487 U . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .488 V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .488 W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .489 17 Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .491 18 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .533

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1 Read This First This section contains important information about the user information for your system and about contacting Philips Ultrasound.

Intended Audience Before you use your user information, you need to be familiar with ultrasound techniques. Sonography training and clinical procedures are not included here. This information is intended for sonographers, physicians, and biomedical engineers who operate and maintain the ultrasound system.

About Your User Information The user information provided with your system includes the following components: •

Compact Disc (CD): Includes all of the user information.

•

Getting Started: Introduces you to system features and concepts, and helps you set up your ultrasound system. This manual also includes procedures for basic operation. For detailed operating instructions, refer to Help or the User Reference.

•

Help: Help is available on the system in some languages and the information in Help is also included in User Reference on the CD. Help contains comprehensive instructions for using the system. Press Help on the system keyboard to display Help. It includes a glossary containing descriptions of all controls and display elements.

•

User Reference: A printed version of the Help that is localized to specific markets.

•

Quick Guide: Contains procedures, imaging tips, and information on system controls.

•

Acoustic Output Tables: Included on the CD, it contains information about mechanical and thermal index precision and accuracy, the acoustic output default tables, and the acoustic output tables.

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1

Read This First

•

Medical Ultrasound Safety: Included on the CD, it contains information on bioeffects and biophysics, prudent use, and implementing ALARA (as low as reasonably achievable).

About Your Compact Disc The CD contains all of the user information, except the Operating Notes. The instructions for using the CD are included with the CD.

Conventions The system uses certain conventions throughout the interface to make it easy for you to learn and use. The accompanying user information also uses typographical conventions to assist you in finding and understanding information.

User Information Conventions The user information follows these conventions: •

Hypertext links appear in blue.

•

All procedures are numbered, and all subprocedures are lettered. You must complete steps in the sequence they are presented to ensure success.

•

Bulleted lists indicate general information about a particular function or procedure. They do not imply a sequential procedure.

•

Control names and menu items or titles are spelled as they are on the system, and they appear in bold text.

•

Symbols appear as they appear on the system.

•

The left side of the system is to your left as you stand in front of the system, facing the system. The front of the system is nearest you as you operate it.

•

Transducers and pencil probes both are referred to as transducers, unless the distinction is important to the meaning of the text.

Information that is essential for the safe and effective use of the ultrasound system appears throughout this manual as follows:

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NOTE

1

Notes bring your attention to important information that will help you operate the ultrasound system more effectively.

CAUTION

Cautions highlight ways that you could damage your ultrasound system and consequently void your warranty or service contract. WARNING

Warnings highlight information vital to the safety of you, the operator, and the patient.

Upgrades and Updates Philips Ultrasound is committed to innovation and continued improvement. When upgrades that consist of hardware or software improvements are released, updated user information sets will accompany those system upgrades.

Customer Comments If you have questions about the user information set, or to report an error in the user information set •

For U.S. customers, call Philips Ultrasound Customer Service at 800-433-3246

•

For customers outside the USA, call your local customer service representative or contact one of the offices under "Customer Service" on page 26.

You can also send e-mail to Philips Ultrasound Technical Communications at the following address: [email protected]

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Ordering Supplies and Accessories You can order transducer covers, biopsy guides, and other supplies and accessories from CIVCO Medical Instruments: CIVCO Medical Instruments 102 First St. South Kalona, IA 52247-9589 Telephone: 800-445-6741, Ext. 1 for Customer Service (USA) +1 319-656-4447 (International) Fax:

877-329-2482 (USA) +1 319-656-4451 (International)

E-mail:

[email protected]

Internet:

civco.com

Customer Service Customer service representatives are available worldwide to answer questions and to provide maintenance and service. Please contact your local Philips Ultrasound representative for assistance. You can also contact one of the following offices for referral to a customer service representative, or visit the Philips Ultrasound Web site: www.medical.philips.com Corporate and North American Headquarters 22100 Bothell-Everett Highway Bothell, WA 98021-8431 USA Telephone: 800-433-3246 or +1 425-487-7000 Fax: +1 425-487-8188

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1

Asia Pacific Headquarters 28/Floor, Hopewell Centre 17 Kennedy Road, Wanchai Hong Kong Telephone: +852 2821 5888 Fax: +852 2527 6727 European Headquarters (also serves Africa and the Middle East) Roentgenstrasse 24, Gebaude S D-22335 Hamburg Germany Telephone: +31 40 27 62092 Fax: +49 40 5078 4546 Latin American Headquarters 1550 Sawgrass Corporate Parkway, Suite 300 Sunrise, FL 33323 USA Telephone: +1 954-835-2600 Fax: +1 954-835-2626

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1

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HD11 User Reference 4535 611 65311

Using Help

2

2 Using Help The HD11 Help window displays four tabs along the top of the left pane to help you navigate to specific topics: •

Click the

tab to view the contents of the Help.

•

Click the

tab to search for topics by keyword.

•

Click the

tab to search the entire Help.

•

Click the

tab to display topics you have bookmarked.

There are two navigational icons on the toolbar. You can click them to navigate through Help topics. • •

Back displays the last topic you viewed. Forward displays the next topic in a previously displayed sequence of topics.

Some words and phrases appear in blue text. If you click these words, additional information appears, in the form of a pop-up window or a related topic. To make the pop-up window disappear, click anywhere outside the pop-up. To return to the original topic, click Back.

Opening Help To open Help, press the Help key. To close Help, press the Help key.

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2

Using Help

Help Viewer Toolbar

Navigation pane

Topic pane

On the left side of the viewer is the navigation pane. It contains four navigational tabs: Contents, Index, Search, and Favorites. On the right side of the viewer is the topic pane. It displays the selected topic. Above the navigation and topic panes is the toolbar.

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Using Help

2

Resizing Help Panes

To temporarily resize the navigation or topic pane, point to the divider between the two panes. When the pointer changes to a double-headed arrow, drag the divider right or left. The panes return to original size when you end an exam or cycle system power.

Finding Help Topics In the navigation pane, do one of the following: •

To browse through the table of contents, click the Contents tab. The table of contents is an expandable list of topics; click the book icons to expand or collapse the list. Click the entry to display the topic.

•

To see a list of index entries, click the Index tab, and then type a word, or scroll through the list. Topics are often indexed under more than one index entry. Click the entry and then Display to display the topic.

•

To locate every occurrence of a word or phrase in Help, click the Search tab, and then type the word or phrase. Click List Topics and then click the entry and Display to display the topic.

To link from one topic to a related topic, click the blue underlined words or phrases at the end of the topic.

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2

Using Help

Searching for Help Topics The Search tab allows both basic and advanced text searches. Advanced searching allows you to search using Boolean and nested expressions. Searches are not case-sensitive, so you can type your search in upper case or lower case. You can search for any combination of letters and numbers. Punctuation marks and symbols are ignored during a search. The AND, OR, NOT, and NEAR operators enable you to precisely define your search by creating a relationship between search terms. To search for both terms in the same topic, use AND. To search for either term, use OR. To search for the first term but not the second term, use NOT. To search for two terms close together in the same topic, use NEAR. Use parentheses to nest expressions within a query. The expressions in parentheses are evaluated before the rest of the query. For example, “interval AND ((absolute OR relative) NEAR time)” finds topics containing the word “interval” along with the words “absolute” or “relative” close to the word “time.”

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➤ To search in Help

2

1

2

1. Click the Search tab. 2. Type the word, phrase, or characters you want to find.

6a

3. Click List Topics.

5

4. Select a topic to view.

3

5. Click Display to view the selected topic. 6. To refine your search, do any of the following:

4

–

To do an advanced search, type a word, select a Boolean operator from the menu, and then type another word.

–

To search only the topics displayed from a previous search, select Search previous results.

–

To search for words similar to your search text as well as exact matches, select Match similar words.

6b

To exclude topic content and search only topic titles, select Search titles only.

6c

–

6d

Using Favorites On the Favorites tab, you can build a list of topics that you use frequently. This list allows quick access to your favorite topics without having to search for them. The topics you add to the list are saved automatically and remain in the list until you delete them.

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➤ To use the Favorites list

1

1. Click the Favorites tab. 2. To add a topic, display the topic in the topic pane and click Add. 3. To display a topic in the Favorites list, select the topic and click Display. 4. To remove a topic from the Favorites list, select the topic and click Remove. 4

3 2

Printing Help Topics ➤ To print the displayed Help topic Press the Record key you assigned to your printer.

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2

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Using Help

HD11 User Reference 4535 611 65311

3 HD11 System Overview Use this section to acquaint yourself with the HD11 ultrasound system and its components.

System Capabilities The HD11 system is a powerful ultrasound imaging and image review tool. This section includes the following:

NOTE

•

"What You Can Do with the HD11 System" on page 37

•

"Image Acquisition Modes" on page 38

•

"Image Formats" on page 38

Some of the following features are options and are not available on all HD11 systems.

What You Can Do with the HD11 System Use the HD11 system to perform the following tasks: •

Image in a variety of modes, including 3D/4D mode and Panoramic Imaging.

•

Store, manage, and review images.

•

Perform measurements and calculations by using the comprehensive analysis package.

•

Create, edit, and add images to reports.

•

Send images and patient information over a network.

•

Print images to one of the printers.

•

Export data in PC formats to removable media.

•

Export DICOM data to removable media (requires the DICOM Media option).

•

Obtain the day’s worklists (requires the DICOM Networking option).

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•

Archive data to removable media (if your system does not have a DICOM option).

•

Send images and patient information over a network to a DICOM picture archiving and communication system (PACS).

Image Acquisition Modes The HD11 system supports the following image acquisition modes: •

2D

•

3D

•

4D

•

Color Doppler

•

Color Power Angio (CPA) Imaging

•

Contrast

•

CW Doppler

•

MMode

•

PW Doppler

•

Stress Echocardiography

•

TDI

You can also perform duplex and triplex imaging.

Image Formats All HD11 systems can export images in one of two ways: •

PC Format PC format allows you to view images on any PC. The different types of images are exported as follows when you export them in PC format:

38

–

Still images are exported as .BMP files

–

Loops are exported as .AVI files

–

Report pages are exported as .HTML files

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NOTE

3

Images that you export using PC format cannot be imported back into the HD11 system. Therefore, do not use this format to back up your studies. •

Export or Export DICOM formats These two formats allow exported images to be imported into the HD11 system. –

If your system has an MOD drive, the Export DICOM option is available and the studies are exported in DICOM format. Images can be imported back into the HD11 system, and you can also view them using any DICOM viewer.

–

If your system does not have an MOD drive, the Export option is available. When you select this option, the images in the study are exported in a proprietary backup format. You can import the images back into the HD11 system, but you cannot view them on a PC or on a DICOM viewer.

System Options In addition to the standard features available in the system, other features are available as purchasable options. The types of options available include clinical, imaging, and connectivity options. •

"Clinical Options" on page 39

•

"Imaging and Connectivity Options" on page 40

Clinical Options Each HD11 system includes one of the four standard clinical software applications. You must purchase the clinical application package for each exam type that you want to perform. Optionally, you can purchase the Shared Service Clinical package which combines all of the applications and presets listed in the following sections and includes physio (ECG), exam-specific calculations and analysis, reports, and biopsy capabilities.

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Cardiac Provides adult and pediatric presets. Also includes physio (ECG), and cardiac calculations and analysis.

General Imaging Provides adult and pediatric presets for abdominal (including renal), small parts, musculoskeletal, and prostate exams. This application also includes biopsy capabilities, and exam-specific calculations and analysis.

OB/GYN Provides presets for obstetrical, gynecological, endovaginal, and fetal echo. This option also includes biopsy capabilities, OB/GYN calculations and analysis, and OB trending.

Vascular Provides presets for carotid, transcranial Doppler (TCD), and bilateral lower and upper extremities. Also includes physio (ECG), and vascular calculations and analysis.

Imaging and Connectivity Options The imaging options listed here are available as supported by the current transducer and application. The following are available as purchasable options on your system:

NOTE

40

•

"Stress Echocardiography" on page 255

•

"DICOM Networking" on page 67

•

"Fetal STIC" on page 203

•

"Contrast Harmonic Imaging" on page 210

Fetal STIC requires the installation of 4D hardware. The 4D package is not a software-configurable option—it is a hardware option that requires the purchase and installation of the motor controller board. The Fetal Heart software option functions if you have installed the basic 4D option. Contact your Philips representative for more information.

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System Layout and Controls The HD11 system is housed in an ergonomic cart. The cart is adjustable to accommodate a wide range of operating positions. You can lock adjustable components to safely move the system. The major components include the monitor, control panel, removable media drives, transducer connector panel, physio panel, and wheel controls (Figure 3-1). Figure 3-1 HD11 System

Monitor

Transducer holders

Soft key panel Control panel

Printer CD Drive

Transducer connector panel

Physio Panel MOD Drive Storage bin

Wheels

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On/Off Button The On/Off button is located in the upper right corner of the soft key panel (Figure 3-2). The indicator above the On/Off button is lit when the system is on. Figure 3-2 On/Off Button

On/Off button

Control Panel The control panel includes two main components: the soft key panel, and the main control panel (Figure 3-3). For more information about the control panel keys and controls, see the "Glossary" on page 491.

Soft Key Panel The soft key panel is the angled panel located below the monitor. It contains buttons and soft key controls. The functions of the soft keys change depending on the mode, the application, the preset, and the transducer. The function of each soft key is described above the soft key on the bottom of the display. Press the control under each soft key label to adjust its setting.

Main Control Panel The main control panel (Figure 3-3) is the horizontal surface that contains the keys and buttons that you press, knobs that you turn and push, and slide controls that you move left and right or up and down. The main control panel includes the keyboard to type information into fields and to type labels, titles, and Quick Text labels onto the display. 42

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3

Figure 3-3 HD11 System Control Panel

Video Monitor The HD11 system includes a color video monitor. You can adjust the monitor’s brightness and contrast to best suit your environment. You can also raise, lower, and swivel the control panel and monitor to make using the HD11 system as comfortable as possible. If you need to transport the HD11 system in a vehicle, you must first remove the monitor from the system. For instructions on removing the monitor, see the HD11 Getting Started. HD11 User Reference 4535 611 65311

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CD and MOD Drives You can store exam data, images, and system settings onto removable media by using the CD drive or the optional magneto-optical disk (MOD) drive. The system hard drive is located inside the system.

CD Drive Each HD11 system includes a CD drive that supports CD-R (Recordable) and CD-RW (Rewritable) discs, on which you can: •

Store images and reports.

•

Back up presets, system settings, and OB trending data.

if the system does not also have an MOD drive, you can export studies to a CD, but the image files cannot be viewed on DICOM viewers. The studies that you export from the HD11 system can only be viewed when you import them back into the HD11 system.

MOD Drive If you purchased the DICOM Media option, your HD11 system also includes an MOD drive. The MOD is reusable media that you can use to manually transfer studies to a picture archiving and communication system (PACs) (if your network is down). On an MOD disk, you can save studies, images, and reports in DICOM format.

Transducer Connector Panel and Cable Management The HD11 system can contain up to five transducer connectors. The number of connectors on your system corresponds to the number of transducers you purchased. If you do not purchase five transducers, the unused connectors will be inactive. The HD11 system supports the following types of transducer connectors:

44

•

Cartridge

•

Explora

•

Nonimaging (Doppler Pencil)

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NOTE

3

The T6H OmniPlane III transducer requires an adapter to connect to the HD11 system. The transducer connector panel is located on the front of the system (Figure 3-4), and the transducer holders are located on each side of the control panel. The holders for transmission gel are located behind each set of transducer holders. Use the hooks to manage the transducer cables. One large hook is centrally located on the front of the system, and the other hooks are located under each transducer holder. Figure 3-4 Transducer Connectors

Cartridge-style

Explora-style

Nonimaging-style

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Physio (ECG) Panel The physio panel is located on the front left side of the system, below the CD drive (Figure 3-5). Figure 3-5 Physio Panel

Peripheral Devices The following peripheral devices are available for use with your HD11 system.

Storage •

Multi-session CD drive (standard on all HD11 systems)

•

1.3-GB MOD drive (optional, included with the DICOM Media option)

Printers The HD11 system supports the following types of printers: •

USB printers, including plain-paper

•

Video printers

VCR •

Mitsubishi HS-MD3000U (NTSC)

•

Mitsubishi HS-MD3000E (PAL)

Foot Switch The foot switch is an option that you can purchase separately. It is also included in the Stress Echo option. 46

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3

Transducers The HD11 ultrasound system supports a wide variety of transducers. The following tables list the transducers by type: •

"Curved Array Transducers" on page 47

•

"Sector Array Transducers" on page 48

•

"Linear Array Transducers" on page 49

•

"Doppler Pencil Transducers" on page 49

•

"3D/4D Transducers" on page 50 Table 3-1 Curved Array Transducers

Name/ Connector C5-2

Applications

Frequency

Biopsy Capable?

Harmonic s Capable?

Abdominal, OB/GYN

2.0–5.0 MHz

Yes

Yes

Endovaginal, OB/GYN

4.0–8.0 MHz

Yes

No

Abdominal, Neonatal head, OB/GYN, Pediatric

5.0–8.0 MHz

Yes

No

4.0–9.0 MHz

Yes

No

Explora

Abdominal, OB/GYN, Pediatric

C9-5ec

Endocavity

5.0–9.0 MHz

Yes

No

Cartridge C8-4v Cartridge C8-5 Explora C9-4

Explora

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Table 3-2 Sector Array Transducers Name/ Connecto r PA 4-2a Cartridge S3-1 Explora S4-2 Cartridge S8-3 Explora S12-4 Explora

Applications

Biopsy Capable?

Frequency

Harmonics Capable?

Abdominal, Cardiac, OB/GYN, TCD

2.0–4.0 MHz

Yes

Yes

Abdominal, Cardiac, TCD

1– 3.0 MHz

No

Yes

Abdominal, Cardiac, TCD, OB/GYN

2.0–4.0 MHz

Yes

Yes

Cardiac, Neonatal head, 3.0–8.0 MHz OB/GYN, Pediatric abdominal

No

No

Pediatric cardiac, Pediatric abdominal, Intraoperative, Neonatal head

No

No

4.0–12.0 MHz

a. Indicates that this transducer is not sold with the system, but is supported.

Table 3-3 TEE Transducers Name S7-2omni

Applications

Frequency

Biopsy Capable?

Harmonics Capable?

No

Yes

Explora

Transesophageal (Adult and 2.0–7.0 MHz Pediatric cardiac)

S7-3t mini-Multi

Transesophageal (Adult and 3.0–7.0 MHz Pediatric cardiac)

No

No

Transesophageal (Adult and 4.6–6.0 MHz Pediatric cardiac)

No

Yes

Explora T6Ha,b SONOS

a. Indicates that this transducer is not sold with the system, but is supported. b. Requires an adapter for use on the HD11 system.

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Table 3-4 Linear Array Transducers Name L8-4 Explora L12-3 Cartridge L12-5 Explora L15-7io Explora

Applications

Frequency

Biopsy Harmonics Capable? Capable?

Abdominal, Musculoskeletal, Pediatric Hips, Small Parts, Vascular

4.0–8.0 MHz

Yes

Yes

Abdominal, Musculoskeletal, Pediatric Hips, Small Parts, Vascular

3.0–12.0 MHz

Yes

Yes

Abdominal, Pediatric Hips, Small Parts, Vascular

5.0–12.0 MHz

Yes

No

Cardiac, Intraoperative, Musculoskeletal, Vascular

7.0–15.0 MHz

No

No

Table 3-5 Doppler Pencil Transducers Name D2cwc

Applications

Frequency

Biopsy Capable?

Harmonics Capable?

Cardiac

2.0 MHz

No

No

Transcranial Doppler

2.0 MHz

No

No

Cardiac, Vascular

5.0 MHz

No

No

Pencil D2tcd Pencil D5cwc Pencil

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Table 3-6 3D/4D Transducers Name 3D 6-2

Applications

Frequency

Biopsy Capable?

Harmonics Capable?

Abdominal, OB/GYN, Pediatric 2.0–6.0 MHz Yes

Yes

Abdominal, OB/GYN, Pediatric 4.0–8.0 MHz Yes

Yes

Endovaginal, OB/GYN

Yes

Explora 3D 8-4 Explora 3D 9-3v

3.0–9.0 MHz Yes

Explora For information on caring for your transducers, see the HD11 Getting Started.

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4 Preparing Your System Use this section to learn how to prepare your HD11 system for use. Preparations include: •

"Turning the System On and Off" on page 51

•

"Setting the System Time and Date" on page 52

•

"Positioning the Control Panel and Monitor" on page 52

•

"Connecting Devices" on page 56

•

"Moving the System" on page 60

•

"Using the Removable Media Drives" on page 62

•

"Recalibrating an Image in VCR Playback" on page 65

Turning the System On and Off The On/Off button is located on the upper right section of the soft key panel. When the system is on, the light above the On/Off button is lit. ➤ To turn the system on or off Press the On/Off button.

NOTE

•

When the system is off, press the On/Off button to turn it on.

•

When the system is on, press the button to start the shutdown process and to turn off the system completely.

Do not hold the On/Off button down. Press it only once.

CAUTION

Do not unplug the system from the wall outlet until the system is completely off. If you unplug your system before the shutdown message appears, you will have to wait longer than usual to use your system the next time you turn it on. You may also corrupt files, which can result in the loss of patient data or an inoperative system. If the system does not turn off after 90 seconds, press and hold the On/Off button for 5 seconds to force the system to turn off. HD11 User Reference 4535 611 65311

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NOTES

•

• •

Pressing and holding the power button to force the system to shut down can cause the same problems as prematurely unplugging the system. Wait the full 90 seconds before assuming that the system has failed to shut down normally. The fan comes on periodically to regulate the temperature within the system, even when the system is turned off. To break the connection from the main power supply, remove the ultrasound system plug from the wall outlet.

Setting the System Time and Date ➤ To set the system time and date 1. Press Setup. 2. In the Setup window, click the System tab. 3. Select Date/Time to open the Date and Time Properties window. 4. Click the Time Zone tab and select the time zone for your area. 5. Click the Date/Time tab and do the following: a. In the Date field, select today’s date. b. In the Time field, enter the current time. 6. Click OK to save the date and time settings.

Positioning the Control Panel and Monitor There are two ways you can adjust the monitor: •

Adjust the display settings each time the ambient light changes. For instructions, see "System Settings" on page 102.

•

Position the monitor and control panel for comfortable use.

➤ To raise, lower, and rotate the system control panel and monitor 1. To unlock the system control panel, do either of the following:

52

–

Grasp the adjustment handle under the system control panel and pull it toward you.

–

Squeeze either button in the center of the system handle.

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2. Raise or lower the control panel, or rotate the control panel left or right as needed. 3. Release the handle or buttons to lock the system control panel in place.

Using the Soft Keys The soft keys are the keys above the system control panel and below the monitor. The functions of the soft keys change depending on the mode, the application, the preset, and the transducer. The function of each soft key is shown above the soft key on the bottom of the display. ➤ To use a soft key Press the up arrow or the down arrow on the soft key to choose or change the selection that corresponds to the text label on the display. ➤ To locate a soft key •

Press Next to see if it appears in the next level of soft keys.

•

Press Select to change the function that is highlighted in the Select menu. In some modes, the soft keys change depending on the active function of the trackball.

Soft Key Levels Some applications and features have more than one level of soft keys. You can determine how many soft key levels are available and which level is active by looking at the soft key level indicator, a vertical set of small circles centered on the bottom of the display. The number of circles indicates the number of available soft key levels, up to three. When only one soft key level is available, no indicator appears. The solid circle indicates the active soft key level. The top circle indicates the primary soft key level, and the bottom indicates the last soft key level. Press Next on the soft key panel to cycle through the soft key levels; as you press Next the solid circle changes to indicate the active soft key level.

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The following illustration shows the soft key level indicator, which is showing that the first of two available soft key levels is active:

In 3D/4D and Fetal STIC Imaging, some soft keys have their own additional sublevel of soft keys. For more information, see "Using 3D Render Soft Keys" on page 183.

Using the Control Panel Using the Select and Enter Keys The main control panel also includes the trackball, Enter key, and the Select key that work together like a computer mouse. Moving the trackball is like moving the mouse. Pressing the Enter key is like pressing the left mouse button. Pressing the Select key is like pressing the right mouse button.

Clicking an Item on the Display or Choosing an Option To click an item on the display or to choose an option, use the trackball to move the cursor over the item or the option, and press the Enter key.

Changing the Active Function of the Trackball In many circumstances, you can use the trackball for more than one function. The possible functions of the trackball for the current mode, transducer, and preset are listed in the Select menu on the bottom right corner of the display. The active trackball function is highlighted. To change the active trackball function, press the Select key.

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4

Using the Control Panel Backlight You can control the backlight level on the control panel by pressing the Ctrl key and B key (Ctrl+B) together. Continue pressing Ctrl+B to cycle through the settings (Low, Medium, and High). For information on using the Setup window to change the control panel backlight settings, see "System Settings" on page 102.

Using Keyboard Shortcuts You can gain quick access to several HD11 system features by using keyboard shortcuts.

Table 4-1 Shortcut Ctrl+B

Table 4-2 Feature Keyboard backlight setting

Ctrl+J

Job Manager

Ctrl+Q

Autotrace Evaluation setting

Using the World Keys The World keys are labeled with a globe. They appear on either side of the spacebar. Use a World key to type the characters that appear on the right side of some keys on the keyboard. ➤ To type a character that appears on the bottom right corner of a keyboard key Press the World key and the keyboard key simultaneously. ➤ To type a character that appears on the top right corner of a keyboard key Press the World key, the Shift key, and the keyboard key simultaneously.

Typing Special Characters ➤ To make an apostrophe ('), a quotation mark (“), an accent (`), a tilde (~), or a caret (^) appear when you are using the keyboard Type the character and then press the spacebar. HD11 User Reference 4535 611 65311

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Connecting Devices In addition to the devices installed in the system cart, the HD11 system supports external peripheral devices, as listed in "Peripheral Devices" on page 46. For instructions on connecting a printer, a VCR, or a foot switch, see the HD11 Getting Started. This section provides instructions for: •

"Connecting Transducers" on page 56

•

"Connecting a Modem" on page 58

•

"Connecting to a Network" on page 59

Connecting Transducers This section provides the following instructions for connecting and removing each type of transducer style to and from the HD11 system (cartridge, Explora, and nonimaging). It also includes information and instructions for connecting and removing the T6H OmniPlane III transducer and its adapter. •

"Connecting and Removing Cartridge-Style, Explora-Style, and Nonimaging Transducers" on page 56

•

"Connecting an OmniPlane III Transducer" on page 57

•

"Connecting the T6H Transducer" on page 57

Connecting and Removing Cartridge-Style, Explora-Style, and Nonimaging Transducers ➤ To connect a transducer 1. Place the transducer in one of the transducer holders on either side of the control panel. 2. Do one of the following, depending on the connector style:

56

–

For a cartridge-style or nonimaging-style connector, align the connector and plug it in.

–

For an Explora-style connector, turn the latch to the unlocked position and plug the transducer into the slot. Be sure the transducer is firmly seated in the connector. To lock, turn the transducer latch to the locked position.

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➤ To remove a transducer Do one of the following, depending on the connector style: •

For a cartridge-style connector, press the Release button on the connector and pull the connector toward you.

•

For a nonimaging-style connector, pull the connector toward you.

•

For an Explora-style connector, turn the latch to the unlocked position and pull the connector toward you.

Connecting an OmniPlane III Transducer Before you connect the OmniPlane III TEE transducer, be sure the tip and shaft are straight. When you connect the transducer, it automatically recalibrates itself to the 0° (horizontal plane) position. As with any array movement, the motor makes a humming sound while recalibrating. NOTE

With TEE transducers, if the “Calibration failed” message appears, try unlocking the transducer connector, straightening the tip and shaft, and then locking the connector.

Connecting the T6H Transducer The T6H OmniPlane III transducer requires an adapter for use with the HD11 system. ➤ To connect the T6H OmniPlane III transducer to the OmniPlane Adapter and to the system 1. Plug the adapter into the HD11 system transducer connector with the latch side facing out. 2. Turn the latch on the adapter to lock the adapter to the system. 3. Plug the T6H OmniPlane III transducer into the adapter. 4. Turn the latch 90 degrees clockwise to lock the transducer into the adapter.

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NOTE

With TEE transducers, if the “Calibration failed” message appears, try unlocking the transducer connector, straightening the tip and shaft, and then locking the connector.

➤ To remove the T6H OmniPlane III transducer from the OmniPlane Adapter Turn the latch to the unlocked position (90 degrees counterclockwise) and pull the connector toward you. ➤ To remove the adapter from the system Turn the adapter latch to its unlocked position and pull it toward you.

Connecting a Modem The system includes a modem that is used in remote diagnostics and for receiving system data. To use these features, the modem must be connected to a dedicated telephone line and the system must be turned on. ➤ To connect a telephone line to the internal modem 1. Connect one end of the provided modular phone cable to the wall phone jack. 2. Connect the other end of the cable to the telephone jack on the rear panel of the system (Figure 4-1). WARNING

If you have a modem, make sure it is not connected to a telephone line while you are imaging a patient. NOTE

58

To facilitate remote diagnosis, remove all connected transducers.

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Figure 4-1 Location of Analog Telephone Jack

Analog telephone jack

Connecting to a Network To use connectivity features, the system must be connected to a network. The Ethernet connector on the rear panel supports both 10Base-T and 100Base-T formats. The system is configured for network connectivity by a Philips field service engineer or your network administrator. CAUTION

Make sure that the system network parameters are properly configured before you connect the network cable. Incorrect network configuration can interfere with the correct operation of your system when the network cable is connected. ➤ To connect the system to a network 1. Connect one end of the provided network connection cable to the wall receptacle for your network. 2. Connect the other end of the cable to the network connector on rear panel of the system (Figure 4-2).

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Figure 4-2 Network Connection

Network connector

Moving the System The weight of the system depends on the peripherals installed, but generally includes the monitor and the power module. The typical weight is approximately 100 kg (220 lb) without peripherals. WARNING

This weight dictates discretion when moving the system. The ability to move the machine is, however, directly related to an individual’s size and strength. Seek assistance to move the system when necessary. This system is equipped with a front handle and brakes on the front wheels. The front wheels on the HD11 system have controls that you can engage and disengage independently. Each front wheel has three levers: one red, one green, and one gray . The back wheels do not have controls.

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Figure 4-3 Wheel Controls

Steer lock

Wheel lock and steer lock release Wheel lock

➤ To lock the front wheels for moving the system in a straight line Press the green lever. ➤ To move the system Always use the handle at the front of the cart to move the system from one location to another. ➤ To apply the brakes to each wheel Press the red lever. ➤ To release the wheel locks or the steer locks Press the gray lever. WARNING

Do not use the wheel controls to hold the system on an incline greater than 5 degrees.

Precautions for Moving the System •

Turn off the system and unplug it from the power source.

•

Always use the front handle to push the system. Do not push the system from the side or the back. Do not use the handle to lift the system.

•

Be sure the system control panel and monitor are locked. Rotate the control panel left and right; it will lock automatically.

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•

Disconnect and remove external devices and all loose equipment from the top of the ultrasound system.

•

Make sure the strap that holds the system peripherals on top of the system cart is securely tightened.

•

Do not move the system over uneven elevator entrances by lifting up on the machine.

•

Use two people to transport the ultrasound system when you are moving it up and down ramps longer than 6 m (20 ft) or steeper than 5 degrees. (Wheelchair ramps are usually less than 5 degrees.)

The system has been tested for stability by using the IEC 60601-1 test protocol. This protocol calls for the device to not tip over when moved over a 10-degree incline in any direction. It is, however, possible to exceed this amount of incline when the system is moved over a roadside curb or some other small but steep incline. Use care when moving the system. WARNING

Avoid ramps that are steeper than 10 degrees to eliminate the potential danger of the system tipping over.

Using the Removable Media Drives This section provides instructions for using CDs and MODs. It includes the following instructions:

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•

"Loading and Ejecting CDs and MODs" on page 63

•

"Viewing a CD or an MOD" on page 63

•

"Formatting an MOD" on page 64

•

"Erasing a Disk" on page 64

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Loading and Ejecting CDs and MODs This section provides instructions for loading and ejecting a CD and an MOD. ➤ To load and eject a CD 1. To open the tray, press the Eject button located below the CD drive. 2.

Place a disc into the tray. Ensure that the disc is seated properly in the recess in the tray.

3. To close the tray, press the Eject button again. ➤ To load and eject an MOD 1. To load the MOD, insert the MOD into MOD drive. 2. To eject the MOD, press the small button located on the MOD drive.

Viewing a CD or an MOD This section provides instructions for viewing the contents of a CD and an MOD. Viewing the contents is called browsing. ➤ To browse the contents of a CD 1. Press Setup. 2. In the Setup window, click the CD tab. 3. Click Browse CD to open the Browse CD window. 4. To close the Browse CD window when done, click Close. 5. To close the Setup window, click Close. ➤ To browse the contents of an MOD 1. Press Setup. 2. In the Setup window, click the Optical Disk tab. 3. Click Browse Disk to open the Browse Disk window. 4. To close the Browse CD window when done, click Close. 5. To close the Setup window, click Close. HD11 User Reference 4535 611 65311

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Formatting an MOD Formatting an unformatted MOD prepares it to store data. Formatting a formatted disk that contains data erases all of the data on it. You can format a disk in the background while you continue to use the system. The system displays a message at the bottom of the display to indicate when the formatting process is finished. NOTE

You only need to format MODs for use. The system automatically formats a CD when you store images to it.

➤ To format an MOD 1. Insert the MOD into the MOD drive. 2. Press Setup. 3. In the Setup window, click the Optical Disk tab. 4. Click Format Disk. 5. Change other settings as necessary. 6. To format the disk, click Start. 7. To close the Setup window, click Close.

Erasing a Disk Erasing a CD-RW or MOD deletes all of the files and data currently stored on the disk. CAUTION

You cannot restore data after is it erased from a disk. ➤ To erase the contents of a CD NOTE

You cannot erase a CD-R; you can only erase a CD-RW. 1. Press Setup. 2. In the Setup window, click the CD tab. 3. Click Erase CD to open the Erase CD window.

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4. To erase the contents of the CD, click OK. 5. To close the Erase CD window, click Close. 6. To close the Setup window, click Close. ➤ To erase the contents of an MOD 1. Press Setup. 2. In the Setup window, click the Optical Disk tab. 3. Click Erase Disk to open the Erase CD window. 4. To erase the contents of the MOD, click OK. 5. To close the Erase Disk window, click Close. 6. To close the Setup window, click Close.

Recalibrating an Image in VCR Playback You can calibrate a paused VCR image so you can perform measurements on it. The system allows five types of calibration on paused VCR frames: •

2D

•

M-mode

•

Doppler Velocity

•

Doppler Frequency

•

Physio

When the you press Caliper or Trace while a paused VCR image is displayed, the system prompts you to choose the type of calibration. The system then provides a series of prompts to walk you through the calibration process.

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5 DICOM Networking DICOM is a format for transferring patient studies over the information management system. These studies are accessed by physicians at remote viewing stations. It is also a format for receiving work order requests at your HD11 system. The HD11 system offers the following DICOM options: •

•

With the DICOM Networking option, you can: –

Export images and studies over a network to a DICOM PACS server or to a DICOM printer. See "Setting Up Automatic DICOM Export and Export Options" on page 74 and "Setting Up Automatic DICOM Printing" on page 83.

–

Use Modality Worklist (MWL) and Modality Performed Procedure Step (MPPS). See "Setting Up Modality Worklist" on page 91.

With the DICOM Media option, you can export to an MOD, a CD-R, or a CD-RW in DICOM format. See the HD11 Getting Started.

To learn how to enter DICOM settings for your system and assign DICOM servers, see "DICOM Setup" on page 67.

DICOM Setup Before you use DICOM Networking features, you must enter DICOM settings for your system and assign DICOM servers. CAUTION

If you want to change DICOM settings not covered here, see your network administrator. Do not make any changes to network settings without consulting with your network administrator.

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DICOM Setup Workflow The following workflow describes the sequence of steps you need to follow for a successful DICOM connection.

Step 1: Enter HD11 System DICOM Settings –

"Entering System DICOM Settings" on page 68

Step 2: Enter Server Information and Assign Servers to Roles –

"Assigning DICOM Servers" on page 71

Step 3: Set Up Automatic Export, Printing, and Study Deletion –

"Automatic DICOM Export" on page 72

–

"Automatic DICOM Printing" on page 82

–

"Setting Up Automatic Study Deletion" on page 80

–

"Setting Up Modality Worklist" on page 91

Entering System DICOM Settings You must enter DICOM settings for your HD11 system before you connect your system to the network. If you have questions, see your network administrator. NOTE

You cannot make DICOM system name or port changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

➤ To enter DICOM settings for your HD11 system 1. Do not connect the LAN cable to the system. If it is already connected, disconnect it. 2. Press Setup. 3. Click the System tab. 4. On the System tab, click DICOM. 5. In the DICOM Setup window, click the This System tab. 68

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6. On the This System tab, in the System Name area, enter the AE Title for your system specified by your network administrator. See "Changing or Setting the PC Name" on page 70. NOTES

NOTE

• • •

The AE Title for each device on the network must be unique. AE Titles are case sensitive (that is, PACS1 is different from Pacs1). In many institutions, the AE Title is derived from the PC Name, which must be unique across the institution’s network.

7.

In the System port number area, enter the port number specified by your network administrator. You can use the up arrow or down arrow to change the number, or you can type it in.

The default port number, 104, is assigned to ultrasound systems at most institutions. 8. In the Network settings area, click the Network settings button. 9. In the Internet Protocols (TCP/IP) Properties window, enter the IP Address, Subnet Mask, and any other network parameters specified by your network administrator. 10. Click OK. 11. Click OK. 12. Click Close. 13. Connect the LAN cable to the system. After about 10 to 20 seconds, the Status should change to Connected.

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Changing or Setting the PC Name The system administrator may want to change the factory-configured PC name on the HD11 system. ➤ To change the PC Name in DICOM setup 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. In the DICOM Setup window, click the This System tab. 5. On the This System tab, in the System Name area, click Change next to the PC Name field. 6. Enter the new computer name in the field provided. 7. Click OK. 8. Click OK to confirm the name change. 9. Click OK to exit the message box. 10. Click OK. 11. Click Close. 12. Shut down the system and restart it. NOTE

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After you change the PC Name, the system disables all DICOM options until you restart the system. After you restart the system, all installed DICOM options will be available again.

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Assigning DICOM Servers You must assign DICOM servers before you connect your system to the network. If you have questions, see your network administrator. ➤ To assign DICOM servers 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. In the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers and Roles window, in the Servers area, click New. 6. Assign a name to the sever and enter it in the Name field. NOTE

This name will be used in all dialog boxes and error messages that relate to this server. It does not have to be the same as the AE Title. 7. Enter the AE Title and Host/IP Address specified by your network administrator in the respective AE Title and Host/IP Address fields. 8. In the Servers area, click Done. 9. To test the server connection, click Ping. In a few seconds, you should see the message “[Server Name] is correctly configured as a DICOM server and is up and running.” 10. In the Roles area, click Modify. 11. For each DICOM role, select the appropriate server from the list. You can assign DICOM servers to the following roles: –

Storage SCP—The server assigned to this role receives and stores images acquired from the system.

–

Storage Commit SCP—The server assigned to this role takes ownership of the study.

–

Black-and-White (B&W) Printer SCP—The server assigned to this role is a black-and-white printer.

–

Color Printer SCP—The server assigned to this role is a color printer. HD11 User Reference 4535 611 65311

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–

MWL SCP—(Modality Worklist) The server assigned to this role provides information about scheduled patients to the HD11 system.

–

MPPS SCP—(Modality Performed Procedure Step) The server assigned to this role receives information about studies that are started and completed on the HD11 system.

12. Click Advanced to the right of the menu for each role to configure additional settings, if applicable. 13. In the Roles area, click Done. 14. Click OK. 15. Click Close. 16. Make a preset backup disk. All DICOM settings will be saved with the System settings, except changes made under Network Settings. See "Backing Up Presets and Settings to a CD" on page 131. NOTES

•

•

You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending DICOM jobs. See "Canceling DICOM Jobs" on page 88. One server may perform more than one role. Storage and Storage Commit roles are often done by one server.

Automatic DICOM Export You can set up automatic DICOM export so that images are automatically exported over a network when you press Acquire or when you save or close a study. You can set up automatic DICOM study deletion so that a study is automatically deleted as soon as all of its images are exported over a network. See "Setting Up Automatic Study Deletion" on page 80.

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NOTES

•

• •

If you have configured a Storage Commit server, automatic study deletion occurs after the images are exported to the PACS and after the Storage Commit server has accepted ownership of the images (which typically means a backup has been made). For example, a Storage Commit server might be configured to accept ownership only after the nightly backup, in which case the study will remain on the system until the next day, after the backup is complete. The ability to export to a DICOM PACS server or to a DICOM printer is a feature of the DICOM Networking option. Before you can make any DICOM setup changes, you need to close any open study and delete any pending DICOM jobs (Print, Store, or MPPS). A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

Managing Networked Studies Several DICOM settings enable you to manage the studies on the system hard drive, as well as how and when the images in those studies are sent to the PACS server.

Hard Drive Management Guidelines ➤ To temporarily disable network export of studies and images Disable the DICOM Networking option on the Options tab in the Setup window. See "Installing Options" on page 101. ➤ To make images available on the DICOM viewer as soon as the study is completed Select the Send as you go AutoSend option. See "Setting Up Automatic DICOM Export and Export Options" on page 74. ➤ To review images before exporting them over the network Select the Batch mode AutoSend option. See "Setting Up Automatic DICOM Export and Export Options" on page 74.

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➤ To remove studies from the HD11 system as soon as they are accepted by the PACS Select the Immediately Auto Delete option. "Setting Up Automatic Study Deletion" on page 80.

Setting Up Automatic DICOM Export and Export Options Before you use automatic DICOM export, you must assign and select a valid Storage SCP server. That is where the images are saved. You can also select a Storage Commit SCP server. If you have any questions about servers, ask your network administrator. ➤ To set up automatic DICOM export 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers and Roles window, in the Roles area, click Modify. 6. Select the appropriate server from the Storage SCP list. 7. Select the appropriate server from the Storage Commit SCP list, if necessary. NOTE

Many sites do not have a Storage SCP server. If you inadvertently assign a server that does not support the Storage Commitment role to the role of Storage Commitment SCP, an error will occur. Check with your network administrator to verify the site supports Storage Commitment. 8. Click the Advanced button to the right of Storage SCP. 9. On the Network Export Preferences window, click the Auto Store tab.

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10. In the Auto Store Mode box, select the appropriate option: –

Manual export only—You must export over the network manually. See "Exporting Patient Studies" on page 430.

–

Batch mode—All images are automatically exported over the network when you save or close the study.

–

Send as you go—Each image is automatically exported over the network when you press Acquire.

11. To set Auto Store options to prevent large or incompatible files from being exported to the Storage SCP, in the Auto Store Options box, select the appropriate options:

NOTE

–

Send all 2D cine loops—An acquired 2D loop will be exported to the Storage SCP.

–

Send all 3D/4D still frames acquired without volume data sets— A 3D/4D image acquired without volume data will be exported to the Storage SCP.

–

Send all 3D swivel loops and 4D Volume replay loops acquired without volume data sets—A 3D/4D loop acquired without volume data will be exported to the Storage SCP.

–

Send all 3D/4D volume data set information—An acquired 3D/4D image with volume data will be exported to the Storage SCP.

3D/4D images and loops can be exported only in RGB Uncompressed ELE format, regardless of which export format you have selected on the Image Format DICOM setup tab. (See "Changing the Image Format for DICOM Export" on page 76.) If your DICOM viewer or PACS does not accept the RGB Uncompressed ELE format, clear all the options in the Auto Store Options box. 12. On the Image Format tab, click Display Compensation. 13. In the Display Compensation window, select the appropriate option: –

No display compensation—for viewing the image at the same brightness as on the HD11 monitor.

–

Optimized for CRT—for viewing on an remote viewing station with a CRT monitor.

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–

Optimized for LCD—for viewing on an remote viewing station with a LCD flat panel monitor.

–

Tailor to your individual preference—move the slider to the appropriate number. For information on how to determine the compensation number, see "Determining the Display Compensation Number" on page 433.

14. Click OK. 15. Click Done. 16. Click OK. 17. Click Close. NOTES

• •

•

The ability to export to a DICOM PACS server or to a DICOM printer is a feature of the DICOM Networking option. Before you turn off your system at the end of each day, check the DICOM Job Manager window to make sure that the queue is empty to ensure that all studies have been sent to the PACS server. You can quickly access the Job Manager window by pressing Ctrl+J (not available in Review mode). You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

Changing the Image Format for DICOM Export You can select the image format for studies that are exported to a PACS (Storage SCP). ➤ To change the image format 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify.

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6. Click the Advanced button to the right of Storage SCP. 7. In the Network export preferences window, click the Image Format tab. 8. Select one of the following options: –

Palette Color with RLE (lossless) compression

–

Palette Color Uncompressed ILE (Implicit VR, Little Endian)

–

Palette Color, Uncompressed ELE (Explicit VR, Little Endian)

–

RGB with RLE (lossless) compression

–

RGB, Uncompressed ILE (Implicit VR, Little Endian)

–

RGB, Uncompressed ELE (Explicit VR, Little Endian)

–

YBR, JPEG Compressed If YBR, JPEG Compressed is selected, click Still frames or Loops and drag the slider to adjust the image quality balance.

NOTES

• •

Not all viewers support all DICOM formats. You should test your selected format by viewing a study on the PACS viewer. 3D/4D images and loops can be exported only in RGB Uncompressed ELE format, regardless of which export format you select. If your DICOM viewer or PACS does not accept the RGB Uncompressed ELE format, clear all the options in the Auto Store Options box when setting up automatic DICOM export. See "Setting Up Automatic DICOM Export and Export Options" on page 74.

9. Click Loop Timing to set the timing of loop frames for DICOM viewers: –

Select Frame Time Vector for viewers that allow frames in a loop to have different time durations.

–

Select Average Frame Time for viewers that require all frames in a loop to have the same time duration.

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10. Click Study Description to determine how to populate the Study Description field on the Patient Identification window: –

Select MWL Information to use the patient data from the Modality Worklist. This is the default setting if you have Modality Worklist.

–

Select Use Entered Text to customize the Study Description field options. This is the default setting if you do not have Modality Worklist.

11. Click Display Compensation to set the brightness of exported images on remote viewing stations: –

No display compensation—for viewing the image at the same brightness as on the HD11 monitor.

–

Optimized for CRT—for viewing on a remote viewing station with a CRT monitor.

–

Optimized for LCD—for viewing on a remote viewing station with a LCD flat panel monitor.

–

Tailor to you individual preference—move the slider to the appropriate number. For information on how to determine the compensation number, see "Determining the Display Compensation Number" on page 433.

12. Click OK. 13. Click Done. 14. Click Close. NOTES

•

• • •

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YBR, JPEG Compressed format offers the most flexibility and image compression. It is useful if you are capturing loops. However, not all DICOM viewers can read this format. RGB, Uncompressed (ILE) is supported on many DICOM devices, but this format offers no compression and therefore stores the largest files. Color Palette provides the best viewing flexibility. Use RGB if Color Palette is not supported by your viewer. You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

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Configuring Your Viewer Based on Study Description Some DICOM viewers use the Study Description field in a patient study to determine their viewer settings. As a result, all studies with a certain value in the Study Description field are automatically viewed with the same viewer configuration. See "Changing the Image Format for DICOM Export" on page 76 to learn how to set the Study Description field value.

Troubleshooting Automatic DICOM Export If you set up Automatic DICOM Export and the images do not store or export, try the following: •

Make sure you configured a Storage SCP server. See "Assigning DICOM Servers" on page 71.

•

Make sure you did not select Manual export only as the Auto Store setting. See "Setting Up Automatic DICOM Export and Export Options" on page 74.

•

If you selected Batch mode as the Auto Store setting, close the study. See "Setting Up Automatic DICOM Export and Export Options" on page 74.

•

If

is displayed in the Search for Study window, the export failed.

Try to export the study manually. See "Exporting the Current Patient Study in DICOM Format" on page 429. •

If you want to check the progress of the export, return to live imaging and press Ctrl+J. Your job will appear in the Job Manager window.

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Setting Up Automatic Study Deletion You can set up automatic DICOM study deletion so that a study is automatically deleted as soon as all of its images are exported over a network. If you assigned Storage Commit server, a study is not deleted until after all its images have been exported to the PACS and the Storage Commit server has taken ownership of the images. ➤ To turn automatic DICOM study deletion on or off 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify. 6. Click the Advanced button to the right of Storage SCP. 7. On the Network Export Preferences window, click the Auto Delete tab. 8. On the Auto Delete tab, select the appropriate option. –

No Auto Deletion—Studies are not deleted from your system after all of their images are exported over the network. When space is limited on your system, the oldest studies are automatically deleted, or you are prompted to delete studies (according to the Disk Full Strategy). See "Specifying the Disk Full Strategy" on page 128.

–

Immediate Auto Delete—A study is automatically deleted when all of its images are exported over the network. If you have just a storage SCP defined, then the study is deleted as soon as all the images have been successfully sent to the Storage SCP. If you also have a Storage Commit SCP defined, then studies are not deleted until the Storage SCP (PACS) server has informed the HD11 system that every image in the study has been successfully stored to its archive and that the Storage Commit server has taken ownership of the images. The Storage Commit server might not accept ownership of the images until the nightly backup has completed.

9. Click OK. 10. Click Done.

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11. Click OK. 12. Click Close. NOTES

• • •

If you have any questions about servers, see your network administrator. DICOM export is a component of the DICOM Networking option. You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

Rescuing Stranded Studies If the networked server goes offline, the HD11 system will retry to export a study. If the server is offline for a long time, however, the study may not be exported successfully to the PACS server. At the end of each day, check the Job Manager (Ctrl+J) for unsuccessful exports that are indicated by

or

.

Try to resend each job from the Job Manager. If that fails, delete the jobs from the Job Manager and manually export each study from Image Review. NOTE

You can configure the number of export retries and the retry interval. See "Assigning DICOM Servers" on page 71.

➤ To resend a job 1. Press Ctrl+J to open the Job Manager from the live display. 2. Look for jobs with a status of Error in the Status column. 3. Select a job with an status of Error. 4. Click Retry Job. 5. If the job retry fails, click Delete Job to delete the job from the Job Manager. 6. Click Close. If the attempt to resend the job fails, manually export the job from Image Review.

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➤ To manually export a job 1. Press Review. 2. Click the Search for Study button. 3. Click the Search button. 4. Look for studies in the search results box with either MRN column.

or

next to the

5. Use the trackball to position the cursor over a study, and press Select. 6. Select Export DICOM from the shortcut menu. 7. Select the DICOM PACS from the Export to Device list. 8. Click Start Export. 9. Click Close. 10. Press Review.

Automatic DICOM Printing You can set up automatic DICOM printing so that images are automatically sent to a DICOM printer when you press Acquire or when you save or close a study. NOTES

•

• •

82

By default, a page is not printed until six images are sent to the DICOM printer. To print a different number of images on a page, see "Changing DICOM Printer Settings" on page 86. The ability to print to a networked DICOM printer is a feature of the DICOM Networking option. You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

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Setting Up Automatic DICOM Printing ➤ To set up automatic DICOM printing 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify. 6. Do one of the following: –

To specify a black-and-white printer, select the appropriate server from the B&W Printer SCP list.

–

To specify a color printer, select the appropriate server from the Color Printer SCP list.

7. To change the automatic DICOM printing setting, click the Advanced button to the right of B&W Printer SCP or Color Printer SCP. 8. On the Printer Configuration window, click the Auto-Print tab. 9. Select the appropriate option: –

Manual print only—You must print manually. See "Exporting Patient Studies" on page 430.

–

Batch mode—Still images in the study are automatically printed when you save or close the study.

–

Send as you go—When a frozen image is acquired, it is automatically queued for printing. When a page is full or the study is closed, the page is immediately sent to the printer.

10. Click OK. 11. Click Done. 12. Click Close.

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NOTES

• •

The ability to print to a networked DICOM printer is a feature of the DICOM Networking option. You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

Troubleshooting Automatic DICOM Printing If you set up automatic DICOM printing and the images do not print, check the following: •

Make sure you configured a B&W Printer SCP or Color Printer SCP server. See "Assigning DICOM Servers" on page 71.

•

Make sure you did not select Manual print only as the Auto-Print setting. See "Setting Up Automatic DICOM Printing" on page 83.

•

If you selected Batch mode as the Auto-Print setting, close the study. See "Setting Up Automatic DICOM Printing" on page 83.

•

Check the DICOM Job Manager window (Ctrl+J). Make sure that there are no jobs with a status of Error, which indicates that a print job failed. If the print failed, delete it and try to print the study manually. See "Importing and Exporting in DICOM Format" on page 93. You can also try to ping the server to see if there is a network problem. See "Assigning DICOM Servers" on page 71.

Configuring a New DICOM Printer ➤ To configure a new DICOM printer 1. Press Setup. 2. Click the System tab. 3. Click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify.

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6. Do one of the following: –

To specify a black-and-white printer, select the appropriate server from the B&W Printer SCP list.

–

To specify a color printer, select the appropriate server from the Color Printer SCP list.

7. To change the automatic DICOM printing setting, click the Advanced button to the right of B&W Printer SCP or Color Printer SCP. 8. On the Printer Configuration window, click the Advanced tab. 9. On the Advanced tab, for immediate printer use, select the Derive number of pixels from ‘Film Size’ and ‘Resolution’ check box. 10. Click OK. 11. Click OK. 12. Click Close. To obtain the specific settings for your DICOM printer, you can contact your Philips Service Representative. Or you can export and view the printer configuration Excel spreadsheet that is stored on the HD11 system hard drive to obtain the correct pixel and resolution settings for your DICOM printer. ➤ To export the DICOM printer spreadsheet 1. Press Setup. 2. Click the System tab. 3. Click DICOM. 4. On the DICOM Setup window, click the Diagnostics tab. 5. On the Diagnostics tab, click Logging. 6. On the DICOM Diagnostics window, click Copy log files. 7. Under Select log files to copy, select PrintCatalog.xls. 8. Under Copy to, select CD. 9. Click OK. 10. Click OK. 11. Click Close. HD11 User Reference 4535 611 65311

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About Intelliprint Intelliprint is an HD11 feature that automatically routes images to the appropriate printer when you have both a color and a black-and-white printer configured. When both printers are configured, Intelliprint automatically routes black-and-white images to the black-and-white printer and color images to the color printer. If you have only a black-and-white printer configured, all images—color and black-and-white—will be sent to it for printing. When color images are sent to a black-and-white printer, either the printer or the HD11 system converts the color to black-and-white, depending upon your printer server connection. These conversions will not look the same, and you may prefer one conversion over the other. If you have only a black-and-white printer, test color prints on it to see which conversion you prefer. Configure it first as a black-and-white printer on the DICOM Servers and Roles tab and do a test print. Then configure it as a color printer on the Servers and Roles tab and do another test print. Compare the results and configure the printer according to the printouts you prefer. NOTE

If you configure a black-and-white printer as a color printer, the print job may end up with an error status if the printer cannot make the color conversion. Check the test print. Then delete any error jobs and reconfigure the printer as a black-and-white printer.

Changing DICOM Printer Settings You can change many DICOM printer settings in the B&W Printer Configuration window and in the Color Printer Configuration window. Information about each setting appears in the Description area. The DICOM information about each setting appears below the Description area. Some menus include Printer-specific so that you can enter a value used specifically for your printer. If you select Printer-specific, you can type a value in the field to the right of the menu.

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➤ To change the DICOM printer settings 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify. 6. Click the Advanced button to the right of B&W Printer SCP or Color Printer SCP. 7. On the Printer Configuration window, click the Basic or the Advanced tab. 8. On the Basic or Advanced tab, make any necessary changes to the printer settings. NOTE

On the Advanced tab, in the Pixel section, you may need to set the number of pixels and resolution in order to lay out the print page properly for your DICOM printer. Your Philips service representative can provide the pixel and resolution settings for your DICOM printer model. See "Configuring a New DICOM Printer" on page 84. 9. Click OK. 10. Click Done. 11. Click Close.

NOTES

• •

The ability to print to a DICOM printer is a feature of the DICOM Networking option. You cannot make DICOM setup changes if you have a study open or if any DICOM jobs are pending. You need to close the open study and delete pending DICOM jobs (Print, Store, or MPPS) first. A message is displayed if you have pending jobs. See "Canceling DICOM Jobs" on page 88.

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Canceling DICOM Jobs ➤ To cancel DICOM jobs (Print, Store, MPPS) 1. Do one of the following: –

Press Ctrl+J.

–

Press Setup, click the System tab, click DICOM, click the Diagnostics tab, and then click Jobs.

2. On the Job Manager window, use the trackball and the Enter key to highlight the job you want to delete. 3. Click Delete Job. NOTE

You cannot use the Delete Job button to delete jobs that are in progress. See "Canceling All DICOM Jobs" on page 88 to cancel in-progress jobs. 4. Click Close. 5. Click OK. 6. Click Close.

Canceling All DICOM Jobs ➤ To cancel all DICOM jobs, including in-progress jobs 1. In live imaging, press Ctrl+J. 2. On the Job Manager window, click Delete all jobs. 3. Click Close. NOTE

88

You cannot cancel a job that is in progress while a study is open. You must close any open studies before canceling all jobs.

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Modality Worklist If your system is connected to the hospital information system (HIS), the Patient Selection window displays a list of scheduled patients, called the Modality Worklist. You select a patient from the list, and the Patient Identification window opens, populated with the patient's demographic information. If you temporarily disconnect your system from the HIS, you can still use Modality Worklist. The most recent information from the HIS is stored on your system and is updated when you reconnect to the HIS. If you specify a server for Modality Performed Procedure Step (MPPS), your system notifies the HIS when a patient study is started and when it is complete. The list of scheduled patients and patient billing information can then be updated. NOTES

• •

Before you use Modality Worklist, you must specify the Modality Worklist server. See "Setting Up Modality Worklist" on page 91. Modality Worklist is a component of the DICOM Networking option.

About the Patient Selection Window If your system is connected to the HIS, you can see and select from a list of scheduled patients in the Patient Selection window. The Patient Selection window opens when you press Patient. The main areas of the window are: Patient selection filter—Enables you to customize which patient names appear in the Modality Worklist by setting filter criteria. If the Find field is clear, all patients on the Modality Worklist are displayed. The In Column field selections are saved when you exit the Patient Selection window. All filter settings are saved when you select Save Filter. Modality Worklist—(Bottom left corner) A list of scheduled patients. You can sort the list by clicking the column headings. You can also change column width by dragging column separators to the left or right. To select a patient to start a study, highlight the patient’s name and click OK, or double-click the patient’s name.

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NOTE

The Scheduled Time and Status columns are minimized by default. If your institution uses these fields, drag the column separators to resize them. Patient information—(Top right corner) Displays demographic information for the highlighted patient in the Modality Worklist on the left. Patient searching tips—Provides alternatives if you cannot find a patient on the Modality Worklist. Clear filter removes filter criteria in the Patient selection filter area so that you can see all patients on the Modality Worklist or create a new filter. Refresh Now updates the Modality Worklist from the server. Manual Entry opens the Patient Identification window so you can enter the patient information manually. More Info tells you when the next update from the server is scheduled.

Using Modality Worklist ➤ To use Modality Worklist 1. Press Patient to open the Patient Selection window. The Modality Worklist displays scheduled patients. 2. On the Patient Selection window, click a column header to sort the Modality Worklist by last name, exam time, or another category. 3.

Search for the patient, if necessary. –

Enter one or more letters or numbers in the Find field and select a column from the In Column menu. As you type, the list changes to show only the patients that match your criteria.

–

To find a subset of the results, type a value for a different column in the And field and select the column from the In Column menu.

–

Click Save Filter to store the current filter settings as the default.

–

Click Clear filter to start a new search.

4. Do one of the following: –

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Select the patient. Click the name of the patient and click OK or double-click the highlighted patient name. The Patient Identification window opens and is populated with the patient's demographic information. You can edit and save.

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–

5

If the patient's name does not appear in the Patient Selection window, click Manual Entry. A blank Patient Identification window opens.

NOTES

•If you click Manual Entry, the HIS will not be updated when the exam is complete, and the patient’s billing information will need to be updated manually. • The In Column field selections are saved when you close the Patient Selection window. • Before you use Modality Worklist, you must specify the Modality Worklist server. See "Setting Up Modality Worklist" on page 91. • Modality Worklist is a component of the DICOM Networking option.

Setting Up Modality Worklist If you set up Modality Worklist, a list of scheduled patients appears when you press Patient. If you select a Modality Performed Procedure Step (MPPS) server, the list of scheduled patients may be updated when you complete a study. ➤ To set up Modality Worklist 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify. 6. Select the Modality Worklist server from the MWL SCP menu. 7. Select the Modality Performed Procedure Step (MPPS) server from the MPPS SCP menu, if necessary. 8. Click Advanced to customize the Modality Worklist entries. 9. Click Done. 10. Click OK. 11. Click Close.

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NOTES

• •

If you have any questions about servers, see your network administrator. Modality Worklist is a component of the DICOM Networking option.

Changing Modality Worklist Settings You can specify which scheduled patients appear in the Modality Worklist. You can either choose from several default queries, or you can define your own query. You can also specify how often your system retrieves patient information from the hospital information system (HIS). ➤ To change Modality Worklist settings 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. On the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers & Roles tab, in the Roles area, click Modify. 6. Click the Advanced button to the right of MWL SCP. 7. On the Set Modality Worklist Query window, click the query you want. –

To modify a query, click the Change button to its right.

–

To restore the queries to their original settings, click Set Factory Defaults.

8. Click the up arrow or the down arrow in the MWL Polling Frequency area or type the number to specify how often your system should retrieve information from the HIS. 9. Click OK. 10. Click Done. 11. Click OK. 12. Click Close.

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NOTES

• •

If you have any questions about servers, see your network administrator. Modality Worklist is a component of the DICOM Networking option.

Importing and Exporting in DICOM Format You can export a patient study in DICOM format to an optical disk, to a CD-R or CD-RW, or over a network. You can import one or more studies that were created on an HD11 system and saved in DICOM format from an optical disk or a CD-R or CD-RW. For information about importing and exporting studies in DICOM format, see the following topics: •

"Importing a Patient Study" on page 428

•

"Exporting the Current Patient Study in DICOM Format" on page 429

•

"Exporting Patient Studies" on page 430

NOTES

• • •

You can also import one or more studies that were created on a Philips EnVisor system and saved in DICOM format to a CD-R or CD-RW. Exporting a study over a network is a component of the DICOM Networking option. If you have the DICOM Media option, you can export studies in DICOM format. Those studies can be viewed on any DICOM viewer. If you do not have the DICOM Media option, exported studies can only be viewed on HD11 systems.

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6 Customizing Your System You can customize your system in the following ways to make it more useful for you:

NOTE

•

Create presets designed specifically for the exams you perform.

•

Add options to enhance your imaging abilities.

•

Change system settings to reflect your needs.

•

Back up and restore system settings and presets.

•

Change the language input settings.

•

Change Physio and Triggering settings.

No matter how you customize your system, be sure to back up your presets, settings, and patient information regularly.

Presets A preset is a group of settings that optimizes the system for a specific type of exam. Presets establish many initial settings, such as gain value, color map, filter, and items on the Label menu. When you turn on your system, the most recently used preset is active. Before you begin an exam, be sure that the appropriate preset is active. You can choose from several default presets. You cannot delete these default presets. However, they provide a starting point from which you can create your own presets. You can create up to 20 presets for each of the 9 exam types. If you need to create more than 180 presets, you can save presets to a CD and restore them when you need to use them. NOTE

Presets are only available if you purchased the corresponding application package option.

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About Exam Types Related presets are organized in categories called exam types. Presets are only available if you purchased the corresponding application package option. Exam Type

Application Package Option

Abdominal

General Imaging

Abdominal Vascular

Vascular

Cardiac

Cardiac

Cardiac Vascular

Cardiac

Musculoskeletal

General Imaging

OB/GYN

OB/GYN

Pediatric

General Imaging

Small Parts

General Imaging

Vascular

Vascular

On the preset menu, the active exam type is displayed at the top of the menu. The presets that belong to that exam type are listed underneath.

Selecting a Preset Before you begin an exam, check to see if the correct preset is active. If it is not, you need to select the appropriate preset from its related exam type. ➤ To select a preset 1. Press Preset. A menu appears with the current exam type at the top and all of the presets for that exam type listed. Presets that you created appear above default presets. 2. If you want to select a preset of a different exam type, click the exam type at the top of the menu and then click the appropriate exam type. 3. Use the trackball to highlight the preset you want and press Enter or Select.

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Creating a Preset You can create a new preset based on a default preset or on a preset that you created previously. ➤ To create a preset 1. Select a preset that you want to use as a starting point for your preset. 2. Modify any settings that you want to change for your preset. 3. Press Preset. 4. Press Save Preset. 5. Click Create New. 6. Type the name of the preset you want to create. 7. Click Save. The Preset application is turned off and the new preset is active. NOTE

You can also create a new preset in the Setup window.

Modifying a Preset You can make changes to any preset that you created. You cannot modify default presets. ➤ To modify a preset that you created 1. Activate the preset. 2. Modify any settings that you want to change. 3. Press Preset. 4. Press Save Preset. 5. Click Modify Current. 6. Click OK. The Preset application is turned off and the modified preset is active. NOTE

You can also change a preset in the Setup window. HD11 User Reference 4535 611 65311

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Deleting a Preset You can delete any preset that you created. You cannot, however, delete default presets. ➤ To delete a preset 1. Press Preset. 2. Use the trackball to highlight the preset you want to delete. 3. Press Delete Preset. 4. Click OK. The Preset application is turned off. If you deleted the active preset, then the Preset menu stays open and the first preset in the current exam type is activated. You can see the preset name update in the side border.

Using Preset Soft Keys ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Delete Preset

Display Name

Save Preset

Removing the Preset Name from the Display By default, the name of the preset appears on the display. You can hide the name and display it again later. ➤ To hide or display the name of the preset 1. Press Preset. 2. Press Display Name. 3. Press Preset. The Display Name control is automatically turned back on when you select a different preset. 98

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Options The following table lists each option you must purchase separately. The left column lists the option as it appears on the Options tab in the Setup window. The right column lists the corresponding option package or packages that you can purchase to obtain that option.

Option

Option Package

Resident Self-Test Panoramic

Panoramic Imaging

Stress

Stress

XRes

Advanced Clinical Performance XRES

DICOM Networking

DICOM Networking

Color for 4D Imaging

4D Imaging

3D Fetal Echo STIC

3D Fetal Echo STIC

Contrast

Contrast

SonoCT

Advanced Clinical Performance

Vascular

Vascular Software Application Shared Services Clinical Option

OB/GYN

OB/GYN Software Application Shared Services Clinical Application

General Imaging

General Imaging Application Shared Services Clinical Application

Cardiac

Cardiac Software Application Shared Services Clinical Application

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You must install a software option before using it for the first time.

Application Package Options Each HD11 system includes one of the following four standard clinical software applications. You must purchase the clinical application package for each exam type that you want to perform. Cardiac—Includes adult and pediatric presets. Also includes physio (ECG), and cardiac calculations and analysis. General Imaging—Includes abdominal (including renal), musculoskeletal, small parts, prostate, and pediatric presets. OB/GYN—Includes obstetric, gynecological, endovaginal, and fetal echo presets. Also includes biopsy capabilities, OB/GYN calculations and analysis, and OB trending. Vascular—Includes presets for carotid, transcranial Doppler (TCD), and bilateral lower and upper extremities. Also includes physio (ECG), and vascular calculations and analysis.

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Installing Options When you receive your system, the options you purchased are installed and enabled.You can install new options and remove or disable options. ➤ To install, remove, or disable an option 1. Press Setup. 2. Click the Options tab. 3. Click the Options button. 4. In the Options window, do one of the following: –

To install an option with an access code, select an option, click Install, and type the access number.

–

To permanently remove an option, click Remove. A password is required to prevent accidental deletion of an option. Note the confirmation number.

–

To temporarily disable an option, deselect the appropriate check box. To re-enable an option, select the appropriate check box.

5. Click Apply. 6. Click OK. 7. Click Close. Information in the Status column in the Options window indicates the status of each application as follows: Not installed—An option that is not yet installed Permanent—An installed option Expires on [date]—A temporary option that expires on the specified date Expired—An expired temporary option Removed—A permanently deleted option

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Assigning Option Keys Before you use the Contrast Harmonic Imaging or Stress Echochardiography options that you have purchased separately, you must assign an option key to the application. The option keys are labeled Option 1 and Option 2. To use the application, press the option key assigned to the application. ➤ To assign an option key to Contrast Harmonic Imaging or Stress Echocardiography 1. Press Setup. 2. Click the Options tab. 3. On the Options tab, click Keyboard. 4. To assign an option key to an application, select the application from the appropriate menu. 5. Click OK. 6. Click Close.

System Settings On the System tab in the Setup window, you can change settings that affect the configuration of your system and that are not typically changed while scanning. You can save settings to a preset unless they are system-wide settings.

System-wide Settings You can change the following system-wide settings, but you cannot save them to a preset: ➤ Border and Prompts Determines the information that appears on the top of your display and the language name representation. Also allows you to disable or enable system prompts. ➤ Date/Time Sets the correct time and date.

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➤ Locale Changes settings, such as language or currency, for your location. ➤ DICOM Changes DICOM settings. See "DICOM Networking" on page 67 to learn more about changing these settings. ➤ Monitor Adjust Adjusts the contrast and brightness for the current lighting conditions. See "Adjusting the Monitor Display" on page 106. ➤ Dual Allows you to choose between Single Buffer and Two Buffer dual imaging. See "Activating Body Markers During Dual Imaging and Freeze" on page 109. ➤ Security Allows the system administrator to manage security settings, such as system timeouts and password requirements. ➤ Name Format Controls the format for displaying the patient name on the top border of the display and in the patient report. ➤ Backlight Level Controls the brightness of the backlighting on the control panel and keyboard. Settings are High, Medium, and Low. ➤ TEE Temperature Units Controls whether the TEE temperature is displayed in Celsius or Fahrenheit. ➤ Activate body marker during freeze and dual Controls whether or not a body marker automatically appears on the display during Dual Imaging and Freeze. ➤ Height/Weight Units Controls whether the height and weight units are displayed in Metric or English. HD11 User Reference 4535 611 65311

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Settings That Can Be Saved to a Preset You can change the following settings and save them to a preset: ➤ LGC Profile Display Controls whether or not a horizontal line, the LGC profile, appears on upper right corner of the display to indicate the LGC setting: On—The LGC profile always appears on the display. Off—The LGC profile does not appear on the display. Auto—The LGC profile appears on the display briefly while you are adjusting the LGC setting. ➤ TGC Profile Display Controls whether or not a vertical line, the TGC profile, appears on the upper right corner of the display to indicate the TGC setting: On—The TGC profile always appears on the display. Off—The TGC profile does not appear on the display. Auto—The TGC profile appears on the display briefly while you are adjusting the TGC setting. ➤ Thermal Index Controls the way the output power is measured and displayed: Normal—The most appropriate index based on the preset, transducer, and other factors TIS (thermal index: soft tissue)—Temperature rise in soft tissue TIB (thermal index: bone)—Temperature rise in deep bone TIC (thermal index: cranial)—Temperature rise at the surface ➤ Depth Marking Controls whether and where the depth markings appear: Off—No depth markings appear. Vertical—Depth markings appear on the right side of the display. 104

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Both—Depth markings appear to the left and the right of the image. Left—Depth markings appear to the left of the image. Right—Depth markings appear to the right of the image. ➤ Background Color Controls whether the display background is set to Black or Gray. ➤ Image Size Controls the size of the image displayed on the display. Choices are Large and Medium. Related Topics

Changing System Settings NOTE

You cannot save system-wide settings to a preset.

➤ To change system settings 1. Press Setup. 2. Click the System tab. 3. On the System tab, do one of the following: –

Click a button in the System Settings area, take the appropriate action in the dialog box that appears, and then click OK.

–

Click a radio button or check box to choose the setting you want.

4. If the setting you change can be saved to a preset, you are prompted to modify the current preset or create a new one. –

To apply the changes you made to the current state of the system and save them to a preset, click Save. If the current preset is a default preset, you are prompted to create a new preset.

–

To apply the changes you made to the current state of the system, but not to the current preset, click Apply.

5. Click Close.

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Adjusting the Monitor Display Every time the ambient light changes, adjust the contrast and brightness of the monitor display. ➤ To adjust the monitor contrast and the brightness 1. Press Setup. 2. Click the System tab. 3. Click Monitor Adjust. 4. Follow the instructions on the display. –

To adjust the monitor brightness, press the + key or the – key below the symbol on the front of the monitor.

–

To adjust the monitor contrast, press the + key or the – key below the symbol on the front of the monitor.

Selecting the Type of Dual Imaging The Dual Imaging setting is a system-wide setting. The most recently used setting is selected when you turn on your system. ➤ To select Single Buffer dual or Two Buffer dual imaging 1. Press Setup. 2. Click the System tab. 3. On the System tab, click Dual. 4. Select Single Buffer or Two Buffer. 5. Click OK. 6. Click Close.

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About Security Settings You can configure a variety of security settings on the HD11 system to protect patient information from unauthorized access. You access the security settings from the System tab in the Setup window. NOTES

•

•

The default administrator password is the system’s serial number, which can be found through the Options tab in the Setup window. See "Options" on page 99. Use this password to access the security settings on the system. Passwords are case sensitive. Note whether the keyboard Caps Lock is on or off when you create a new administrator or user password.

You can configure the following security settings: ➤ Password Protected Operations Controls whether or not the user is required to enter a case-sensitive password before being able to complete the action. When a user is logged on, they have access until they log off or are automatically logged off by the system. The user only needs to log in once, not each time a password-protected operation is used. The user can also login or logout by clicking the Login/Logout button on the Image Review toolbar. Password required to search for existing studies—The user is required to enter a password in order to have access to the Search for Studies and the Search for Patient Folder window in Image Review. Password required to enter a new patient—The user is required to enter a password in order to have access to the Patient Identification window. Password required to access the Modality Worklist—The user is required to enter a password in order to have access to the Modality Worklist. Set User Password—Enables the system administrator to create the user password that is required for the selected password protected operations. Only one user password can be created, which all users will share. ➤ Automatic Logoff Controls whether or not the user will be logged off the system if the system sits idle for a specified period of time. HD11 User Reference 4535 611 65311

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Automatically log off if idle for <specified> minutes (1-120)—Logs off the user if the system is idle for the specified number of minutes. The administrator can set the time-out from between one and 120 minutes. Automatically close in-progress study on automatic logoff—Available if the automatic logoff option is selected. Closes the in-progress study when the user is automatically logged off. The closed study will then be exported according to the selected Auto Store option in DICOM setup. If this option is not selected when the system automatically logs off a user, the system is locked from all access until the user password is entered or the system is powered down. See "Setting Up Automatic DICOM Export and Export Options" on page 74. ➤ Set Administrator Password Enables you to change the administrator password. If the administrator password is lost, contact your field service representative to obtain a temporary password to reset the password back to the serial number.

Changing the Background Color You can change the background color, that is, the color outside of the image. ➤ To change the background color 1. Press Setup. 2. Click the System tab. 3. On the System tab, select the appropriate Background color option: Black or Gray. 4. Click Apply or Save. 5. Click Close.

Changing the Image Size You can specify the size of the image. Your choices are Medium and Large. ➤ To change the image size 1. Press Setup. 2. Click the System tab.

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3. On the System tab, select the Large or the Medium option to specify the 2D image size. 4. Click Apply or Save. 5. Click Close.

Activating Body Markers During Dual Imaging and Freeze You can choose to have a body marker automatically appear on the display during dual imaging and Freeze (when you press the Left key, the Right key, or Freeze). ➤ To activate body markers during dual imaging and Freeze 1. Press Setup. 2. Click the System tab. 3. On the System tab, select Activate body marker during freeze and dual. 4. Click Apply or Save. 5. Click Close. NOTE

When you activate body markers during dual imaging and Freeze, the following occur: •

When you press Freeze, you must press Marker before using the trackball to scroll through the frames.

•

When you press the Left key or the Right key, a body marker appears on both images.

Mode Settings The Mode tab in the Setup window enables you to customize display layouts (formats) for M-mode and Spectral. It also enables you to change the settings for Doppler and trace modes.

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Changing the M-mode Format and the Doppler Settings ➤ To change the M-mode format and the Doppler settings 1. Press Setup. 2. Click the Mode tab. 3. On the Mode tab, select an M-mode format option: –

Small over large

–

Side by side

–

Full screen

4. Select a Doppler Spectral format option: –

Small over large

–

Large over small

–

Side by side

–

Full screen

5. Select a Doppler scale units option: –

kHz

–

cm/s

–

m/s

6. For PW Doppler mode, select an Optimum cursor angle option:

NOTE

110

–

0

–

50

–

55

–

60

–

65

If you select m/s or cm/s, the spectrum is measured as a velocity. If you select kHz, the spectrum is measured as a frequency.

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7. Select an AutoTrace Evaluation option: –

Above

–

Below

8. Select Scrolling Trace On or Off. 9. Select Adaptive Doppler On or Off. 10. Click Apply or Save. 11. Click Close.

Turning Adaptive Doppler On or Off Adaptive Doppler reduces the background noise in the spectral trace and in the audio. Adaptive Doppler is turned on by default on the HD11 system. ➤ To turn Adaptive Doppler on or off 1. Press Setup. 2. Click the Mode tab. 3. On the Mode tab, do one of the following: –

To turn Adaptive Doppler on, select the Adaptive Doppler check box.

–

To turn Adaptive Doppler off, deselect the Adaptive Doppler check box.

4. Click Apply or Save. 5. Click Close.

Controlling Spectral and M-mode Trace Scrolling You can control whether the spectral or M-mode trace is scrolling or nonscrolling. ➤ To control spectral trace scrolling 1. Press Setup. 2. Click the Mode tab.

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3. On the Mode tab, do one of the following: –

For a scrolling trace, select the Scrolling Trace check box.

–

For a nonscrolling trace, deselect the Scrolling Trace check box.

4. Click OK.

Changing the Spectral Trace Format You can specify the format of the Doppler display, which is how the spectral trace and the 2D reference image appear on the display. ➤ To change the spectral trace format 1. Press Setup. 2. Click the Mode tab. 3. On the Mode tab, select a Spectral format: –

Small over large

–

Large over small

–

Side by side

–

Full screen

4. Click Apply or Save. 5. Click Close.

Changing the Autotrace Evaluation Setting You can specify how much of the waveform is evaluated and used by Doppler Auto Trace and High Q Doppler Analysis. The Autotrace Evaluation setting takes effect when you unfreeze a waveform. You can change the Autotrace Evaluation setting in the Setup window or while imaging.

Specifying the Autotrace Evaluation Setting in the Setup Window ➤ To specify the Autotrace Evaluation setting in the Setup window 1. Press Setup. 2. Click the Mode tab.

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3. On the Mode tab, do one of the following to select the appropriate Autotrace Evaluation option: –

Above—Information above the baseline

–

Below—Information below the baseline

–

Both—Information above and below the baseline (non-cardiac presets only)

4. Click Apply or Save. 5. Click Close.

Changing the Autotrace Evaluation Setting While Imaging ➤ To change the Autotrace Evaluation setting while Imaging Press Ctrl+Q to cycle through the Autotrace Evaluation settings.

Changing the Default Tissue Doppler Setting The Default Tissue Doppler setting determines the type of Tissue Doppler imaging selected when you press the TDI key. ➤ To change the Default Tissue Doppler setting 1. Press Setup. 2. Click the Mode tab. 3. On the Mode tab, select a Default Tissue Doppler setting: –

Color

–

PW

–

PW and Color

4. Click Apply or Save. 5. Click Close.

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Controlling Cursor Tracking You can control whether or not the Color box or CPA box moves with the cursor. ➤ To turn Color and CPA cursor tracking on or off 1. Press Setup. 2. Click the Mode tab. 3. On the Mode tab, do one of the following: – To turn cursor tracking on, select the Color/CPA/Cursor Tracking check box. –

To turn cursor tracking off, deselect the Color/CPA/Cursor Tracking check box.

4. Click Apply or Save. 5. Click Close.

Turning the M-mode Reference Line On or Off You can choose to display or hide the M-mode reference line. ➤ To turn the M-mode reference line on or off 1. Press Setup. 2. Click the Measurements tab. 3. On the Measurements tab, do one of the following: –

To turn the M-mode reference line on, select the M-mode Ref Line check box.

–

To turn the M-mode reference line of, deselect the M-mode Ref Line check box.

4. Click Apply or Save. 5. Click Close.

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Label Settings The Label tab in the Setup window allows you to customize the labels that appear on the label menu when you are annotating an image. On the Label tab, you can add and delete labels, as well as rearrange the sequence of labels in the label menu for a given preset. NOTE

You cannot use parentheses in a label.

Editing the Label Menu ➤ To edit the label menu 1. Press Setup. 2. Click the Label tab. 3. On the Label tab, use the trackball to position the cursor on the list of labels. 4. Type a new label or delete or edit an existing label. 5. Click Apply or Save. 6. Click Close.

Measurements and Analysis Settings The Measurements tab in the Setup window enables you to customize a variety of measurement settings, including general measurement settings and settings specific to 2D mode, M-mode, and Doppler modes. The Analysis tab in the Setup window enables you to configure the measurement and calculation menus for different analysis packages and groups.

Specifying the Measurement Circumference Method You can specify the measurement circumference method for labeled measurements as either Manual Trace or Ellipse. ➤ To specify the measurement circumference method 1. Press Setup. 2. Click the Measurements tab. HD11 User Reference 4535 611 65311

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3. On the Measurements tab, select an option under Circumference Method: –

Manual Trace

–

Ellipse

4. Click Apply or Save. 5. Click Close.

Defaulting to Doppler Auto Trace If you want your system to automatically trace a Doppler spectrum the first time you press Trace in PW Doppler, select the Default to Doppler Auto Trace setting. ➤ To default to Doppler Auto Trace 1. Press Setup. 2. Click the Measurements tab. 3. On the Measurements tab, select the Default to Doppler Auto Trace check box. 4. Click Apply or Save. 5. Click Close.

Specifying the Measurement Caliper Connection You can select the type of line that connects measurement calipers. The setting applies to measurements in live imaging as well as measurements in Image Review. ➤ To specify the measurement caliper connection 1. Press Setup. 2. Click the Measurements tab. 3. On the Measurements tab, select a type of caliper connection under the Caliper Connection box:

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–

None

–

Dotted Line

–

Solid Line

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4. Click Apply or Save. 5. Click Close.

Choosing Quick Calcs You can specify which Quick Calcs appear in the results box for the current preset. ➤ To select which Quick Calcs appear in the results box 1. Press Setup. 2. Click the Measurements tab. 3. On the Measurements tab, click 2D, M-mode, or Doppler to configure the Quick Calcs that appear when you are in that mode. 4. Select the check boxes for the Quick Calcs that you want to see in the results box for the current preset when you are in the specified mode. 5. Click Apply. 6. Click OK. 7. Click Apply or Save. 8. Click Close.

Changing High Q Settings For High Q Doppler, you can specify the number of cycles used for the averaged measurements. You can also specify whether you want to display the peak trace, the mean trace, or both. ➤ To change High Q settings 1. Press Setup. 2. Click the Measurements tab. 3. To change the Number of Cycles Averaged, click the up arrow or the down arrow or type the number in the box. 4. To specify which trace or traces are displayed, select the check box for Display Peak Trace, Display Mean Trace, or both. HD11 User Reference 4535 611 65311

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5. Click Apply or Save. 6. Click Close. NOTES

• • •

•

ECG input is required for High Q Doppler (cardiac only). The High Q feature is only available in PW Doppler mode. Only those waveforms (peak trace or mean trace) that you selected on the Measurements tab are displayed in High Q Doppler and when you press Freeze. If you selected neither Peak Trace nor Mean Trace on the Measurements tab, press Freeze and then the Waveform soft key to view both waveforms.

Changing the Position of the Measurements Results Box You can specify which corner of the display you want the measurements results box to appear. ➤ To change the position of the measurements results box 1. Press Setup. 2. Click the Measurements tab. 3. On the Measurements tab, select an option from the Results Box Position list: –

Upper Lt

–

Upper Rt

–

Lower Rt

–

Lower Lt

4. Click Apply or Save. 5. Click Close. NOTE

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You can also change the position of the measurements results box while imaging.

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Customizing the Measurements and Calculations Menus You can select which labeled measurements and calculations appear in the Measurements and the Calculations menu for each application package and group. ➤ To customize the Measurements and Calculations menus 1. Press Setup. 2. Click the Analysis tab. 3. In the top left corner of the Analysis tab, select the application package and group whose menu items you want to change. 4. In the bottom right corner of the Analysis tab, click View. 5. In the Available box, select an imaging mode to filter the Measurements and Calculations lists in the Available list. 6. Add or remove measurements and calculations: –

To add measurements and calculations, select items in the Available box and click the left arrow button.

–

To remove measurements and calculations, select items in the In Menu box and click the right arrow button.

–

To remove all items from the list, click the double-right arrow button.

7. To resequence the menu items, select the calculation or measurement you want to move, hold the Enter key, and use the trackball to drag it to its new position on the list. 8. To reset the menu to the default list, click Default. 9. If you are in a Cardiac package/group, to configure protocol measurements: a. Click Protocol. b. Select the appropriate measurements in the Protocol Measurement Sequence Configuration window. c. Click OK.

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10. If you are in an OB/GYN package/group, to configure average ultrasound age measurements: a. Click AUA. b. Select the appropriate measurements in the AUA Component Configuration window. c. Click OK. 11. Click Apply or click Save to save your changes to a preset. 12. Click Close.

Analysis and Reports Application Package/Group List The following table lists the analysis packages and groups from which you can choose when customizing the Measurements and Calculations menus and when changing the Reports work area:

Cardiac/Adult

General/Prostate

Cardiac/Pediatric

General/Thyroid

Cardiac/Fetal Heart

General/Breast

Vascular/TCD

General/Testicular

Vascular/Carotid

General/Superficial

Vascular/UE Artery

General/Pediatric Hips

Vascular/UE Vein

OB/1st Trimester

Vascular/LE Artery

OB/2nd-3rd Trimester

Vascular/LE Vein

Gynecology

General/Abdomen

Musculoskeletal

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Obstetrics Settings In the Setup window, the Obstetrics tab enables you to add user-defined calculations and configure fetal weight tables.

Creating a User-Defined Calculation by Using a Formula You can create a calculation by using a formula. You can add the calculations that you create to the Calculations menu for OB/GYN. NOTES

•

•

You must define a gestational age (GA) calculation so that the answer is displayed in weeks. You must define a GA range calculation so that the answer is displayed in days. You cannot define range calculations for fetal weights or for ratios.

➤ To create a user-defined equation by using a formula 1. Press Setup. 2. Click the Obstetrics tab. 3. On the Obstetrics tab, under Calculation Type, select the type of calculation you want to create: –

Gestational Age

–

Fetal Growth

–

Fetal Weight

–

Ratio

4. Click the New Equation button. 5. In the Equation Editor window, type the name of the calculation in the Equation Name field. 6. Click an option button under Formula to specify whether the formula is a Value (weeks) or a Range (days).

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7. Generate the formula: a. Click the keypad to place numbers and mathematical operators in the formula. Or type the formula on the system keyboard. b. Select inputs to the formula from the Biometry menu. c. Click Edit Input Limits to edit input limits for the formula. 8. Click OK. 9. Click Apply or Save. 10. Click Close.

Creating a User-Defined Calculation by Using a Table When you are in an OB/GYN package/group, you can create an calculation by using a table. You can add the calculations that you create to the Calculations menu for OB/GYN package/group. You can use the table to calculate fetal growth. ➤ To create a user-defined calculation by using a table 1. Press Setup. 2. Click the Obstetrics tab. 3. On the Obstetrics tab, under Calculation Type, select the type of calculation you want to create: –

Gestational Age

–

Fetal Growth

4. Click New Table. 5. On the Table Editor window, type the name of the calculation in the Table Name field. 6. Select the biometry from the Biometry menu.

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7. Indicate how the age should be displayed by selecting the appropriate option under Display Age: –

Weeks

–

Weeks and Days

–

Days

8. Type values in the Measurement, GA, and Range columns. –

To type a value, click a table cell and then type the value.

–

To move between table cells, press Tab or the arrow keys.

–

To remove all of the values in the table, click Clear Table.

–

To add a row above the current row, click Insert Row.

–

To delete the current row, click Delete Row.

9. Click OK. 10. Click Apply or Save. 11. Click Close.

Editing a User-Defined Calculation After you create a calculation by using a formula or a table, you can modify the calculation. ➤ To edit a user-defined calculation 1. Press Setup. 2. Click the Obstetrics tab. 3. On the Obstetrics tab, under Calculation Type, select the type of calculation you want to edit: –

Gestational Age

–

Fetal Growth

–

Fetal Weight

–

Ratio

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5. In the Table Editor or Equation Editor window, select the calculation you want to edit from the Equation Name or the Table Name menu. 6. Make any necessary changes to the calculation. 7. Click OK. 8. Click Apply or Save. 9. Click Close.

Deleting a User-Defined Calculation You can delete a user-defined calculation that you created by using a formula or a table. ➤ To delete a user-defined calculation 1. Press Setup. 2. Click the Obstetrics tab. 3. On the Obstetrics tab, under Calculation Type, select the type of calculation you want to delete: 4. Click Delete Equation or Delete Table. 5. In the Table Editor or Equation Editor window, select the calculation you want to delete from the Equation Name or the Table Name menu. 6. Click Delete Calculation or Delete Table. 7. To confirm, click OK. 8. Click OK. 9. Click Apply or Save. 10. Click Close.

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Selecting Fetal Growth Graphs You can select the fetal growth graph used for each biometry. ➤ To select a fetal growth graph 1. Press Setup. 2. Click the Obstetrics tab. 3. On the Obstetrics tab, under Fetal Growth Graphs, select a graph for each biometry. 4. Click Apply or Save. 5. Click Close.

Setting Fetal Weight Options You can set the fetal weight to be calculated in metric or English units. ➤ To set the fetal weight options 1. Press Setup. 2. Click the Obstetrics tab. 3. On the Obstetrics tab, under Fetal Weight Options: –

Specify the weight units (grams or lbs/oz) under Units.

–

Select the Fetal Weight Percentiles check box if you want fetal weight percentiles to appear in the report.

4. Click Apply or Save. 5. Click Close.

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Acquisition Settings In the Setup window, the Acquisition tab allows you to control several settings related to image acquisition. Loop Duration—Enables you to specify whether loops will be acquired by Time (seconds, maximum of 30) or Beats (cardiac cycles, maximum of 10). Acquire Border—Enables you to specify whether or not the system will capture the blue borders when an image is captured. Switch to Review after acquire completes—Enables you to specify whether or not the system will transition either to live imaging or Image Review mode after an image is captured. Beep after acquire completes—Enables you to specify whether or not the system will play an audio tone whenever the system has successfully acquired a loop or frame. Display Warning Message—Enables you to specify whether or not the system will display a warning message when you press Acquire and you have not yet entered patient information for the active study. Disk Full Strategy—Enables you to specify the strategy the system uses when the disk is almost full.

Specifying Acquisition Preferences You can control some aspects of image acquisition. ➤ To specify acquisition preferences 1. Press Setup. 2. Click the Acquisition tab. 3. On the Acquisition tab, do any combination of the following:

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–

If you want the blue border around the image to be saved when you press Acquire, select the Acquire Border check box.

–

If you want to switch to Image Review after you press Acquire, select the Switch to Review after acquire completes check box.

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–

If you want to hear a beep after an image is acquired, select the Beep after acquire completes check box.

–

If you want to see a warning message if the patient’s last name isn’t entered when you press Acquire, select the Display warning message when Acquire control is pressed if patient last name is not entered check box.

4. Click Apply or Save. 5. Click Close. To learn about the Disk Full Strategy, see "Specifying the Disk Full Strategy" on page 128.

Setting the Duration of a Loop You can specify the duration (in seconds or number of heartbeats) of an acquired loop. ➤ To specify the length of a loop 1. Press Setup. 2. Click the Acquisition tab. 3. On the Acquisition tab, under Loop Duration, do one of the following: –

To define the length of the loop in seconds, select Time.

–

To define the length of the loop in number of heartbeats, select Beats.

–

To change the number of Seconds or Heartbeats, click the up arrow or the down arrow or type the number in the field.

4. Click Apply or Save. 5. Click Close.

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Specifying the Disk Full Strategy You can specify the strategy the system uses when the disk is almost full. You have two choices: •

The oldest studies are automatically deleted when the disk is almost full.

•

When you press Patient, you are automatically prompted to specify which studies to delete if the disk is almost full.

➤ To specify the disk full strategy 1. Press Setup. 2. Click the Acquisition tab. 3. On the Acquisition tab, click Disk Full Strategy. 4. Select the disk full strategy: –

Automatically delete the oldest studies

–

Prompt the user to manually delete studies

5. Click OK. 6. Click Apply or Save. 7. Click Close.

3D/4D Settings In the Setup window, the 3D/4D tab enables you to display or hide the distance ruler and the axis icon. You can control navigational crosshairs on the rendered 3D image and MPR images in 3D Render and 4D acquisition.

Changing the 3D/4D Settings ➤ To change the 3D/4D settings 1. Press Setup. 2. Click the 3D/4D tab. 3. To display the distance ruler instead of white selection brackets on each corner, select the Show Distance Ruler check box. 4. To display the axis icon, select the Show Axis Icon check box. 128

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5. To change the rendered 3D image crosshair setting, choose an option under Volume Graphics: –

Off

–

On

–

Crosshair

6. To change the MPR crosshair setting, choose an option under MPR Graphics: –

Off

–

Partial

–

Crosshair

7. Click Apply or Save. 8. Click Close.

Optical Disk, CD, and Peripherals Settings The Optical Disk tab in the Setup window enables you to view a list of the files on the MOD (browse the disk), as well as erase or format the disk. The CD tab enables you to view a list of the files on the CD and erase all the files from the CD (CD-RW only). You can also backup or restore your system settings to a CD-R or a CD-RW. The Peripherals tab enables you to: •

Specify which peripherals are attached to the system and specify the Record keys (Rec 1, Rec 2, Rec 3) that control them.

•

Install peripheral software drivers.

•

Set the VCR tape time.

•

Set display settings for record mode.

•

Assign the foot switch pedals to the Record (Rec 1, Rec 2, Rec 3) keys and the Freeze key.

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About Backup and Restore Options It is very important to back up the information on your system in case your system's memory fails for any reason.

Backing Up Presets and System Settings You need to back up the presets that you create. If you do not and your system's memory fails, you will need to re-create all of the presets you created. If you need to create more presets than you can store on your system, you can save the presets to a disk and restore them when you need to use them. Every time you back up presets, your system settings, user-defined calculations, printer and VCR settings, and options settings are automatically backed up. You can restore one or more of these at any time. To learn how to back up presets and settings, see "Backing Up Presets and Settings to a CD" on page 131.

Backing Up Patient Studies The data in your system's memory is temporary storage. You need to save any important patient data and images to an MO Disk, a CD-R or a CD-RW, or over a network. If your system's memory fails and you did not back up the patient folders, all patient information and images will be lost. To learn how to back up patient studies, see "Exporting Patient Studies" on page 430. NOTES

• • •

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The ability to export data over a network is a component of the DICOM Networking option. An optical disk drive is included with the DICOM Media option. If you have the DICOM Media option, you can export studies in DICOM format. Those studies can be viewed on any DICOM viewer. If you do not have the DICOM Media option, exported studies can only be viewed on HD11 systems.

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Backing Up Presets and Settings to a CD You should regularly back up your presets and settings. If your system's memory fails for any reason and you did not save your presets and settings to a disk, you will lose all of this information. You can create up to 20 presets for each exam type. If you need to create more presets, you can save presets to a CD-R or a CD-RW and restore them when you need to use them. ➤ To back up presets, system settings, printer and VCR settings, or options settings 1. Insert a CD-R or CD-RW into the CD drive. CAUTION

System settings, printer and VCR settings, and options that are already on the CD will be overwritten. If you try to save a preset with the same name as a preset already on the CD, you have to choose whether or not to overwrite the preset. 2. Press Setup. 3. Click the CD tab. 4. On the CD tab, click Backup. 5. In the Backup Settings window, do one of the following:

NOTE

–

Select the check boxes for the presets you want to save

–

Select the Select All check box

System settings, printer and VCR settings, options, and security settings are automatically saved. 6. Click Start. 7. Click Close.

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Restoring Presets and Settings from a CD ➤ To restore presets, system settings, VCR and printer settings, options, or security settings from a CD 1. Insert into the CD drive the CD-R or CD-RW that contains the presets or settings you want to restore. 2. Press Setup. 3. Click the CD tab. 4. On the CD tab, click Restore. 5. In the Restore Settings window, do one of the following: –

Select the check boxes for the presets you want to restore

–

Select the Select all check box

6. In the Restore Settings window, click the check boxes for the settings you want to restore:

NOTE

–

System settings

–

Printer and VCR settings

–

Options

–

Security settings

When you restore options, the system must have the same serial number as the system from which the backup was made. 7. Click Start.

NOTE

The display is blank for a moment while the system restores the presets or settings. 8. Click Close.

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Assigning Record Keys You must assign a Record key to each VCR, printer, and serial output cable that is connected to your system. The Record keys, which appear on the system control panel, are labeled Rec1, Rec2, and Rec3. ➤ To assign a Record key to a peripheral or to a serial output cable 1. Press Setup. 2. Click the Peripherals tab. 3. On the Peripherals tab, select from the menu the device that you want associated with each Record key. 4. Click Apply or Save. 5. Click Close. NOTE

Your Philips representative types a value for the Tape Time setting when installing peripherals. This setting determines the time displayed on the display when a videotape is inserted into the VCR. You can change this setting when you assign a Record key to a peripheral.

Setting the VCR Record Time Display You can set how the VCR tape time is displayed on your system: flashing, highlighted, or normal. ➤ To set how the VCR tape time is displayed 1. Press the Setup key. 2. Click the Peripherals tab. 3. In the Peripherals window, select the Record Display: –

Highlight—shows the tape time in reverse video

–

Flash—shows the tape time flashing

–

No Highlight—shows the tape time unhighlighted.

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About the Foot Switch The HD11 system foot switch has three pedals. Each pedal corresponds to a key on the system control panel. The foot switch pedals have different functions in different modes. The following table summarizes the foot switch functions:

Mode

Left Pedal

Middle Pedal

Right Pedal

2D

Rec1

Freeze

Rec2

3D

Rec1

Freeze

Acquire

Panoramic Imaging

Rec1

None

Acquire

Stress Echocardiography

None

Review

Acquire

You can change the configuration of the foot switch for 2D Mode. See "Configuring the Foot Switch" on page 134. NOTES

• •

The foot switch is an option that you can purchase separately. It is also included in the Stress Echo option. For the foot switch to function as described in the preceding table, the Stress Echo soft keys must be visible. To display the Stress Echo soft keys, press the Stress Echo option key.

WARNING

The foot switch supplied with the ultrasound system meets only drip-proof construction requirements and cannot be used in the operating room.

Configuring the Foot Switch You can use the foot switch during 2D imaging, 3D imaging, Panoramic imaging, and Stress imaging. You can change the default configuration for 2D imaging but not for the others. ➤ To configure the foot switch 1. Press Setup. 2. Click the Peripherals tab.

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3. On the Peripherals tab, in the Footswitch section, select a control panel key from the Left, Middle, or Right drop-down menu. The options are: –

Rec1

–

Rec2

–

Rec3

–

Freeze

4. Click Apply or Save. 5. Click Close. WARNING

The foot switch supplied with the ultrasound system meets only drip-proof construction requirements and may not be used in the operating room.

Installing Peripheral Software Drivers ➤ To install the software drivers for system peripherals 1. Press Setup. 2. Click the Peripherals tab. 3. On the Peripherals tab, click Install Software Drivers. 4. Do one of the following: –

Select the peripheral types in the Installation Groups Options box.

–

Click Select All to select all the options in the Installation Groups Options box.

5. Click OK. The drivers are installed and the Peripherals tab is displayed. 6. Click Close.

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Setting the VCR Display for Record Mode You can set how the VCR tape time is displayed on your system: flashing, inverse video, or normal. ➤ To set how the VCR tape time is displayed 1. Press the Setup key. 2. Click the Peripherals tab. 3. In the Peripherals window, select the timer display. 4. Click OK. 5. Click Close.

Using the VCR Soft Keys To change any of the soft key settings, press the soft key below the soft key label. Click the name of a soft key in the following list to learn about its function: ➤ External Video Use the External Video soft key to display VCR images from any VCR other than the Panasonic MD-835. ➤ FF/RW Use the FF/RW soft key to rewind or fast forward through the videotape. Press the up arrow to fast forward. Press the down arrow to rewind. ➤ Jog Use the Jog soft key to move forward or backward through the recording frame by frame. ➤ Play or Pause Use the Play soft key to play back what you recorded. Use the Pause soft key to pause the playback. ➤ Search Use the Search soft key to play the recording forward or backward at a high speed. 136

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➤ Stop Use the Stop soft key to halt the playback of the tape. ➤ Tape Find Use the Tape Find soft key to advance or rewind the videotape to a specified point. Press the Tape Find soft key while the search is in progress to cancel.

Language Input Settings You can enter patient information and annotation labels using any of your system’s input languages. In addition, on Japanese systems, you can use up to three name representation methods to enter information in the Patient Identification window: •

Roman

•

Ideographic

•

Phonetic

All representations of the patient information appear in the patient’s report. NOTE

To learn how to select input languages for your system, contact your Philips representative.

Changing the Input Language You can enter patient information and annotation labels using any of your system’s input languages. ➤ To change the current input language Press Alt+Shift to cycle through the available input languages. NOTE

To learn how to select input languages for your system, contact your Philips representative.

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Selecting the Name Representation for the Top Border On Japanese systems, you can specify the name representation for the information that appears in the top border of the display. ➤ To specify the name representation for the top border 1. Press Setup. 2. Click the System tab. 3. On the System tab, click Borders and Prompts. 4. In the Borders and Prompts window, click a Name Representation option button: –

Roman

–

Ideographic

–

Phonetic

5. Click OK. 6. Click Apply or Save. 7. Click Close.

Entering Japanese Characters in the Patient Identification Window On Japanese systems, option buttons appear in the Patient Identification window that allow you to enter patient information using up to three name representation methods: •

Roman

•

Ideographic

•

Phonetic

➤ To enter characters in the Patient Identification window 1. Enter the patient information normally. See "Creating a Patient Study" on page 399. 2. Click the Ideographic or Phonetic option button. 138

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3. Enter patient information by using the selected name representation method. All representations appear in the report. NOTES

• •

On a Japanese system, you must enter information by using the Roman method first. On a Chinese or Russian system, name representation buttons do not appear, but you can enter non-Roman characters in the Patient Identification window.

Displaying the Input Method Editor Status Window If the selected input language uses an input method editor (IME), the IME status window appears by default in Image Review and in the report. It does not appear by default in live imaging. ➤ To display or hide the IME status window Press the World key twice.

Physio (ECG) and Stress Settings In the Setup window, the Physio tab enables you to choose whether the ECG physio input, the auxiliary physio input, or the ECG and the auxiliary physio inputs appear on the display. You can also control the R-wave source and the R-wave beep when you use a 12-lead ECG, display the auxiliary physio input. The Stress tab in the Setup window enables you to activate stress protocols and to configure stress protocols and save them as presets. See "Stress Echocardiography" on page 255 for more details To perform a Stress Echocardiography study, you must display an ECG or an auxiliary physio input on the display. See "Changing Physio Settings" on page 141.

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Connecting the ECG Cable and Attaching the ECG Leads For the ECG physio inputs to appear on the display, you must connect the ECG cable and properly attach the ECG leads. WARNING

Do not use ECG patient cables with detachable lead wires that have exposed male pins. Electrocution can result if these pins are plugged into AC power. ➤ To connect the ECG cable and to attach the ECG leads 1. Plug the ECG cable into the port on the physio panel, which is under the CD drive and above the MOD drive. 2. Attach the ECG leads to the patient as shown in the following illustration:

A = Right arm B = Left leg C = Left arm NOTE

Although the lead placement does not match the anatomical labels on the leads, you need to attach the electrodes as shown to receive a good ECG signal. 3. Make sure the ECG signal appears properly on the display. If it does not, check the cable connections and the placement of the electrodes and leads.

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Using Physio Soft Keys ➤ To display the Physio soft keys Press Setup. The Physio soft keys appear on the display, under the Setup window. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Beats

Display Dialog

ECG Gain or Aux Gain

ECG Invert or Aux Invert

ECG Position or Aux Position

Select ECG or Select Aux

Sweep

Changing Physio Settings You can choose whether the ECG physio input, the auxiliary physio input, or the ECG and the auxiliary physio inputs appear on the display. You can also control the R-wave source and the R-wave beep. ➤ To change physio settings 1. Press Setup. 2. Click the Physio tab. 3. On the Physio tab, select either Display ECG or Display Aux, or both, to specify which input or inputs appear on the display. 4. Select the appropriate R-Wave Source and R-Wave Beep options. 5. Click Apply or Save. 6. Click Close.

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Triggering Triggering allows you to control how often and when an image is updated in live 2D mode or in Doppler mode. 2D image triggering can be set up to occur at specific time intervals or after a specified time period has elapsed since the occurrence of an ECG R-Wave peak. Doppler image triggering is automatically set by the system, depending upon whether or not an R-Wave is detected. When a triggered acquisition is in progress, the triggering icon appears to the right of the transducer depth on the display. NOTE

Triggering is not available in Stress Echocardiography.

Setting the Trigger Type in Doppler Modes In Doppler modes, the system selects the Trigger mode based on whether an R-wave is detected or not. If it is detected, Trigger mode is set to ECG; otherwise it is set to Timer.

Setting the Trigger Type in 2D Mode ➤ To set the Trigger in 2D mode Press Trigger to set the type of 2D image triggering:

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•

Off—Triggering is turned off and images are displayed in real time.

•

ECG—The live image is updated after a specified number of heart beats.

•

Timer —The live image is updated after a specified number of milliseconds.

•

Loop/ECG—The acquired loop, rather than the live image, is triggered. The system will acquire a frame for every nth heart beat, as specified in the setting.

•

Loop/Timer—The acquired loop, rather than the live image, is triggered. The system will acquire frames that occur between the specified number of milliseconds.

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NOTE

6

If a stress protocol is activated, Triggering is disabled no matter what state Trigger is set to. When the stress protocol is deactivated, Triggering is re-enabled in whatever state it was in before the protocol, unless stress is deactivated by a change in presets in which case triggering will be in whatever state the preset designates.

Changing Triggering Settings ➤ To change triggering settings 1. Press Setup. 2. Press Next to display the Triggering soft keys. NOTE

Triggering soft keys are displayed on the primary level if Contrast Harmonic Imaging is turned on, and the Physio soft keys are moved to the secondary level. 3. Press Trigger to turn triggering on or off and to specify the triggering mode. 4. Use the triggering soft keys to specify the triggering frequency and the ECG sweep speed. 5. Press Setup.

NOTE

When Trigger is set to Loop/ECG or Loop/Timer, you can press Acquire to stop the loop acquisition manually.

Using Triggering Soft Keys ➤ To display the Triggering soft keys 1. Press Setup. 2. Press Next. The Triggering soft keys appear on the display, under the Setup window. ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key.

Beats Sweep

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Delay

Update

7 Performing a Basic Exam This section provides a brief guide to performing a basic ultrasound exam on the HD11 system. You can learn more about specific imaging modes and features in the appropriate Help sections. ➤ To perform an exam 1. Enter or select patient information: a. Press Patient. If the Patient Selection window opens, select the patient from the Modality Worklist. See "Using Modality Worklist" on page 90 for more information. If the Patient Identification window opens, click New. b. Type the patient information in the Patient Identification window. c. To add other patient information relevant to the exam type, click the Additional tab. d. Click OK. 2. Choose a preset: a. Press Preset. b. Use the trackball to highlight the preset you want. If you need to see a list of exam types, highlight the exam type at the top of the menu and press Enter. c. Press Enter. 3. Select a transducer. Press Probe until the transducer you want to use is displayed on the right side of the display. The active transducer is listed under the preset name. 4. (Cardiac) Adjust the physio settings: a. Press Setup. b. Click the Physio tab.

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c. On the Physio tab, select either Display ECG or Display Aux, or both, to specify which input or inputs appear on the display. d. Select the appropriate options to turn the R-wave source on or off and to turn the R-wave beep on or off. e. Click Apply or Save. f. Click Close. 5. Optimize the image: a. Press iSCAN to automatically optimize the TGC, 2D Gain, and Compress settings. b. Adjust other settings as required: –

TGC slide controls

–

LGC slide controls

–

Gain

–

Depth

–

Focus

–

Zoom

–

Fusion

–

Tissue Harmonic fusion setting (THI)

6. Acquire an image. Do one of the following: –

Press Acquire to obtain a loop.

–

Press Freeze, and then press Acquire to obtain a still image.

–

Press Rec 1, Rec 2, or Rec 3 to send the image to a printer or the VCR.

7. Annotate the image: a. Press Text. b. Use the trackball to position the cursor on the image. c. Type the label on the image. d. Use the trackball to position the cursor at a new location on the image to add another label. Then type the label on the image. 146

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e. Press Text to exit. 8. Take measurements: a. Press Caliper. b. Use the trackball to position the caliper on the image. c. Press Select or Caliper to freeze the first caliper and bring up a second one. d. Position the second caliper on the image. e. Press Enter to freeze the second caliper.

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8 Imaging Modes The HD11 ultrasound system offers several imaging modes to accommodate a variety of imaging requirements. The following topics are covered in this section. •

"General Imaging Information" on page 149

•

"2D Mode" on page 153

•

"M-mode" on page 156

•

"PW Doppler Mode" on page 160

•

"CW Doppler Mode" on page 167

•

"Tissue Doppler Mode" on page 169

•

"Color Mode" on page 170

•

"Color Power Angio (CPA) Mode" on page 173

•

"3D/4D Mode" on page 176

•

"4D Imaging Mode" on page 199

•

"Fetal STIC" on page 203

General Imaging Information This section includes the following information: •

"Beginning an Exam" on page 150

•

"Acquiring an Image" on page 151

•

"Printing in Live Imaging" on page 151

•

"Resizing and Repositioning an Image" on page 152

•

"Moving a Reference Line" on page 152

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Beginning an Exam Before you begin acquiring images, you must create a patient study. If you do not, you cannot acquire images. ➤ To begin an exam 1. Enter or select patient information: a. Press Patient. –

If the Patient Selection window opens, select the patient from the Modality Worklist. See "Using Modality Worklist" on page 90 for more information.

–

If the Patient Identification window opens, click New.

b. Type the patient information in the Patient Identification window. c. To add other patient information relevant to the exam type, click the Additional tab. d. Click OK. 2. Choose a preset: a. Press Preset. b. Use the trackball to highlight the preset you want. If you need to see a list of exam types, highlight the exam type at the top of the menu and press Enter. c. Press Enter. 3. Select a transducer. Press Probe until the transducer you want to use is displayed on the right side of the display. The active transducer is listed under the preset name.

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Acquiring an Image You can acquire a single frame or an image loop. The loop or frame is saved in the patient study. If Automatic DICOM Export is on, images are automatically exported across the network when you press Acquire. See "Automatic DICOM Export" on page 72. ➤ To acquire an image Press the Freeze and then press Acquire. ➤ To acquire a loop Press Acquire in live imaging. NOTES

•

•

• •

When it is possible to acquire an image, the acquisition icon (a small, open box) appears on the bottom right corner of the display to the right of the transducer frequency and depth. When an image is acquired, the system beeps to confirm that the loop or frame was saved in the patient's study, if you have selected Beep after acquire completes in your Acquisition preferences. Do not press Review until you hear the beep. See "Specifying Acquisition Preferences" on page 126. If you press Acquire while a live M-mode or Doppler trace is displayed, you acquire an image, not a loop. Automatic DICOM Export is a component of the DICOM Networking option.

Printing in Live Imaging You must assign a Record key to a printer or a VCR before you can use it. See "Assigning Record Keys" on page 133. ➤ To print an image Press the Record key assigned to the printer you want to use. During printing, a printer icon appears and the soft keys disappear. You cannot start printing again until the printer icon is removed from the display.

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NOTES

• • • •

To learn how to print images to a DICOM printer when you press Acquire, see "Setting Up Automatic DICOM Printing" on page 83. The ability to print to a networked DICOM printer is a feature of the DICOM Networking option. You cannot assign a Record key to a DICOM printer. Pressing the Record key assigned to a VCR begins a VCR recording.

Resizing and Repositioning an Image You can resize an image. If an image is not full size, you can change its position.

Resizing an Image ➤ To resize an image 1. Press Select until Size is highlighted on the Select menu. 2. Use the trackball to change the size of the image.

Repositioning an Image ➤ To reposition an image 1. Press Select until Position is highlighted on the Select menu. 2. Use the trackball to reposition the image. NOTE

Position only appears on the Select menu if the image is not full size. You cannot reposition a full-size image.

Moving a Reference Line A 2D reference line appears in cardiac presets, an M-mode reference line appears in M-mode, and a Doppler reference line appears in Doppler mode. ➤ To move the reference line 1. Press Select until Line is highlighted on the Select menu. 2. Use the trackball to move the reference line.

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NOTE

8

The CW Doppler transmit and receive focus is indicated by a small focus diamond on the CW reference line. Use the trackball to move the CW Doppler transmit and receive focus and the reference line as one unit.

2D Mode In 2D mode, the image is displayed in grayscale. You can use the 2D control as an “exit” key from any other mode. When you press 2D, you exit the current mode and return to 2D mode with the previous 2D settings restored. The 2D control is unique in this “exit” behavior.

Using 2D Mode ➤ To use 2D mode 1. Press 2D. 2. Adjust the following controls to optimize the image: –

2D GAIN

–

Depth and Focus

–

LGC and TGC

3. To change the appearance of your image, use the soft keys. 4. To change the fusion setting, press Fusion. 5. To change the size of the image, press Select to highlight Size on the Select menu. Then use the trackball to resize the image. 6. If you are using a linear transducer, turn the Angle knob to steer the 2D image. 7. To exit 2D mode, press a key for any other imaging mode.

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Fusion Settings Fusion settings control the transmit and receive frequencies for the transducer. Each fusion setting is optimized for one or more of the following: •

Penetration (P)

•

General (G)

•

Resolution (R)

Fusion settings apply to: •

2D mode

•

Tissue Harmonic Imaging

•

Contrast Harmonic Imaging

The number of available fusion settings depends on the transducer and mode you are using. In 2D mode, you can choose from a maximum of five fusion settings. In Tissue Harmonic imaging and in Contrast Harmonic Imaging fewer settings may be available.

Fusion Icons A fusion icon appears on the lower left corner of the display. This icon summarizes information about the fusion setting. The following table shows representative icons used for each imaging mode: Mode 2D mode

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Icon

Description The transducer is transmitting and receiving over a range of 1.6 to 4.3 MHz. The dark portion near the G indicates that the Fusion setting is optimized for General.

Imaging Modes

Tissue Harmonic Imaging

8

The transducer is transmitting at 1.9 MHz and is receiving at 3.8 MHz. The circle around the R indicates that the Fusion setting is optimized for Resolution. The transducer is transmitting at 2.1 MHz and is receiving at 4.2 MHz. The circles around the G and the R indicate that the Fusion setting is optimized for General and Resolution. This icon is used for enhanced Pulse Inversion.

Contrast Harmonic Imaging

The transducer is transmitting at 1.8 MHz and is receiving at 3.6 MHz. The circle around the P indicates that the Fusion setting is optimized for Penetration. The transducer is transmitting at 1.8 MHz and is receiving at 3.6 MHz. The circle around the P indicates that the Fusion setting is optimized for Penetration. This icon is used for enhanced Pulse Inversion.

NOTE

The transmit and receive frequencies depend on the current preset and transducer.

Using 2D Soft Keys Soft key availability is transducer and preset dependent. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key. Biopsy

Chroma

Compress

Edit End

Edit Start

Focal Zones

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L/R Invert

Map

Persist

Replay

Smooth

SonoCT

Trap

U/D Invert

XRes

M-mode In M-mode, you can learn about the movement of an area of anatomy. It involves two steps: •

Position the M-mode reference line in the 2D image on the anatomy of interest.

•

The system displays information about movement along that line in an M-mode trace.

An M-mode trace can be helpful when you perform measurements, especially heart rate. You can also work in Color mode when in M-mode.

M-mode Zoom When you are in M-mode and Zoom at the same time, only the part of the M-mode line that falls within the Zoom box is used to supply data for the M-mode trace. The area of the anatomy displayed in the 2D image aligns with the area of the anatomy captured in the M-mode trace. Both the 2D image and the M-mode trace are zoomed. You cannot use Magnify while an M-mode trace is displayed. If Magnify is on with a 2D image, it is temporarily turned off while an M-mode trace is displayed. Magnify is turned back on after M-mode is turned off.

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Using M-mode ➤ To use M-mode 1. Do one of the following: –

If you are in a non-cardiac preset, press Mmode to enter M-mode Preview. An M-mode reference line appears on the 2D image. Use the trackball to move the M-mode reference line to the anatomy of interest. Press Mmode.

–

If you are in a cardiac preset, use the trackball to move the 2D reference line to the anatomy of interest. Press Mmode.

The M-mode trace appears with the 2D reference image. NOTE

If Magnify was applied to the 2D image, it is automatically turned off while the M-mode trace is displayed. 2. To change the travel speed of the scrolling trace, press Sweep. 3. To change the appearance of your M-mode trace, use the soft keys. The soft keys available to you depend on the term that is highlighted on the Select menu. –

M-mode soft keys are available when Line is highlighted.

–

2D soft keys are available when Size or Position is highlighted.

4. To review the M-mode trace, press Freeze, and use the trackball to scroll forward or backward. 5. To exit M-mode, press Mmode or 2D.

Using M-mode Soft Keys Soft key availability is transducer, preset, and mode dependent. ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key. B/W Suppress

XRes

Sweep

Filter

Chroma

Compress

Map

Frequency

L/R Invert

Persist

Map Invert

Packet

SonoCT

Priority

Smooth

About the M-mode Format You can specify the format of the M-mode display, which is how the M-mode trace and the 2D reference image appear on the display. You have the following three options: •

Small over large—The small 2D reference image appears above the large M-mode trace.

•

Side by side—The M-mode trace and the 2D reference image appear next to each other.

•

Full screen—A full-screen M-mode trace appears. A very small reference image appears in the corner.

About M-mode Trace Scrolling You can control whether the M-mode trace is scrolling or nonscrolling.

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Scrolling trace—While the trace is live, it moves from right to left, with new data appearing at the right margin.

•

Nonscrolling trace—An erase bar slides from left to right across the trace, with new data appearing just to the left of the erase bar.

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About Color M-mode You are in Color M-mode when you are in Color mode and M-mode at the same time. In Color M-mode, a color box appears on the 2D reference image, and information about color flow along the entire M-mode reference line appears in the M-mode trace. The position of the color box in the 2D reference image does not affect the color information displayed in the M-mode trace.

Using Color M-mode ➤ To use Color M-mode 1. Do one of the following: –

If you are in a non-cardiac preset, press Mmode to enter M-mode Preview. An M-mode reference line appears on the 2D image. Use the trackball to move the M-mode reference line to the anatomy of interest.

–

If you are in a cardiac preset, use the trackball to move the 2D reference line to the anatomy of interest.

2. Press Color. 3. Press Mmode. NOTE

If you want, you can press Mmode before pressing Color. 4. To change the travel speed of the scrolling trace, press Sweep. 5. To change the appearance of your M-mode trace, use the soft keys. The soft keys available to you depend on the term that is highlighted on the Select menu. –

M-mode soft keys are available when Line is highlighted.

–

Color Mode soft keys are available when Size or Position is highlighted.

6. To review the M-mode trace, press Freeze, and use the trackball to scroll forward or backward. 7. To exit Color M-mode, press Mmode or 2D. HD11 User Reference 4535 611 65311

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PW Doppler Mode Pulsed-Wave (PW) Doppler mode measures velocity in a PW sample volume gate and displays that information in a spectral trace with audio output. PW Doppler mode is available only with transducers that support PW Doppler.

Using Doppler Soft Keys The following sections list the soft keys available in different Doppler modes.

Doppler Preview Soft Keys (PW, TDI) The following soft keys may appear in PW Doppler mode or in Tissue Doppler Preview mode, depending upon the selected transducer, preset, or specific function when Gate is selected on the Select menu (as the trackball function). ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Audio

Gate

Spectral Doppler Soft Keys (PW, CW, TDI) The following soft keys may appear in Doppler in live spectral mode, depending upon the selected transducer, preset, or specific function when Gate or Line is selected on the Select menu (as the trackball function). When Size or Position is selected on the Select menu, the soft keys relate to 2D, Color, or CPA modes and are described in their respective sections. ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key.

2D Hold

Chroma

Compress

Delay

Duplex

Filter

Frequency

Gate

Reject

Smooth

Spectral Invert

Steer

Sweep

Triplex

Update

Doppler Freeze Soft Keys (PW, CW, TDI) The following soft keys may appear in Doppler freeze mode, depending upon the selected transducer, preset, or specific function when Trace is selected on the Select menu (as the trackball function). When Image is selected in the Select menu, the soft keys relate to 2D, Color, or CPA modes and are described in their respective sections. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Chroma

Compress

Reject

Waveform

Map

Using PW Doppler Mode ➤ To use PW Doppler mode 1. Press PW. A PW cursor line and an angle-to-flow arrow appear on the 2D image. The PW sample volume gate lies on the PW cursor line. This is PW Doppler Preview. 2. Use the trackball to place the PW sample volume gate in the vessel. 3. To adjust the width of the PW sample volume gate, press Gate. HD11 User Reference 4535 611 65311

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4. Press PW, Enter, or the Update key. A PW spectral trace appears with a 2D reference image. This is PW Spectral Doppler. 5. To adjust the volume of the Doppler audio, turn the Volume knob. 6. To adjust the angle-to-flow arrow, turn the Angle knob. NOTE

Pressing the Angle knob selects 60, -60, or 0 degrees for the angle-to-flow arrow. 7. To adjust the spectrum, use the Color/Doppler Gain knob and the Scale and Baseline controls. 8. To optimize the spectral trace, use the soft keys and the iSCAN control. If you are in Color PW Doppler mode or Color Power Angio PW Doppler mode, the soft keys available to you depend on the item that is highlighted on the Select menu. –

PW Doppler soft keys appear when Gate is highlighted.

–

2D, Color Mode, or Color Power Angio (CPA) soft keys appear when Size or Position is highlighted.

9. To control whether the 2D reference image or the PW spectral trace is live, press Enter or the Update key. 10. To scroll the spectral trace, press Freeze and use the trackball to scroll forward or backward. 11. To exit PW Doppler, press PW or 2D. NOTE

If you press the Update key when you are in 2D mode, the system enters PW Spectral Doppler.

Repositioning the PW Sample Volume Gate ➤ To reposition the PW sample volume gate 1. Press Select until Gate is highlighted on the Select menu. 2. Use the trackball to reposition the PW sample volume gate. 162

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Changing Doppler Settings You can change the following Doppler settings: •

Optimum cursor angle

•

Doppler scale units

•

Spectral format

•

Autotrace Evaluation

•

Scrolling Trace

•

Adaptive Doppler

Turning Intelligent Doppler On or Off When Intelligent Doppler is on, turning the Angle knob moves the PW cursor line whenever the angle-to-flow arrow is moved to maintain an optimum cursor angle between the angle-to-flow arrow and the direction of PW cursor line. You select the optimum cursor angle on the System Setup window. ➤ To turn on Intelligent Doppler 1. If PW Doppler is off, press PW. 2. Press Steer. 3. Select the Auto setting. Intelligent Doppler is only available in PW Doppler with linear transducers.

About High Pulse Repetition Frequency Doppler Mode High Pulse Repetition Frequency (HPRF) Doppler mode is a system-mediated Doppler mode, based on PW Doppler. Pulse repetition frequency (PRF) and the transducer frequency determine the maximum velocity that can be measured using PW Doppler mode. These relationships come into play especially when attempting to record and to measure increased velocities that might occur in the case of an obstructive lesion such as a valvular or subvalvular stenosis. Above the Nyquist limit aliasing occurs. Aliasing is an ambiguous display of velocities, which have exceeded the Nyquist Limit. Forward velocities may be displayed below the zero line, or vice versa. HD11 User Reference 4535 611 65311

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HPRF extends the ability of the system to accurately measure high velocity at a given depth by establishing additional gates with echoes that coincide with the selected gate echoes. The additional gates are shown on the display as smaller sample volume gates along the Doppler line.

About Nonimaging Doppler Tips for using nonimaging transducers with Doppler: •

If you are using a nonimaging transducer that supports only CW Doppler, the system is automatically in CW Spectral Doppler mode.

•

If you are using a nonimaging transducer that supports only PW Doppler, the system is automatically in PW Spectral Doppler mode.

•

When you are using a nonimaging transducer that supports CW Doppler and PW Doppler, press CW or PW to switch between CW Doppler mode and PW Doppler mode.

•

When you use a nonimaging transducer, no reference image appears.

•

The Update key is inactive when you are using a nonimaging transducer.

•

PW Gate depth and size are available.

Optimizing Doppler Trace Settings with Doppler iSCAN Intelligent Optimization Doppler iSCAN Intelligent Optimization automatically optimizes key imaging settings during Doppler Trace acquisition. Doppler iSCAN optimization allows you automatically optimize the Doppler Trace settings by pushing one button. Instead of manually adjusting the Doppler velocity scale and baseline settings, which may need several adjustments, you can press iSCAN once. Doppler iSCAN optimization is available only when the system is in PW or CW Doppler mode and the spectral trace is live.

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Using Doppler iSCAN Optimization ➤ To use Doppler iSCAN optimization Press iSCAN. After the iSCAN button is pressed, a progress notification message appears on the display. While Doppler iSCAN is in progress, the system freezes the area of the display. When the optimal settings are determined, the progress notification message is removed, and the trace area returns to a live state.

About Duplex and Triplex Duplex enables you to simultaneously display a live 2D image and a PW spectral trace. Triplex enables you to simultaneously display a live 2D image with color or CPA and a PW Doppler trace.

Tips for Using Duplex and Triplex •

Duplex and Triplex are only available with transducers that support PW Doppler mode.

•

Triplex is not available with cardiac presets.

•

Duplex is only available with cardiac presets when PW Tissue Doppler is on.

•

Being in Duplex and Triplex limits the Doppler pulse repetition frequency (PRF), which limits the maximum velocity of blood flow that can be measured without aliasing. When you are in Duplex or Triplex, the displayed velocity scale may automatically be reduced.

Using Duplex ➤ To use Duplex 1. While in PW Doppler mode, press the Duplex soft key. 2. Do one of the following: –

To exit Duplex and remain in spectral Doppler, press the Duplex soft key again.

–

To exit spectral Doppler, press any 2D in PW. HD11 User Reference 4535 611 65311

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NOTE

If the system is in Duplex and you press Color or Angio, the system enters Triplex.

Using Triplex ➤ To use Triplex 1. While in PW Doppler mode, press Color or Angio. 2. Press the Triplex soft key. 3. Do one of the following: – To exit Triplex and remain in spectral Doppler, press the Triplex soft key again. – To exit spectral Doppler, press 2D or PW. NOTE

If the system is in Triplex mode and you press Color or Angio, you enter Duplex mode.

Using Duplex Soft Keys The soft keys available to you depend on the term that is highlighted on the bottom right corner of the display. In Duplex, PW Doppler soft keys appear when Gate is highlighted on the Select menu. See the Glossary to learn about the function of each soft key.

Chroma

Compress

Focal Zone

L/R Invert

Map

Persist

Smooth

SonoCT

U/D Invert

XRes

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Using Triplex Soft Keys The soft keys available to you depend on the term that is highlighted on the bottom right corner of the display. In Triplex: •

PW Doppler soft keys appear when Gate is highlighted on the Select menu.

•

Color Mode or Color Power Angio soft keys appear when Size or Position is highlighted on the Select menu.

➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key. B/W Suppress

Density

Filter

Frequency

Map

Map Invert

Packet

Persist

Priority

Smooth

XRes

CW Doppler Mode Continuous-Wave (CW) Doppler mode measures velocity along a Doppler line and displays that information in a spectral trace with audio output. CW Doppler mode is available only with transducers that support CW Doppler.

Using CW Doppler Mode ➤ To use CW Doppler mode 1. Do one of the following: –

If you are in a non-cardiac preset, press CW. A CW reference line appears on the 2D image. This is CW Doppler Preview.

–

If you are in a cardiac preset, you do not need to press CW. A 2D reference line appears on the 2D image.

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2. Use the trackball to move the focus diamond on the reference line to the anatomy of interest. 3. Press CW. From CW Doppler Preview, you can alternatively press Enter, CW, or the Update key. A CW spectral trace appears with a 2D reference image. This is CW Spectral Doppler. 4. To change the appearance of your image, use the soft keys. If you are in Color CW Doppler mode or Color Power Angio CW Doppler mode, the soft keys available to you depend on the term that is highlighted on the bottom right corner of the display. –

CW Doppler soft keys appear when Line is highlighted.

–

2D, Color Mode, or Color Power Angio (CPA) soft keys appear when Size or Position is highlighted on the Select menu.

5. To scroll the spectral trace: a. Press Freeze and use the trackball to scroll forward or backward. b. Press Select until Trace is highlighted on the Select menu. 6. To specify whether the 2D reference image or the CW spectral trace is live, press Enter or the Update key. The soft keys affect the element that is live. 7. To exit CW Doppler mode, press 2D or CW. NOTE

If you press Update when the system is in 2D mode, the system enters PW Spectral Doppler mode.

About Spectral Trace Scrolling You can control whether the spectral trace is scrolling or nonscrolling on the Setup Mode window.

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Scrolling trace—While the trace is live, it moves from right to left, with new data appearing at the right margin.

•

Nonscrolling trace—An erase bar slides from left to right across the trace, with new data appearing just to the left of the erase bar.

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About the Spectral Trace Format You can specify the format of the Doppler display on the Setup Mode window. This specifies how the spectral trace and the 2D reference image appear on the display. You have four options: •

Small over large—The small 2D reference image appears above the large Doppler trace.

•

Large over small—The large 2D reference image appears above the small Doppler trace.

•

Side by side—The Doppler trace and the reference image appear next to each other.

•

Full screen—A full-screen Doppler trace appears. A very small reference image appears in the corner.

Tissue Doppler Mode Tissue Doppler optimizes settings to measure the movement of tissue by using color or pulsed-wave Doppler. Tissue Doppler imaging is available only with: •

Adult cardiac presets

•

Sector transducers in those presets.

You can choose one of the following types of Tissue Doppler imaging to be the default: •

Color Tissue Doppler

•

PW Tissue Doppler

•

Color PW Tissue Doppler

The default Tissue Doppler setting determines the type of Tissue Doppler imaging selected when you press the TDI key. You can also activate Color M-mode Tissue Doppler ➤ To activate Color M-mode Tissue Doppler 1. Turn on Color Tissue Doppler. 2. Turn on M-mode. HD11 User Reference 4535 611 65311

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Using Tissue Doppler Imaging ➤ To use Tissue Doppler imaging 1. Press TDI. Depending on the default Tissue Doppler imaging setting, you are in one of the following modes:

NOTE

–

Color Tissue Doppler mode

–

Color PW Tissue Doppler mode

–

PW Tissue Doppler mode

To enter Color M-mode Tissue Doppler mode, you must press Mmode. You cannot enter Color M-mode Tissue Doppler mode by default. 2. You can switch from one type of Tissue Doppler imaging to another: –

To switch between Color Tissue Doppler and Color PW Tissue Doppler, press PW.

–

To switch between Color Tissue Doppler from Color M-mode Tissue Doppler, press Mmode.

–

To switch between PW Tissue Doppler and Color PW Tissue Doppler, press Color.

3. Press 2D or TDI to exit Tissue Doppler imaging mode.

Color Mode In Color mode, a color box appears on the image. The velocity and direction of flow in the color box are represented with different colors for direction and different shades for velocity. The colors being used appear in the color bar in the upper right corner of the display. Turning on Color mode turns off Color Power Angio (CPA) mode, but does not turn off M-mode, PW Doppler mode, or CW Doppler mode.

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Using Color Mode ➤ To use Color mode 1. In 2D mode, optimize the image. 2. Resize and reposition the 2D image by using the trackball. 3. Press Color. 4. Resize and reposition the color box by using the trackball. 5. Adjust the Baseline, Color Gain, and Scale if necessary. 6. Change the appearance of your image by using the soft keys. 7. If you are using a linear transducer, use the Angle knob to steer the color box. 8. To exit Color mode, press Color or 2D.

Resizing and Repositioning an Angio, a Color, an ROI, or a Zoom Box ➤ To resize a box 1. Press Select until Size is highlighted on the Select menu. 2. Change the size of the box by using the trackball. ➤ To reposition a box 1. Press Select until Position is highlighted on the Select menu. 2. Reposition the box by using the trackball. NOTE

If you change the size or position of an angio or a color box, the 2D image will, if necessary, move or become larger to accommodate it.

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Using Color Suppress Color Suppress temporarily removes color data from a frozen color image without exiting Color mode. ➤ To use Color Suppress 1. While in Color mode, press Freeze to freeze the image. 2. Press Color. Color data is removed from the image. 3. Press Color again to bring color data back to the frozen image. 4. Press Freeze to return to live imaging.

About Color Compare Color Compare shows two versions of the same live image, side-by-side on the display. The right-hand image displays color; the left-hand image has color suppressed. Color Compare is similar to and uses the same controls as Dual Imaging. Color Compare is available in live imaging in the following modes: •

Color

•

Color Power Angio imaging

•

Tissue Doppler Imaging

Using Color Compare ➤ To use Color Compare 1. While you are viewing a live image in Color mode, press Dual. 2. If you are using Two Buffer, press the key for the displayed buffer. Two images appear: an image that shows color flow on the right and a color-suppressed version of the same image on the left. 3. To transition to standard "Dual Imaging" on page 215, press Dual again. 4. If you are using Two Buffer, press the key for the displayed buffer. 5. To exit Color Compare, press 2D. 172

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Using Color Soft Keys Soft key availability is transducer and preset dependent. ➤ To change any of the soft key settings Press the key below the soft key label.

See the Glossary to learn about the function of each soft key. B/W Suppress

Density

Filter

Frequency

Map

Map Invert

Packet

Persist

Priority

Smooth

XRes

Color Frozen Soft Keys Soft key availability is transducer and preset dependent. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key. Chroma

Edit End

Edit Start

Map

Map Invert

Replay

XRes

Color Power Angio (CPA) Mode In Color Power Angio mode, an angio box appears on the image. The amplitude (intensity) of flow in the angio box is represented with different hues. The colors being used appear in the color bar on the upper right corner of the display. Turning on Color Power Angio mode turns off Color mode and M-mode, but does not turn off PW Doppler mode or CW Doppler mode.

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Using Color Power Angio Mode ➤ To use Color Power Angio mode 1. In 2D mode, optimize the image. 2. Resize and reposition the 2D image by using the trackball. 3. Press CPA to enter Color Power Angio mode. 4. Resize and reposition the angio box by using the trackball. 5. Adjust the Baseline, CPA Gain, and Scale if necessary. 6. To change the appearance of your image, use the soft keys. 7. If you are using a linear transducer, use the Angle knob to steer the angio box. 8. To exit Color Power Angio mode, press CPA or 2D.

Using Color Power Angio Suppress Color Power Angio Suppress temporarily removes angio data from a frozen angio image without exiting Color Power Angio mode. ➤ To use Color Power Angio Suppress 1. While in Color Power Angio mode, press Freeze to freeze the image. 2. Press CPA to remove Angio data from the image. 3. Press CPA again to bring angio data back to the frozen image. 4. To return to live imaging, press Freeze.

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Using Color Power Angio Compare Color Power Angio Compare shows angio flow on the right-hand image and a flow-suppressed version of the same image on the left. ➤ To use Color Power Angio Compare 1. While you are viewing a live image in Color Power Angio mode, press Dual. 2. If you are using Two Buffer, press the key for the displayed buffer. Two images appear: an image that shows angio flow on the right and a flow-suppressed version of the same image on the left. 3. To transition to Dual Imaging, press Dual again. 4. If you are using Two Buffer, press the key for the displayed buffer. 5. To exit Color Power Angio Compare, press 2D.

Using Color Power Angio (CPA) Soft Keys Soft key availability is transducer and preset dependent. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key. B/W Suppress

Density

Filter

Frequency

Map

Priority

Packet

Persist

Smooth

XRes

Color Power Angio (CPA) Frozen Soft Keys Soft key availability is transducer and preset dependent. ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key. Chroma

XRes

Edit Start

Map

Edit End

Replay

3D/4D Mode The HD11 3D/4D application supports both freehand and motorized image acquisition, and it has a special feature to capture fetal heart images (Fetal STIC).

3D/4D Acquisition and Transducers Freehand acquisition is supported on all hand-held imaging transducers. TEE transducers are not supported. Motorized acquisition requires transducers that support motorized 3D acquisition. These transducers support the following modes of operation: •

3D mode, also called single sweep, in which a single volume is acquired

•

4D mode, also called Live 3D mode, in which a stream of volumes are acquired and rendered live

•

Fetal STIC mode, in which multiple fetal heart cycles are acquired in a single sweep of a motorized transducer.

3D/4D and Other Modes and Features •

3D acquisitions can be made in grayscale, Color, and Color Power Angio (CPA) modes.

•

4D mode is restricted to grayscale imaging.

•

Both 3D and 4D can be combined with Zoom.

About 3D Volume Data Sets In 3D/4D acquisitions, you acquire a series of 2D images, form which one or more volumes, or 3D data sets, are constructed. The system processes this 3D data set and produces multiplanar reformatted image (MPR) views and the rendered 3D image.

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The rendered 3D image presents information with depth as well as height and width, enabling you to visualize the region of interest in 3D. You can review and edit the 3D volume data.

Managing 3D Data Sets You can save the MPR and the 3D image with or without its associated data set. If you are exporting studies to a PACS, you might not want to send the data set because the files are large and may not be compatible with your DICOM viewer. To learn how to set up your system to handle 3D data exporting, see "Setting Up Automatic DICOM Export and Export Options" on page 74.

About Acoustic Artifacts in 3D Imaging Resolution, attenuation, and propagation artifacts are all common to 3D imaging. Careful scrutiny of the original 2D image planes is necessary to identify and preclude these types of artifacts from the 3D volume image. Color gain, directional, and motion artifacts can present themselves in 3D imaging. Color and Color Power Angio gain artifacts are mainly related to the use of excessive gain resulting in random color patterns in the 3D image that might be interpreted as diagnostically significant. Directional artifacts are due to aliasing or directional confusion: The velocity range must be set properly, and the relationship between the transducer orientation and the flow vector must be understood. Motion artifacts in 3D volumes can be caused by fetal movement, cardiac motion, and the movement of adjacent structures. Patient motion can produce flash artifacts that are less obvious in 3D imaging than in 2D imaging. Acquisition, rendering, and editing artifacts are specific to 3D volume images. Acquisition artifacts are related to patient motion, organ motion, or position-sensing errors. Rendering artifacts include elimination of structures by limiting the region-of-interest (ROI) boundaries, thresholding that eliminates structures, and adjacent structure artifacts that add additional information or hide structures. Editing artifacts result from data deleted from a rendered image. Limb deficit artifacts are specific to 3D volume images. In some studies, partially absent fetal limb bones have been demonstrated. One explanation for the missing limbs was shadowing caused by adjacent skeletal structures. Overcoming the limb deficit artifact can be accomplished by changing the transducer position and the acquisition plane. HD11 User Reference 4535 611 65311

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Pseudoclefting and pseudonarrowing artifacts may be related to limb deficit artifacts. Some studies have also shown that artifacts may be present in 3D imaging of the fetal face. Being aware of pseudoclefting of the fetal face and psuedonarrowing of the fetal spine can help the sonographer understand and identify these artifacts. As with 2D imaging, it is important to verify putative physical defects by using additional images and other modalities. Drop out and shadowing are present in 3D imaging although more difficult to recognize due to different and unfamiliar displays. Acoustic shadowing and other artifacts look very different when displayed in 3D volumes and may be more difficult to recognize than on standard 2D imaging. These artifacts may produce apparent defects such as limb abnormalities or facial clefts where they are not present. Acquiring data from multiple orientations may avoid artifacts of this type.

About 3D Freehand and Motorized Imaging Single sweep 3D volumes can be acquired for grayscale, color, and CPA images by using standard imaging (freehand) transducers or transducers that support motorized 3D imaging. TEE transducers are not supported. •

Standard imaging transducers require you to move the transducer by using either a fanned or linear movement. This is called freehand acquisition.

•

Transducers that support motorized 3D acquisition require you to hold the transducer in a fixed location during acquisition. This is called motorized acquisition.

Freehand Imaging Technique Because the quality of the MPR and volume images is dependent upon the quality of the 2D acquisition, special attention should be paid to 2D imaging technique. It may take several tries for you to match the frame rate of the system with the sweep speed of the transducer. You may need to adjust the frame rate, line density, and focal zones to synchronize the acquisition with the sweep speed. In freehand 3D imaging, you can use one of two types of motion to acquire a 3D volume. You can pivot (tilt) a transducer in a fan-like motion or drag (slide) a transducer over the region of interest.

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Consider the following tips: •

If you drag the transducer, hold the transducer perpendicular to the skin throughout the motion to keep the image planes parallel to each other, and drag the transducer from left to right.

•

If you tilt the transducer, pivot the transducer at an even rate, keeping the face of the transducer in the same position on the skin.

•

Move the transducer at a constant rate for equally spaced images.

•

The freehand motion must be perpendicular to the transducer’s image.

About Freehand Imaging and Geometry If you select a curved or sector transducer, the system sets Geometry to Fan. If you select a linear array transducer, the system sets Geometry to Linear. You can change the Geometry setting by pressing the Geometry soft key.

Activating 3D/4D Mode ➤ To activate 3D/4D mode 1. Press 3D/4D. 2. If the 4D or 4D and the Fetal STIC options are installed, press 3D/4D Mode soft key to cycle through the volume acquisition modes.

3D/4D Control Functionality The 3D/4D control works differently depending upon which mode is active and which transducer is selected when you activate 3D/4D mode. •

When in 2D grayscale, pressing 3D/4D enters 3D/4D in the same acquisition mode in which you last used 3D/4D.

•

When the 3D Color option is installed, in Color mode or CPA mode with an motorized transducer selected, pressing 3D/4D enters 3D mode with Color and CPA modes retained. However, if 3D/4D was last used in STIC Acquisition mode, STIC is selected with color retained if it was on and with CPA turned off if it was on. For all other modes and transducers, the system enters 3D Grayscale mode.

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NOTE

•

When the 3D Color option is installed, in 3D Grayscale, Color, or CPA Preview modes with a motorized transducer selected, pressing Color enters and exits 3D Color Preview mode; pressing CPA enters and exits 3D CPA Preview mode.

•

In any 3D/4D submode, pressing 3D/4D exits 3D and returns to the originating mode (2D, Color, or CPA).

The 3D/4D application is available only with standard imaging transducers and transducers that support motorized 3D acquisition. If you switch to a nonimaging or a TEE transducer during 3D/4D imaging, the system exits 3D/4D mode.

About Working in 3D Preview Modes When you first enter 3D mode, 4D mode, or Fetal STIC mode, you are in Preview mode. Preview mode allows you to make the following adjustments before acquiring the 3D, 4D, or 3D fetal heart images:

NOTE

•

Position and size the preview ROI.

•

Adjust the Elevation angle by using the Angle soft key.

•

Adjust the Resolution by using the Resolution soft key (not in Fetal STIC).

•

Adjust 2D image controls.

When volume acquisition starts, Persistence, SonoCT, and XRes are turned off.

Acquiring a Freehand 3D Data Set ➤ To acquire a freehand 3D data set with an imaging transducer 1. Optimize the 2D image in a 2D imaging mode. 2. Press 3D/4D to enter 3D Preview. 3. Adjust the size and position of the Preview ROI with the Select key and the trackball.

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4. To make additional grayscale image optimizations, press Next to see next level of soft keys. 5. Press Geometry to specify the scanning method. 6. Begin moving the transducer at a constant speed. Be sure to scan with the method specified by the Geometry soft key. 7. Press Acquire. 8. Acquisition automatically stops when the maximum number of frames are acquired. 9. To end the acquisition before the maximum number of frames are acquired, do one of the following: –

Press Back to Preview to return to 3D Preview and discard the acquired frames.

–

Press Acquire or Freeze to end the acquisition and enter 3D Render to view the acquired volume.

CAUTION

Confirm any diagnosis made with 3D/4D imaging with 2D imaging.

Acquiring a Motorized 3D Data Set Requires a transducer that supports motorized 3D imaging (3D6-2, 3D8-4, 3D9-3v). ➤ To acquire a motorized 3D data set 1. Optimize the 2D image in a 2D imaging mode. 2. Press 3D/4D to enter 3D Preview. 3. Adjust the size and position of the Preview ROI with the Select key and the trackball. 4. To make additional grayscale image optimizations, press Next to see the next level of soft keys. 5. To set the scanning resolution or elevation angle, press Resolution or Angle. 6. Hold the transducer steady over the area you want to image. HD11 User Reference 4535 611 65311

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7. Press Acquire. Acquisition automatically stops when the appropriate number of frames are acquired. 8. To end the acquisition early, press Back to Preview. CAUTION

Confirm any diagnosis made with 3D/4D imaging with 2D imaging.

Using 3D Preview and Acquisition Soft Keys Soft key availability is transducer and preset dependent. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

3D Preview Soft Keys 3D/4D Mode

Angle

Compress

Geometry

Map

Persist

Resolution

Smooth

Length

3D Color and CPA Preview Soft Keys 3D/4D Mode

Angle

Smooth

Filter

Geometry

Map

Map Invert

Packet

Resolution

3D Acquisition Soft Key Back to Preview

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3D Image Review This section includes information on working with MPR and rendered 3D images in 3D Render.

About 3D Render After the 3D data set has been acquired, the 3D volume is generated and the system enters 3D Render. The rendered 3D image and the three MPR images appear on the display in Quad format. The three MPR images represent: •

The acquisition, or the front view (A)

•

90 degrees to the acquisition, or the right view (B)

•

90 degrees to both views, or the top view (C)

You can perform manipulations on images when in 3D Render. You can perform some manipulations on the rendered 3D image and the MPR images, such as orientation and cross-hair placement; you can perform others only on the rendered 3D image, such as editing the volume. ➤ To return to 3D Preview Press Freeze.

Using 3D Render Soft Keys In 3D/4D and Fetal STIC Imaging, some soft keys have their own additional sublevel of soft keys (Render Controls, Image Controls, Swivel, and Sculpt/ Erase). The symbols, >>, on the soft key label indicates that a sublevel will become available when the soft key is pressed. Sublevel soft key labels are green. To exit the soft key sublevel, press Next. The following illustration shows soft key labels that indicate an available sublevel:

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The following illustration shows an active soft key sublevel. On the display, the soft key labels and level indicator appear in green.

➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Acquire 3D Data

Accept ROI

Edit ROI

Format

Image Controls

Render Controls

Reset

Rotate

Sculpt/Erase

Swivel

View

Resize

About the 3D Render Display The following features appear on the 3D Render display. Selection Bracket—The four corner brackets that appear at the corners of the active view. Move the selection bracket to the view you want to manipulate by using the Enter, Left, or Right keys. Distance Ruler—A ruler that appears at the lateral edge of the active view if the view for motorized acquisitions. If the image is for a freehand acquisition, the ruler is not displayed. You can enable or disable the ruler on the 3D/4D tab in the Setup window. Crosshairs—Each view contains crosshairs to help orient the image or indicate an important spot. The crosshairs represent the three axes. The x-axis is red, the y-axis is yellow, and the z-axis is blue. You can adjust the volume and MPR crosshair settings in the Setup window. When Edit ROI is off and an MPR view is active, the XYZ rotation knobs rotate around the crosshair point. See "3D/4D Settings" on page 128.

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View—Shows the MPR or rendered 3D image. The MPR views show slices through the volume. The Volume view shows a rendered 3D image. View Direction—The direction from which the rendered 3D image is being viewed. The choices are Front, Back, Top, Bottom, Left, and Right. Axis Icon—The icon that appears on the bottom left of each 3D image. It illustrates the orientation of the image in relation to the x-axis, the y-axis, and the z-axis of the volume as originally acquired. As you rotate, orbit, or otherwise manipulate the MPRs or volume view, the Axis Icon spins to reflect the changing orientation. As an axis moves toward you, its letter changes to uppercase. If an axis points towards you, its letter is uppercase. If an axis points away from you, its letter is lowercase. Screen Format—The layout of the images on the screen, in this case Quad format. Other layouts available with the Format soft key are: Full, Dual, and Expanded. Select Menu—The Select menu options change in 3D Render depending upon certain conditions. When Edit ROI is on, the options are Size, Pan, and Slice. When Edit ROI is off and an MPR view is active, the options are Pan, X-Hair, and Slice. When Edit ROI is off and the rendered 3D image is active, the options are Pan, Orbit, and Rotate.

About 3D/4D Display Layouts You can select from the following screen formats, or layouts, in 3D Render, 4D acquisition, and Volume Cine. A view is a single image in any format. •

Quad—Displays four images of similar size. The bottom right image is the rendered 3D image. The other three images are the MPR images.

•

Full—Displays one image (MPR or rendered volume).

•

Dual—Displays two images of similar size side by side. An MPR image is on the left and the rendered 3D image is on the right.

•

Expanded—Displays one view on a larger scale on the left side and the three remaining views on the right side of the display.

The default format in 3D Render and Fetal STIC is Quad. The default format in 4D acquisition is Dual.

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Changing the Format ➤ To change the screen format in 3D Render, 4D acquisition, and Volume Cine Press Format to cycle between Quad, Full, Dual, and Expanded screen formats. The first press of Format brings up Full format. In OB presets and the cardiac fetal heart preset, it also activates the Volume view. For all other presets, the view that was active remains active in Full format. Subsequent presses of Format cycle through the other options.

Changing the Active Image In Quad, Dual, and Expanded formats, one image is active at a time. The active image has selection brackets or the ruler. In Full format, the displayed image is active. ➤ To change the active image in 3D Render, 4D acquisition, and Volume Cine To move the selection bracket from image to image in Quad and Expanded formats or to display a different image in Full format, press Enter or the Left and Right keys. To move the selection bracket from image to image in Dual format, press Enter. To make the left or right volume active in Dual format, press Left or Right.

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Editing the ROI When you enter 3D Render and 4D acquisition, the Edit ROI feature is on, which allows you to modify the ROI. You can resize the ROI box and pan (change the position of) and magnify the image. You can also rotate the volume within the ROI. When you enter Volume Cine from a Fetal STIC acquisition, the Edit ROI feature is off. ➤ To adjust the ROI or pan the image within the ROI 1. Press Edit ROI to turn it on if it is not already on. 2. Move the trackball to resize the ROI. The trackball is assigned to ROI Size by default. 3. Press Select to switch the trackball function to Pan. 4. Move the trackball to pan the image. 5. Turn the Zoom knob to magnify the image in the ROI box. 6. Turn the X, Y, and Z knobs to rotate the volume. 7. To return to the volume to its acquisition state, press Reset. 8. To save the ROI and turn the Edit ROI feature off, press Accept ROI. NOTES

•

• •

If you press Reset while the Edit ROI feature is on, the ROI is returned to its acquisition state, even if you have previously edited the ROI. If you press Reset while Edit ROI is off, the 3D volume position, orientation, and zoom is returned to the last Accept ROI state. When the Edit ROI feature is off and you turn it back on, the Zoom, Pan, Size, and orientation settings are returned to the last Accept ROI state. After the ROI is accepted, volume manipulations apply to the ROI intersected with the volume. Zooming, panning and rotations apply to both the ROI and the volume.

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Making Measurements on 2D MPR Images You can make distance and circumference area measurements on MPR images from motorized acquisitions. You cannot make measurements on rendered 3D images or on MPR images from freehand acquisitions.

Using Slice Use Slice, an option on the Select menu when an MPR view is active, to look at various planes in the MPR views. Slice is also available on the Select menu when the volume view is active and Edit ROI is on. ➤ To look at planes of the MPR views 1. Press Enter until the MPR view you want is active. 2. Press Select until Slice is highlighted on the Select menu. 3. Use the trackball to scroll through the MPR image. In Quad and Expanded formats, when Edit ROI is off, the crosshair moves in the non-active MPR views to show, in profile, which plane the active view is showing. When Edit ROI is on, the MPR images move while the crosshairs remain fixed.

Changing the Orientation of the Volume You can change the orientation of the 3D volume by rotating and orbiting it. All of the views, the MPRs, and the rendered 3D images are affected by theses operations. The MPRs change because the plane where each MPR intersects the volume moves to a new orientation. The rendered 3D image changes because it shows the volume looked at from a different angle.

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•

The X, Y, and Z knobs change the orientation of the 3D volume in small increments on a specific, controlled rotation axis (X, Y, or Z). The X, Y, and Z knobs work when any view is active.

•

The Rotate option on the Select menu spins the image about the axis of the volume view.

•

The Orbit option on the Select menu spins the image about any axis perpendicular to the axis of the volume view.

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➤ To rotate a 3D volume 1. Turn the X, Y, and Z knobs to rotate the 3D volume and MPRs on each plane. 2. Press Enter until the rendered 3D image is active. 3. Press Select until Rotate is highlighted on the Select menu. 4. Move the trackball to rotate the volume. ➤ To orbit a 3D volume 1. Press Enter until the rendered 3D image is active. 2. Press Select until Orbit is highlighted on the Select menu. 3. Spin the image by using the trackball. NOTES

•

•

When you rotate the volume with the Rotate option on the Select menu in combination with orbiting the volume, you have the same control over the volume as you do when you use the X, Y, and Z knobs in combination. The orientation changes are reset with every new acquisition.

Changing the View Direction of the Rendered 3D Image You can change the view direction of the rendered 3D image, the direction from which you are viewing it. There are six view directions to choose from: Front, Back, Right, Left, Top, or Bottom. ➤ To change the view direction of the rendered 3D image 1. Press Enter until the volume view is active. 2. Press Next to view the next level of soft keys. 3. Press View until you have the view direction you want. The Rotate soft key changes the orientation of the rendered 3D image in the following increments: 0, 180, 90, and 270 degrees). ➤ To rotate a rendered 3D image with the Rotate soft key 1. Press Enter until the volume view is active. 2. Press Next to view the next level of soft keys. HD11 User Reference 4535 611 65311

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3. Press Rotate until you have the rotation you want. NOTES

• •

The View and Rotate soft key change only the volume view. The X, Y, Z knobs affect both the MPRs views and the volume view. The View and Rotate soft key settings are presettable.

Swiveling a 3D Volume Swivel rotates the 3D volume by showing a sequence of rendered 3D images. It is available in 3D Render or Volume Cine. Swivel can rotate about the vertical or horizontal axes. Its motion can be back and forth or one way. The Swivel feature has its own soft key sublevel that is activated when you press Swivel. ➤ To swivel a 3D volume 1. Press Next to view the next level of soft keys. 2. Press Swivel. 3. Adjust the Left-Right or Up-Down step size to 1, 3, or 6 degrees – Left-Right swivels around the vertical axis. – Up-Down swivels around the horizontal axis. –

A larger step size minimizes the time to calculate the rendered 3D images and to give rapid motion to the swiveling loop.

–

A smaller step size gives slower motion to the swiveling loop.

4. Adjust the Min Angle setting to the lower end or the range of angle over which you want to swivel. The system displays the volume is rotated by the setting you selected. 5. Adjust the Max Angle setting to the upper end of the range over which you want to swivel. The system displays the volume is rotated by the setting you selected. 6. Press Play or Freeze to start swiveling. A progress bar indicates how soon swivel will play at full speed.

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7. Press the play direction soft key to toggle between one-way play and back-and forth. 8. After the swivel is playing at full speed, press Speed to adjust the speed. 9. To increase or decrease the range of angles over which the volume is swiveling, use the Min Angle and Max Angle keys. 10. To stop swiveling without exiting Swivel, press Stop or Freeze. 11. While stopped, up can do any of the following:

NOTE

–

Resume playing with Resume or Freeze.

–

Adjust the MinAngle and MaxAngle

–

Adjust the step size

–

Switch between vertical and horizontal

–

Change the volume orientation

–

Change the zoom

If yo use Reset to undo any changes, you can Resume swiveling, taking advantage of the images calculated before you paused. 12. To exit, press Next.

Saving Cine Loops, Still 3D Images, and 3D Volumes in Swivel ➤ To save a 3D cine loop or still image in Swivel Press Acquire.

NOTE

•

If the image is still, then it is stored as a still image.

•

If the image is swiveling, then it is stored as a Cine loop.

When storing a Dineloop, the box in the lower right corner goes blank until the acquisition is complete. If you start pushing buttons before the box Comes back, only a partial loop is stored.

➤ To save a 3D volume (image and data set) in Swivel Press Acquire 3D Data. HD11 User Reference 4535 611 65311

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Using Swivel Soft Keys ➤ To use any of the Swivel sublevel of soft keys Press the key below the soft key label. ➤ To exit the Swivel soft key sublevel Press Next. See the Glossary to learn about the function of each soft key.

Acquire 3D Data

Stop/Play/Resume

Speed

Reset

Step Size

Min Angle

Max Angle

Play Direction

About Editing 3D Volumes You can remove extraneous information from the 3D Volume when in 3D Render or Volume Cine. Pressing Sculpt/Erase enables this feature. •

The Sculpt function allows you to use the trackball to cut away areas of the volume by encircling them with a freehand motion.

•

The Erase function activates an “eraser” that you control with the trackball. Information is deleted from the volume as you move the eraser across the volume.

The Sculpt/Erase feature has its own soft key sublevel that is activated when you press Sculpt/Erase.

Editing 3D Volumes with Sculpt/Erase The Sculpt/Erase feature does not affect MPR images, just the rendered 3D image.

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➤ To edit a 3D volume 1. Press Enter until the volume view is active. 2. Rotate the volume to display the extraneous material so that you know you are only removing unwanted material from the volume. See "Changing the Orientation of the Volume" on page 188. 3. Press Sculpt/Erase. 4. Use the trackball to position the cursor over the area in which you want to draw. 5. Press Enter to turn on the drawing capability. The Sculpt cursor on the screen is green, indicating that it is active. 6. Move the trackball to draw around the portion you want to remove. 7. Press Enter to end the drawing. The contents of the shape you drew are deleted from the 3D volume. 8. To correct a drawing mistake, press Undo and try again. 9. Press Select to activate Erase on the Select menu. 10. Use the trackball to position the cursor over the area you want to erase. 11. Press Enter to activate the eraser. The Erase cursor is green, indicating that it is active. 12. Move the trackball to erase the information from the 3D volume. The information is erased as you move the eraser with the trackball. 13. Press Enter to turn off the eraser. 14. Press Next.

Using Sculpt/Erase Soft Keys ➤ To use any of the Sculpt/Erase sublevel of soft keys Press the key below the soft key label. ➤ To exit the Sculpt/Erase soft key sublevel Press Next. HD11 User Reference 4535 611 65311

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See the Glossary to learn about the function of each soft key. Redo

Reset

Undo

Zooming and Magnifying Images in 3D/4D You can use both zoom features, Zoom and Magnify, with 3D and 4D images. You can magnify in 3D Preview, but it has no effect on the subsequent volume acquisition.

Acoustic Zoom with 3D/4D Images You can Zoom a 2D image before entering 3D or 4D imaging. ➤ If you want 3D/4D imaging of acoustically zoomed anatomy 1. In 2D, enter acoustic zoom. 2. Press 3D/4D to enter 3D Preview. 3. Select the volume acquisition mode: 3D, 4D, or Fetal STIC. 4. Resize and position the 3D Preview ROI. 5. Start the volume acquisition.

Magnifying a Rendered 3D Image After 3D acquisition, during 4D acquisition, and in Volume Cine, you can magnify the rendered image. Magnify is applied to all displayed views and is maintained across format changes. You can also magnify in Sculpt/Erase and Swivel (stopped) modes. ➤ To magnify a rendered 3D image Turn the Zoom knob. The amount of magnification is displayed in the right border. NOTE

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You must accept the ROI before you Zoom.

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Using Render Controls Soft Keys Render Controls soft keys are used to modify the individual settings for a Vision setting. They are available from any 3D/4D submode that displays a volume: •

3D Render

•

4D Acquisition

•

Volume Cine

➤ To activate the 3D Render Controls Press Render Controls. These controls are activated as a soft key sublevel and are displayed in green text on the display. ➤ To exit the Render Controls soft key sublevel Press Next. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Brightness

Transparency

Smooth

Threshold

Opacity

Using Image Controls Soft Keys Image Controls soft keys are used to change the Vision setting and color mode, as well as modify map and chroma values. They are available from any 3D/4D submode that displays a volume: •

3D Render

•

4D Acquisition

•

Volume Cine

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➤ To activate the Image Controls Press Image Controls. These controls are activated as a soft key sublevel and are displayed in green text on the display. ➤ To exit the Image Controls soft key sublevel Press Next. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Adjusta

MPR Chromab

Priority

Render Mode

Reset

Vision

Vol Chroma

Vol Map

a. Displayed only in Render mode Color/Gray. b. Displayed only in Render mode Grayscale.

About 3D/4D Render Mode Options The Render Mode soft key is available only in 3D Color mode and 3D CPA mode. It is accessible when Image Controls are enabled from within 3D Render and Volume Cine. The Render Mode determines which information to display in the volume and MPR views. •

Grayscale shows only grayscale anatomy with no color.

•

Color shows only color anatomy with no grayscale.

•

Color/Gray shows both grayscale and color anatomy.

Within each Render Mode, several Vision settings are available.

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Changing the Render Mode ➤ To change the Render Mode 1. From within 3D Render, press Image Controls. 2. Press Render Mode to select the Render Mode you want. 3. Press Next to exit Image Controls and return to 3D Render.

About 3D/4D Vision Settings A Vision setting is a set of predefined values for the Render Mode. Vision settings control the aesthetics, or “look,” of the data set. The available Vision settings depend upon the selected Render Mode. You can change the default Vision settings and save them as a preset. The Vision soft key is accessible when Image Controls are enabled from within: •

3D Render

•

4D Acquisition

•

Volume Cine

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Vision Definitions The following table lists the Vision settings available for each Render Mode.

Render Mode Grayscale

Vision Setting Surface Skeletal

Color or Color/Gray with Color Velocity

Surface

Color or Color/Gray with CPA

Surface

Translucent Glass Body

Changing the Vision Setting ➤ To change the Vision setting 1. Press Image Controls. 2. Press Vision to select the Vision setting you want. 3. Press Next to exit the Image Controls soft keys.

Modifying a Render Control You can change the render controls of a Vision setting and save the changes in a preset. Click a setting to learn more about it.

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•

Threshold

•

Brightness

•

Transparency

•

Opacity

•

Smooth

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➤ To Modify Vision Settings NOTE

In Color/Gray rendering, you must use the Adjust key to select the Grayscale or Color Vision. 1. Press Image Controls. 2. Press Vision to select the Vision setting you want to change. 3. Press Next to access the primary level of soft keys. 4. Press Render Controls to access the Vision Settings. 5. Change the Vision settings by using the soft keys. 6. Press Next to return to the primary level of soft keys. 7. To restore the original Vision settings, press Reset. You can save the new Vision settings as a preset. See "Creating a Preset" on page 97.

4D Imaging Mode In 4D imaging mode, also called Live 3D, the system acquires a stream of grayscale volumes and renders them live. 4D requires a transducer that supports motorized acquisition of 3D images. In 4D Preview, you can optimize the image with 3D Preview controls. During 4D acquisition, you can manipulate the volume with 3D Render controls. And you can freeze and unfreeze the acquisition to enter and exit Volume Cine replay mode, where you can play and edit the volume. NOTE

The 3D/4D option is not available with nonimaging or TEE transducers. If you switch to a nonimaging or TEE transducer while imaging, 3D/4D mode closes.

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Using 4D Soft Keys ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

4D Preview Soft Keys The soft keys in the following list are available in 4D Preview mode and in 3D Preview mode: 3D/4D Mode

Angle

Compress

Geometry

Map

Persist

Resolution

Smooth

4D Acquisition Soft Keys The soft keys in the following list are available during 4D image acquisition:

Angle

Back to Preview

Edit ROI

Format

Image Controls

Render Controls

Reset

Resolution

Rotate

View

Vision

Acquiring 4D Images 4D mode requires a transducer that supports motorized acquisition of images. ➤ To acquire 4D images 1. Optimize the 2D image in a 2D mode. 2. Position the transducer over the anatomy of interest. 3. Press 3D/4D. 4. Press 3D Mode until 4D is selected. 200

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5. Adjust the size and position of the preview ROI with the Select key and the trackball. 6. Press Next to see the next level of soft keys to make additional grayscale image optimizations. 7. Press Resolution or Angle to set the scanning resolution or angle. NOTE

You may not need to adjust the Resolution or Angle settings, depending upon the selected preset. 8. Hold the transducer steady over the area you want to image. 9. Press Acquire to begin acquiring the data set. 10. Modify the angle, resolution, ROI, Image Controls, and Render Controls settings as needed during the live acquisition. 11. Press Freeze to end the acquisition. When acquisition has ended, the system enters Volume Cine so you can review the images.

CAUTION

Confirm any diagnosis made with 3D/4D imaging with 2D imaging.

Reviewing 4D and Fetal STIC Images You review 4D images and 3D Fetal STIC images in Volume Cine mode. You can scroll, edit, and play volumes in a loop. NOTE

When 3D Fetal STIC image acquisition is complete, the system automatically enters playback mode, with the cine loop playing at 100% speed.

➤ To review 4D images in Volume Cine Mode 1. Press Freeze during 4D image acquisition. 2. Move the trackball to scroll through the cine loop frames. 3. Press Replay to play the volume cine loop. 4. Press Replay again to increase or decrease playback speed or to stop playback. HD11 User Reference 4535 611 65311

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5. To modify the start and end points of the loop, use Edit Start and Edit End. 6. Press Freeze to return to 4D imaging. ➤ To review 3D Fetal STIC images in Volume Cine 1. When acquisition is complete, press Replay to increase or decrease playback speed or to stop playback. 2. Move the trackball to scroll through the cine loop frames if playback is stopped. 3. To modify the start and end points of the loop, use Edit Start and Edit End. 4. Press Freeze to return to Fetal STIC imaging.

Saving 4D and Fetal STIC Loops, Images, and Volumes ➤ To save a 4D or a Fetal STIC cine loop or a still image in Volume Cine Press Acquire. •

If the image is frozen, then it is stored as a still image.

•

If the loop is playing, then it is stored as a Cine loop.

➤ To save a 4D or a Fetal STIC volume (image and data set) in Volume Cine Press Acquire 3D Data.

Using Volume Cine Soft Keys The soft keys in the following list are available in 4D and Fetal STIC after you press Freeze. ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key. Accept ROI

Acquire 3D Data

Edit End

Edit ROI

Edit Start

Format

Image Controls

Render Controls

Replay

Reset

Sculpt/Erase

Swivel

View

Fetal STIC 3D Fetal STIC is a special 3D acquisition mode. It acquires multiple fetal heart cycles in a single sweep of a motorized transducer. Then it creates a volume cineloop of the fetal heart through a single composite heart cycle. If the data is sufficient, it also calculates the fetal heart rate.

Acquiring Fetal STIC Images ➤ To acquire fetal STIC images 1. In 2D mode, place the transducer in the center of the anatomy. 2. Locate the fetal heart in the 2D image. 3. Zoom to include just the fetal heart in the image window. The system sets the elevation angle based on the lateral angle of the image window. 4. Optimize the fetal heart image. NOTE

There is no Smoothing control in Fetal STIC mode. 5. Press 3D/4D. 6. Press 3D Mode until Fetal STIC is selected. 7. Press Acquire and hold the transducer still until acquisition stops. During the acquisition phase the system displays 2D images in real time.

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8. If the calculated fetal heart rate is determined to be reasonable, click Yes to accept it. To reject the calculated rate and return to Preview mode, click No. 9. If the fetus or transducer moves during the acquisition, press Back to Preview and begin the procedure again. After the acquisition, the system renders the 3D images and plays the volume cineloop. See "Reviewing 4D and Fetal STIC Images" on page 201.

Using Fetal STIC Soft Keys ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Fetal STIC Preview Soft Keys 3D/4D Mode

Acquire Time

Compress

Map

Persist

Smooth

Color Fetal STIC Preview Soft Keys 3D/4D Mode

Acquire Time

Density

Filter

Map

Map Invert

Packet

Fetal STIC Acquisition Soft Key Back to Preview

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About the Fetal Heart Rate The HD11 system calculates the fetal heart rate after acquisition is complete. You are prompted to accept the calculated rate. Verify that the calculated fetal heart rate is reasonable. If you reject the calculated rate, the system returns to preview mode. If you accept the calculated heart rate, the volumes are displayed. The fetal heart rate is displayed on the right border of the display.

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9 Imaging Features The HD11 system offers the following range of imaging features that provide improved imaging and greater flexibility when you are imaging a patient: •

"Biopsy Guides" on page 207

•

"Contrast Harmonic Imaging" on page 210

•

"Dual Imaging" on page 215

•

"iSCAN Intelligent Optimization" on page 220

•

"Panoramic Imaging" on page 222

•

"Quick Review" on page 229

•

"SonoCT Real-time Compound Imaging" on page 231

•

"Tissue Harmonic Imaging" on page 232

•

"Trapezoidal Imaging" on page 233

•

"XRES Adaptive Image Processing" on page 234

•

"Zoom" on page 235

Biopsy Guides The Biopsy Guide feature helps you position transducers with biopsy needle guide attachments. The Biopsy Guide displays guide lines on the image that show the anticipated path of the needle. You can use these guide lines to ensure that the needle or instrument is following the correct path. NOTE

The biopsy guide for the L12-5 50 has infinite angle capability and can be installed on either side of the transducer; it does not constrain the biopsy needle to a particular path. Because the needle path is not predictable, neither the Biopsy soft key nor biopsy graphics appear on the display when you are using the L12-5 50. A biopsy with this transducer is a manual action. For information about the L12-5 50 biopsy guide, see the HD11 Getting Started.

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WARNINGS

• Do not attempt to use the biopsy guide until you have read the instructions for selecting the display, installing the sterile transducer cover, and verifying alignment of the biopsy guide. See the HD11 Getting Started.

• Biopsy guidelines are intended as guides only. Never use biopsy guidelines as an absolute reference.

• Biopsy guidelines do not take into account the possible bending of the needle. • The crossover depth is only an estimate. Never use the crossover depth exclusively to identify the needle position on the biopsy guide. Never use the crossover depth as a replacement for using the depth marker or for performing measurements. Some biopsy guides can inadvertently be installed backward. When you turn Biopsy Guide on for the first time during an exam, a warning appears on the display if the selected transducer supports one of these biopsy guides.

Turning the Biopsy Guide On Before you can access the Biopsy Guide, the system must •

Be in 2D mode only (for example, all Flow, Mmode, and Doppler modes are off)

•

Be in a non-cardiac preset

•

Have a transducer that supports biopsy selected

•

Have Zoom turned off

•

Have the General Imaging or the OB/GYN application package installed

➤ To turn Biopsy Guide on 1. Press Next to access the next level of 2D soft keys. 2. Press Biopsy to turn it on. 3. Press Biopsy again to select either the Gun or Needle setting. 4. If the selected transducer supports a biopsy guide with more than one needle position, the Biopsy soft key displays the current crossover depth. Press Biopsy to select the correct crossover depth. 208

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NOTES

• •

If the selected transducer supports a biopsy guide that can inadvertently be installed backward, a warning appears on the display. The biopsy guide for the L12-5 50 has infinite angle capability. When you are using the L12-5 50 transducer, neither the Biopsy soft key nor biopsy graphics appear on the display. For information about the L12-5 50 biopsy guide, see the HD11 Getting Started.

About the Biopsy Guide Display The following elements are displayed on the display when Biopsy Guide is turned on: •

The biopsy guide lines

•

The needle length crosshair

About the Biopsy Guide Lines When Biopsy Guide is turned on, one or two dotted lines are displayed on the image. •

One line represents gun graphics—this line indicates the most probable needle path.

•

Two lines represent needle graphics—these lines make up a cone shape and indicate the probable limits on the needle path.

When depth is changed, the biopsy display is redrawn to reflect the new relationships at the new depth setting.

Moving the Needle Length Crosshair When Biopsy Guide is turned on, a thick blue crosshair, the needle length crosshair, can be controlled by the trackball. It is initially hidden from view, however. You should use the trackball to make the crosshair visible on the display and to position it at the presumed final location of the needle point. The needle length, the distance from the top of the needle guide to the crosshair, appears in the upper right corner of the display. You can move the needle length crosshair to any position along the needle path by using the trackball. HD11 User Reference 4535 611 65311

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➤ To display and move the biopsy needle length crosshair 1. Press Select until Needle is highlighted on the Select menu. 2. Scroll the trackball downward to move the crosshair onto the display and to move it along the anticipated needled path.

Contrast Harmonic Imaging Contrast Harmonic Imaging is a type of harmonic imaging that is optimized for imaging with contrast agents. You can use Contrast Harmonic Imaging with any imaging mode and preset. Contrast Harmonic Imaging is an option and is only available with harmonics-capable transducers, for example, C5-2 and S3-1. In Contrast Harmonic Imaging, you need to adjust settings to improve your ability to see the contrast agent while minimizing the destruction of the contrast agent. See "Adjusting Settings for Contrast Harmonic Imaging" on page 212. Before you use Contrast Harmonic Imaging soft keys, you need to assign one of the Option keys to Contrast Harmonic Imaging. See "Assigning Option Keys" on page 102.

Using Contrast Harmonic Imaging NOTE

Before you can use the Contrast Harmonic Imaging option, it must be installed and you must set up a Contrast Option key to use it. See "Installing Options" on page 101 and "Assigning Option Keys" on page 102.

➤ To use Contrast Harmonic Imaging 1. Press Contrast Option to turn on Contrast Harmonic Imaging. A Contrast icon appears on the lower left corner of the display

2. Adjust the necessary settings to minimize the destruction of the contrast agent and to improve your ability to see the contrast agent. See "Adjusting Settings for Contrast Harmonic Imaging" on page 212. 210

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3. Press the Contrast Option key to cycle through and select a Contrast fusion recipe. 4. To display the Contrast Timer, press Contrast Timer. Press Contrast Timer again to start the timer. Press it again to stop it. 5. Press Next to cycle through the three levels of soft keys and make the appropriate setting adjustments. 6. Press FusionTHI to exit Contrast Harmonic Imaging. NOTES

• •

•

Contrast Harmonic Imaging is an option and is only available with harmonics-capable transducers: PA4-2, s4, C5-2, and s3-1. The Contrast Option key is available only in Contrast mode. When Contrast Harmonic Imaging is enabled, pressing Contrast Option cycles through the Contrast fusion recipes. Pressing Contrast Option will not turn off Contrast Harmonic Imaging. You can turn it off only by pressing Fusion.

Using Contrast Harmonic Imaging Soft Keys When Contrast Harmonic Imaging is turned on, Contrast-specific soft keys are active. There are two more levels of soft keys available during Contrast Harmonic Imaging. ➤ To cycle through the Contrast Harmonic Imaging soft key sets Press Next. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Contrast Timer

Flash

Power

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Adjusting Settings for Contrast Harmonic Imaging You can prolong the life of the contrast agent and improve your ability to see the contrast agent by adjusting certain system settings. Every contrast agent is unique. Therefore, after you determine the proper settings for each contrast agent that you use, be sure to save those settings to a preset.

Improving Ability to See the Contrast Agent Studies have shown that minimizing the exposure of contrast microbubbles to ultrasound increases both the duration and the intensity of the contrast agent. The following sections provide information for improving your ability to see the contrast agent. Adjusting the Gain Receive gains that are set so that a little signal is present help maximize the ability to see the contrast agent. ➤ To adjust the Gain Turn the Gain knob. Moving the Transmit Focus Deeper Making the mechanical index (MI) more uniform prevents contrast microbubbles from being selectively destroyed in one section of the image. Changing the transmit focus affects both the maximum MI, which appears on the right side of the display, and the image depth at which this maximum occurs. Generally, to make the MI more uniform, you move the transmit focus deeper. At times, too much microbubble destruction will occur in the near field, particularly with cardiac imaging. This will show up as “swirling” in the apex in cardiac images from the apical window. To minimize this effect, lower the Mechanical Index. If the swirling persists, moving the transmit focus to mid cavity will help. ➤ To move the transmit focus deeper Press the down arrow on the Focus key.

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Decreasing the Dynamic Range Dynamic range, or compression, determines the amount of acoustic dynamic range that appears on the display. As the dynamic range setting is lowered, smaller changes appear larger, making them better for visualizing the contrast agent. When you are using a contrast agent, decrease the dynamic range to minimize this effect. ➤ To decrease the dynamic range Press Compress. Using the Appropriate Postprocessing Map The postprocessing map determines the video intensity that is displayed for a given acoustic intensity. Postprocessing maps A and E are recommended for imaging contrast agents. However, for purely qualitative studies and for offline analysis of video intensity, use the linear postprocessing map A. ➤ To specify a postprocessing map Press Map.

Minimizing Ultrasonic Exposure The following sections provide information for minimizing ultrasonic exposure. Decreasing the Transmit Power If You Are Not Using Triggering An effective way to prolong the life of the contrast agent is to lower the transmit power. One indication of transmit power is the mechanical index (MI), which appears in the border on the right side of the display. Although higher transmit power causes shorter contrast effect, the higher power generates greater nonlinearities, which results in a stronger harmonic signal. Using a lower frame rate allows the destroyed microbubbles to replenish before the next frame. Therefore, Philips recommends using a higher power setting when using triggering. ➤ To change the transmit power, do one of the following •

Turn the Power knob.

•

When Contrast Harmonic Imaging soft keys are displayed, press the Power soft key. HD11 User Reference 4535 611 65311

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NOTE

The power limits of the HD11 ultrasound system adhere to all FDA guidelines concerning patient and operator safety. For more safety information, see the HD11 Getting Started. Using Triggering Changing the triggering settings allows you to control how often and when the image is updated so that you can reduce the destruction of the contrast agent. You can trigger off of the patient’s ECG or you can use a timer. When you are using triggering, increase the transmit power.

➤ To use triggering 1. Press Setup. 2. Use the Trigger soft key to specify the triggering source. If you need temporal resolution (for endocardial border definition, for example), Philips does not recommend the use of triggering.

About Contrast Harmonic Imaging Principles The principle of Contrast Harmonic Imaging is based on the fact that microbubbles (which have diameters between 1 and 8 micrometers) resonate when excited by ultrasonic energy in the diagnostic frequency range (1 to 10 MHz). Resonating microbubbles undergo large changes in their diameters as they contract and expand in the ultrasonic field. If the alternate expansion and contraction phases do not produce equal changes in bubble size, a nonlinear response occurs. The resulting nonlinear response of the contrast agent then contains harmonics of the transmitted (fundamental) frequency. Tissue produces harmonics as well, but of much lower intensity. Therefore, when you use contrast agents with Contrast Harmonic Imaging, the system displays the energy at the second harmonic rather than the fundamental frequency, resulting in considerably more backscatter in the microbubbles than the tissue. The use of harmonic imaging for imaging contrast agents has been shown to increase the sensitivity and the duration of the contrast agent. You can adjust settings to prolong the life of the contrast agent and to improve your ability to see the contrast agent.

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About Acoustic Artifacts in Contrast Imaging Artifacts can be generated during Contrast imaging by the interaction of the contrast agent, the ultrasound beam, and the anatomy. A rib artifact appears as a dark, linear area in a lateral part of a sector image. Rib artifacts occur when a rib blocks scan lines, preventing microbubbles in the rib’s shadow from resonating. You can minimize or eliminate rib artifacts by repositioning the transducer in relation to the ribs. Shadowing or attenuation is a common artifact that appears as a dark area, generally in the mid field to far field. Shadowing is caused by administering the contrast agent at a high rate or concentration. The resulting high concentration of microbubbles in an area causes backscatter of the ultrasound energy, preventing sufficient energy from reaching the area behind the concentration. Shadowing is alleviated as the contrast agent becomes diluted. You can avoid shadowing by administering the contrast agent at a lower rate and concentration. Swirling occurs when the higher level of ultrasound energy in the near field disrupts or destroys the microbubbles in the contrast agent. Factors that contribute to swirling are high MI, low blood flow near the apex, and low concentration of contrast agent. Frame rate can also have an effect on swirling.

Dual Imaging Dual Imaging allows you to display two images side by side. One image can be live while the other is held inactive. Or both images can be frozen. Only one image can be active on the display at a time. If one image is live, it is by default the active image, and the other image is held inactive. If you press Freeze, both images are frozen. Either of them can be the active one. You can scroll through the frames of the active image by using Quick Review. Dual Imaging is available in: •

"2D Mode" on page 153

•

"Tissue Harmonic Imaging" on page 232

•

"Color Mode" on page 170

•

"Color Power Angio (CPA) Mode" on page 173 HD11 User Reference 4535 611 65311

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About Single Buffer and Two Buffer Modes The HD11 system has two buffer settings that affect full-screen and Dual modes. A buffer is temporary memory where image frames are accumulated for Quick Review. You select the buffer mode of operation with the Dual button on the System Setup window, but the buffer mode affects both Dual and full-screen operation. Single Buffer Mode When Single Buffer mode is active with a full-screen display, all of the system’s Quick Review memory is organized into a single buffer. When Single Buffer mode is active and Dual is turned on (with the Dual, Left, or Right) controls, the single buffer is split in two. The older half of the single buffer is flushed and becomes the new active Dual buffer, associated with the active Dual side. You select the active buffer or side with the Left and Right keys. The active buffer or side is the one where new frames are accumulated when Freeze is off or the one the at is scrollable when Freeze is on. The most recent half of the single buffer, accumulated just before Dual is turned on, is retained at the initial contents of the inactive Dual buffer. The most recent frame, before Dual is turned on, is initially displayed as the held image on the inactive side. When Dual turns off, both buffers are flushed and combined back into a single buffer, accumulating new, live frames. When Single Buffer mode is active and Dual turns off, Freeze is forced off.

Two Buffer Mode In Two Buffer mode, the quick review memory is organized into two separate buffers. When Two Buffer mode is active with a full-screen display, the transducer dot indicates whether the Right buffer or the Left buffer is active. Un Two Buffer full-screen mode, the Left and Right keys switch the active buffer, but do not turn on Dual mode. When Two Buffer mode is active and Dual turns on, through the Dual control, the left buffer is displayed on the left side of the display and the Right buffer is dis216

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played on the right. the buffer that was active in full-screen mode remains the active on when Dual turns on. The Left and Right keys switch the active buffer. When Dual turns off, both buffers are retained exactly as they were in Dual mode, with the active buffer remaining active and displayed full-screen. The inactive buffer is hidden but saved.

About The Active Buffer Indicators In Single Buffer mode, the active image displays an open circle, the transducer orientation dot, on the upper left of an uninverted image. In Single Buffer Dual display, the active image displays the transducer dot with an open circle, while the inactive image displays a solid circle. In Two Buffer full-screen display, the transducer dot becomes a two-toned oval:

•

When the right half of the oval is brighter, the displayed frame is stored in the right buffer.

•

When the left half of the oval is brighter, the displayed frame is stored in the left buffer.

In Two Buffer Dual Display, the active image is marked with a bright oval and the inactive image is marked with a dim oval:

NOTES

• • •

•

You can use a different preset or transducer to image each side in Dual or for each buffer in Two Buffer mode. To acquire Dual images into Cine Review, press Freeze and then Acquire. To take measurements across Dual images, both images must have been obtained from the same transducer at the same the depth setting with Zoom off. When you acquire Dual images into Cine Review with Color on one side and CPA n the other, only the active image’s flow data is displayed in review.

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Using Two Buffer and Two Buffer Dual Imaging In Two Buffer Dual Imaging, while you are viewing a full-screen image, you can change the active image by pressing its corresponding buffer key (Left or Right). ➤ To view images side-by-side in Two Buffer Dual Imaging 1. Activate Dual Imaging by doing one of the following: –

Press Dual.

–

If you are in Color Mode or Color Power Angio, press Dual twice. Pressing it once activates Color Compare or Color Power Angio Compare.

2. To activate the inactive image, press its key (Left or Right). 3. To turn on Color mode or Color Power Angio for the active image, press Color or CPA. 4. To use Color Suppress or Color Power Angio Suppress on the active image, press Freeze and then Color or CPA. 5. To magnify the active image, turn the Zoom knob. 6. To view a full-screen image, press Dual or 2D to exit Dual Imaging. The image that was active in Dual Imaging is displayed. NOTE

When the images are frozen and you switch between full-screen and Dual Imaging, the frame selected by Quick Review scrolling stays the same for the active buffer, the Color Suppress or Color Power Angio Suppress state does not change, and the magnification stays the same.

Using Single Buffer Dual Imaging ➤ To use Single Buffer Dual Imaging 1. Press Dual to activate Dual Imaging. 2. Change which image is active by doing one of the following:

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–

Press Left or Right.

–

If you are in Color Mode or Color Power Angio, press Left or Right twice. Pressing the key once activates Color Compare or Color Power Angio Compare.

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3. To turn on Color mode or Color Power Angio for the active image, press Color or CPA. 4. To use Color Suppress or Color Power Angio Suppress on the active image, press Freeze and then Color or CPA. 5. To magnify the active image, turn the Zoom knob. 6. Press Dual or 2D to exit Dual Imaging. The image that was active in Dual Imaging is displayed.

Using Quick Review in Dual Imaging In Dual Imaging, you can freeze both images and use Quick Review on the active image. ➤ To use Quick Review while you are in Dual Imaging 1. Press Freeze. Both images are frozen. The active image is labeled with the Quick Review icon. 2. To scroll through the active image frame by frame, move the trackball. 3. To change which image is active, press Left or Right. 4. To unfreeze the active image, press the Freeze again. NOTE

In Two Buffer, when the images are frozen, and you switch between full-screen imaging and Dual Imaging, the frame selected by Quick Review scrolling stays the same for the active image.

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iSCAN Intelligent Optimization iSCAN Intelligent Optimization automatically optimizes key imaging settings during either 2D or Doppler Trace acquisition. 2D iSCAN optimization adjusts the TGC, 2D Gain, and Compress settings for the current image. Doppler iSCAN optimization adjusts the baseline and scale. When 2D iSCAN optimization is on, the following iSCAN icon appears on the display:

You must be in 2D mode to turn 2D iSCAN optimization on or off. 2D iSCAN optimization remains on if you switch to another mode. The iSCAN Gain soft key allows you to adjust the default 2D iSCAN optimization gain. 2D iSCAN optimization is available with all transducers and in all non-cardiac presets. 2D iSCAN optimization is not available with nonimaging transducers.

About 2D iSCAN Intelligent Optimization Pressing iSCAN during live 2D acquisition optimizes the system for imaging. The image will freeze for a very short period of time while the system evaluates grayscale distribution to optimize TGC, Gain, and Compress settings for the image.

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•

You can adjust the TGC, Gain, and Compress settings after turning 2D iSCAN optimization on. They are treated as adjustments to the iSCAN optimization settings, not to your original settings.

•

When 2D iSCAN optimization is on, pressing and holding iSCAN will turn it off.

•

When you turn 2D iSCAN optimization off, the pre-iSCAN optimization 2D Gain and Compress values are restored and the TCC locations determine the TGC curve.

•

2D iSCAN is turned off automatically when any preset is activated or there is a transducer change.

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Using 2D iSCAN Intelligent Optimization ➤ To use iSCAN optimization 1. In 2D mode, press iSCAN to optimize the image. The iSCAN icon appears on the display. 2. To reoptimize the image, press iSCAN again. 3. To turn 2D iSCAN optimization off, press and hold iSCAN until the iSCAN icon no longer appears on the display. The original gain and compression settings are restored. When you turn 2D iSCAN optimization on, if the transducer does not make complete contact with the skin, you must narrow the image width and press iSCAN again to reoptimize the image. See "Resizing and Repositioning an Image" on page 152.

Adjusting the Default 2D iSCAN Gain You can adjust the default brightness of images generated with 2D iSCAN optimization with the iSCAN Gain soft key in the Setup window. ➤ To adjust the default 2D iSCAN optimization gain 1. Press Setup. 2. Press Next. The iSCAN Gain soft key appears below the Setup window. 3. Press iSCAN Gain to increase or decrease the default iSCAN gain. 4. Press Setup to exit Setup.

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Panoramic Imaging In Panoramic Imaging, you acquire a series of images in 2D mode. These images are called the panoramic data set. This data set is compiled to show a larger area of anatomy. As you scan, the image frames are held in memory and are then electronically stitched together for display. The panoramic image is static and appears in grayscale. To use Panoramic Imaging, you must first acquire the panoramic data set in Panoramic Preview. You can then review and edit the panoramic image in Panoramic Render. Panoramic Imaging does not support up/down inverted images. Up/down inverted images appear uninverted in Panoramic Imaging.

About the Accuracy of Panoramic Images If the skin is moved significantly or the tissue is compressed to various degrees by the transducer during the acquisition of a panoramic data set, resulting artifacts can affect the quality and reliability of the rendered panoramic image. A panoramic image acquired along a radius smaller than 30 cm (such as a neck transverse or an arm or a leg transverse) may not correspond to the real anatomy. Therefore, do not use such an image to make a measurement or a diagnosis based on anatomic geometry. WARNING

If you determine by the previous criteria or by your own clinical training or experience that a panoramic image is poorly reconstructed, do not use the image to make dimensional measurements. If for any reason such an image is used to make a measurement, do not use the measurement to make diagnostic decisions. If you have any doubt about image-related artifacts or the accuracy of the panoramic image, reacquire the panoramic data set.

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Acquiring a Panoramic Data Set When you use Panoramic Imaging, you must first acquire a series of 2D images, called the panoramic data set. ➤ To acquire a panoramic data set 1. Press Pano to enter Panoramic Preview. 2. To optimize your image, use system controls and soft keys. 3. Press Scan Direction to specify the scanning direction. 4. Begin moving the transducer at a constant speed across the area of interest. NOTE

Avoid rocking and tilting the transducer. Do not move the transducer backward. 5. Press Acquire to acquire the panoramic data set. Continue moving the transducer during acquisition. 6. To complete the acquisition, press Acquire again.

NOTE

Imaging automatically stops when the maximum number of frames is acquired. 7. If you decide not to complete the acquisition, press Cancel Acquire. When the acquisition is complete, the panoramic image is displayed so you can review or edit it.

NOTES

•

•

When you enter Panoramic Preview, SonoCT Real-time Compound Imaging and XRES Adaptive Image Processing are turned off and persistence is set to 0. The result is a coarser image than you had when Panoramic imaging was turned off. When you return to 2D imaging from Panoramic Imaging, your previous 2D image settings are restored.

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Using Panoramic Preview and Acquisition Soft Keys 2D soft keys are available during Panoramic Imaging, depending upon the chosen preset and transducer. In addition, the following soft keys are available during Panoramic Imaging. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Panoramic Preview Soft Key Scan Direction

Panoramic Acquisition Soft Key Cancel Acquire

Exiting Panoramic Imaging ➤ To exit Panoramic Imaging Press Pano or 2D.

Panoramic Image Review After you acquire the panoramic data set, the system enters Panoramic Render. The panoramic image appears on the display. You can manipulate it by using the system control panel and soft keys.

Using Panoramic Render Soft Keys The following soft keys are available when you are reviewing panoramic images in Panoramic Render mode. ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key.

Archive

Re-Acquire

Reset

Save to CD NOTE

To display or hide the cursor in Panoramic Render mode, press Enter. When the cursor is hidden, the trackball function is assigned to the highlighted function on the Select menu.

Moving a Panoramic Image Around the Display ➤ To reposition the panoramic image 1. If the cursor appears on the display, press Enter to remove it. 2. If Zoom appears on the Select menu, press Zoom. Pan and Rotate appear on the Select menu. 3. Press Select until Pan is highlighted in the bottom right corner of the display. 4. Move the trackball to reposition the panoramic image.

Rotating a Panoramic Image ➤ To rotate the panoramic image 1. If the cursor appears on the display, press Enter to remove the cursor from the display. 2. If Zoom appears on the Select menu, press Zoom. Pan and Rotate appear on the Select menu. 3. Press Select until Rotate is highlighted. 4. Move the trackball to rotate the image.

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Changing the Point of Rotation ➤ To change the point of rotation 1. Press Enter until the cursor appears on the display. 2. Use the trackball to move the cursor to the point you want the panoramic image to rotate around. 3. Press Enter again to set the new point of rotation. Related Topics

Magnifying Panoramic Images There are two methods for magnifying a panoramic image, using the Depth key or the Zoom knob. ➤ To magnify a panoramic image by using the Depth key Press Depth to increase or decrease magnification. ➤ To magnify a panoramic image by using the Zoom knob 1. If the cursor appears on the display, press Enter to remove it. 2. If Pan and Rotate appear on the Select menu, press Zoom. Zoom is highlighted on the Select menu. 3. Move the trackball up or to the left to increase magnification. Move it down or to the right to decrease magnification.

Performing Measurements on a Panoramic Image You can perform only 2-point measurements on a panoramic image. You can delete measurements on a panoramic image, but you cannot reactivate measurements. Whenever possible, perform measurements on a single acquired image frame. NOTE

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The calipers and other measurement displays look different from when Panoramic Imaging is off. Measurement functionality is identical, however, whether Panoramic Imaging is on or off.

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You can perform a 2-point (linear) measurement to measure the length of a structure or a length of time. As you perform unlabeled measurements, the results of the measurements and of the Quick Calcs appear in the results box on the display. ➤ To perform a 2-point measurement on a panoramic image 1. Press Caliper. 2. Use the trackball to position the caliper that appears on the image and press Enter or Caliper. A second caliper appears on the display, Endpt 2 is highlighted on the Select menu, and the length appears in the results box in blue. 3. Use the trackball to position the second caliper. 4. Do one of the following: –

To approve the measurement, press Enter.

–

To approve the measurement and start a new measurement, press Caliper.

When complete, the measurement changes to green.

Placing a Title Above a Panoramic Image You can place a title above a panoramic image before you save the panoramic data set. It appears on the upper left corner of the display. ➤ To place a title above a panoramic image 1. Press Text. 2. Press the Title soft key. 3. Do one of the following: –

If no title currently exists, a cursor appears on the upper left corner of the display. Type a title for the panoramic image.

–

If a title already exists, the title is selected so that you can edit it.

–

To delete the title, press Clear.

4. When you are finished, press Text again.

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Placing a Label on a Panoramic Image You can type a label anywhere on a panoramic image. ➤ To place a label on a panoramic image 1. Press Text. 2. Use the trackball to move the I cursor to the location where you want to type a label. 3. Type the label. 4. You can move, edit, or delete the label: –

To move a label, use the trackball to move the cursor over the label, press Enter, and use the trackball to move the label. Press Enter again to reposition the label.

–

To edit a label, use the trackball to move the cursor over the label until the cursor starts to blink. Use the Backspace key to remove characters. Then type new characters.

–

To delete a label, use the trackball to move the cursor over the label. Press Clear. If you press Clear without moving the cursor over a label, all labels are deleted.

5. When you are finished, press Text again.

Saving Panoramic Images and Data Sets You can save panoramic images and data sets in DICOM format. Or you can save only panoramic images in PC format to a CD. ➤ To save panoramic images and data sets in DICOM format 1. In Panoramic Render mode, press Archive. 2. Select the appropriate option to save the data set or the still image. 3. Click Save. The image title is saved with the data set. The title, labels, and measurements are saved with the still image.

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Saving Panoramic Images to CD ➤ To save panoramic images to CD 1. In Panoramic Render mode, press Save to CD. 2. Type the name for the image in the File Name field. 3. Click Save.

Quick Review Quick Review allows you to interrupt live imaging and scroll through a loop, scroll through a trace, or cause a loop to play back. •

If you are in 2D mode, Color Power Angio mode, or Color mode, you can either scroll through the loop frame by frame or cause the loop to play back repeatedly.

•

If you are in CW Spectral Doppler mode, PW Spectral Doppler mode, or M-mode Trace, you can scroll through either the image loop or the trace.

•

When you return to live imaging, the Quick Review images are erased from memory.

Using Quick Review ➤ To use Quick Review 1. While in live imaging, press Freeze. The image freezes on the current frame. Any measurements are removed from the image. 2. If you are in CW Spectral Doppler mode, PW Spectral Doppler mode, or M-mode Trace, do one of the following: – To scroll through the image loop, press Select until Image is highlighted on the Select menu. – To scroll through the trace, press Select until Trace is highlighted on the Select menu. 3. Move the trackball to the right or the left to scroll forward or backward frame by frame. HD11 User Reference 4535 611 65311

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4. To save the frame to the patient study, press Acquire. 5. Press Freeze again to return to live imaging.

Using Quick Review Soft Keys In Quick Review, three related soft keys become active. Other soft keys appear as well, depending on the mode you are in. If you are in M-mode, PW Doppler mode, or CW Doppler mode, the soft keys apply to the image when Image is highlighted on the Select menu. The soft keys apply to the trace or the spectrum when Trace is highlighted. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Edit End

Edit Start

Replay

Playing Back a Quick Review Loop You can play back a Quick Review loop if you are in 2D mode, Color Power Angio mode, or Color mode. ➤ To play back a Quick Review loop 1. While in live imaging, press Freeze. The image freezes on the current frame. 2. Press Replay to play back the loop. 3. To increase or decrease the playback speed, press top or the bottom of the Replay soft key. The loop speed appears on the soft key label, written as a percentage of actual speed. The loop speed and the location of the frame appear on the bottom right corner of the display. 4. To adjust the endpoints of the loop, use the Edit Start and Edit End soft keys. 230

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5. To save the loop to the patient study, press Acquire. NOTE

Only the portion of the loop between the start and the end markers is saved to the study. 6. To scroll through the loop, press Select and use the trackball. 7. Press Freeze to return to live imaging.

SonoCT Real-time Compound Imaging SonoCT Real-time Compound Imaging provides the following benefits: •

Reduces speckle and improves image smoothness

•

Enhances contrast resolution

•

Improves contrast and definition of tissues interfaces.

SonoCT imaging takes successive frames at different steering angles and blends them together. You can use SonoCT imaging during: •

Live 2D acquisition, including harmonic imaging modes

•

Freehand 3D and motorized 3D imaging (not available in 4D)

SonoCT imaging is available only for linear and curved linear transducers. SonoCT imaging works well in conjunction with XRES Image Processing.

About SonoCT Imaging SonoCT imaging acquires frames at different steering angles and averages the pixels of each frame together, blending holes and filling seams. A maximum of 11 angles are available, depending upon the selected transducer. When SonoCT imaging is on, the following icon appears on the display, above the Select menu:

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SonoCT Imaging Modes SonoCT imaging has the following modes: •

Survey mode limits the number of angles to three and is typically used when positioning the transducer to an optimal scanning location.

•

Target mode begins the full SonoCT imaging frame processing, with the number of frames determined by the transducer.

NOTES

• •

In 3D imaging, only Survey mode is available. If Trapezoidal Imaging is on, turning SonoCT imaging on will turn Trapezoidal Imaging off.

Using SonoCT Imaging ➤ To use SonoCT imaging 1. Press the SonoCT soft key to enter Survey mode. appears on the side border. 2. Position the transducer over the area of interest. 3. Press the SonoCT soft key to enter Target mode. 4. Press the SonoCT soft key again to turn it off.

Tissue Harmonic Imaging Tissue Harmonic Imaging (THI) is a 2D mode in which the transducer receives at twice the transmit frequency. THI reduces artifacts, haze, and clutter from the image. It also increases contrast resolution and border delineation. It can be helpful when imaging areas that are filled with fluid, such as the gallbladder or heart chambers and is useful in difficult-to-image patients, as well. THI can be used in conjunction with "SonoCT Real-time Compound Imaging" on page 231 and "XRES Adaptive Image Processing" on page 234. NOTE

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In THI, the frame rate is generally limited to 30 Hz for the black-and-white image.

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Using Tissue Harmonic Imaging ➤ To use Tissue Harmonic Imaging 1. Press THI to turn on Tissue Harmonic Imaging. An icon like the one that follows appears on the lower left corner of the display:

2. Adjust the 2D Gain and the TGC controls. 3. To change the appearance of your image, use the soft keys. 4. To change the fusion recipe, press THI until you find the recipe you want. 5. Press Fusion to exit Tissue Harmonic Imaging. NOTE

Tissue Harmonic Imaging is only available with harmonics-capable transducers.

Trapezoidal Imaging Trapezoidal Imaging adds an additional imaging area by changing a linear transducer's rectangular image to a trapezoidal shape. The extended field of view is often useful in vascular and small parts presets. The linear portion of the image becomes slightly narrower when Trapezoidal Imaging is on. The amount of narrowing varies with transducer and imaging depth; deeper imaging depths cause more narrowing of the linear portion of the image. You can use Trapezoidal Imaging when: •

General Imaging or Vascular application is installed.

•

A linear transducer is selected.

•

Biopsy and Zoom are both off.

SonoCT imaging is not available in Trapezoidal Imaging.

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Using Trapezoidal Imaging ➤ To use Trapezoidal Imaging 1. Press Next to access the next level of soft keys. 2. Press Trap to turn Trapezoidal Imaging on or off. If you turn Trapezoidal Imaging on when you are in 2D mode, it remains on if you switch to another mode. NOTE

When you turn on Trapezoidal Imaging, SonoCT imaging is turned off. The result is a coarser image than you had when Trapezoidal Imaging was turned off.

XRES Adaptive Image Processing The XRES Adaptive Image Processing feature enhances images without altering the image resolution. XRES processing provides the following benefits: •

Improves contrast resolution

•

Reduces artifacts

•

Improves visibility of tissue texture patterns

•

Improves border definition and continuity

•

Works well in conjunction with SonoCT imaging.

XRES is not available with M-mode or PW trace. In 4D and Panoramic Imaging, XRES is available only on rendered images. XRES processing affects only the black-and-white portion of the 2D or 3D images; it does not affect flow data or traces. When XRES processing is on, the XRES icon appears on the side border of the display.

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Using XRES processing ➤ To turn XRES processing on and off Press XRES. When XRES processing is on, the following icon appears on the display, above the Select menu:

Zoom The HD11 system has two zoom features: •

Zoom enables you to enlarge an isolated area of the original image. It offers improved image resolution because it recalibrates the image data in order to enlarge it. Zoom can be performed only on live images.

•

Magnify enables you to incrementally enlarge the entire image, regardless of the area of interest. It offers lower image quality but faster results than Zoom because it does not reprocess the acoustic data. Magnify can be performed on live and frozen images.

Both Zoom and Magnify are controlled with the Zoom knob. •

Push Zoom to enable Zoom.

•

Turn Zoom to enable Magnify.

The Zoom and Magnify features function differently depending upon the selected mode.

Using Zoom During Live Imaging ➤ To use Zoom during live imaging 1. Press the Zoom knob. A zoom box appears on the image. 2. Use the trackball to change the size and position of the zoom box so that the zoom box contains the area that you want to enlarge. 3. Press Zoom again to enlarge the selected area. HD11 User Reference 4535 611 65311

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4. To change the size or position of the zoomed portion of the image, press Select while the image is live until Size or Position is highlighted on the Select menu. Use the trackball to resize or reposition the image. 5. Press Zoom or 2D to exit Zoom.

Magnifying Live and Frozen Images You can magnify live and frozen images in grayscale or in a flow mode. ➤ To magnify a live image Do one of the following: •

Turn Zoom clockwise to increase magnification.

•

Turn Zoom counterclockwise to decrease magnification.

➤ To magnify a frozen image 1. Press Freeze. 2. Turn Zoom clockwise to increase magnification. Turn it counterclockwise to decrease magnification. 3. To pan around the entire image, press Select until Pan is highlighted on the Select menu. Use the trackball to pan the image. 4. To acquire the portion of the image visible on the display, press Acquire. NOTE

You cannot magnify images when an M-mode trace is displayed. However, you can apply Zoom to both the 2D image and the M-mode trace together.

Using Color or Color Power Angio Zoom Color Zoom shows color flow in zoomed image. Color Power Angio (CPA) Zoom shows angio flow in a zoomed image. ➤ To use Color or CPA zoom 1. Press Color or CPA to turn Color or CPA on. 2. To change the size and position of the color or angio box, use the trackball. 3. Press Zoom. A zoom box appears on the image. 236

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4. Use the trackball to change the size and position of the zoom box so that it contains the area that you want to magnify. NOTE

As you resize and reposition the zoom box, the color or angio box moves around the image to remain centered inside the zoom box. 5. Press Zoom again. The zoomed area appears. 6. To change the size and position of the color or angio box, use the trackball.

NOTE

The size of the color or angio box is limited to the size of the zoomed image. 7. To change the size and position of the zoom box: a. Press Color or CPA to turn Color or CPA off and assign the trackball to the zoom box. b. Use the trackball to change the size and position of the zoom box. c. Press Color or CPA to turn Color or CPA back on. 8. Press Zoom to exit zoom.

Using M-mode Zoom When you are in M-mode, you can zoom a portion of the reference image by entering M-mode Zoom. In M-mode Zoom, the M-mode trace represents only the information in the zoom box. You can also magnify the M-mode image by turning the Zoom knob. ➤ To use M-mode Zoom 1. Press Mmode. 2. Use the trackball to move the M-mode reference line to the anatomy of interest. 3. Press Mmode again. The M-mode trace appears with the reference image. NOTE

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4. Press Zoom. A zoom box appears on the image. 5. Use the trackball to change the size and position of the zoom box so that it contains the area that you want to enlarge. 6. Press Zoom again. The enlarged image appears on the display. 7. Exit Zoom and M-mode.

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–

To exit M-mode and remain in Zoom, press Mmode.

–

To exit Zoom and remain in M-mode, press Zoom.

–

To exit M-mode Zoom, press 2D or Mmode and Zoom.

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10 Imaging Tips Imaging tips help you improve the appearance of your image or solve problems you encounter while imaging. Imaging tips are available for several imaging modes. •

"Imaging Tips for 2D Mode" on page 239

•

"Imaging Tips for M-mode" on page 242

•

"Imaging Tips for PW Doppler Mode" on page 243

•

"Imaging Tips for CW Doppler Mode" on page 245

•

"Imaging Tips for Color Mode" on page 248

•

"Imaging Tips for Color Power Angio Mode" on page 251

Imaging Tips for 2D Mode Click the statement that best describes your goal: •

"I need to increase the penetration." on page 239

•

"I need to improve the resolution." on page 240

•

"I want the image to be less soft, hazy, or gray." on page 240

•

"I want the image to be less contrasty or grainy." on page 241

•

"I need to be able to see the soft tissue." on page 241

•

"I want the fluid-filled structures to have fewer echoes." on page 242

I need to increase the penetration. Possible Actions: •

Press Fusion to try the P (Penetration) setting.

•

Lower the position of the focal zones by pressing Focus.

•

Increase the gain by turning 2D Gain clockwise.

•

Move the bottommost TGC slide controls to the right.

•

Increase the power by turning Power clockwise. HD11 User Reference 4535 611 65311

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NOTE

After adjusting any control, always check the position of the transducer.

I need to improve the resolution. Possible Actions:

NOTE

•

Press Fusion to try the R (Resolution) setting.

•

Press Focus to move the focal zone to the area of interest.

•

If you are using a linear or a curved linear array transducer, press Focal Zones to increase the number of focal zones.

•

If you are using a linear transducer, turn Angle to achieve the optimal angle for the 2D structure.

•

Adjust the compression by pressing Compress.

•

Use the trackball to decrease the image width.

•

Increase the persistence by pressing Persist.

After adjusting any control or soft key, always check the position of the transducer.

I want the image to be less soft, hazy, or gray. Possible Actions:

240

•

Decrease the gain by turning 2D Gain counterclockwise.

•

Move the TGC slide controls to the left.

•

Change the grayscale contrast by pressing Map.

•

Decrease the compression by pressing Compress.

•

Decrease the Smooth setting by pressing Smooth.

•

Sharpen the image by decreasing the persistence by pressing Persist.

•

If you are using a transducer that supports harmonics, press THI to turn on Tissue Harmonic Imaging.

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Imaging Tips

NOTE

10

After adjusting any control or soft key, always check the position of the transducer.

I want the image to be less contrasty or grainy. Possible Actions:

NOTE

•

Change the grayscale postprocessing map to a softer, less contrasty map by pressing Map.

•

Increase compression by pressing Compress.

•

Increase the Smooth setting by pressing Smooth.

•

Press Fusion to select the R setting.

•

Increase the persistence by pressing Persist.

After adjusting any control or soft key, always check the position of the transducer.

I need to be able to see the soft tissue. Possible Actions:

NOTE

•

Reposition the transducer.

•

Increase the gain by turning 2D Gain clockwise.

•

Move the TGC slide controls to the right.

•

Adjust the compression by pressing Compress.

•

Press Fusion to try a different fusion setting.

•

Adjust the Smooth setting by pressing Smooth.

•

Press Chroma to improve the contrast resolution.

•

Increase the persistence by pressing Persist.

•

Increase the power by turning Power clockwise.

After adjusting any control or soft key, always check the position of the transducer. HD11 User Reference 4535 611 65311

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Imaging Tips

I want the fluid-filled structures to have fewer echoes. Possible Actions:

NOTE

•

Decrease the gain by turning 2D Gain counterclockwise.

•

Move the TGC slide controls to the left.

•

Decrease the compression by pressing Compress.

•

If you are using a transducer that supports harmonics, press THI to turn on Tissue Harmonic Imaging.

•

Choose a more contrasty postprocessing map by pressing Map.

•

Decrease the Smooth setting by pressing Smooth.

After adjusting any control or soft key, always check the position of the transducer.

Imaging Tips for M-mode Click the statement that best describes your goal: •

"I want to reduce noise in the M-mode trace." on page 242

•

"I want to increase the size of the M-mode trace." on page 243

I want to reduce noise in the M-mode trace. Possible Actions:

NOTE

242

•

Decrease the gain by turning Doppler Gain counterclockwise.

•

Select a map with more contrast by pressing Map.

After adjusting any control or soft key, always check the position of the transducer.

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Imaging Tips

10

I want to increase the size of the M-mode trace. Possible Actions:

NOTE

•

Change the M-mode format to Small over large or Full screen.

•

Press Resize 2D Image, if necessary, and press Zoom to make the M-mode image and trace larger.

After adjusting any soft key, always check the position of the transducer.

Imaging Tips for PW Doppler Mode Click the statement that best describes your goal: •

"I want the Doppler to be more sensitive." on page 243

•

"I need to be able to see a Doppler signal that is audible, but not visible." on page 244

•

"I need to unwrap an aliased spectrum." on page 244

•

"I want to reduce artifacts and noise in the spectrum." on page 244

•

"I want the 2D reference image to be updated." on page 245

•

"I want to display low-velocity signals." on page 245

I want the Doppler to be more sensitive. Possible Actions:

NOTE

•

Increase the gain by turning Doppler Gain clockwise; increase the compression by pressing Compress; and decrease the Reject setting by pressing Reject to increase the amount of Doppler information displayed.

•

Turn on Adaptive Doppler. Press Setup, click the Mode tab, and select the Adaptive Doppler check box.

•

Increase the size of the PW sample volume gate by pressing Gate.

•

Decrease the scale by pressing Scale.

After adjusting any control or soft key, always check the position of the transducer. HD11 User Reference 4535 611 65311

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Imaging Tips

I need to be able to see a Doppler signal that is audible, but not visible. Possible Actions:

NOTE

•

Adjust the scale by pressing Scale.

•

Increase the gain by turning Doppler Gain clockwise.

•

Increase the compression by pressing Compress, and decrease the Reject setting by pressing Reject to increase the range of echoes displayed.

•

Decrease the Filter setting by pressing Filter.

•

If you are using a linear transducer, press Steer to adjust the cursor steer.

After adjusting any control or soft key, always check the position of the transducer.

I need to unwrap an aliased spectrum. Possible Actions:

NOTE

•

Press Baseline to unwrap the signal.

•

Increase the scale by pressing Scale to increase the range of displayed velocities and to decrease the size of the waveform.

After adjusting any control, always check the position of the transducer.

I want to reduce artifacts and noise in the spectrum. Possible Actions:

244

•

Decrease the gain by turning Doppler Gain counterclockwise.

•

Increase the Filter setting by pressing Filter.

•

Increase the Reject setting by pressing Reject.

•

Decrease the compression by pressing Compress.

•

Decrease the power by turning Power counterclockwise.

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Imaging Tips

NOTE

10

After adjusting any control or soft key, always check the position of the transducer.

I want the 2D reference image to be updated. Possible Actions:

NOTE

•

Make sure that the Delay or the Update soft key is not set to 2D Hold On.

•

Change the Update interval at which your 2D image is updated by pressing the Update soft key.

•

Increase the ECG Gain setting. Press Setup. The ECG Gain soft key setting is displayed. Press ECG Gain to adjust the setting in cardiac presets.

•

Incardiac presets, press Enter or Update to manually update the 2D image. Press Enter or Update again to make the spectral trace live again.

•

Check the ECG leads for proper placement.

After adjusting any control or soft key, always check the position of the transducer.

I want to display low-velocity signals. Possible Actions:

NOTE

•

Decrease the scale by pressing Scale.

•

Decrease the Filter setting by pressing Filter.

After adjusting any soft key, always check the position of the transducer.

Imaging Tips for CW Doppler Mode Click the statement that best describes your goal: •

"I want the Doppler to be more sensitive." on page 246

•

"I need to be able to see a Doppler signal that is audible, but not visible." on page 246

•

"I want to reduce artifacts and noise in the spectrum." on page 247 HD11 User Reference 4535 611 65311

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Imaging Tips

•

"I want the 2D reference image to be updated." on page 247

•

"I want to display low-velocity signals." on page 247

I want the Doppler to be more sensitive. Possible Actions:

NOTE

•

Increase the gain by turning Doppler Gain clockwise; increase the compression by pressing Compress; and decrease the Reject setting by pressing Reject to increase the amount of Doppler information displayed.

•

Turn on Adaptive Doppler. Press Setup, click the Mode tab, and select the Adaptive Doppler check box.

•

If you are using a linear transducer, adjust the Steer setting to achieve the optimal angle of flow.

•

Use the trackball to move the focus diamond on the CW reference line over the area where the greatest sensitivity is needed.

•

Decrease the scale by pressing Scale.

After adjusting any control or soft key, always check the position of the transducer.

I need to be able to see a Doppler signal that is audible, but not visible. Possible Actions:

NOTE

246

•

Adjust the scale by pressing Scale.

•

Increase the gain by turning Doppler Gain clockwise.

•

Increase the compression by pressing Compress and decrease the Reject setting by pressing Reject to increase the range of echoes displayed.

•

Decrease the Filter setting by pressing Filter.

After adjusting any control or soft key, always check the position of the transducer.

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10

I want to reduce artifacts and noise in the spectrum. Possible Actions:

NOTE

•

Decrease the gain by turning Doppler Gain counterclockwise.

•

Increase the Filter setting by pressing Filter.

•

Increase the Reject setting by pressing Reject.

•

Decrease the compression by pressing Compress.

•

Decrease the power by turning Power counterclockwise.

After adjusting any control or soft key, always check the position of the transducer.

I want the 2D reference image to be updated. Possible Actions:

NOTE

•

Make sure that the Delay or Update soft key is not set to 2D Hold On.

•

Change the Update interval at which your 2D image is updated by pressing the Update soft key.

•

Increase the ECG Gain setting. Press Setup. The ECG Gain soft key setting is displayed. Press ECG Gain to adjust the setting.

•

Press Enter or Trace to manually update the 2D image. Press Enter or Trace again to make the spectral trace live again.

•

Check the ECG leads for proper placement.

After adjusting any control or soft key, always check the position of the transducer.

I want to display low-velocity signals. Possible Actions:

NOTE

•

Decrease the scale by pressing Scale.

•

Decrease the Filter setting by pressing Filter.

After adjusting any soft key, always check the position of the transducer. HD11 User Reference 4535 611 65311

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Imaging Tips for Color Mode Click the statement that best describes your goal: •

"I want the color to be more sensitive." on page 248

•

"I want the color to have less noise, flashing, or fewer artifacts." on page 248

•

"I want the color to be less speckled or fragmented." on page 249

•

"I need to improve the color filling." on page 249

•

"I want to unwrap aliased signals." on page 250

•

"I need to increase the frame rate." on page 250

I want the color to be more sensitive. Possible Actions:

NOTE

•

Reposition the transducer.

•

Increase the gain by turning Color Gain clockwise.

•

Use the Focus key to place the focal zone at the area of interest.

•

Decrease the scale by pressing Scale.

•

Decrease the Filter setting by pressing Filter.

•

Increase the Smooth setting by pressing Smooth.

•

Change the Doppler frequency by pressing Frequency.

•

Decrease the density by pressing Density.

After adjusting any control or soft key, always check the position of the transducer.

I want the color to have less noise, flashing, or fewer artifacts. Possible Actions:

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•

Decrease the gain by turning Color Gain counterclockwise.

•

Increase the Filter setting by pressing Filter.

•

Increase the scale by pressing Scale.

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10

•

Resize the color box to make it narrower, to remove the source of artifacts.

•

Increase the persistence by pressing Persist.

NOTES

• •

After adjusting any control or soft key, always check the position of the transducer. In cardiac imaging, mechanical heart valves occasionally cause unavoidable flashing artifacts. Artifacts can also be caused by external sources such as lighting, other equipment, or telecommunications devices.

I want the color to be less speckled or fragmented. Possible Actions:

NOTE

•

Increase the gain by turning Color Gain clockwise.

•

Increase the Smooth setting by pressing Smooth.

•

For slow-moving blood or structures, increase the persistence by pressing Persist.

•

Decrease the Density setting by pressing Density.

After adjusting any control or soft key, always check the position of the transducer.

I need to improve the color filling. Possible Actions: •

Increase the gain by turning Color Gain clockwise.

•

Use the Focus key to place the focal zone at or just below the area of interest.

•

Decrease the scale by pressing Scale.

•

Decrease the Filter setting by pressing Filter.

•

Increase the packet size by pressing Packet.

•

Decrease the density by pressing Density.

•

For slow-moving blood or structures, increase the persistence by pressing Persist. HD11 User Reference 4535 611 65311

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Imaging Tips

NOTE

•

Increase the Smooth setting by pressing Smooth.

•

If you are using a linear transducer, turn Angle to adjust the color box to achieve the optimal angle for the 2D structure.

•

Select a lower frequency by pressing Frequency, if available.

After adjusting any control or soft key, always check the position of the transducer.

I want to unwrap aliased signals. Possible Actions:

NOTE

•

Increase the scale by pressing Scale.

•

Unwrap aliased signals by pressing Baseline.

•

Select the lowest frequency by pressing Frequency, if available. Otherwise, use a lower frequency transducer.

After adjusting any control or soft key, always check the position of the transducer.

I need to increase the frame rate. Possible Actions:

250

•

Resize the color box to make it smaller.

•

If the scale setting is very low, increase the scale by pressing Scale.

•

If you are using a sector or curved linear array transducer, turn on B/W Suppress by pressing B/W Suppress.

•

If you are using a linear transducer, resize the 2D image before pressing Color to turn on Color Mode.

•

Decrease the packet size by pressing Packet.

•

Decrease the Density setting by pressing Density.

•

Decrease the imaging depth by pressing Depth.

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Imaging Tips

NOTE

10

After adjusting any control or soft key, always check the position of the transducer.

Imaging Tips for Color Power Angio Mode Click the statement that best describes your goal: •

"I want the angio to be more sensitive." on page 251

•

"I want the angio to have less noise, flashing, or fewer artifacts." on page 251

•

"I need to improve the angio filling." on page 252

•

"I need to improve the angio resolution." on page 253

•

"I need to increase the frame rate." on page 253

I want the angio to be more sensitive. Possible Actions:

NOTE

•

Reposition the transducer.

•

Increase the gain by turning CPA Gain clockwise.

•

Use the Focus key to place the focal zone at the area of interest.

•

Decrease the scale by pressing Scale.

•

Decrease the Filter setting by pressing Filter.

•

Increase the Smooth setting by pressing Smooth.

•

Change the Doppler frequency by pressing Frequency.

•

Decrease the density by pressing Density.

After adjusting any control or soft key, always check the position of the transducer.

I want the angio to have less noise, flashing, or fewer artifacts. Possible Actions: •

Decrease the gain by turning CPA Gain counterclockwise. HD11 User Reference 4535 611 65311

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Imaging Tips

•

Increase the persistence by pressing Persist.

•

Increase the scale by pressing Scale.

•

Resize the angio box to make it narrower, to remove the source of artifacts.

•

Increase the Filter setting by pressing Filter.

NOTES

• •

After adjusting any control or soft key, always check the position of the transducer. In cardiac imaging, mechanical heart valves occasionally cause unavoidable flashing artifacts. Artifacts can also be caused by external sources such as lighting, other equipment, or telecommunications devices.

I need to improve the angio filling. Possible Actions:

NOTE

252

•

Increase the gain by turning CPA Gain clockwise.

•

Use the Focus key to place the focal zone at or just below the area of interest.

•

Decrease the scale by pressing Scale.

•

Decrease the Filter setting by pressing Filter.

•

Increase the packet size by pressing Packet.

•

Decrease the density by pressing Density.

•

For slow-moving blood or structures, increase the persistence by pressing Persist.

•

Increase the Smooth setting by pressing Smooth.

•

If you are using a linear transducer, turn Angle to adjust the angio box to achieve the optimal angle for the 2D structure.

•

If you are using a multifrequency transducer, press Frequency to select a lower frequency.

After adjusting any control or soft key, always check the position of the transducer.

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Imaging Tips

10

I need to improve the angio resolution. Possible Actions:

NOTE

•

Press Focus to place the focal zone at the area of interest.

•

Increase the packet size by pressing Packet.

•

For small vessels, decrease the Smooth setting by pressing Smooth.

•

Increase the Density setting by pressing Density.

•

If you are using a multifrequency transducer, press Frequency to select a higher frequency.

After adjusting any control or soft key, always check the position of the transducer.

I need to increase the frame rate. Possible Actions:

NOTE

•

Resize the angio box to make it smaller.

•

If the scale setting is very low, increase the scale by pressing Scale.

•

If you are using a sector or curved linear array transducer, turn on B/W Suppress by pressing B/W Suppress.

•

If you are using a linear transducer, resize the 2D image before pressing CPA to turn on CPA Mode.

•

Decrease the packet size by pressing Packet.

•

Decrease the Density setting by pressing Density.

•

Decrease the imaging depth by pressing Depth.

After adjusting any control or soft key, always check the position of the transducer.

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Imaging Tips

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Stress Echocardiography

11

11 Stress Echocardiography On the HD11 system, a Stress Echo study consists of two to eight stages and can acquire loops for up to eight anatomical views.

Before You Perform Your First Stress Echo Study Before you perform the first Stress Echo study, Stress Echo must be installed on your system. See "Installing Options" on page 101. Also, you need to assign one of the option keys to Stress Echo. See "Assigning Option Keys" on page 102.

Gain Save During the first stage of a Stress Echo protocol, you can adjust the system settings, the ROI setting, and imaging controls, such as Depth, 2D Gain, and TGC. Because of a feature called Gain Save, the settings for each view are saved and then are restored when you acquire the same view in the other stages. NOTE

If you stop and resume a Stress Echo study, Gain Save no longer applies.

ECG in Stress Echo In Stress Echo, the acquisition of loops is triggered by the R-wave. Therefore, to perform a Stress Echo study, an ECG trace with R-waves must appear on the display. If no R-wave is detected,

displayed, and a 1-second Stress Echo loop

is acquired: The ECG is captured and displayed with loops that you acquire in Stress Echo. NOTES

• • •

Stress Echo is an option. The foot switch option is included in the Stress Echo option. When you export a Stress Echo study, only the preferred loops are exported.

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Stress Echo Setup Before you begin a Stress Echo study, you can create Stress Echo presets based on default Stress Echo protocols. During a Stress Echo study, you can modify the Stress Echo preset you are using by adding views or stages.

Creating a Stress Echo Preset ➤ To create a Stress Echo preset 1. Select a cardiac preset as a starting point for your Stress Echo preset. See "Selecting a Preset" on page 96. 2. Press Setup. 3. Click the Stress tab. 4. On the Stress tab, make changes that you want for your preset:

256

–

Load Defaults—Choose one of three default protocols or create your own. See "About Stress Echo Protocols" on page 257.

–

Default Acquisition Type—Specify whether the stages are single-cycle or quad-cycle acquisition stages. See "About Stress Echo Acquisition Methods" on page 258.

–

Stage Name—Add stages or edit stage names.

–

Start View—Select a new starting view for any stage. The view order appears below the Load Defaults button.

–

Multi—Specify the multi-cycle stage. See "About Stress Echo Acquisition Methods" on page 258.

–

VCR—Specify which stages are VCR stages. See "Using a VCR During a Stress Echo Study" on page 260.

–

Timer—Specify the timer stage. See "Using the Timer During a Stress Echo Study" on page 260.

–

Edit Views—Add views or edit view names.

–

Clear All—Delete all of the settings.

–

R-Wave Delay—Specify the time lapse between the R-wave and the acquisition of the first frame. A positive number results in acquisition after the R-wave; a negative number results in acquisition before the R-wave.

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5. Click Apply. 6. Click Close. 7. Press Preset. 8. Press Save Preset. 9. Click Create New. 10. Type the name of the preset you want to create. 11. Click Save.

Modifying a Stress Echo Preset You can modify the current Stress Echo preset at any time. ➤ To modify the current Stress Echo preset 1. Press Setup. 2. Click the Stress tab. 3. On the Stress tab, make changes to the preset. –

You can define additional views or delete views for a protocol before you acquire the first loop of a study.

–

You can create additional stages anytime.

–

You can delete a stage if you have not yet acquired a loop for that stage.

4. Click Apply or Save. 5. Click Close.

About Stress Echo Protocols You can use one of the three Philips Stress Echo protocols to perform a Stress Echo study, or you can base your own preset on one of the protocols. Protocol Name Exercise 2-Stage

Stages

Timer

VCR

First View

Acquisition Type

Rest

Off

Off

LAX

Quad-cycle

ImPost

On

On

AP4

Multi-cycle HD11 User Reference 4535 611 65311

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Exercise 3-Stage

Rest

Off

Off

LAX

Quad-cycle

Peak

On

On

AP4

Multi-cycle

Post

Off

Off

LAX

Quad-cycle

Pharmacol Base ogical Low 4-Stage Peak

Off

Off

LAX

Quad-cycle

Off

Off

LAX

Quad-cycle

On

On

LAX

Quad-cycle

Post

Off

Off

LAX

Quad-cycle

About Stress Echo Acquisition Methods For each Stress Echo stage, you can choose from the following three acquisition methods:

NOTE

•

Single-cycle—When you press Acquire, one loop is acquired and saved to the study.

•

Quad-cycle—When you press Acquire, four consecutive loops (one per heart cycle) are acquired and saved to the study.

•

Multi-cycle—When you press Acquire, up to 200 loops (one per heart cycle) are continuously acquired and saved to the study, allowing you to continuously acquire loops for all views in a particular stage. Press Enter to proceed from one view to the next. After you have imaged all of the views, press Acquire to end the acquisition. Press End Acquire when you are finished with the multi-cycle acquisition to enter Image Review.

Only one multi-cycle stage is allowed in each protocol.

About ECG Artifacts Although artifacts can occur during traditional echocardiography exams while patients are lying at rest, exercise-induced Stress Echo exams are more likely to produce ECG artifacts due to increased muscle movement and respiration rates. The type of Stress Echo exam you perform influences the probability of ECG artifact occurrences, as described in the following table:

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Stress Echocardiography

Respiration Artifacts

Muscle Motion Artifacts

Recommended Type of ECG

Traditional Echocardiography

No

No

3-lead

Stress Echo (Pharmacological)

Yes

No

12-lead

Stress Echo (Exercise)

Yes

Yes

12-lead

Examination Type

11

The presence of ECG artifacts can cause the following problems: •

The heart rate display may be inaccurate if an artifact is detected as a heart beat.

•

A premature trigger for image acquisition may occur due to an ECG artifact.

Philips highly recommends that you videotape Stress Echo studies to avoid losing image data due to ECG artifacts.

Minimizing ECG Artifacts The following options may reduce the incidence of ECG artifacts and triggering problems during Stress Echo studies:

NOTE

•

The best way to monitor ECG artifacts is to activate the audible R-wave beep. This audio signal helps you distinguish between true arrhythmias and premature triggering caused by ECG artifacts.

•

To minimize motion and respiration artifacts, use a 12-lead cardiograph. Adjust the ECG Gain so that the QRS pulses are detected and an accurate heart rate appears on the ultrasound system.

To learn how to change the ECG Gain, see "Using Physio Soft Keys" on page 141. •

Some 12-lead cardiographs provide a square-wave pulse output signal that can be input into the ultrasound system’s ECG auxiliary channel on the physio panel. This output signal helps minimize ECG artifacts. If a square-wave pulse from another machine is used, you may have to increase the ECG Gain.

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Using a VCR During a Stress Echo Study The VCR begins recording when you do one of the following: •

You press the Record key that is assigned to the VCR.

•

You press Acquire to acquire the first view of a VCR stage.

The VCR stops recording when one of the following occurs: •

One loop has been acquired for a single-cycle VCR stage.

•

Four loops have been acquired for a quad-cycle VCR stage.

•

You press End Acquire during a multi-cycle VCR stage.

•

Two hundred loops have been acquired for a multi-cycle VCR stage.

•

You press the VCR Stop soft key.

•

You press the Record key assigned to the VCR to pause recording.

Using the Timer During a Stress Echo Study The timer indicates the time that has elapsed since the timer started. The timer starts under the following circumstances: •

The timer automatically starts when you begin acquiring loops in a stage that you defined as a timer stage.

•

You can start the timer at any point by pressing Timer. If the timer is already running, pressing Timer hides the timer. Elapsed time is maintained while the timer is hidden.

The timer stops automatically at the end of the stage. You cannot manually turn off the timer. NOTE

260

If an ImPost stage is defined to be a timer stage, be sure to account for the time lapse between the moment exercise ends and acquisition begins.

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Stress Echo Acquisition A Stress Echo protocol leads you through the acquisition and acceptance of loops for each view for each stage of the protocol. The number of loops acquired for each stage depends on the acquisition method you choose for the stage. ➤ To display the Stress Echo soft keys at any time Press the Stress Echo option key.

Performing a Stress Echo Study The following overview describes how to perform a Stress Echo study. ➤ To perform a Stress Echo study 1. Connect the ECG cable and attach the ECG leads. See "Connecting the ECG Cable and Attaching the ECG Leads" on page 140. 2. Assign an option key to Stress Echo if you have not done so already. See "Assigning Option Keys" on page 102. 3. Create a Stress Echo preset, or select a Stress Echo preset that you created previously. See "Creating a Preset" on page 97 or "Creating a Stress Echo Preset" on page 256. 4. Create a new patient study. See "Creating a Patient Study" on page 399. 5. Press the Stress Echo option key. 6. A view icon and a stage-view label appear on the display. See "About the View Icon and the Stage-View Label" on page 262. 7. Acquire loops for single-cycle or quad-cycle acquisition stages. See "Acquiring Loops for a Single-Cycle or a Quad-Cycle Acquisition Stage" on page 263. 8. Select the preferred loop for each view in Image Review. See "Selecting the Preferred Stress Echo Loop" on page 267. 9. Acquire loops for the multi-cycle acquisition stage (if the protocol includes one). See "Acquiring Loops for a Multi-Cycle Acquisition Stage" on page 264. 10. Select the preferred loop for each view in Image Review. See "Selecting the Preferred Stress Echo Loop" on page 267.

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NOTE

To perform a Stress Echo study, an ECG trace must appear on the display. If no R-wave is detected,

is displayed, and a 1-second Stress Echo loop is

acquired.

Using Stress Echo Soft Keys ➤ To display the Stress Echo soft keys at any time Press the Stress Echo option key. ➤ To change any of the soft key settings Press the key below the soft key label. Refer to the Glossary to learn about the function of each soft key.

End Acquire

Hide/Show ROI

Pause/Unpause Protocol

Stage

Timer

View

About the View Icon and the Stage-View Label When you are acquiring loops in a Stress Echo study, a view icon and a stage-view indicator appear on the display to help you monitor loop acquisition.

View Icon A rectangle appears on the upper right corner of the display that indicates how many views have been acquired for the current stage. The rectangle contains four or eight squares, one for each possible view.

262

•

Blank square—The view has not yet been acquired, or the loop has been deleted.

•

Check mark—The view has been acquired.

•

X—No view needs to be acquired. For instance, if a stage has five views, three of the eight squares will contain an X.

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Stage-View Label The stage-view label lists the name of the current stage and view.

Acquiring Loops for a Single-Cycle or a Quad-Cycle Acquisition Stage ➤ To acquire loops for a single-cycle or a quad-cycle acquisition stage 1. Press Acquire to begin acquiring loops for the first view of the first stage. –

For a single-cycle acquisition stage, one loop is acquired and is displayed for your review in Image Review.

–

For a quad-cycle acquisition stage, four loops (one per heart cycle) are acquired and are displayed for your review in Image Review.

The first loop you acquire for each view is by default the preferred loop. 2. To change the preferred loop, select the check box in the bottom left corner of the loop. 3. Do one of the following: –

To accept the loop or the loops and proceed to the next view, press Review or 2D.

–

To reject the loop or loops and reacquire the view, press Acquire.

4. After you acquire all of the views for a stage, do one of the following: –

To accept the loop or loops and proceed to the next stage, press Review or 2D.

–

To reject the loop or loops and reacquire any views, press Acquire.

5. To add a stage or view, press Setup. See "Modifying a Stress Echo Preset" on page 257. NOTE

Although you automatically advance to the next view or stage, you can use the View or Stage soft keys to specify which view or stage you want to acquire.

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Acquiring Loops for a Multi-Cycle Acquisition Stage ➤ To acquire loops for a multi-cycle acquisition stage 1. Press Acquire. Up to 200 consecutive loops (one per heart cycle) can be acquired. A memory gauge appears on the top left corner of the display, showing how many loops of the possible 200 have been acquired. 2. Do one of the following: – To begin acquiring loops for the second view, press Enter. – To begin acquiring loops for a different view, press View. NOTE

If you do not press Enter or View, all loops will be labeled with the same view. You can relabel these loops after the multi-cycle acquisition ends. 3. Press Acquire to pause acquisition. Press Acquire again to resume. 4. Complete the exam. a. Press Acquire to pause the acquisition. b. Press End Acquire to view the loops in Image Review.

Acquiring Images Outside of a Stress Echo Protocol You can temporarily leave the Stress Echo protocol so that you can acquire loops or frames, such as images in Color mode or PW Doppler mode, outside of the Stress Echo protocol. ➤ To acquire images outside of the stress echo protocol 1. Press Pause Protocol. 2. Acquire images in any mode. 3. Return to the Stress Echo protocol. a. Press 2D. b. Press the Stress Echo option key to display the Stress Echo soft keys. 4. Press Unpause Protocol.

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Using the ROI Box in Stress Echo When you are in a Stress Echo protocol, a region of interest (ROI) box appears on the image. The area in the ROI box is the portion of the image that is acquired. ➤ To reposition the ROI box 1. Press Select until ROI is highlighted on the Select menu. 2. Move the ROI box with the trackball. ➤ To remove the ROI box from the display Press Hide ROI. ➤ To display the ROI box Press Show ROI.

Moving the 2D Reference Line in Stress Echo When you are in a Stress Echo protocol and an ROI box appears on the image, the reference line may obscure the acquired image. ➤ To move the reference line in Stress Echo 1. Press the Stress Echo option key to display the Stress Echo soft keys. 2. Press Hide ROI. 3. Press Select until Line is highlighted on the Select menu. 4. Move the reference line with the trackball. 5. Press the Stress Echo option key to display the Stress Echo soft keys. 6. Press Show ROI.

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Stopping and Resuming a Stress Echo Study You can stop a partially completed Stress Echo study to perform another study and then resume the prior Stress Echo study without having to reacquire resting images. The study can only be resumed on the same day you started the study. You must also be using the same system and preset.

Stopping a Stress Echo Study ➤ To stop a partially completed Stress Echo study 1. Complete the current stage.

2. Click

.

Resuming a Stress Echo Study ➤ To resume a Stress Echo study 1. Make sure you are in the same preset you used before you stopped the study. 2. Press Review.

3. Click

.

4. Highlight the study you want to resume with the trackball. 5. Click Open Study to open the report. 6. Press Review to view the images you acquired before you stopped the study. 7. Press 2D to resume acquiring images. 8. Click OK to confirm that you want to resume the study. The view icon and the stage-view label appear on the display. 9. Press the Stress Echo option key to display the Stress Echo soft keys. 10. Press Stage to change the stage, if necessary. 11. Continue acquiring images.

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Stress Echo Review After you acquire all of the loops for a view, you view the loops in Image Review. The loops are labeled with the following: •

Name of the stage

•

Name of the view

•

Time (if the timer was on)

•

Heart rate

Specifying the Type of Stress Echo Review Display In Thumbnails, you can view all of the images in the order they were acquired, all of the images of the same view, or all of the images in a stage. ➤ To specify the type of display Use the trackball to select Display Stages, Display Views, or Show Sequence from the Stress Display menu.

Adding Information About Stress Echo Stages in the Report Work Area You can enter information about stress echo stages on the Information tab in the report work area if at least one image has been acquired during the study.

Selecting the Preferred Stress Echo Loop After you acquire Stress Echo loops, they appear in Image Review, which is where you select the preferred loop. The default preferred loop is indicated with a check mark in the lower left corner of the image. ➤ To choose another loop to be the preferred loop Select the check box in the lower left corner of that image. All of the loops are still saved except those you marked for deletion. You can change the preferred loop at a later time. The preferred loop is the loop that you see when you are in the View Stages Stress Display in Thumbnails. HD11 User Reference 4535 611 65311

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NOTE

When you export a Stress Echo study, only the preferred loops are exported.

Relabeling Views You can change the name of the view associated with a loop by using the Select key or the Enter key. ➤ To relabel a Stress Echo view while in Stress Echo review using the Select key 1. Use the trackball to move the cursor over the loop. 2. Press Select. 3. Highlight Relabel Views with the trackball. 4. Highlight the correct view name with the trackball. 5. Press Enter. ➤ To relabel a Stress Echo view while in Stress Echo review using the Enter key 1. Use the trackball to move the cursor over the view name in the upper left corner of the loop. 2. Press Enter. 3. Highlight the correct view name with the trackball. 4. Press Enter.

Viewing All the Stress Echo Loops for a View If you acquire more than one loop for a view, only the preferred loop is visible in Thumbnails when you are in the Show Stages Stress Display. ➤ To view all of the loops you acquired for that view Click

on the lower left corner of the preferred image.

All of the loops you acquired for that view are displayed.

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Playing Back Stress Echo Loops ➤ To play back one Stress Echo loop in Thumbnails 1. Use the trackball to move the cursor over the image. 2. Do one of the following: –

Press Enter twice.

–

Press Enter and click Play.

➤ To play back all of the Stress Echo loops for a stage or a view 1. In Thumbnails, select Display Stages or Display Views from the Stress Display menu. 2. Use the trackball to move the cursor over the first image, and do one of the following: –

Press Enter twice.

–

Press Enter and click Play.

For more information about playing back loops, see "Playing Back More Than One Image in Image Review" on page 414.

Performing Wall Motion Scoring After a Stress Echo study, you can perform wall motion scoring for each wall segment. Graphics showing the wall scores automatically appear in the report. NOTE

To enter scores for wall segments, you must be in Image Review, and you must be in a cardiac preset.

➤ To perform wall motion scoring 1. In Thumbnails, view the stage you want to score. 2. Click

.

3. Use the slider at the top of the window to indicate which stage you are scoring. 4. Click the view icons to see the wall segments from different perspectives. HD11 User Reference 4535 611 65311

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5. Do one of the following: –

If all wall segments are normal, click All Normal.

–

Use the trackball to move the cursor over the wall segment, press Select, highlight the wall score for the segment, and press Enter.

6. Repeat step 2 through step 5 for each stage. Click Carry Over to apply the scores from the previous stage to the current stage.

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12 Annotation You can annotate an image with labels and arrows. You can also add body marker graphics that indicate the parts of the anatomy you are scanning.

Labels You can place a label anywhere on the display so that you can comment on the image. You can also add an arrow to indicate which part of the image the label applies to.

Using Quick Text The quickest way to place a label on the display is to position the cursor on the screen with the four keyboard arrow keys and then start typing. If you do not position the cursor, the Quick Text label will appear at the home position. To learn how to move or delete a Quick Text label, see "Moving or Deleting Annotations" on page 273.

Placing a Label on the Display You can place system-defined labels on the display by pressing the Label key or the Text key.

Using the Label Key to Place a Label ➤ To place a system-defined label on the display by using the Label key 1. Press Label. 2. Use the trackball to select the label you want on the Label menu. 3. Do one of the following: –

Use the trackball to drag the label onto the display and to position it on the display. Press Enter to anchor the label.

–

Press Enter to place the label on the display at the current location of the cursor.

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Using the Text Key to Place a Label ➤ To place a system-defined label on the display by using the Text key: 1. Press Text. 2. Use the trackball to position the cursor where you want the label to appear. 3. Press Select to highlight Label on the Select menu. 4. Move the trackball up and down to scroll through the menu selections on the display. 5. Press Enter to anchor the label you want on the display. 6. Press Text to exit.

Typing a Label on the Display ➤ To type your own label on the display by using the Text key 1. Press Text. 2. Use the trackball to position the cursor where you want the label. 3. Type the label. 4. Press Text to exit.

Modifying a Label ➤ To modify a label on the display 1. Press Text. 2. Move the cursor over the label. 3. Add or remove text from the label by using the keyboard and the soft keys. 4. Press Text to exit. NOTE

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You can also press the Tab key on the keyboard to move word by word through the labels on the display.

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Placing Arrows and Drawings on the Display You can add arrows and freehand drawings to images. ➤ To place an arrow on the display 1. Press Pointer. 2. Position the arrow by using the trackball. 3. Press Enter to anchor the arrow.

Creating Freehand Drawings on the Display ➤ To add a freehand drawing to an image 1. Press Pointer. 2. Position the cursor where you want to start the drawing. 3. Press Select to highlight Draw on the Select menu. 4. Move the trackball to create the drawing. 5. Press Pointer to exit.

Rotating an Arrow ➤ To rotate an arrow 1. Press Text. 2. Use the trackball to position the cursor over the arrow. 3. Turn the Angle knob to rotate the arrow. 4. Press Text to exit.

Moving or Deleting Annotations You can move or delete labels, arrows, and drawings.

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Moving Annotations ➤ To move a label, an arrow, or a drawing 1. Press Text. 2. Position the cursor over the label, arrow, or drawing you want to move by using the trackball. The selected item is highlighted. 3. Press Enter. 4. Position the label, arrow, or drawing in its new location by using the trackball. 5. Press Enter to anchor the label, arrow, or drawing. 6. Press Text to exit.

Deleting Annotations ➤ To delete a label, an arrow, or a drawing 1. Press Text. 2. Use the trackball to select the label, arrow, or drawing. 3. Press Clear. 4. Press Text to exit. NOTE

If you do not select an annotation before pressing Clear, all annotations on the display are deleted.

Using Annotation Soft Keys ➤ To change any of the soft key settings Press the key below the soft key label. Refer to the Glossary to learn about the function of each soft key. Arrow

Home

Long/Trans

Set Home

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Body Markers You can place a body marker graphic on the display to indicate the part of the anatomy that you are scanning. When you place the body marker, a transducer icon also appears. You can manipulate it to show the position and orientation of the transducer.

Exiting Body Markers ➤ To exit Body Markers and remove the body marker and the transducer icon from the display Press the Erase Marker soft key. ➤ To exit Body Markers and leave the body marker and the transducer icon on the display Press the Marker key or the key for another mode or application.

Placing a Body Marker on the Display ➤ To place a body marker and a transducer icon on the display Press the Marker key.

Choosing a Body Marker You can use three different methods to specify which body marker appears on the display. ➤ To specify which body marker appears on the display, using the Body Marker soft key 1. Press Marker. 2. Press the soft key to the left of the View All soft key repeatedly until the set of body markers that you want appears. NOTE

Body marker sets are organized by exam type. 3. Press the soft key on the far left until the body marker that you want appears.

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➤ To specify which body marker appears on the display, using a dialog box 1. Press Marker. 2. Press View All. 3. In the Body Markers window, click the tab for the exam type. 4. Use the trackball to move the cursor over the body marker you want. 5. Press Enter. ➤ To specify which body marker appears on the display, using the Select menu and the trackball 1. Press Marker. 2. Press Select until Scroll is highlighted on the Select menu. 3. Scroll through the body markers in the current body marker set by using the trackball. 4. To change the body marker set, press Enter. 5. Press Marker to exit.

Moving a Body Marker or the Transducer Icon You can move a body marker or the transducer icon.

Moving a Body Marker ➤ To move a body marker 1. Press Select until Icon is highlighted on the Select menu. 2. Use the trackball to move the body marker. 3. Press Enter to anchor the body marker. 4. Press Marker to exit.

Moving the Transducer Icon ➤ To move the transducer icon 1. Press Select until Probe is highlighted on the Select menu. 2. Use the trackball to move the transducer icon. 276

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3. Press Marker or any imaging mode or application key to anchor the transducer icon and exit Body Markers. NOTE

If you change modes, the body marker will remain in the same relative position.

Returning a Body Marker to the Default Position ➤ To return a body marker to the default position on the display 1. Press Next to access the next level of soft keys. 2. Press Default Position.

Rotating or Specifying the Shape of the Transducer Icon You can rotate the transducer icon and change its shape.

Rotating the Transducer Icon ➤ To rotate the transducer icon Do one of the following: •

Press Rotate Probe.

•

Turn the Angle knob to rotate the icon.

Specifying the Shape of the Transducer Icon ➤ To specify the shape of the transducer icon 1. Press Next to access the next level of soft keys. 2. Press Probe Size until the shape that you want is displayed.

Using Body Marker Soft Keys ➤ To change any of the soft key settings Press the key below the soft key label.

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See the Glossary to learn about the function of each soft key. Body Marker

Body Marker Set

Default Position

Erase Marker

Left

Probe Size

Right

Rotate Probe

View All

Using Body Markers and Dual Imaging ➤ To use body markers and Dual Imaging at the same time 1. Do one of the following: –

Press the Left key or the Right key while a body marker is displayed.

–

If you are in Dual Imaging, press Marker.

The body marker appears on both images. 2. Press the Left soft key to manipulate the body marker on the left-hand image. Press the Right soft key to manipulate a body marker on the right-hand image. 3. To freeze the active image, press Freeze. You can manipulate the body marker on the frozen image.

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13 Analysis Analysis of 2D images, M-mode traces, and Doppler spectral traces is made by measuring displayed image features. You can then display the measurements, use them in calculation, or store them in a database for reporting. The following features enable you to analyze images.

Unlabeled Measurements Unlabeled measurements are measurements that are not associated with an anatomical label. Each measurement graphic can report one primitive, or a set of measurement primitives obtained. Unlabeled measurements of the same primitive are not averaged. Unlabeled measurements are displayed in the results box.

Quick Calculations Quick calculations are computed based on one unlabeled measurement primitive and are displayed in the results box with their unlabeled primitives. Quick calculations are nonspecific, have no anatomic labeling, and are not averaged.

Labeled Measurements and Calculations A labeled measurement consists of one measurement primitive that is specific to an anatomical structure. A labeled measurement can be an input to one or many calculations. When you perform multiple instances of the same labeled measurement in a study, it is considered a collection. The collection is given one value that is used as the input to a calculation. Labeled measurements are organized in package/group divisions.

High Q Automatic Doppler Analysis and Automatic Doppler Trace High Q Doppler is an automatic quantification on a live spectral image, and Automatic Doppler Trace is an automatic quantification on a frozen spectral image. Both functions analyze the Doppler spectrum and return quantitative information on the speed and time duration of the spectrum at various event points. Both High Q Doppler and Automatic Doppler Trace can perform this analysis over a

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single heart cycle, or over multiple heart cycles. High Q and Automatic Doppler Trace are only available in PW spectral mode. NOTE

When you export a study to an optical disk or over a network, measurements and calculations appear on exported images but the calculation data is not saved with your study.

Analysis Setup and Controls Analysis options are organized according to application packages and groups. See "Analysis and Reports Application Package/Group List" on page 120. Some of the settings you can configure in the Setup window are: •

Default to Doppler Auto Trace

•

Measurement caliper connection

•

How Quick Calcs appear

For more information, see "Customizing Your System" on page 95.

Configuring the Analysis Menu The Analysis menu is configured in the Setup window. Analysis configuration is system-wide and is not associated with any preset. You can configure the following: •

Measurements and Calculations Menus

•

User-Defined Calculation by using a table

•

User-defined equation by using a formula

•

Fetal growth graphs

•

Fetal Weight options

•

High Q settings

For more information, see "Customizing Your System" on page 95. 280

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About the Accuracy of Measurements and Calculations You can use the HD11 system to provide measurements and calculations derived from ultrasound images. The quantified image data is then used in conjunction with other clinical data to make a diagnosis. Philips does not recommend making a diagnosis based solely on measurement data. There are numerous factors to consider when using quantified data from any ultrasound imaging system. A careful analysis of those factors indicates that the accuracy of each measurement and subsequent calculation is highly dependent on image quality. Image quality in turn is highly dependent on system design, operator scanning technique, familiarity with system controls and, most importantly, patient echogenicity.

About the Sources of Measurement Error Measurement errors can be caused by several factors, including: •

"Doppler Alignment" on page 281

•

"Formulas" on page 282

•

"Height, Weight, and Age Demographics" on page 282

•

"Operator Variability" on page 282

•

"Screen Pixel Resolution" on page 282

•

"Speed of Sound" on page 282

•

"Sphygmomanometer Error" on page 283

•

"Sweep Speed" on page 283

Doppler Alignment Doppler velocity measurements are most accurate when the direction of blood flow is aligned with the acoustic beam axis. Errors due to misalignment are typically about ±5%. For best accuracy, aim the transducer so that the acoustic beam axis is aligned as closely as possible with blood flow. With linear transducers, when alignment is not possible, use the Angle knob to compensate. HD11 User Reference 4535 611 65311

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Formulas Some formulas used in clinical calculations are based on assumptions or approximations. For example, volume formulas may assume a particular three-dimensional shape. Circumference measurements approximate the actual shape by using a polygon made up of many short line segments. Be sure you understand how the formulas you are using are calculated.

Height, Weight, and Age Demographics Height and weight values are manually entered to estimate body surface area for cardiac calculations. Height and weight values can be estimated incorrectly. Moreover, adult weight values can vary over the course of the day. Entering an incorrect age can also result in errors.

Operator Variability A skilled sonographer can reduce the largest potential component of measurement variability—namely, operator variability. With training and experience, a sonographer learns how to acquire the best view and image quality for each type of measurement. Identification of anatomical structures and correct, consistent cursor placement are needed.

Screen Pixel Resolution The ultrasound screen is composed of an array of (roughly) square picture elements known as pixels. The measurement pixel resolution error is assumed to be ±1 pixel. The pixel error is significant for small dimensions. Using Zoom minimizes pixel resolution error, which is 0.23% (or better) of the full-scale screen.

Speed of Sound Ultrasound imaging algorithms assume that the speed of sound in tissues is 1,540 m/s. However, the speed of sound varies for different tissues. Within soft tissues, the error is typically within 2% of the speed of sound, but may be as high as 5%, particularly if fatty tissue is present in the measurement area.

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Sphygmomanometer Error Some pressure calculations require manual entry of blood pressure. The system assumes that the pressures you enter are perfect. However, sphygmomanometer errors are typically ±5 to 10 mm Hg.

Sweep Speed Time measurement errors are larger when slower display sweep speeds are used.

About Measurement Primitives The HD11 system uses the following primary measurements, called primitives, to produce other measurements and calculations.

Depth In 2D mode, when you press the Caliper key, a free crosshair appears on the image, and the system reports the depth at that point in the image. The depth is displayed in centimeters as a measurement primitive in the results box. The depth is calculated from the apex (for sector transducers) or from the scanning edge of the footprint (for linear transducers) to the center of the free crosshair. A vertical tick mark appears at the origin point of the depth measurement, and there is no line connecting this point with the free crosshair.

Frequency The frequency measurement is calibrated using a frequency source traceable to the National Institute of Science and Technology (NIST). The accuracy of this calibration is considerably greater than 99%. There is no need to recalibrate this measurement given the high level of initial accuracy and the knowledge that drift due to equipment age or thermal issues should not be a routine concern.

Length The system assumes that the speed of sound is 1,540 m/s and that this speed is homogeneous in all tissues. Several books on ultrasound cite differences in the speed of sound based on the type of tissue. One source says that sound speeds can range from 1,500 to 1600 m/s. These differences would produce an inaccuracy of up to 4%. HD11 User Reference 4535 611 65311

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The length measurements on the system are verified using an American Institute of Ultrasound in Medicine (AIUM) standard phantom. The calibrations are performed using depth settings that give the greatest resolution for the phantom length being measured. The accuracy of this calibration should be within ±5%.

Time Time measurements can be used for calculations performed in the following areas: physio channels, M-mode, and Doppler mode. The time calibration is performed using a time-interval signal generator with a calibration traceable to National Institute of Science and Technology (NIST). The calibration of the display is not expected to drift. Calibration of the time axis should be done by measuring 1-second pulses at the different sweep speeds. The accuracy of these measurements should be within ±5%, independent of the sweep speed. These specifications are based on data taken with optimum control settings. Accuracy specifications can be obtained at other control settings by repeating the calibration at the settings you want. The depth and sweep speed settings have the greatest impact on measurement accuracy. The accuracy of a 1-cm length and a 3-cm2 area measurement on a 24-cm depth display is different from the accuracy of the same measurements performed on a 4-cm depth display. Measurements taken at a sweep speed of 100 mm/s are more accurate than those taken at 25 mm/s.

About Volume Calculations The following sections describe the methods used to calculate cardiac, three-distance, and one-distance volumes.

Cardiac Volumes You can calculate cardiac volumes in two ways:

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•

Method of Discs (MOD): single-plane method and biplane method

•

Area-length method (Non-MOD)

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Method of Discs The method of discs (MOD) single-plane volume calculation uses one orthogonal plane for area (the apical four-chamber view or the apical two-chamber view) and a long-axis length. The area traces are divided into 20 elliptical disc segments. The MOD biplane volume calculation uses two orthogonal-plane area traces (the two-chamber apical view and the four-chamber apical view) and a long-axis length (the longer of the two long axes). The area traces are divided into 20 elliptical disc segments. Area-Length Method The non-MOD single-plane ellipse, biplane ellipse, and Bullet volume calculations use the area-length method, which uses apical measurements. When a two-chamber or a four-chamber measurement is made, the area values are copied into the equivalent generic apical measurement, using the meta-measurement feature. However, generic apical measurements are not copied back into either the two-chamber view or the four-chamber view measurements.

Three-Distance Volumes For radiology and other applications, volumes of solids are calculated using the following formula:

One-Distance Volumes Follicular volumes are one-distance volumes. They are calculated using the following formula: 0.523 x D x D x D HD11 User Reference 4535 611 65311

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where D = follicular distance

About PISA Measurements and Calculations The following PISA (proximal isovelocity surface area) calculations are used when you are in PW Doppler mode or CW Doppler mode and in a cardiac preset: •

MR PISA

•

MR flow rate

•

MR ERO

•

MR volume

•

MR RF

Before you obtain the preceding calculations, you need to perform the following measurements:

NOTE

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•

MR PISA radius (measured on a full-screen 2D image or a 2D reference image)

•

MR max vel

•

MR VTI

•

MR alias vel

•

MV E point

•

MV diam 1

•

MV diam 2

To perform an MR alias vel, shift the baseline down until aliasing occurs. Then match the color of the isovelocity hemisphere to the color bar and the pulse repetition frequency (PRF) to the scale. The PRF is the alias velocity.

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About Pulsatility Index and Resistivity Index Doppler Trace uses the end-diastolic velocity (D)—not the minimum velocity, as recommended in some medical sources—to calculate pulsatility index (PI) and resistivity index (RI).

End-Diastolic Velocity vs. Minimum Velocity

You can manually position the S, D, and S1 bars. If you manually move the D bar to select the minimum velocity in the situation shown in the previous figure, PI and RI are calculated according to PI and RI formulas, which use the minimum velocity. However, Acceleration Time (AT), Acceleration Slope (AS), Diastolic/ Systolic (D/S) ratio, and Systolic/Diastolic (S/D) ratio are now inaccurately reported, because these formulas require use of the end-diastolic rather than the minimum diastolic velocity. If you want to use the minimum velocity method, you should use your best diagnostic judgment in making and using PI and RI calculations that come from Doppler Auto Trace. You can also use manual Doppler trace to produce PI and RI calculations. References Roger C. Sanders, ed. Clinical Sonography - A Practical Guide, 2nd ed. Little Brown and Company, 1991. Nanda, Navin D. Doppler Echocardiography, 2nd ed. Lea and Febiger, Philadelphia 1993, p. 29. Sahn, D., DeMaria, A., Kisslo, J., Weyman, A., The Committee on MMode Standardization of the American Society of Echocardiography. “Recommendations Regarding Quantitation in MMode Echocardiography: Results of a Survey of Echocardiographic Measurements.” Circulation, Vol. 58, No. 6: 1072–1083, 1978.

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Feigenbaum, Harvey. Echocardiography, 4th ed. Lea and Febiger, Philadelphia 1986, 115–122. Emamian, S.A., et al. “Kidney Dimensions at Sonography: Correlation With Age, Sex, and Habitus in 665 Adult Volunteers.” American Journal of Radiology, 160:83– 86, January 1993.

Doppler Trace Analysis You can use three types of Doppler trace: •

Doppler Auto Trace

•

Manual Doppler trace

•

High Q Doppler

Doppler Auto Trace and Manual Doppler Trace Doppler Auto Trace automatically traces a frozen Doppler spectrum over one heart cycle and uses the trace to calculate and display the results of key Doppler measurements and calculations. Doppler Auto Trace allows you to save time during a patient exam. In a manual Doppler trace, you manually trace the Doppler spectrum. In Doppler Auto Trace in non-cardiac presets, the system displays measurement bars on the trace that represent three points on the spectrum: •

Systolic (S)

•

Diastolic (D)

•

Next systolic (S1)

In cardiac presets, a begin and an end bar appear on the spectrum at the beginning and end of an R-wave.

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High Q Doppler High Q Doppler automatically traces a waveform in live imaging. Measurements are made on the Doppler spectrum, are displayed in the results box, and are updated every heart cycle. You can specify the number of cycles used for the averaged measurement values. NOTES

• •

ECG input is required for cardiac Doppler Auto Trace and High Q Doppler. Doppler Auto Trace and High Q Doppler are only available in PW Doppler mode.

About Doppler Auto Trace Doppler Auto Trace is intended for use on spectral waveforms that are fully displayed above and below the baseline; for example, in studies of arterial grafts, carotid arteries, umbilical arteries, renal arteries, and transcranial arteries. When initiated on a frozen Doppler spectrum, Doppler Auto Trace automatically detects the strongest Doppler complex in which the first and succeeding systolic points (S and S1) are similar. •

In non-cardiac presets, the system marks the first systolic, the end-diastolic, and the succeeding systolic points with S, D, and S1 measurement bars.

•

In cardiac presets, the system displays a begin bar and an end bar at the beginning and end of an R-wave.

In non-cardiac presets, you can use your judgment to manually position the S, D, and S1 points. If you move the S bar to another complex, the measurements are averaged over multiple waveforms.

Using Doppler Auto Trace If you want your system to automatically trace a Doppler spectrum the first time you press Trace, select the Default to Doppler Auto Trace check box on the Measurements Setup tab. To learn how to use multi-cycle Doppler Auto Trace, see "Using Multi-Cycle Doppler Auto Trace" on page 291.

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➤ To use Doppler Auto Trace 1. In PW Spectral Doppler, press Freeze. 2. Do one of the following: –

If the Default to Doppler Auto Trace check box is selected, press Trace once.

–

If the Default to Doppler Auto Trace check box is not selected, press Trace twice.

The spectrum is automatically traced, and several calculations appear in the results box. In non-cardiac presets, S, D, and S1 measurement bars appear on the spectral trace. In cardiac presets, bars appear on the spectral trace that mark the beginning and end of an R-wave. 3. To adjust points, press Select. 4. To show or hide the waveform, press Waveform. 5. To reposition the measurement bars if you are in a non-cardiac preset, use the soft keys or press Select until the name of the bar is highlighted on the Select menu. Use the trackball to move the measurement bar. 6. Do one of the following: –

To approve the measurement and exit, press Enter.

–

To erase measurements from the results box, press Clear.

The measurement changes to white to indicate that it is complete.

Changing the Autotrace Evaluation Setting You can specify how much of the waveform is evaluated and used by Doppler Auto Trace and High Q (above the baseline, below the baseline, or both). The autotrace evaluation setting takes effect when you unfreeze a waveform. ➤ To change the Autotrace Evaluation setting while imaging Press Ctrl+Q. NOTES

• •

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ECG input is required for cardiac Doppler Auto Trace and High Q Doppler. Doppler Auto Trace and High Q Doppler are only available in PW Doppler.

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Using Doppler Auto Trace Soft Keys Doppler Auto Trace soft keys are only available in non-cardiac single cycle presets. ➤ To change any of the soft key settings Press the key below the soft key label. See the Glossary to learn about the function of each soft key.

Box Position

Calcs Results

D Time

D Velocity

S Time

S Velocity

S1 Time

S1 Velocity

Waveform

The High Q settings determine whether the peak trace, the mean trace, or both are displayed. Without the High Q feature, both traces are displayed.

Using Multi-Cycle Doppler Auto Trace If you are using Doppler Auto Trace, you can select more than one waveform. Measurements are averaged over the selected waveforms. ➤ To use multi-cycle Doppler Auto Trace 1. Press Trace. Measurement bars that are appropriate for the current preset appear on the display and Off is highlighted on the Select menu. The measurement values appear in the results box. NOTE

You cannot use the trackball to adjust measurements. 2. To activate the measurement, press Select. Depending on the preset, S or Begin is highlighted on the Select menu. 3. Position the S bar or Begin bar at the beginning of the first cycle by using the trackball.

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4. Press Select. Depending on the preset, S1 or End is highlighted on the Select menu. 5. Move the S1 or end bar to include the number of cycles you want included in the averaged measurements. The number of cycles averaged and the averaged measurements appear in the results box. NOTE

In non-cardiac presets, Begin and End measurement bars appear and End is highlighted on the Select menu. 6. Press Enter to approve the measurement.

NOTES

• •

ECG input is required for cardiac Doppler Auto Trace and High Q Doppler. Doppler Auto Trace and High Q Doppler are only available in PW Doppler mode.

Performing a Manual Doppler Trace Measurement ➤ To perform a manual Doppler trace measurement 1. In PW Spectral Doppler mode, press Freeze. 2. Do one of the following: –

If the Default to Doppler Auto Trace check box is selected, press Trace twice.

–

If the Default to Doppler Auto Trace check box is not selected, press Trace once.

3. Press Select. 4. Move the trackball to trace the waveform. 5. To erase the trace one dot at a time, press Clear. 6. To approve the measurement and exit, press Enter. 7. If you are in a non-cardiac preset, you are prompted to position the end diastolic point. The measurement changes to white to indicate that it is complete. 292

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Using High Q Doppler High Q Doppler automatically traces a waveform in live imaging. ➤ To use High Q, in live spectral Doppler mode Press Trace. The number of heart cycles used for the measurements and the averaged measurements appear in the results box. The measurements are updated every heart cycle. You can specify the number of cycles used for the averaged measurements. You can also specify whether you want to display the peak trace, the mean trace, or both. See "Changing High Q Settings" on page 117.

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14 Measurements and Calculations This section includes the following: •

"Working with Measurements" on page 295

•

"Calculations" on page 298

•

"Unlabeled Measurements" on page 299

•

"Quick Calculations" on page 304

•

"Labeled Measurements" on page 311

Working with Measurements The information and procedures in this section will help you work with measurements on the HD11 system. The measurements available at any one time depend on the system configuration and mode.

NOTE

•

"About Calipers" on page 296

•

"Approving Measurements" on page 296

•

"Displaying Measurement Values" on page 297

•

"Reactivating a Measurement" on page 297

•

"Deleting a Measurement" on page 298

•

"Labeled Measurements" on page 311

•

"Performing a Labeled Measurement" on page 311

•

"Performing a Protocol Measurement" on page 312

•

"Using Labeled Measurement Soft Keys" on page 312

•

"Assigning a Measurement Value" on page 313

•

"Performing a Hip Angle Measurement" on page 313

When you export a study to an optical disk or over a network, measurements and calculations appear on exported images but the calculation data is not saved with your study.

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About Calipers HD11 supports up to eight sets of distinct calipers that are used as the pointing device when performing measurements. You control the calipers with the trackball. The caliper sets are:

Calipers have four states denoted by four distinct colors.

Color

State

White

The measurement is complete.

Yellow

The measurement is highlighted.

Orange

The measurement can be reactivated at this point.

Blue

The measurement is active.

The measurement calipers will shrink and grow dynamically to accommodate measurements of both small and large structures. As you move the caliper farther away from the anchor point, both the anchor and the caliper grow in size. As you move the caliper closer to the anchor point, they both shrink. When you press Caliper or Trace, a large free caliper appears in the middle of the image. You can move this caliper within the image by using the trackball. Each measurement and its corresponding value in the results box are labeled with the same type of caliper so that you know which value is associated with each measurement.

Approving Measurements ➤ To approve a measurement, do any of the following

296

•

After you perform a measurement, press Calc to approve and to save the measurement and initiate another.

•

Press Enter to approve and save the measurement and exit analysis.

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Enter any of the following modes to automatically approve the currently active measurement: –

Print

–

Acquire

–

Freeze

–

Analysis menu

Displaying Measurement Values Results of measurements that you perform appear in the results box on the display. Use the Box Position soft key to position the results box in any corner of the display. You can also specify the display mode for the results box with the Calcs Results soft key. The options are:

NOTE

•

All Meas—All measurements are displayed along with any associated calculations.

•

Last Meas—Only the last or highlighted measurement is displayed along with any associated calculations.

•

Hidden—The results box is not displayed.

TCG measurement graphics are not displayed when the results box is on the right side of the display.

Reactivating a Measurement You can reactivate an existing measurement if you want to move the endpoints. When you reactivate a measurement, the system saves the first measurement value and calculates the new one. Both values are displayed in the report. ➤ To reactivate a measurement 1. Press Caliper or Trace. 2. Use the trackball to move the crosshair over an endpoint until the measurement changes to orange to indicate that it is active.

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3. Press Enter. The measurement changes to blue to indicate that it is active again. 4. Use the trackball to move the endpoint. 5. To approve the measurement, press Enter.

Deleting a Measurement You can delete a single measurement or you can erase all measurements. ➤ To delete a single measurement 1. Press Caliper or Trace to reactivate the completed measurement. 2. Use the trackball to move the crosshair over the measurement until the measurement changes to orange or yellow to indicate that it is active. 3. Press Clear to erase the measurement graphic. NOTE

You can also erase individual measurements by performing more than eight measurements on the image. Each measurement that you perform erases the measurement graphic in the order in which it is performed to accommodate for new measurements.

➤ To delete all measurements When there is no active free crosshair, press Clear to erase all measurements. NOTE

Pressing Clear erases the measurement graphics but does not remove the associated values from the report.

Calculations You can perform many calculations in each preset. You can change the calculations available in the Analysis menu, and you can create your own calculations for OB/ GYN presets. The calculations available depend on the system configuration and mode. Measurements that you perform, and any resulting calculations, appear in the results box in the corner of the display as specified. 298

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Performing Calculations ➤ To perform a calculation 1. Press Calc. 2. Use the trackball to highlight the calculation you want to perform and press Enter or Select. A list of the measurements and calculations that you need to perform for the selected calculation appears. 3. Select and perform each of the measurements or calculations on the list. You can perform them in any order. NOTE

You can access the entire list of calculations for all installed packages by selecting Main Menu on the Calculations menu.

Unlabeled Measurements You can perform five types of unlabeled measurements: •

1-point velocity or 1-point depth

•

2-point

•

Ellipse

•

Method of discs (MOD)

•

Trace

Results of unlabeled measurements that you perform appear in the results box. Results of unlabeled measurements are not saved in the report. Quick Calcs are common calculations that are computed automatically as unlabeled measurements are made. Quick Calc results appear in the results box.

Performing a 1-Point Depth or Velocity Measurement When you are in 2D, PW Doppler, or CW Doppler mode and initiate a measurement, a 1-point depth measurement or a 1-point velocity measurement automatically appears in the results box.

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As you perform unlabeled measurements, the results of the measurements and of the associated Quick Calcs appear in the results box on the display. ➤ To perform a 1-point depth or velocity measurement 1. Press Freeze. 2. Press Caliper. A caliper appears on the image and the measurement value appears in blue in the results box. 3. Use the trackball to position the caliper. 4. Press Enter to approve the measurement. NOTE

When you unfreeze an image, measurements disappear from the image.

Performing a 2-Point Measurement You can perform a 2-point (linear) measurement to measure the length of a structure or a length of time. As you perform unlabeled measurements, the results of the measurements and of the Quick Calcs appear in the results box on the display. ➤ To perform a 2-point measurement 1. Press Freeze. 2. Press Caliper. 3. Use the trackball to position the caliper that appears on the image and press Select or Caliper. A second caliper appears on the display, Endpt 2 is highlighted on the Select menu, and the length appears in the results box in blue. 4. Use the trackball to position the second caliper. 5. Do one of the following: –

To approve the measurement, press Enter.

– To reactivate the first caliper, press Select. When complete, the measurement changes to white.

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Performing an Ellipse Measurement You can perform an ellipse measurement on a 2D image to measure a volume. As you perform unlabeled measurements, the results of the measurements and of the associated Quick Calcs appear in the results box on the display. ➤ To perform an ellipse measurement on a 2D image 1. Press Freeze. 2. Press Trace. An ellipse appears on the display, Endpt 2 is highlighted on the Select menu, and the active measurement appears in blue in the results box. 3. Use the trackball to position the second endpoint. 4. Press Select until AXIS is highlighted on the Select menu. 5. Move the trackball to adjust the width of the ellipse, and then press Select. The previously anchored endpoint is active and Endpt 1 is highlighted on the Select menu. 6. To reposition an endpoint or to change the width of the ellipse, press Select repeatedly until the part of the measurement you want to change is highlighted on the Select menu. Move the trackball to make the change. 7. Do one of the following: –

To approve the measurement and initiate another measurement, press Trace.

–

To approve the measurement and exit analysis, press Enter.

The measurement changes to white to indicate that it is complete.

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Performing a Trace Measurement You can perform a trace measurement to measure the area or circumference of an irregularly shaped area. As you perform unlabeled measurements, the results of the measurements and of the associated Quick Calcs appear in the results box. ➤ To perform a manual trace measurement 1. Press Freeze. 2. Press Trace two times. A caliper appears on the display, Endpt is highlighted on the Select menu, and the active measurement values appear in blue in the results box. 3. Position the endpoint with the trackball and press Select. The active caliper appears on the display and Manual is highlighted on the Select menu. 4. Move the trackball. The values in the results box are updated as you move the trackball. 5. To erase the trace one dot at a time, press Clear. 6. Do one of the following: –

To approve the measurement and perform another measurement, press Trace.

– To approve the measurement and exit analysis, press Enter.

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Performing a Method of Discs Measurement or SPE Volume You can perform a method of discs (MOD) measurement to measure the volume of an irregularly shaped area. As you perform unlabeled measurements, the results of the measurements and of the associated Quick Calcs appear in the results box. ➤ To perform a method of discs measurement 1. Press Freeze. 2. Press Trace two times. A caliper appears on the display, Endpt is highlighted on the Select menu, and the active measurement appears in blue in the results box. 3. Move the trackball to position the endpoint. 4. To initiate the trace, press Select and move the trackball. A caliper appears on the display, Manual is highlighted on the Select menu, and the active measurement appears in blue in the results box. 5. To erase the trace one dot at a time, press Clear. 6. To complete the trace, press Select. A short axis appears across the trace and Endpt 2 is highlighted on the Select menu. 7. Move the trackball to move the endpoint. Chords appear on the MOD volume trace graphic. 8. Press Select. The previously anchored endpoint is active and you can control it with the trackball. The measurement values appear in the results box. 9. Do one of the following: –

To approve the measurement and perform another measurement, press Trace.

–

To approve the measurement and exit analysis, press Enter.

The measurement changes to white to indicate that it is complete.

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Quick Calculations Quick Calcs are common calculations that are computed automatically as unlabeled measurements are made. Quick Calc results appear in the results box. The following tables list all Quick Calculations in the order in which they are displayed in the results box: •

"2D Quick Calculations" on page 305

•

"M-mode Quick Calculations" on page 305

•

"Physio Quick Calculations" on page 306

•

"Cardiac Doppler Quick Calculations" on page 306

•

"Doppler Quick Calculations" on page 308

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references. See "Choosing Quick Calcs" on page 117 for information about selecting which Quick Calcs are displayed.

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2D Quick Calculations Associated Quick Calculation

Measurement Type

Units

1-Pointa

DEPTH

cm

2-Point

DIST

cm

AREA

cm2

AREA

cm2

CIRC

cm

AREA

cm2

CIRC

cm

DIST

cm

SPE-VOL

cm3

MOD-VOL

cm3

Trace

Volume

a. This measurement cannot be configured using the Measurement tab in the Setup window.

M-mode Quick Calculations Measurement Type 2-Point

Associated Quick Calculation

Units

DIST

cm

TIME

sec

SLP

cm/s HD11 User Reference 4535 611 65311

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Physio Quick Calculations Measurement Type 2-Pointa

Associated Quick Calculation TIME

Units sec

a. This measurement cannot be configured through the Measurement tab in the Setup window.

Cardiac Doppler Quick Calculations Measurement Type 1-Pointa

2-Point

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Associated Quick Calculation

Units

VEL

cm/s

PG

mm Hg

FREQ

kHz

MAX

cm/s

MAX

kHz

TIME

sec

SLP

cm/s2

MAX PG

mm Hg

P1/2T

msec

Measurements and Calculations

Measurement Type Trace

Automatic Trace/ High Qb

Associated Quick Calculation

14

Units

TIME

sec

MAX

cm/s

MAX

kHz

Mean VEL

cm/s

VTI

cm

MAX PG

mm Hg

MEAN PG

mm Hg

TIME

sec

MAX

cm/s

MAX

kHz

MEAN VEL

cm/s

VTI

cm

MAX PG

mm Hg

MEAN PG

mm Hg

a. You cannot configure this measurement using the Measurement tab in the Setup window. b. This measurement is not available in CW Doppler mode.

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Doppler Quick Calculations Associated Quick Calculation

Measurement Type 1-Pointa

2-Point

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Units

VEL

cm/s

PG

mm Hg

FREQ

kHz

S

cm/s

D

cm/s

S

kHz

D

kHz

TIME

sec

S/D Ratio

unitless

D/S Ratio

unitless

RI

unitless

Measurements and Calculations

Associated Quick Calculation

Measurement Type Manual Trace

14

Units

S

cm/s

D

cm/s

S

kHz

D

kHz

MEAN VEL

cm/s

VTI

cm

S/D RATIO

unitless

D/S RATIO

unitless

RI

unitless

PI

unitless

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Associated Quick Calculation

Measurement Type Automatic Trace/ High Qb

Units

S

cm/s

D

cm/s

S

kHz

D

kHz

MEAN VEL

cm/s

AT

sec

AS

cm/s2

TAVM

cm/s

S/D RATIO

unitless

D/S RATIO

unitless

RI

unitless

PI

unitless

a. This measurement cannot be configured using the Measurement tab in the Setup window. b. This measurement is not available in CW Doppler mode.

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Labeled Measurements You select labeled measurements from the Analysis menu by pressing Calc. You can perform several labeled measurements in each preset. The measurements available depend on the system configuration and mode. Results of measurements that you perform appear in the results box on the display. Results of labeled measurements appear in the report.

Performing a Labeled Measurement As you perform labeled measurements, the results of the measurements appear in the results box on the display, and the results are saved in the report. ➤ To perform a labeled measurement 1. Press Calc. A menu appears listing the labeled measurements and calculations that are configured on your system. 2. Use the trackball to highlight the measurement you want to perform and press Enter or Select. A crosshair appears on the image. 3. Perform the measurement. NOTE

You can enter the measurement value manually by pressing the Keyboard Entry soft key. 4. To approve the measurement, press Enter. The measurement changes to white to indicate that it is complete.

NOTE

You can access the entire list of measurements for all installed packages by selecting Main Menu on the Measurements menu.

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Performing a Protocol Measurement When you perform one of the measurements in a set of protocol measurements and press Enter, the next measurement in the protocol sequence is initiated. If you do not want to perform the next measurement, press Clear.

Entering a Measurement Value Manually You can enter a measurement value manually in live imaging and Report view. ➤ To enter a measurement value manually in live imaging See "Performing a Labeled Measurement" on page 311. ➤ To enter a measurement manually in Report view 1. Press Report. 2. Press Calc. 3. Select the Measurement Mode from the list. 4. Select the measurements. 5. Double-click the measurement or click Keyboard. 6. In the Keyboard Entry window, type the value and click OK. 7. Press Calc. The measurement appears in the measurements list.

Using Labeled Measurement Soft Keys ➤ To change any of the soft key settings, Press the key below the soft key label. See the Glossary to learn about the function of each soft key. Assign Value

Box Position

Calcs Results

Explain Text

Fetus A, B, C, D

Keyboard Entry

Right, Left, Mid/Main

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Assigning a Measurement Value You can assign a value from an unlabeled or a labeled measurement value to a labeled measurement of the same type. You can assign multiple values at a time. ➤ To assign a value to a measurement 1. Perform an unlabeled or a labeled measurement that produces a measurement graphic. 2. Press Calc. The Analysis menu appears. 3. Select the measurement you want to assign the previous measurement value to. 4. Press the Assign Value soft key. The value from the previous measurement is assigned to the selected labeled measurement.

Performing a Hip Angle Measurement When performing a hip angle measurement, perform all segments of the measurement either from left to right or from right to left. The first point of each line, depicted by a caliper, represents the source of the line. The second point, depicted by the arrow, represents the end of the line. When the hip angle measurement is complete, the arrows on each line should point in the same direction. •

The first line you create is the baseline reference line.

•

The second line is the alpha reference line.

•

The third line is the beta reference line.

➤ To readjust an endpoint Press Select to select the endpoint and use the trackball. ➤ To perform a hip angle measurement 1. Press Calc. The Analysis menu appears. HD11 User Reference 4535 611 65311

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2. Use the soft key to specify the right or left hip. 3. Press Enter to select the hip angle measurement. Hip angle Alpha and Beta measurements appear in blue in the results box and Endpt 1 is highlighted on the Select menu. 4. Place the first caliper on the hip and press Select. A caliper appears on the display and Endpt 2 is highlighted on the Select menu. 5. Place the second caliper on the distal end of the femur toward the knee and press Caliper. A caliper appears on the display and Endpt 3 is highlighted on the Select menu. 6. Place the third caliper above the baseline and press Select. A caliper appears on the display and Endpt 4 is highlighted on the Select menu. 7. Place the fourth caliper below the baseline to create the alpha angle. NOTE

The two lines must intersect. 8. Press Caliper. A caliper appears on the display. 9.

Press Select to highlight Endpt 5 on the Select menu.

10. Place the fifth caliper below the baseline and press Select. A caliper appears on the display and Endpt 6 is highlighted in the Select menu. 11. Place the sixth caliper above the baseline to create the beta angle. NOTE

The two lines must intersect. 12. Press Enter to complete the measurement. The Hip Angle-Alpha and Hip Angle-Beta measurements appear in the results box.

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Performing an IMT Trace Measurement ➤ To perform an IMT trace measurement 1. Press Calc. 2. Select an IMT measurement from the Measurements menu. A caliper is displayed. 3. Use the trackball to position the caliper. 4. Press Select or Trace. The caliper is anchored and another caliper is displayed. 5. Use the trackball to trace the wall. 6. Press Trace or Enter. A third caliper is displayed. 7. Use the trackball to position the caliper. 8. Press Select or Trace. The caliper is anchored and another caliper is displayed. 9. Use the trackball to trace the second wall. 10. Press Enter.

Performing an IMT Linear Measurement ➤ To perform an IMT linear measurement 1. Press Calc. 2. Select an IMT measurement from the measurements menu. A caliper is displayed. 3. Use the trackball to position the caliper. 4. Press Caliper. The caliper is anchored and another caliper is displayed. 5. Use the trackball to position the second caliper. 6. Press Enter. HD11 User Reference 4535 611 65311

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Labeled Measurements by Exam Type This section lists all labeled measurements by exam type: •

"Cardiac Measurements" on page 316

•

"Vascular Measurements" on page 326

•

"General Measurements" on page 348

•

"Obstetric Measurements" on page 362

•

"Gynecology Measurements" on page 365

•

"Musculoskeletal Measurements" on page 368

Information about each measurement, such as units, measurement type, and meaning, is included in the tables in each section. Instructions for performing the measurements are not included in the tables. To learn how to perform labeled measurements, see "Performing a Labeled Measurement" on page 311. ➤ To view a list of all available calculations Press Calc and select Main Menu.

Cardiac Measurements The following tables list all cardiac measurements and demographics:

316

•

"Cardiac Demographics" on page 317

•

"2D/Physio Cardiac Measurements" on page 317

•

"LVAd sax epi, LVAd sax PM, and LVLd apical" on page 319

•

"Doppler Cardiac Demographics" on page 320

•

"Doppler/Physio Cardiac Measurements" on page 320

•

"M-mode/Physio Cardiac Measurements" on page 323

•

"M-mode Protocol Measurements" on page 324

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Cardiac Demographics Demographic

Meaning

Type of Data

Patient ID

Patient identification

text

Institution Name

Institution name

text

Ht

Patient Height

real number

Wt

Patient Weight

real number

BSA

Body Surface Area calculation

real number

DOB

Date of Birth

date

Age

Patient Age

real and units

Sex

Sex of patient

integer

2D/Physio Cardiac Measurements

Label

Unit s

Type

Meaning

Asc Ao

cm

Length

Ascending aorta dimension

Duct Art

cm

Length

Ductus arteriosis dimension

EDA

cm2

Area

End diastolic area

EDV (MOD-sp2)

cm3

Volume

Volume (single-plane, 2-chamber MOD)

EDV (MOD-sp4)

cm3

Volume

Volume (single-plane, 4-chamber MOD)

ESA

cm2

Area

End systolic area

ESV (MOD-sp2)

cm3

Volume

Volume (single-plane, 2-chamber MOD)

ESV (MOD-sp4)

cm3

Volume

Volume (single-plane, 4-chamber MOD)

IVSd

cm

Length

Interventricular septal dimension at end diastole

IVSs

cm

Length

Interventricular septal dimension at end systole

LA

cm

Length

Left atrial dimension HD11 User Reference 4535 611 65311

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Label

Unit s

Type

Meaning

Left diam

cm

Length

Flow diameter on left side of heart

LVAd ap2

cm2

Area

Left ventricular long-axis area at end diastole, apical two-chamber

LVAd ap4

cm2

Area

Left ventricular long-axis area at end diastole, apical four-chamber

LVAd apical

cm

Length

LVAd sax epi

cm2

Area

Left ventricular area at end diastole, apical Left ventricular short-axis area at epicardium at end diastole

LDAd sax MV

cm2

Area

Left ventricular short-axis area at mitral valve level at end diastole

LVAd sax PM

cm2

Area

Left ventricular short-axis area at papillary muscle level at end diastole

LVAs ap2

cm2

Area

Left ventricular area at end diastole, apical

LVAs ap4

cm2

Area

Left ventricular long-axis area at end systole, apical four-chamber

LVAs apical

cm2

Area

Left ventricular area at end systole, apical

LVAs sax MV

cm2

Area

Left ventricular short-axis area at mitral valve level at end systole

LVAs sax PM

cm2

Area

Left ventricular short-axis area at papillary muscle level at end systole

LVIDd

cm

Length

Left ventricular internal diameter at end diastole

LVIDs

cm

Length

Left ventricular internal diameter at end systole

LVLd apical

cm2

Length

Left ventricular length at end diastole, apical

LVLs apical

cm

Length

Left ventricular length at end systole, apical

LVOT diam

cm

Length

Left ventricular outflow tract diameter

LVPWd

cm

Length

Left ventricular posterior wall dimension at end diastole

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Label

Unit s

Type

14

Meaning

LVPWs

cm

Length

Left ventricular posterior wall dimension at end systole

MR PISA radius

cm

Length

Alias radius of the proximal convergence zone of the mitral valve regurgitation

MV Diam 1

cm

Length

Mitral valve diameter 1

MV Diam 2

cm

Length

Mitral valve diameter 2

Right diam

cm

Length

Flow diameter on right side of heart

RVAWd

cm

Length

Right ventricular wall dimension at end diastole

RVDd

cm

Length

Right ventricular internal diameter at end diastole

LVAd sax epi, LVAd sax PM, and LVLd apical

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Doppler Cardiac Demographics Label

Units

RA press

mm Hg

Meaning Estimated right atrial pressure

Doppler/Physio Cardiac Measurements Label

Units

Type

Meaning

AI max PG

mm H g

Pressure gradient

Aortic insufficiency maximum pressure gradient

AI max vel

cm/s

Maximum velocity

Maximum velocity of aortic insufficiency

Annular Vel

cm/s

Maximum velocity

Annular velocity

Ao dec slope

cm/s2

Acceleration

Aortic insufficiency deceleration slope

Ao dec timea

sec

Time

Measure the aortic deceleration time

Ao max PG

mm H g

Pressure gradient

Aortic flow maximum pressure gradient

Ao mean PG

mm H g

Pressure gradient

Aortic flow mean pressure gradient

Ao V2 max

cm/s

Maximum velocity

Maximum velocity for continuity formula

Ao V2 VTI

cm

Velocity time integral

Velocity time integral 2 for continuity formula

Aortic R-R

sec

Time

R-R interval measured when making measurements on the aortic valve

Duct Art Flow

cm/s

Velocity

Ductus arteriosis flow velocity

IVR Time

sec

Time

Isovolumic relaxation time

Left max vel

cm/s

Maximum velocity

Maximum flow volume on left side of heart

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Type

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Label

Units

Meaning

LV mean PG

mm H g

Pressure gradient

Left ventricular mean pressure gradient

LV V1 max

cm/s

Maximum velocity

Maximum velocity for continuity formula at “2D diam”

LV V1 VTI

cm

Velocity time integral

Velocity time integral 1 for continuity at “2D diam”

LVOT diam

cm

Length, height

Left ventricular outflow tract diameter

LVOT maxV

cm/s

Keyboard entry

Velocity of the left ventricular outflow tract

MR alias vel

cm/s

Maximum velocity

Aliasing velocity of the proximal convergence zone of the mitral valve regurgitation

MR max PG

mm H g

Pressure gradient

Mitral regurgitation maximum pressure gradient

MR max vel

cm/s

Maximum velocity

Maximum velocity of mitral regurgitation

MR mean PG

mm H g

Pressure gradient

Mitral regurgitation mean pressure gradient

MR mean vel

cm/s

Mean velocity

Mean velocity of the mitral valve regurgitant flow

MR VTI

cm

Velocity time integral

Velocity time integral of the mitral valve regurgitant flow

MV A point

cm/s

Maximum velocity

Mitral valve A-point maximum velocity

MV dec slope

cm/s2

Acceleration

Mitral valve deceleration slope

MV dec timea

sec

Time

MV E point

cm/s

Maximum velocity

Mitral valve E-point maximum velocity

MV Max PG

mm H g

Pressure gradient

Maximum pressure gradient of the flow distal to the mitral valve HD11 User Reference 4535 611 65311

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Measurements and Calculations

Label

Units

MV Mean PG

mm H g

Pressure gradient

Mean pressure gradient of the flow distal to the mitral valve

MV P1/2t max v

cm/s

Maximum velocity

Mitral valve maximum velocity for P1/2t

MV V2 Max

cm/s

Velocity

Maximum velocity of the flow distal to the mitral valve

MV V2 VTI

cm

Velocity time integral

Velocity time integral based on flow distal to the mitral valve

Myocardial Vel

cm/s

Maximum velocity

Myocardial velocity

PA acc time

sec

Time

Measure the pulmonic acceleration time

PA dec slope

cm/s2

Acceleration

Pulmonic deceleration slope

PA dec timea

sec

Time

Measure the pulmonic deceleration time

PA max PG

mm H g

Pressure gradient

Pulmonary artery maximum pressure gradient

PA mean PG

mm H g

Pressure gradient

Mean pressure gradient of the flow distal to the mitral valve

PA V2 max

cm/s

Maximum velocity

Maximum velocity measured distal to the pulmonary artery with CW Doppler

PI max PG

mm H g

Pressure gradient

Pulmonic insufficiency maximum pressure gradient

PI max vel

cm/s

Maximum velocity

Maximum velocity of pulmonic insufficiency

Pul V A wave max

cm/s

Maximum velocity

A-wave maximum velocity of the pulmonic valve

Pul V D

cm/s

Minimum velocity

Diastolic velocity of the pulmonic valve

Pul V S

cm/s

Maximum velocity

Systolic velocity of the pulmonic valve

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Type

Meaning

Measurements and Calculations

Label

Units

Type

14

Meaning

Right max vel

cm/s

Maximum velocity

Maximum flow volume on right side of heart

RVOT maxV

cm/s

Maximum velocity

Velocity of the right ventricular outflow tract

TR Max PG

mm H g

Maximum pressure gradient

Maximum pressure gradient of the tricuspid regurgitation

TR max vel

cm/s

Maximum velocity

Maximum velocity of the tricuspid valve regurgitation

TV max PG

mm H g

Pressure gradient

Maximum pressure gradient of the fow distal to the tricuspid valve

TV mean V

cm/s

Pressure gradient

Mean velocity of the flow distal to the tricuspid valve

a. These measurements are not included on the Analysis menu and cannot be performed individually. Non-performable measurements are usually associated with a meta-measurement.

M-mode/Physio Cardiac Measurements

Label

Unit s

Type

Meaning

ACS

cm

Height

Aortic cusp separation

Ao root diam

cm

Height

Aortic root diameter

Aortic R-R

sec

Time

R-R interval measured when making measurements on the aortic valve

EPSS

cm

Height

E-point septal separation

IVSd

cm

Height

Interventricular septal dimension at end diastole

IVSs

cm

Height

Interventricular septal dimension at end systole

LA dimension

cm

Height

Left atrial dimension

LVIDd

cm

Height

Left ventricular internal diameter at end diastole

LVIDs

cm

Height

Left ventricular internal diameter at end systole

LVPWd

cm

Height

Left ventricular posterior wall dimension at end diastole HD11 User Reference 4535 611 65311

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Measurements and Calculations

Label

Unit s

Type

Meaning

LVPWs

cm

Height

Left ventricular posterior wall dimension at end systole

MM R-R int

sec

Time

M-mode or 2D R-R interval

MV E-F slope

cm/s MM slope Mitral valve E-F slope

MV excursion

cm

Height

Mitral valve excursion

Q-to-PV close

sec

Time

Q-wave to pulmonic valve closing

Q-to-TV open

sec

Time

Q-wave to tricuspid valve opening

RVAWd

cm

Height

Right ventricular wall dimension at end diastole

RVDd

cm

Height

Right ventricular internal diameter at end diastole

M-mode Protocol Measurements M-mode also supports the following protocol measurements. These are measurements that are made one after the other, usually occurring in a single slice of the anatomy. NOTE

324

Whenever a gap is created (by turning off one of the following measurements), a free crosshair appears for the next measurement in the protocol list.

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Cardiac Triggered Measurements A number of triggered measurements are supported in the cardiac package. When these measurements are performed, a set of associated measurement values are automatically performed by the system. The associated measurements do not need to be added to the Analysis menu in order to be performed. The following table lists the triggered measurements with their corresponding measurements: Triggered Measurement ESV(MOD-sp2)

Associated Measurements LVAs ap2 LVAs apical LVLs apical

EDV(MOD-sp2)

LVAd ap2 LVAd apical LVLd apical

ESV(MOD-sp4)

LVAs ap4 LVAs apical LVLs apical

EDV(MOD-sp4)

LVAd ap4 LVAd apical LVLd apical

Ao V2 VTI

Ao V2 max Ao max PG Ao mean PG

MV V2 VTI

MV V2 max MV max PG MV mean PG

LV V1 VTI

LV V1 max LV mean PG HD11 User Reference 4535 611 65311

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MR max

MR max PG

PI max vel

PI max PG

AI max vel Ao V2 max

AI max PG

MV V2 max PA V2 max

MV max PG

TR max vel

TR max PG

PA mean PG

PA V2 max

Ao max PG PA max PG

PA max PG Ao dec slope

Ao dec time

MV dec slope

MV dec time

PA dec slope

PA dec time

Vascular Measurements This section lists the following vascular measurements: •

"TCD Measurements" on page 326

•

"Carotid Measurements" on page 330

•

"UE Artery Measurements" on page 336

•

"UE Vein Measurements" on page 340

•

"LE Artery Measurements" on page 341

•

"LE Vein Measurements" on page 347

•

"IMT Measurement" on page 348

TCD Measurements This section lists the following TCD vascular measurements:

326

•

"% Stenosis Measurements" on page 327

•

"3-Axis Volume Measurements" on page 327

•

"A/B Velocity Ratio Measurements" on page 327

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•

"Flow Volume Measurements" on page 328

•

"Resistivity and Pulsatility Index Measurements" on page 328

14

% Stenosis Measurements Unit Label s Type

Meaning

Area 1 cm2

Area

True or residual area

Area 2 cm2

Area

True or residual area

Diam 1

cm

Length True or residual diameter

Diam 2

cm

Length True or residual diameter

3-Axis Volume Measurements

Label

Unit s Type

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

A/B Velocity Ratio Measurements

Label Velocity A

Unit s

Type

Meaning

cm/s Velocit y

Generic velocity

Velocity B cm/s Velocit y

Generic velocity

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Flow Volume Measurements

Label

Unit s

Type

Flow Diam

cm

Distance

Flow TAVM

cm/s Mean velocity

Meaning Flow volume’s diameter Mean velocity for flow volume

Resistivity and Pulsatility Index Measurements The following table lists TCD vessels. When you select any of the following vessels from the analysis menu, the system automatically initiates a 2-point Doppler measurement. Table 14-1 TCD Vessels Label

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TAVP

ACA

✓

Dist Basilar

✓

MCA (M1)

✓

Mid Basilar

✓

PCA (P1)

✓

PCA (P2)

✓

Prox Basilar

✓

Prox ECA

✓

Prox ICA

✓

Vertebral

✓

Measurements and Calculations

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The following table lists the Resistivity and Pulsatility Index Measurements. Table 14-2 Resistivity and Pulsatility Index Measurements Label

Unit s

Type

SV

cm/s Velocity

DV

cm/s Velocity

TAVP (PI)

cm/s Velocity

ACA DVa

cm/s Velocity

ACA SVa

cm/s Velocity

ACA TAVP (PI)a

cm/s Velocity

Dist Basilar DVa

cm/s Velocity

Dist Basilar SVa

cm/s Velocity

Dist Basilar TAVP (PI)a

cm/s Velocity

MCA (M1) DVa

cm/s Velocity

MCA (M1) SVa

cm/s Velocity

MCA (M1) TAVP (PI)a

cm/s Velocity

Mid Basilar DVa

cm/s Velocity

Mid Basilar SVa

cm/s Velocity

Mid Basilar TAVP (PI)a

cm/s Velocity

PCA (M1) DVa

cm/s Velocity

PCA (M1) SVa

cm/s Velocity

PCA (M1) TAVP (PI)a

cm/s Velocity

PCA (M2) DVa

cm/s Velocity

PCA (M2) SVa

cm/s Velocity

PCA (M2) TAVP (PI)a

cm/s Velocity HD11 User Reference 4535 611 65311

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Table 14-2 Resistivity and Pulsatility Index Measurements Prox Basilar DVa

cm/s Velocity

Prox Basilar SVa

cm/s Velocity

Prox Basilar TAVP (PI)a

cm/s Velocity

a. You cannot add these measurements to the Analysis menu. You can only add the name of the vessel.

Carotid Measurements This section lists the following carotid measurements: •

"Carotid % Stenosis Measurements" on page 330

•

"Carotid 3-Axis Volume Measurements" on page 331

•

"Carotid A/B Velocity Ratio Measurements" on page 331

•

"Carotid Flow Volume Measurements" on page 331

•

"Carotid Intima Media Thickness (IMT) Measurements" on page 332

•

"Carotid ICA/CCA Ratio Measurements" on page 333

•

"Carotid Resistivity Index and Pulsatility Index Measurements" on page 333

Carotid % Stenosis Measurements Unit Label s Type

330

Meaning

Area 1 cm2

Area

True or residual area

Area 2 cm2

Area

True or residual area

Diam 1

cm

Length True or residual diameter

Diam 2

cm

Length True or residual diameter

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Carotid 3-Axis Volume Measurements Unit s Type

Label

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

Carotid A/B Velocity Ratio Measurements

Label Velocity A

Unit s

Type

Meaning

cm/s Velocit y

Generic velocity

Velocity B cm/s Velocit y

Generic velocity

Carotid Flow Volume Measurements

Label

Unit s

Type

Flow Diam

cm

Distance

Flow TAVMFlow TAVM

cm/s Mean velocity

Meaning Flow volume’s diameter Mean velocity for flow volume

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Measurements and Calculations

Carotid Intima Media Thickness (IMT) Measurements

Label

NOTE

332

Unit s

Type

Dist CCA IMT

cm

Length

Dist ICA IMT

cm

Length

Mid CCA IMT

cm

Length

Mid ICA IMT

cm

Length

Prox CCA IMT

cm

Length

Prox ICA IMT

cm

Length

The IMT measurements appear on the report under the IMT heading. Therefore, IMT does not appear in each IMT measurement in the report.

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Carotid ICA/CCA Ratio Measurements Label

Unit s

Type

Meaning

CCA DV (ratio)

cm/s Velocity

Common carotid artery diastolic velocity for the ICA/CCA ratio

CCA SV (ratio)

cm/s Velocity

Common carotid artery systolic velocity for the ICA/CCA ratio

ICA DV (ratio)

cm/s Velocity

Internal carotid artery diastolic velocity for the ICA/CCA ratio

ICA SV (ratio)

cm/s Velocity

Internal carotid artery systolic velocity for the ICA/CCA ratio

Carotid Resistivity Index and Pulsatility Index Measurements The following table lists carotid vessels. When you select any of the following vessels from the Analysis menu, the system automatically initiates a 2-point Doppler measurement. Table 14-3 Carotid Vessels Label

TAVP

Bulb

—

Dist CCA

—

Dist ECA

✓

Mid CCA

✓

Mid ECA

—

Mid ICA

—

Prox CCA

—

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Table 14-3 Carotid Vessels (Continued) Label

TAVP

Prox ECA

—

Prox ICA

—

Vertebral

✓

Where: Label

334

Unit s

Type

DV

cm/s Velocity

SV

cm/s Velocity

TAVP (PI)

cm/s Velocity

Bulb DVa

cm/s Velocity

Bulb SVa

cm/s Velocity

Bulb TAVP (PI)a

cm/s Velocity

Dist CCA DVa

cm/s Velocity

Dist CCA SVa

cm/s Velocity

Dist CCA TAVP (PI)a

cm/s Velocity

Dist ECA DVa

cm/s Velocity

Dist ECA SVa

cm/s Velocity

Dist ECA TAVP (PI)a

cm/s Velocity

Dist ICA DVa

cm/s Velocity

Dist ICA SVa

cm/s Velocity

Dist ICA TAVP (PI)a

cm/s Velocity

Mid CCA DVa

cm/s Velocity

Mid CCA SVa

cm/s Velocity

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Label

Unit s

14

Type

Mid CCA TAVP (PI)a

cm/s Velocity

Mid ECA DVa

cm/s Velocity

Mid ECA SVa

cm/s Velocity

Mid ECA TAVP (PI)a

cm/s Velocity

Mid ICA DVa

cm/s Velocity

Mid ICA SVa

cm/s Velocity

Mid ICA TAVP (PI)a

cm/s Velocity

Prox CCA DVa

cm/s Velocity

Prox CCA SVa

cm/s Velocity

Prox CCA TAVP (PI)a

cm/s Velocity

Prox ECA DVa

cm/s Velocity

Prox ECA SVa

cm/s Velocity

Prox ECA TAVP (PI)a

cm/s Velocity

Prox ICA DVa

cm/s Velocity

Prox ICA SVa

cm/s Velocity

Prox ICA TAVP (PI)a

cm/s Velocity

Vertebral DVa

cm/s Velocity

Vertebral SVa

cm/s Velocity

Vertebral TAVP (PI)a

cm/s Velocity

a. You cannot add these measurements to the Analysis menu. You can only add the name of the vessel.

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UE Artery Measurements This section lists the following UE artery measurements: •

"UE Artery % Stenosis Measurements" on page 336

•

"UE Artery 3-Axis Volume Measurements" on page 336

•

"UE Artery A/B Velocity Ratio Measurements" on page 337

•

"UE Artery Flow Volume Measurements" on page 337

UE Artery % Stenosis Measurements

Label

Unit s Type

Meaning

Area 1 cm2

Area

True or residual area

Area 2 cm2

Area

True or residual area

Diam 1

cm

Length True or residual diameter

Diam 2

cm

Length True or residual diameter

UE Artery 3-Axis Volume Measurements

Label

336

Unit s Type

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

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UE Artery A/B Velocity Ratio Measurements

Label Velocity A

Unit s

Type

Meaning

cm/s Velocit y

Generic velocity

Velocity B cm/s Velocit y

Generic velocity

UE Artery Flow Volume Measurements

Label

Unit s

Type

Flow Diam

cm

Distance

Flow TAVM

cm/s Mean velocity

Meaning Flow volume’s diameter Flow volume’s velocity

UE Artery Resistivity Index and Pulsatility Index Measurements The following table lists UE artery vessels. When you select any of the following vessels from the analysis menu, the system automatically initiates a 2-point Doppler measurement. Table 14-4 UE Artery Vessels Label

TAVP

Axillary

—

Dist Brachial

—

Dist Radial

—

Dist Subclavian

—

Dist Ulnar

—

Mid Radial

—

Mid Subclavian

—

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Table 14-4 UE Artery Vessels Label

TAVP

Mid Ulnar

—

Prox Brachial

—

Prox Radial

—

Prox Subclavian

—

Prox Ulnar

—

Where: Label

338

Unit s

Type

DV

cm/s Velocity

SV

cm/s Velocity

TAVP (PI)

cm/s Velocity

Axillary DVa

cm/s Velocity

Axillary SVa

cm/s Velocity

Axillary TAVP (PI)a

cm/s Velocity

Dist Brachial DVa

cm/s Velocity

Dist Brachial SVa

cm/s Velocity

Dist Brachial TAVP (PI)a

cm/s Velocity

Dist Radial DVa

cm/s Velocity

Dist Radial SVa

cm/s Velocity

Dist Radial TAVP (PI)a

cm/s Velocity

Dist Subclavian DVa

cm/s Velocity

Dist Subclavian SVa

cm/s Velocity

Dist Subclavian TAVP (PI)a

cm/s Velocity

HD11 User Reference 4535 611 65311

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Label

Unit s

14

Type

Dist Ulnar DVa

cm/s Velocity

Dist Ulnar SVa

cm/s Velocity

Dist Ulnar TAVP (PI)a

cm/s Velocity

Mid Radial DVa

cm/s Velocity

Mid Radial SVa

cm/s Velocity

Mid Radial TAVP (PI)a

cm/s Velocity

Mid Subclavian DVa

cm/s Velocity

Mid Subclavian SVa

cm/s Velocity

Mid Subclavian TAVP (PI)a

cm/s Velocity

Mid Ulnar DVa

cm/s Velocity

Mid Ulnar SVa

cm/s Velocity

Mid Ulnar TAVP (PI)a

cm/s Velocity

Prox Brachial DVa

cm/s Velocity

Prox Brachial SVa

cm/s Velocity

Prox Brachial TAVP (PI)a

cm/s Velocity

Prox Radial DVa

cm/s Velocity

Prox Radial SVa

cm/s Velocity

Prox Radial TAVP (PI)a

cm/s Velocity

Prox Subclavian DVa

cm/s Velocity

Prox Subclavian SVa

cm/s Velocity

Prox Subclavian TAVP (PI)a

cm/s Velocity

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Unit s

Label

Type

Prox Ulnar DVa

cm/s Velocity

Prox Ulnar SVa

cm/s Velocity

Prox Ulnar TAVP (PI)a

cm/s Velocity

a. You cannot add these measurements to the to the Analysis menu. You can only add the name of the vessel.

UE Vein Measurements This section lists the following UE vein measurements: •

"UE Vein 3-Axis Volume Measurements" on page 340

•

"UE Vein A/B Velocity Ratio Measurements" on page 340

•

"UE Vein Flow Volume Measurements" on page 341

UE Vein 3-Axis Volume Measurements

Label

Unit s Type

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

UE Vein A/B Velocity Ratio Measurements

Label Velocity A

340

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Unit s

Type

Meaning

cm/s Velocit y

Generic velocity

Velocity B cm/s Velocit y

Generic velocity

Measurements and Calculations

14

UE Vein Flow Volume Measurements

Label

NOTE

Unit s

Type

Flow Diam

cm

Distance

Flow TAVM

cm/s Mean velocity

Meaning Flow volume’s diameter Mean velocity for flow volume

Other measurements are available. See "UE Artery Measurements" on page 336.

LE Artery Measurements This section lists the following LE artery measurements: •

"LE Artery% Stenosis Measurements" on page 341

•

"LE Artery 3-Axis Volume Measurements" on page 342

•

"LE Artery A/B Velocity Ratio Measurements" on page 342

•

"LE Artery Flow Volume Measurements" on page 342

•

"LE Artery Resistivity Index and Pulsatility Index Measurements" on page 343

LE Artery% Stenosis Measurements

Label

Unit s Type

Meaning

Area 1 cm2

Area

True or residual area

Area 2 cm2

Area

True or residual area

Diam 1

cm

Length True or residual diameter

Diam 2

cm

Length True or residual diameter

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LE Artery 3-Axis Volume Measurements Unit s Type

Label

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

LE Artery A/B Velocity Ratio Measurements

Label Velocity A

Unit s

Type

Meaning

cm/s Velocit y

Generic velocity

Velocity B cm/s Velocit y

Generic velocity

LE Artery Flow Volume Measurements

Label

342

Unit s

Type

Flow Diam

cm

Flow TAVM

cm/s Mean velocity

HD11 User Reference 4535 611 65311

Distance

Meaning Flow volume’s diameter Flow volume's velocity

Measurements and Calculations

14

LE Artery Resistivity Index and Pulsatility Index Measurements The following table lists LE artery vessels. When you select any of the following vessels from the AIMTnalysis menu, the system automatically initiates a 2-point Doppler measurement. Table 14-5 LE Artery Vessels Label

TAVP

CFA

—

Dist ATA

—

Dist Pero

—

Dist POP

—

Dist PTA

—

Dist SFA

—

Dorsalis Pedis

—

Ext Iliac

—

Iliac

—

Int Iliac

—

Mid ATA

—

Mid Pero

—

Mid PTA

—

Mid SFA

—

PFA

—

Prox ATA

—

Prox Pero

—

Prox POP

—

Prox PTA

—

Prox SFA

—

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Where: Label

344

Unit s

Type

DV

cm/s Velocity

SV

cm/s Velocity

TAVP (PI)

cm/s Velocity

CFA DVa

cm/s Velocity

CFA SVa

cm/s Velocity

CFA TAVP (PI)a

cm/s Velocity

Dist ATA DVa

cm/s Velocity

Dist ATA SVa

cm/s Velocity

Dist ATA TAVP (PI)a

cm/s Velocity

Dist Pero DVa

cm/s Velocity

Dist Pero SVa

cm/s Velocity

Dist Pero TAVP (PI)a

cm/s Velocity

Dist POP DVa

cm/s Velocity

Dist POP SVa

cm/s Velocity

Dist POP TAVP (PI)a

cm/s Velocity

Dist PTA DVa

cm/s Velocity

Dist PTA SVa

cm/s Velocity

Dist PTA TAVP (PI)a

cm/s Velocity

Dist SFA DVa

cm/s Velocity

Dist SFA SVa

cm/s Velocity

Dist SFA TAVP (PI)a

cm/s Velocity

Dorsalis Pedis DVa

cm/s Velocity

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Dorsalis Pedis SVa

cm/s Velocity

Dorsalis Pedis TAVP (PI)a

cm/s Velocity

Ext Iliac DVa

cm/s Velocity

Ext Iliac SVa

cm/s Velocity

Ext Iliac TAVP (PI)a

cm/s Velocity

Iliac DVa

cm/s Velocity

Iliac SVa

cm/s Velocity

Iliac TAVP (PI)a

cm/s Velocity

Int Iliac DVa

cm/s Velocity

Int Iliac SVa

cm/s Velocity

Int Iliac TAVP (PI)a

cm/s Velocity

Mid ATA DVa

cm/s Velocity

Mid ATA SVa

cm/s Velocity

Mid ATA TAVP (PI)a

cm/s Velocity

Mid Pero DVa

cm/s Velocity

Mid Pero SVa

cm/s Velocity

Mid Pero TAVP (PI)a

cm/s Velocity

Mid POP DVa

cm/s Velocity

Mid POP SVa

cm/s Velocity

Mid POP TAVP (PI)a

cm/s Velocity

Mid PTA DVa

cm/s Velocity

Mid PTA SVa

cm/s Velocity

Mid PTA TAVP (PI)a

cm/s Velocity HD11 User Reference 4535 611 65311

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Mid SFA DVa

cm/s Velocity

Mid SFA SVa

cm/s Velocity

Mid SFA TAVP (PI)a

cm/s Velocity

PFAa

cm/s Velocity

Prox ATA DVa

cm/s Velocity

Prox ATA SVa

cm/s Velocity

Prox ATA TAVP (PI)a

cm/s Velocity

Prox Pero DVa

cm/s Velocity

Prox Pero SVa

cm/s Velocity

Prox Pero TAVP (PI)a

cm/s Velocity

Prox POP DVa

cm/s Velocity

Prox POP SVa

cm/s Velocity

Prox POP TAVP (PI)a

cm/s Velocity

Prox PTA DVa

cm/s Velocity

Prox PTA SVa

cm/s Velocity

Prox PTA TAVP (PI)a

cm/s Velocity

Prox SFA DVa

cm/s Velocity

Prox SFA SVa

cm/s Velocity

a. You cannot add these measurements to the Analysis menu. You can only add the name of the vessel.

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LE Vein Measurements This section lists the following LE vein measurements: •

"LE Vein 3-Axis Volume Measurements" on page 347

•

"LE Vein A/B Velocity Ratio Measurements" on page 347

•

"LE Vein Flow Volume Measurements" on page 347

LE Vein 3-Axis Volume Measurements Unit s Type

Label

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

LE Vein A/B Velocity Ratio Measurements

Label Velocity A

Unit s

Type

Meaning

cm/s Velocit y

Generic velocity

Velocity B cm/s Velocit y

Generic velocity

LE Vein Flow Volume Measurements

Label

Unit s

Type

Flow Diam

cm

Distance

Flow TAVM

cm/s Mean velocity

Meaning Vessel diameter Flow time average velocity peak

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NOTE

Other measurements are available. See "LE Artery Measurements" on page 341.

IMT Measurement This section lists the Intima Media Thickness (IMT) measurements:

Label

Unit s

Type

Dist CCA IMT

cm

Length

Dist ICA IMT

cm

Length

Mid CCA IMT

cm

Length

Mid ICA IMT

cm

Length

Prox CCA IMT

cm

Length

Prox ICA IMT

cm

Length

General Measurements This section lists the following general labeled measurements by exam type: •

"Abdominal Measurements" on page 349

•

"Prostate Measurements" on page 352

•

"Thyroid Measurements" on page 354

•

"Breast Measurements" on page 356

•

"Testicular Measurements" on page 357

•

"Superficial Measurements" on page 359

•

"Pediatric Hip Measurements" on page 361

Information about each measurement—such as units, measurement type, and meaning—is included in the tables in each section.

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Instructions for performing the measurements are not included in the tables. To learn how to perform labeled measurements, see "Performing a Labeled Measurement" on page 311.

Abdominal Measurements This section lists the following abdominal measurements:

NOTE

•

"% Stenosis Measurements" on page 349

•

"A/B Velocity Ratio Measurements" on page 350

•

"Flow Volume Measurements" on page 350

•

"Resistivity Index and Pulsatility Index Measurements" on page 351

•

"3-Axis Volume Measurements" on page 351

•

"Bladder Volume Measurements" on page 352

•

"PV Bladder Volume Measurements" on page 352

The following types of abdominal measurements have side restrictions: Aortic measurements can only be performed on the mid/main side. Renal measurements can only be performed on the left and right side.

% Stenosis Measurements Label

Type

Meaning

Aortic Area 1

Area

True or residual area

Aortic Area 2

Area

True or residual area

Aortic Diam 1

Distance

True or residual diameter

Aortic Diam 2

Distance

True or residual diameter

Area 1

Area

True or residual area

Area 2

Area

True or residual area

Diam 1

Distance

True or residual diameter

Diam 2

Distance

True or residual diameter

Renal Artery Area 1

Area

True or residual area HD11 User Reference 4535 611 65311

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Renal Artery Area 2

Area

True or residual area

Renal Artery Diam 1

Distance

True or residual diameter

Renal Artery Diam 2

Distance

True or residual diameter

A/B Velocity Ratio Measurements Unit s

Label

Type

Meaning

Ao Velocity A

cm/s Velocit y

Generic velocity

Ao Velocity B

cm/s Velocit y

Generic velocity

RA Velocity A

cm/s Velocit y

Generic velocity

RA Velocity B

cm/s Velocit y

Generic velocity

Velocity A

cm/s Velocit y

Generic velocity

Velocity B

cm/s Velocit y

Generic velocity

Flow Volume Measurements

Label

350

Unit s

Type

Ao Flow Diam

cm

Ao Flow TAVM

cm/s Mean velocity Flow volume's velocity

Flow Diam

cm

Flow TAVM

cm/s Mean velocity Flow volume's velocity

RA Flow Diam

cm

RA Flow TAVM

cm/s Mean velocity Mean velocity for flow volume

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Distance

Meaning

Distance Distance

Flow volume's diameter Flow volume’s diameter Flow volume's diameter

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Resistivity Index and Pulsatility Index Measurements Unit s

Label

Type

Ao DV

cm/s Aortic diastolic velocity

Ao SV

cm/s Aortic systolic velocity

Ao TAVP (PI)

cm/s

RA DV

cm/s Renal Diastolic velocity

RA SV

cm/s Renal systolic velocity

RA TAVP (PI)

cm/s

3-Axis Volume Measurements

Label

Unit s

Type

Meaning

Aortic Distance 1 cm

Distance Height, length, or width

Aortic Distance 2 cm

Distance Height, length, or width

Aortic Distance 3 cm

Distance Height, length, or width

Distance 1

cm

Distance Height, length, or width

Distance 2

cm

Distance Height, length, or width

Distance 3

cm

Distance Height, length, or width

Renal Distance 1

cm

Distance Height, length, or width

Renal Distance 2

cm

Distance Height, length, or width

Renal Distance 3

cm

Distance Height, length, or width

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Bladder Volume Measurements

Label

Unit s

Type

Meaning

Bladder H

cm

Length

Height

Bladder L

cm

Length

Length

Bladder W

cm

Length

Width

PV Bladder Volume Measurements

Label

Unit s

Type

Meaning

PV Bladder H

cm

Length

Height

PV Bladder L

cm

Length

Length

PV Bladder W

cm

Length

Width

Prostate Measurements This section lists the following prostate measurements:

352

•

"Prostate Volume Measurements" on page 353

•

"Bladder Volume Measurements" on page 353

•

"PV Bladder Volume Measurements" on page 353

•

"3-Axis Volume Measurements" on page 353

•

"Flow Volume Measurements" on page 354

•

"A/B Ratio Measurements" on page 354

•

"Resistivity Index and Pulsatility Index Measurements" on page 354

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Prostate Volume Measurements Unit s

Label

Type

Meaning

Prostate H

cm

Length

Height

Prostate L

cm

Length

Length

Prostate W

cm

Length

Width

Bladder Volume Measurements Unit s

Label

Type

Meaning

Bladder H

cm

Length

Height

Bladder L

cm

Length

Length

Bladder W

cm

Length

Width

PV Bladder Volume Measurements Unit s

Label

Type

Meaning

PV Bladder H

cm

Length

Height

PV Bladder L

cm

Length

Length

PV Bladder W

cm

Length

Width

3-Axis Volume Measurements

Label

Unit s

Type

Meaning

Distance 1

cm

Length

Height, Length, or Width

Distance 2

cm

Length

Height, Length, or Width

Distance 3

cm

Length

Height, Length, or Width HD11 User Reference 4535 611 65311

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Flow Volume Measurements

Label

Unit s

Type

Flow diam

cm

Length

Flow TAVM

cm/s Mean velocity

Meaning Vessel diameter Time averaged velocity mean

A/B Ratio Measurements

Label

Unit s

Type

Meaning

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

Resistivity Index and Pulsatility Index Measurements Label

Unit s

Type

Meaning

SV

cm/s Velocity

Systolic velocity

DV

cm/s Velocity

Diastolic velocity

TAVP (PI)

cm/s Velocity

Time averaged peak velocity

Thyroid Measurements This section lists the following thyroid measurements:

354

•

"3-Axis Volume Measurements" on page 355

•

"Flow Volume Measurements" on page 355

•

"A/B Ratio Measurements" on page 355

•

"Resistivity and Pulsatility Index Measurements" on page 355

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3-Axis Volume Measurements Unit s

Label

Type

Meaning

Distance 1

cm

Length

Height, length, or width

Distance 2

cm

Length

Height, length, or width

Distance 3

cm

Length

Height, length, or width

Flow Volume Measurements Unit s

Label

Type

Meaning

Flow diam

cm

Length

Vessel diameter

Flow TAVM

cm/s Mean velocity

Time averaged velocity mean

A/B Ratio Measurements

Label

Unit s

Type

Meaning

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

Resistivity and Pulsatility Index Measurements

Label

Unit s

Type

Meaning

SV

cm/s Velocity

Systolic velocity

DV

cm/s Velocity

Diastolic velocity

TAVP (PI)

cm/s Velocity

Time averaged velocity peak

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Breast Measurements This section lists the following breast measurements: •

"Mass Volume (1–10)" on page 356

•

"3-Axis Volume Measurements" on page 356

•

"Flow Volume Measurements" on page 356

•

"A/B Ratio Measurements" on page 357

•

"Resistivity Index and Pulsatility Index Measurements" on page 357

Mass Volume (1–10) Unit s

Label

Type

Meaning

Mass # Dist 1

cm

Length

Height, length, or width

Mass # Dist 2

cm

Length

Height, length, or width

Mass # Dist 3

cm

Length

Height, length, or width

3-Axis Volume Measurements

Label

Unit s

Type

Meaning

Distance 1

cm

Length

Height, length, or width

Distance 2

cm

Length

Height, length, or width

Distance 3

cm

Length

Height, length, or width

Flow Volume Measurements

Label

356

Unit s

Type

Flow diam

cm

Flow TAVM

cm/s Mean velocity

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Length

Meaning Flow volume’s diameter Time averaged velocity mean

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A/B Ratio Measurements

Label

Unit s

Type

Meaning

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

Resistivity Index and Pulsatility Index Measurements

Label

Unit s

Type

Meaning

SV

cm/s Velocity

Systolic velocity

DV

cm/s Velocity

Diastolic velocity

TAVP (PI)

cm/s Velocity

Time averaged velocity peak

Testicular Measurements This section lists the following testicular measurements: •

"Testicle Volume" on page 358

•

"3-Axis Volume Measurements" on page 358

•

"Flow Volume Measurements" on page 358

•

"A/B Ratio Measurements" on page 358

•

"Resistivity Index and Pulsatility Index Measurements" on page 359

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Testicle Volume Unit s

Label

Type

Meaning

Testicle L

cm

Length

Length

Testicle W

cm

Length

Width

Testicle H

cm

Length

Height

3-Axis Volume Measurements Unit s

Label

Type

Meaning

Distance 1

cm

Length

Height, length, width

Distance 2

cm

Length

Height, length, width

Distance 3

cm

Length

Height, length, width

Flow Volume Measurements Label

Units

Type

Meaning

Flow diam

cm

Length

Vessel diameter

Flow TAVM

cm/s

Mean velocity

Time averaged velocity mean

A/B Ratio Measurements

Label

358

Unit s

Type

Meaning

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

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Resistivity Index and Pulsatility Index Measurements

Label

Unit s

Type

Meaning

SV

cm/s Velocity

Systolic velocity

DV

cm/s Velocity

Diastolic velocity

TAVP (PI)

cm/s Velocity

Time averaged velocity peak

Superficial Measurements This section lists the following superficial measurements: •

"% Stenosis" on page 359

•

"3-Axis Volume Measurements" on page 360

•

"Flow Volume Measurements" on page 360

•

"A/B Ratio Measurements" on page 360

•

"Resistivity Index and Pulsatility Index Measurements" on page 360

% Stenosis Label

Type

Meaning

Area 1

Area

True or residual area

Area 2

Area

True or residual area

Diam 1

Distance

True or residual diameter

Diam 2

Distance

True or residual diameter

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3-Axis Volume Measurements Unit s

Label

Type

Meaning

Distance 1

cm

Length

Height, length, or width

Distance 2

cm

Length

Height, length, or width

Distance 3

cm

Length

Height, length, or width

Flow Volume Measurements

Label

Unit s

Type

Meaning

Flow diam

cm

Length

Flow volume’s diameter

Flow TAVM

cm/s Mean velocity

Mean velocity for flow volume

A/B Ratio Measurements

Label

Unit s

Type

Meaning

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

Resistivity Index and Pulsatility Index Measurements

Label

360

Unit s

Type

Meaning

SV

cm/s Velocity

Systolic velocity

DV

cm/s Velocity

Diastolic velocity

TAVP (PI)

cm/s Velocity

Time averaged velocity peak

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Pediatric Hip Measurements This section lists hip angle measurements. The hip angle component has no associated value. When you select Hip Angle from the menu, you can measure the alpha and beta angles of the hip angles.

Label Hip Angle

Unit s —

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Obstetric Measurements The following table lists all obstetric measurements: Label

Unit s

Type

Meaning

2 Beat Pk-to-Pk

sec

Time

AC traced

cm

Circumference Traced abdominal circumference

ADap

cm

Length

Anterior-posterior abdominal diameter

ADtrv

cm

Length

Transverse abdominal diameter

BPD

cm

Length

Biparietal diameter

CD

cm

Length

Cerebellar diameter

Cist Mag

cm

Length

Cisterna magna

CLAV

cm

Length

Clavicle length

CRL

cm

Length

Crown-rump length

Distance 1

cm

Length

3-axis volume length

Distance 2

cm

Length

3-axis volume length

Distance 3

cm

Length

3-axis volume length

Ductus Venosus DV

cm/s Velocity

Diastolic velocity of the ductus venosus

Ductus Venosus SV

cm/s Velocity

Systolic velocity of the ductus venosus

Ductus Venosus TAVP (PI)

cm/s Velocity

Mean velocity of the Ductus Venosus

DV

cm2

Velocity

Diastolic velocity (for the PI and RI calculation)

Ear

cm

Length

Ear length

FIB

cm

Length

Fibula length

FL

cm

Length

Femur length

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Two-beat, peak-to-peak time interval

Measurements and Calculations

Label

Unit s

Type

14

Meaning

Flow diam

cm

Length

Diameter for flow volume

Foot

cm

Length

Foot length

FTA traced

cm2

Area

Traced fetal trunk cross-sectional area

GSD1

cm

Length

Gestational sac diameter one

GSD2

cm

Length

Gestational sac diameter two

GSD3

cm

Length

Gestational sac diameter three

HC traced

cm

Circumference Traced head circumference

HL

cm

Length

HrtC

cm

Circumference Heart circumference

IOD

cm

Length

Inner orbital diameter

Lat V

cm

Length

Lateral ventricle width

M Phalanx 5

cm

Length

Length of the middle phalanx on the fifth digit

MCA DV

cm/s Velocity

Diastolic velocity of the middle cerebral artery

MCA SV

cm/s Velocity

Systolic velocity of the middle cerebral artery

MCA TAVP (PI)

cm/s Velocity

Time averaged velocity peak of the middle cerebral artery

TAVP (PI)

cm/s Velocity

Time averaged velocity peak

TAVM

cm/s Velocity

Time averaged velocity mean

NUCH

cm

Length

Nuchal thickness

OFD

cm

Length

Occipitofrontal diameter

OOD

cm

Length

Outer orbital diameter

Orbit 1

cm

Length

First orbit

Orbit 2

cm

Length

Second orbit

Humerus length

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Label

Unit s

Type

Meaning

QUAD1

cm

Length

AFI dimension: quadrant 1

QUAD2

cm

Length

AFI dimension: quadrant 2

QUAD3

cm

Length

AFI dimension: quadrant 3

QUAD4

cm

Length

AFI dimension: quadrant 4

Renal AP

cm

Length

Renal anterior-posterior

Renal L

cm

Length

Renal length

RL

cm

Length

Radius length

SL

cm

Length

Spine length

SV

cm2

Velocity

Systolic velocity (for the PI and RI calculation)

TC traced

cm

Circumference Traced thoracic circumference

TDap

cm

Length

Anterior-posterior thoracic diameter

TDtrv

cm

Length

Transverse thoracic diameter

TL

cm

Length

Tibia length

TTD

cm

Length

Transverse trunk diameter

UL

cm

Length

Ulna length

Umbilical DV

cm/s Velocity

Diastolic velocity of the umbilical artery

Umbilical SV

cm/s Velocity

Systolic velocity of the umbilical artery

Umbilical TAVP (PI)

cm/s Velocity

Time averaged velocity peak

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

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Gynecology Measurements The following tables list all gynecology measurements: •

"Uterus Measurements" on page 365

•

"Ovarian Measurements" on page 366

•

"Flow Volume Measurements" on page 367

•

"A/B Ratio Measurements" on page 367

•

"3-Axis Volume Measurements" on page 367

•

"Resistivity Index and Pulsatility Index Measurements" on page 367

Uterus Measurements

Label

Unit s

Type

Meaning

Cervix

cm

Contour Length

Cervix length

Endometrium

cm

Length

Endometrium thickness

UTH

cm

Length

Uterine height

UTL

cm

Length

Uterine length

UTW

cm

Length

Uterine width

Uterine DV

cm/s Velocity

Diastolic velocity of the uterine artery

Uterine SV

cm/s Velocity

Systolic velocity of the uterine artery

Uterine TAVP (PI)

cm/s Velocity

Time averaged velocity peak of the uterine artery

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Ovarian Measurements

Label

Unit s

Type Length

Meaning

L follicle (1–16) Dist

cm

Diameter of left ovarian follicle (1–16)

L ovary DV

cm/s Velocity

Left ovary diastolic velocity

Left ovary Mean (PI)

cm/s Velocity

Left ovary mean velocity

Left ovary SV

cm/s Velocity

Left ovary systolic velocity

LOH

cm

Length

Left ovarian height

LOL

cm

Length

Left ovarian length

LOW

cm

Length

Left ovarian width

R follicle (1–16) Dist

cm

Length

Diameter of right ovarian follicle (1–16)

R ovary DV

cm/s Velocity

Right ovary diastolic velocity

R ovary SV

cm/s Velocity

Right ovary systolic velocity

Right ovary TAVP (PI)

cm/s Velocity

Right ovary mean velocity

ROH

cm

Length

Right ovary height

ROL

cm

Length

Right ovary length

ROW

cm

Length

Right ovary width

NOTES

•

•

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You can perform up to five different diameter measurements on each follicle. Only the average appears in the report. All instances appear in the report work area. You can measure up to 15 different follicles in each ovary. For example, R Follicle 3 Dist is the diameter of the third follicle in the right ovary.

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Flow Volume Measurements Unit s

Label

Type

Flow diam

cm

Length

Flow TAVM

cm/s Velocity

Meaning Diameter for flow volume Mean velocity for flow volume

A/B Ratio Measurements Unit s

Label

Type

Meaning

Velocity A

cm/s Velocity

Generic velocity

Velocity B

cm/s Velocity

Generic velocity

3-Axis Volume Measurements

Label

Unit s Type

Meaning

Distance 1 cm

Length Height, length, or width

Distance 2 cm

Length Height, length, or width

Distance 3 cm

Length Height, length, or width

Resistivity Index and Pulsatility Index Measurements Label

Unit s

Type

Meaning

SV

cm/s Velocity

Systolic velocity

DV

cm/s Velocity

Diastolic velocity

TAVP (PI)

cm/s Velocity

Mean velocity for flow volume

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Musculoskeletal Measurements The following table lists the tendon measurements that are included in the Musculoskeletal option package.

Tendon Measurements (1–10) Label

Unit s

Type

Ankle # (1–10)

cm

Length

Knee # (1–10)

cm

Length

Shoulder # (1–10)

cm

Length

Tendon # (1–10

cm

Length

Wrist # (1–10)

cm

Length

Labeled Calculations by Exam Type References are provided for many of the calculations and formulas. Clinical calculations are usually based on studies of large patient populations. The formulas that are derived have some uncertainty or inaccuracy based on the correlation coefficient for the study involved. In many cases, these uncertainties are greater than the inaccuracies of the ultrasound system measurement. Clinicians should always be familiar with the clinical reference provided for each calculation before using the system measurement and analysis data to make a clinical decision. This section lists the following calculations:

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•

"General Calculations" on page 369

•

"Cardiac Calculations" on page 380

•

"Obstetric Calculations" on page 386

•

"Gynecology Calculations" on page 389

•

"Vascular Calculations" on page 391

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The tables include the type and the meaning of the calculation. Instructions for performing the calculations are not included in the tables. For general instructions on performing calculations, see "Performing Calculations" on page 299. See "Clinical References for Calculations" on page 439 for the formula, inherent approximations and assumptions, and clinical references for each calculation.

General Calculations This section lists the following general calculations: •

"Abdomen Calculations" on page 369

•

"Prostate Calculations" on page 371

•

"Thyroid Calculations" on page 374

•

"Breast Calculations" on page 375

•

"Testicular Calculations" on page 376

•

"Superficial Calculations" on page 378

•

"Hip Angle Calculations" on page 380

Abdomen Calculations This section lists the following abdomen calculations: •

"% Stenosis Calculations" on page 370

•

"3-Axis Volume Calculations" on page 370

•

"Flow Volume Calculations" on page 370

•

"Resistivity Index and Pulsatility Index Calculations" on page 371

•

"Velocity Ratios Calculations" on page 371

•

"Renal-to-Aortic Ratio" on page 371

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

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% Stenosis Calculations Typ e

Label

Meaning

% Area sten

%

Percent area stenosis

% Diam sten

%

Percent diameter stenosis

Aortic % Area sten

%

Percent area stenosis

Aortic % Diam sten

%

Percent diameter stenosis

Renal Artery % Area sten

%

Percent area stenosis

Renal Artery % Diam sten

%

Percent diameter stenosis

3-Axis Volume Calculations Label

Type

Meaning

Ao Volume

Volum e

Ellipsoid three-axis volume

Renal Volume

Volum e

Ellipsoid three-axis volume

Volume

Volum e

Ellipsoid three-axis volume

Flow Volume Calculations Label

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Type

Meaning

Ao Flow vol

Volume

Flow volume via diameter

Flow vol

Volume

Flow volume via diameter

RA Flow vol

Volume

Flow volume via diameter

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Resistivity Index and Pulsatility Index Calculations Label

Type

Aortic RI

Resistivity Index

Aortic PI

Pulsatility index using time-averaged mean of the peaks

S/D

Systolic-to-Diastolic ratio

Renal Artery RI

Resistivity index

Renal Artery PI

Pulsatility index using time-averaged mean of the peaks

RI

Resistivity index

PI

Pulsatility index using time-averaged mean of the peaks

Velocity Ratios Calculations Label

Typ e

Meaning

A/B Ratio

Rati o

Generic A/B velocity ratio

A/B Ratio

Rati o

Generic A/B velocity ratio

A/B Ratio

Rati o

Generic A/B velocity ratio

Renal-to-Aortic Ratio Label RAR

Typ e Rati o

Meaning Renal aortic systolic velocity ratio

Prostate Calculations The following tables list all prostate calculations. HD11 User Reference 4535 611 65311

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Measurements and Calculations

•

"Prostate Volume Calculation" on page 373

•

"Bladder Volume Calculation" on page 373

•

"PV Bladder Volume Calculation" on page 373

•

"3-Axis Volume Calculation" on page 373

•

"Flow Volume Calculation" on page 373

•

"A/B Ratio Calculation" on page 373

•

"Resistivity Index and Pulsatility Index Calculations" on page 374

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

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Prostate Volume Calculation Label

Units cm3

Prostate Vol

Meaning Volume of prostate

Bladder Volume Calculation Label

Units

Bladder Vol

cm3

Meaning Volume of bladder

PV Bladder Volume Calculation Label

Units

PV Bladder Vol

cm3

Meaning Post-void volume of bladder

3-Axis Volume Calculation Label

Units cm3

Volume

Meaning Ellipsoid three-axis volume

Flow Volume Calculation Label Flow vol

Units l/min

Meaning Flow volume via diameter and TAVM

A/B Ratio Calculation Label A/B Ratio

Unit s Ratio

Meaning Generic A/B velocity ratio

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Resistivity Index and Pulsatility Index Calculations Label

Meaning

PI

Pulsatility index

RI

Resistivity index

S/D

Systolic-diastolic Ratio

Thyroid Calculations The following tables list all thyroid calculations. •

"3-Axis Volume Calculation" on page 373

•

"Flow Volume Calculation" on page 373

•

"A/B Ratio Calculation" on page 373

•

"Resistivity Index and Pulsatility Index Calculations" on page 374

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

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3-Axis Volume Calculation Label

Units cm3

Volume

Meaning Volume of Thyroid

Flow Volume Calculation Label Flow vol

Units l/min

Meaning Flow volume via diameter and TAVM

A/B Ratio Calculation Label A/B Ratio

Unit s cm/s

Meaning Generic A/B ratio

Resistivity Index and Pulsatility Index Calculations Label

Meaning

PI

Pulsatility index

RI

Resistivity index

S/D

Systolic-diastolic Ratio

Breast Calculations The following tables list all breast calculations: •

"Mass Volume (1–10) Calculation" on page 376

•

"3-Axis Volume Calculation" on page 376

•

"Flow Volume Calculation" on page 376

•

"A/B Ratio Calculation" on page 376

•

"Resistivity Index and Pulsatility Index Calculations" on page 376

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Measurements and Calculations

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

Mass Volume (1–10) Calculation Label

Units

Mass # Vol

cm3

Meaning Ellipsoid three-axis volume

3-Axis Volume Calculation Label

Units

Volume

cm3

Meaning Ellipsoid three-axis volume

Flow Volume Calculation Label Flow vol

Units l/min

Meaning Flow volume via diameter and TAVM

A/B Ratio Calculation Label A/B Ratio

Unit s cm/s

Meaning Generic A/B Ratio

Resistivity Index and Pulsatility Index Calculations Label

Meaning

PI

Pulsatility index

RI

Resistivity index

S/D

Systolic-diastolic Ratio

Testicular Calculations The following tables list all testicular calculations: 376

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Measurements and Calculations

•

"Testicle Volume Calculation" on page 378

•

"3-Axis Volume Calculation" on page 378

•

"Flow Volume Calculation" on page 378

•

"A/B Ratio Calculation" on page 378

•

"Resistivity Index and Pulsatility Index Calculations" on page 378

14

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

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Measurements and Calculations

Testicle Volume Calculation Label

Units cm3

Testicle Vol

Meaning Volume of testicle

3-Axis Volume Calculation Label

Units

Volume

cm3

Meaning Ellipsoid three-axis volume

Flow Volume Calculation Label Flow vol

Units l/min

Meaning Flow volume via diameter and TAVM

A/B Ratio Calculation Label A/B Ratio

Unit s cm/s

Meaning Generic A/B Ratio

Resistivity Index and Pulsatility Index Calculations Label

Meaning

PI

Pulsatility index

RI

Resistivity index

S/D

Systolic-diastolic Ratio

Superficial Calculations The following tables list all superficial calculations: • 378

"% Stenosis Calculations" on page 379

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Measurements and Calculations

•

"3-Axis Volume Calculation" on page 379

•

"Flow Volume Calculation" on page 379

•

"A/B Ratio Calculation" on page 380

•

"Resistivity Index and Pulsatility Index Calculations" on page 380

14

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

% Stenosis Calculations Typ e

Label

Meaning

% Area sten

%

Percent area stenosis

% Diam sten

%

Percent diameter stenosis

3-Axis Volume Calculation Label Volume

Type Volume

Meaning Ellipsoid three-axis volume

Flow Volume Calculation Label Flow vol

Type Volume

Meaning Flow volume via diameter

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A/B Ratio Calculation Label A/B Ratio

Unit s cm/s

Meaning Generic A/B ratio

Resistivity Index and Pulsatility Index Calculations Label

Meaning

PI

Pulsatility index

RI

Resistivity index

S/D

Systolic-diastolic Ratio

Hip Angle Calculations The following table lists hip angle calculations. See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references. Label

Type

Meaning

Hip angle A

Angle in degrees

Bony acetabular root line angle (bony root angle)

Hip angle B

Angle in degrees

Cartilage root line angle (cartilage root angle)

Cardiac Calculations This section lists the following cardiac calculations: •

"2D Mode/Physio Cardiac Calculations" on page 381

•

"Doppler/Physio Cardiac Calculations" on page 384

•

"M-mode/Physio Cardiac Calculations" on page 385

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

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2D Mode/Physio Cardiac Calculations Label

Type

Meaning

AVA(V,D)

Area

Valve area (continuity formula) by velocity time interval

AVA(ID)

Area

Valve area (continuity formula) by maximum velocity

CO(bp-el)

Cardiac output Cardiac output (2D)

CO(Bullet)

Cardiac output Cardiac output (2D)

CO(Cubed)

Cardiac output Cardiac output (2D)

CO(LVOT)

Cardiac output Cardiac output (Doppler)

CO(MOD-bp)

Cardiac output Cardiac output (2D)

CO(mod-Simp)

Cardiac output Cardiac output (2D)

CO(MOD-sp2)

Cardiac output Cardiac output (2D)

CO(MOD-sp4)

Cardiac output Cardiac output (2D)

CO(sp-el)

Cardiac output Cardiac output (2D)

CO(Teich)

Cardiac output Cardiac output (2D)

EDV(Cubed)

Volume

Volume (cubed)

EDV(bp-el)

Volume

Volume (biplane)

EDV(Bullet)

Volume

Volume (bullet)

EDV(MOD-bp)

Volume

Volume (biplane MOD)

EDV(mod-Simp)

Volume

Volume (mod-Simp)

EDV(sp-el)

Volume

Volume (single-plane ellipse)

EDV(Teich)

Volume

Volume (Teich)

EF(bp-el)

EF

Ejection fraction

EF(Bullet)

EF

Ejection fraction

EF(Cubed)

EF

Ejection fraction

EF(MOD-bp)

EF

Ejection fraction

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Measurements and Calculations

Label

Type

Meaning

EF(mod-Simp)

EF

Ejection fraction

EF(MOD-sp2)

EF

Ejection fraction

EF(MOD-sp4)

EF

Ejection fraction

EF(sp-el)

EF

Ejection fraction

EF(Teich)

EF

Ejection fraction

ESV(bp-el)

Volume

Volume (biplane)

ESV(Bullet)

Volume

Volume (bullet)

ESV(Cubed)

Volume

Volume (cubed)

ESV(MOD-bp)

Volume

Volume (biplane MOD)

ESV(mod-Simp)

Volume

Volume (mod-Simp)

ESV(sp-el)

Volume

Volume (single-plane ellipse)

ESV(Teich)

Volume

Volume (Teich)

FAC

%

Fractional area change

FS

FS

Fractional shortening

LVLd % diff

%

% Difference of LV lengths

LVLs % diff

%

% Difference of LV lengths

LVmass(AL)d

Mass

Left ventricular mass at end diastole

LVmass(AL)dI

Mass index

Left ventricular mass at end diastole, indexed by body surface area

LVmass(C)d

Mass

Left ventricular mass via the cubic formula at end diastole

LVmass(C)dI

Mass index

Left ventricular mass via the cubic formula at end diastole, indexed by body surface area

LVOT Area

Area

Left ventricular outflow tract area

MM HR

BPM

Heart rate

MR ERO

Area

Mitral valve effective regurgitant orifice area

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Label

Type

14

Meaning

MR flow rate

Flow rate

Mitral valve regurgitation flow rate

MR PISA

Surface area

Mitral valve regurgitation proximal isovolumic surface area

MR RF

Fraction

Mitral valve regurgitant fraction

MR volume

Regurgitant volume

Mitral valve regurgitant volume

MV Flow Area

Area

Mitral valve flow area

Qp:Qs

Flow ratio

Ratio of pulmonic flow to systemic flow via simplified Doppler echocardiographic method

SV(bp-el)

Stroke volume Stroke volume (2D)

SV(Bullet)

Stroke volume Stroke volume (2D)

SV(Cubed)

Stroke volume Stroke volume (2D)

SV(LVOT)

Stroke volume Stroke volume (Doppler)

SV(MOD-bp)

Stroke volume Stroke volume (2D)

SV(mod-Simp)

Stroke volume Stroke volume (2D)

SV(MOD-sp2)

Stroke volume Stroke volume (2D)

SV(MOD-sp4)

Stroke volume Stroke volume (2D)

SV(MV)

Stroke volume Mitral valve stroke volume (Doppler)

SV(sp-el)

Stroke volume Stroke volume (2D)

SV(Teich)

Stroke volume Stroke volume (2D)

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Doppler/Physio Cardiac Calculations Label

Type

Meaning

Ao max PG

Pressure gradient

Aortic flow maximum pressure gradient (simplified Bernoulli)

Ao mean PG

Pressure gradient

Aortic flow mean pressure gradient (simplified Bernoulli)

Ao P1/2t

Pressure half-time

Aortic flow pressure half-time

Aortic HR

BPM

Heart rate

AVA (I,D)

Area

Valve area (continuity formula) via velocity time integral

AVA (V,D)

Area

Valve area (continuity formula) via maximum velocity

CO(LVOT)

Cardiac output

Cardiac output via the left ventricular outflow tract

MR ERO

Area

Mitral valve effective regurgitant orifice area

MR flow rate

Flow rate

Mitral valve regurgitation flow rate

MR RF

Fraction

Mitral valve regurgitant fraction

MR volume

Regurgitant volume

Mitral valve regurgitant volume

MV E/A

Ratio

Mitral valve E-to-A ratio

MV P1/2t

Pressure half-time

Mitral valve pressure half-time

MVA P1/2t

Area

Mitral valve area via P1/2t

PA P1/2t

Pressure half-time

Pulmonary insufficiency pressure half-time

Qp:Qs

Flow ratio

Ratio of pulmonic flow to systemic flow via simplified Doppler echocardiographic method

RVSP(TR)

Pressure

Right ventricular systolic pressure via TR

SV(LVOT)

Stroke volume

Left ventricular outflow tract stroke volume (Doppler)

SV(MV)

Stroke volume

Mitral valve stroke volume (Doppler)

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M-mode/Physio Cardiac Calculations Label

Type

Meaning

Aortic HR

BPM

Heart rate

CO(bp-el)

Cardiac output Cardiac output (M-mode)

CO(Bullet)

Cardiac output Cardiac output (M-mode)

CO(Cubed)

Cardiac output Cardiac output (M-mode)

CO(LVOT)

Cardiac output Cardiac output (M-mode)

CO(MOD-bp)

Cardiac output Cardiac output (M-mode)

CO(mod-Simp)

Cardiac output Cardiac output (M-mode)

CO(MOD-sp2)

Cardiac output Cardiac output (M-mode)

CO(MOD-sp4)

Cardiac output Cardiac output (M-mode)

CO(sp-el)

Cardiac output Cardiac output (M-mode)

CO(Teich)

Cardiac output Cardiac output (M-mode)

EDV(bp-el)

Volume

Volume (biplane)

EDV(Cubed)

Volume

Volume (cubed)

EDV(Teich)

Volume

Volume (Teich)

EF(bp-el)

EF

Ejection fraction

EF(Cubed)

EF

Ejection fraction

EF(Teich)

EF

Ejection fraction

ESV(bp-el)

Volume

Volume (biplane)

ESV(Cubed)

Volume

Volume (cubed)

ESV(Teich)

Volume

Volume (Teich)

FS

FS

Fractional shortening

LA/AO

Ratio

LA dimension to aortic root ratio

LVmass(C)d

Mass

Left ventricular mass via the cubic formula at end diastole

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Measurements and Calculations

Label

Type

Meaning

LVmass(C)dI

Mass index

Left ventricular mass via the cubic formula at end diastole, indexed by body surface area

MM HR

BPM

Heart rate

SV(bp-el)

Stroke volume Stroke volume (2D)

SV(Cubed)

Stroke volume Stroke volume (2D)

SV(Teich)

Stroke volume Stroke volume (2D)

Obstetric Calculations The following table lists all obstetric calculations. See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references. Label

Type

Meaning

A/B

Ratio

Generic A/B velocity ratio

AC

Circumference

Abdominal circumference

AFI

AFI

Amniotic fluid index

CI(BPD,OFD)

CI

Cephalic index

Ductus Venosus PI

Pulsatility index

Pulsatility index using time-averaged mean of the peaks

Ductus Venosus RI

Resistivity index Resistivity index

Ductus Venosus S/D

Ratio

Systolic-to-diastolic ratio

EFW(AC,BPD)Hadl

Weight

Estimated fetal weight via AC and BPD (Hadlock) Normal fetal weight percentiles

EFW(AC,BPD)Sh

Weight

Estimated fetal weight via AC and BPD (Shephard) Normal fetal weight percentiles

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Measurements and Calculations

Label EFW(AC,FL)Hadl

Type Weight

14

Meaning Estimated fetal weight via AC and FL (Hadlock) Normal fetal weight percentiles

EFW(AC,HC,FL)Hadl

Weight

Estimated fetal weight via AC, HC, and FL (Hadlock) Normal fetal weight percentiles

EFW(B,H,A,F)Hadl

Weight

Estimated fetal weight via BPD, HC, AC, and FL (Hadlock) Normal fetal weight percentiles

EFW(BPD,AD,FL)Tokyo

Weight

Estimated fetal weight via BPD, ADap, ADtrv, and FL (Tokyo)

EFW(BPD,FTA,FL)Osaka

Weight

Estimated fetal weight via BPD, FTA, and FL (Osaka)

Fetal HR

BPM

Fetal heart rate

FL/AC

Ratio

FL to AC ratio

FL/BPD

Ratio

FL to BPD ratio

Flow vol

Flow volume

Flow volume via diameter and TAVM

GA(AC)Hadlock

Age

Gestational age via AC (Hadlock)

GA(BPD)Hadlock

Age

Gestational age via BPD (Hadlock)

GA(BPD)Jeant

Age

Gestational age via BPD (Jeanty)

GA(BPD)Osaka

Age

Gestational age via BPD (Osaka)

GA(BPD)Tokyo

Age

Gestational age via BPD (Tokyo)

GA(CRL)Jeanty

Age

Gestational age via CRL (Jeanty)

GA(CRL)Osaka

Age

Gestational age via CRL (Osaka)

GA(CRL)Rempen

Age

Gestational age via CRL (Rempen)

GA(CRL)Robinson

Age

Gestational age via CRL (Robinson)

GA(CRL)Tokyo

Age

Gestational age via CRL (Tokyo)

GA(FL)Hadlock

Age

Gestational age via FL (Hadlock) HD11 User Reference 4535 611 65311

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Measurements and Calculations

Label

Type

Meaning

GA(FL)Jeanty

Age

Gestational age via FL (Jeanty)

GA(FL)Osaka

Age

Gestational age via FL (Osaka)

GA(FL)Tokyo

Age

Gestational age via FL (Tokyo)

GA(FTA)Osaka

Age

Gestational age via FTA (Osaka)

GA(GSD)Rempen

Age

Gestational age via GSD (Rempen)

GA(GSD)Tokyo

Age

Gestational age via GSD (Tokyo)

GA(HC)Hadlock

Age

Gestational age via HC (Hadlock)

GA(HL)Jeanty

Age

Gestational age via HL (Jeanty)

GA(HL)Osaka

Age

Gestational age via HL (Osaka)

GA(MSD)Hellman

Age

Gestational age via MSD (Hellman)

GA(SL)Tokyo

Age

Gestational age via SL (Tokyo)

GA(TC)Nimrod

Age

Gestational age via TC (Nimrod)

GA(TL)Jeanty

Age

Gestational age via TL (Jeanty)

GA(UL)Jeanty

Age

Gestational age via UL (Jeanty)

HC

Circumference

Head circumference computed

HC/AC

Ratio

Ratio of head circumference to abdominal circumference

HrtC/TC

Ratio

HrtC-to-TC ratio

MCA PI

Pulsatility index

Pulsatility index

MCA RI

Resistivity index Resistivity index

MCA S/D

Ratio

Systolic-to-diastolic ratio

MSD

Diameter

Mean sac diameter

PI

Pulsatility index

Pulsatility index using time-averaged mean of the peaks

RI

Resistivity index Resistivity index

S/D

Ratio

Systolic-to-diastolic ratio

TC

Circumference

Thoracic circumference computed

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Measurements and Calculations

Label

Type

Meaning

Umbilical PI

Pulsatility index

Pulsatility index using the time-averaged mean of the peaks

Umbilical RI

Resistivity index Resistivity index

Umbilical S/D

Ratio

Umbilical systolic-to-diastolic ratio

Volume

Volume

3-axis volume

Gynecology Calculations The following tables list all gynecology calculations: •

"Uterus Calculations" on page 390

•

"Ovarian Calculations" on page 390

•

"Flow Volume Calculation" on page 390

•

"A/B Ratio Calculations" on page 391

•

"Resistivity Index and Pulsatility Index Calculations" on page 391

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

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Measurements and Calculations

Uterus Calculations Label

Type

Meaning

Uterine PI

Pulsatility index

Pulsatility index using the time-averaged mean of the peaks

Uterine RI

Resistivity index

Resistivity index

Uterine S/D

Ratio

Systolic-to-diastolic ratio

UTV

Volume

Uterine volume

Ovarian Calculations Label

Type

Meaning

L Follicle Vol (1– 16)

Volume

1-distance volume of the 1st–16th follicle in the left ovary

L Ovary PI

Pulsatility index

Left ovarian pulsatility index

L Ovary RI

Resistivity index

Left ovarian resistivity index

L Ovary S/D

Ratio

Left ovary systolic-to-diastolic ratio

LOV

Volume

Left ovary volume

R Follicle Vol (1– 16)

Volume

1-distance volume of the 1st–16th follicle in the right ovary

R Ovary PI

Pulsatility index

Right ovarian pulsatility index

R Ovary RI

Resistivity index

Right ovarian resistivity index

R Ovary S/D

Ratio

Right ovary systolic-to-diastolic ratio

ROV

Volume

Right ovarian volume

Flow Volume Calculation Label Flow vol

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Type Flow volume

Meaning Flow volume via diameter and TAVM

Measurements and Calculations

14

A/B Ratio Calculations Label A/B Ratio

Type Ratio

Meaning Generic A/B velocity ratio

Resistivity Index and Pulsatility Index Calculations Label

Type

Meaning

PI

Pulsatility index

Pulsatility index using time-averaged mean of the peaks

RI

Resistivity index

Resistivity index

S/D

Ratio

Systolic-to-diastolic ratio

Vascular Calculations The following tables list all vascular calculations: •

"Vascular % Stenosis Calculations" on page 391

•

"Vascular Carotid Calculations" on page 392

•

"Vascular A/B Velocity Ratio Calculation" on page 392

•

"Vascular Flow Volume Calculation" on page 392

•

"Vascular Resistivity Index and Pulsatility Index Calculations" on page 392

•

"Vascular Volume Calculation" on page 397

See "Clinical References for Calculations" on page 439 for details on the formula used, inherent approximations and assumptions, and clinical references.

Vascular % Stenosis Calculations

Label

Typ e

Meaning

%Area Sten

%

Percent area stenosis

%Diam Sten

%

Percent diameter stenosis

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Measurements and Calculations

Vascular Carotid Calculations Label

Type

ICA/CCA DV

Diastolic ratio

Meaning Internal carotid artery diastolic velocity to common carotid artery diastolic velocity ratio

ICA/CCA SV Systolic ratio

Internal carotid artery systolic velocity to common carotid artery systolic velocity ratio

Vascular A/B Velocity Ratio Calculation

Label

Typ e

A/B Ratio Rati o

Meaning Generic A/B velocity ratio

Vascular Flow Volume Calculation Label Flow vol

Type Volume

Meaning Flow volume via diameter and TAVM

Vascular Resistivity Index and Pulsatility Index Calculations Each of the calculations in the following table are Reported Calculations and therefore, do not appear in the Analysis menu. Each of the vessels listed in the followin table include one RI and one S/D ratio calculation. For vessels that have a labeled TAVP calculation, the analysis package also displays a PI calculation. Label

Type

ACA PI

Pulsatility index using time-averaged mean of the peaks

ACA RI

Resistivity index

ACA S/D

Systolic-to-diastolic ratio

Axillary RI

Resistivity index

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Measurements and Calculations

Label

14

Type

Axillary S/D

Systolic-to-diastolic ratio

Bulb RI

Resistivity index

Bulb S/D

Systolic-to-diastolic ratio

CFA RI

Resistivity index

CFA S/D

Systolic-to-diastolic ratio

Dist ATA RI

Resistivity index

Dist ATA S/D

Systolic-to-diastolic ratio

Dist Basilar PI

Pulsatility index using time-averaged mean of the peaks

Dist Basilar RI

Resistivity index

Dist Basilar S/D

Systolic-to-diastolic ratio

Dist Brachial RI

Resistivity index

Dist Brachial S/D

Systolic-to-diastolic ratio

Dist CCA RI

Resistivity index

Dist CCA S/D

Systolic-to-diastolic ratio

Dist ECA PI

Pulsatility index using time-averaged mean of the peaks

Dist ECA RI

Resistivity index

Dist ECA S/D

Systolic-to-diastolic ratio

Dist ICA PI

Pulsatility index using time-averaged mean of the peaks

Dist ICA RI

Resistivity index

Dist ICA S/D

Systolic-to-diastolic ratio

Dist Pero RI

Resistivity index

Dist Pero S/D

Systolic-to-diastolic ratio

Dist POP RI

Resistivity index

Dist POP S/D

Systolic-to-diastolic ratio

Dist PTA RI

Resistivity index

Dist PTA S/D

Systolic-to-diastolic ratio

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Measurements and Calculations

Label

Type

Dist Radial RI

Resistivity index

Dist Radial S/D

Systolic-to-diastolic ratio

Dist SFA RI

Resistivity index

Dist SFA S/D

Systolic-to-diastolic ratio

Dist Subclavian RI

Resistivity index

Dist Subclavian S/D

Systolic-to-diastolic ratio

Dist Ulnar RI

Resistivity index

Dist Ulnar S/D

Systolic-to-diastolic ratio

Dorsalis Pedis RI

Resistivity index

Dorsalis Pedis S/D

Systolic-to-diastolic ratio

Ext Iliac RI

Resistivity index

Ext Iliac S/D

Systolic-to-diastolic ratio

Iliac RI

Resistivity index

Iliac S/D

Systolic-to-diastolic ratio

Int Iliac RI

Resistivity index

Int Iliac S/D

Systolic-to-diastolic ratio

MCA (M1) PI

Pulsitility index

MCA (M1) RI

Resisitivity index

MCA (M1) S/D

Systolic-to-diastolic ratio

Mid ATA RI

Resistivity index

Mid ATA S/D

Systolic-to-diastolic ratio

Mid Basilar PI

Pulsatility index using time-averaged mean of the peaks

Mid Basilar RI

Resistivity index

Mid Basilar S/D

Systolic-to-diastolic ratio

Mid CCA RI

Resistivity index

Mid CCA S/D

Systolic-to-diastolic ratio

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Measurements and Calculations

Label

14

Type

Mid ECA RI

Resistivity index

Mid ECA S/D

Systolic-to-diastolic ratio

Mid ICA RI

Resistivity index

Mid ICA S/D

Systolic-to-diastolic ratio

Mid Pero RI

Resistivity index

Mid Pero S/D

Systolic-to-diastolic ratio

Mid PTA RI

Resistivity index

Mid PTA S/D

Systolic-to-diastolic ratio

Mid Radial RI

Resistivity index

Mid Radial S/D

Systolic-to-diastolic ratio

Mid SFA RI

Resistivity index

Mid SFA S/D

Systolic-to-diastolic ratio

Mid Subclavian RI

Resistivity index

Mid Subclavian S/D

Systolic-to-diastolic ratio

Mid Ulnar RI

Resistivity index

Mid Ulnar S/D

Systolic-to-diastolic ratio

PCA (P1) PI

Pulsatility index using time-averaged mean of the peaks

PCA (P1) RI

Resistivity index

PCA (P1) S/D

Systolic-to-diastolic ratio

PCA (P2) PI

Pulsatility index using time-averaged mean of the peaks

PCA (P2) RI

Resistivity index

PCA (P2) S/D

Systolic-to-diastolic ratio

PFA RI

Resistivity index

PFA S/D

Systolic-to-diastolic ratio

PI

Pulsatility index using time-averaged mean of the peaks

Prox ATA RI

Resistivity index

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Measurements and Calculations

Label

Type

Prox ATA S/D

Systolic-to-diastolic ratio

Prox Basilar PI

Pulsatility index using time-averaged mean of the peaks

Prox Basilar RI

Resistivity index

Prox Basilar S/D

Systolic-to-diastolic ratio

Prox Brachial RI

Resistivity index

Prox Brachial S/D

Systolic-to-diastolic ratio

Prox CCA RI

Resistivity index

Prox CCA S/D

Systolic-to-diastolic ratio

Prox ECA RI

Resistivity index

Prox ECA S/D

Systolic-to-diastolic ratio

Prox ICA RI

Resistivity index

Prox ICA S/D

Systolic-to-diastolic ratio

Prox Pero RI

Resistivity index

Prox Pero S/D

Systolic-to-diastolic ratio

Prox POP RI

Resistivity index

Prox POP S/D

Systolic-to-diastolic ratio

Prox PTA RI

Resistivity index

Prox PTA S/D

Systolic-to-diastolic ratio

Prox Radial RI

Resistivity index

Prox Radial S/D

Systolic-to-diastolic ratio

Prox SFA RI

Resistivity index

Prox SFA S/D

Systolic-to-diastolic ratio

Prox Subclavian RI

Resistivity index

Prox Subclavian S/D

Systolic-to-diastolic ratio

Prox Ulnar RI

Resistivity index

Prox Ulnar S/D

Systolic-to-diastolic ratio

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Measurements and Calculations

Label

14

Type

RI

Resistivity index

S/D

Systolic-to-diastolic ratio

Vertebral PI

Pulsatility index using time-averaged mean of the peaks

Vertebral RI

Resistivity index

Vertebral S/D

Systolic-to-diastolic ratio

Vascular Volume Calculation Label Volume

Type Volume

Meaning 3-axis volume

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15 Patient Studies, Image Review, and Reports Patient Studies A patient study includes demographic information, images, quantitative values, and a summary of findings. All patient studies for one patient are saved in a patient folder. During an exam, all of the images you acquire are saved to the patient study, and a report is automatically generated. At any time, you can view all of the images in Image Review by pressing Review. You can view the report by pressing Report.

Creating Patient Studies Before you begin acquiring images, you must create a patient study. If you do not, you cannot capture, print, or save the images you acquire.

Creating a Patient Study The way you create a patient study depends on whether or not you are using Modality Worklist. To learn how to create a patient study if you are using Modality Worklist, see "Using Modality Worklist" on page 90. ➤ To create a patient study if you are not using Modality Worklist 1. Press Patient. 2. In the Patient Identification window, click New. 3. Enter the demographic information about the patient, pressing Tab to move from field to field.

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NOTES

•

• •

If you enter a last name, but do not enter an MRN, an MRN is automatically generated based on the current time and date. Philips recommends that you enter the MRN. The same MRN is used for a single patient folder. If you create two studies with different patient names but with the same MRN, a message is displayed that notifies you that the system will put both studies in the same patient folder.

4. Click OK.

Editing Patient Demographic Information ➤ To edit demographic information about the current patient 1. Do one of the following: –

Press Patient.

– If you are using Modality Worklist, select a patient from the Patient Selection window. 2. In the Patient Identification window, click Edit. 3. Add or edit demographic information. 4. Click OK. NOTE

The information shown in the Patient Identification window is for the current preset. To display information related to a different exam type, click the Additional tab and select the appropriate type from the Additional Data Types menu.

Saving a Patient Study ➤ To save all of the changes you made to the current study, including changes in the report work area Press Review and click

.

The study is saved on your system. 400

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To save a study to a disk, you must export the study. See "Exporting Patient Studies" on page 430.

Closing a Patient Study ➤ To close a study and save all of the changes you made 1. Press Review and click

.

2. Click Yes to confirm you want to save your changes. The study is saved on your system. NOTES

• •

A study takes several seconds to close. When you create or open a patient study, the active study is closed before the new study is opened.

Managing Patient Studies The procedures in this section will help you manage patient studies.

Restarting a Patient Study ➤ To continue or restart a patient study that is saved on your system NOTE

To restart a study, it must be less than 24 hours old. 1. Press Patient.

NOTE

If you have a Modality Worklist, click Manual Entry to access the Patient Identification window. 2. Click Restart. 3. In the Search for Study window, do one of the following: – Type information you know about the patient, such as the MRN or last name, and click Search. HD11 User Reference 4535 611 65311

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–

To list all patient studies saved on your system, select All Dates from the Study Date menu, and click Search.

4. Click a column header to sort by MRN, Name, Time, #Images, Type, Performed By, or Referring Physician. 5. Use the trackball to move the icon over the patient study that you want to restart. 6. Press Enter. 7. Click OK. The Patient Identification window opens, populated with the selected patient's demographic information. 8. Click OK.

Searching for a Patient Study ➤ To search for a patient study 1. Press Review. 2. Click

.

3. In the Search for Study window, do one of the following: –

Type information you know about the patient, such as the MRN or last name, and click Search.

– To list all patient studies, select All Dates from the Study Date menu, and click Search. 4. Click a column header to sort by MRN, Patient Name, #Images, Time, Type, Performed By, or Referring Physician. 5. Use the trackball to move the icon over the patient study that you want to open, and do one of the following:

402

–

Double-click Enter twice.

–

Press Enter, and click Open Study.

–

Press Select, use the trackball to highlight Open, and press Enter.

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NOTE

To see all the studies for a given patient, you must search by all dates and not by patient name.

Searching for a Patient Folder A patient folder contains all of the patient studies for one patient with the same MRN. ➤ To search for a patient folder 1. Press Review to enter Image Review. 2. Click

.

3. In the Search for Folder window, do one of the following: –

To search, type the last name or MRN in the Search for field, and then select Last Name or MRN from the menu.

–

To list all of the patient folders saved on your system, type * (asterisk).

4. Click Search Now. 5. Click a column header to sort by MRN or Patient Name. 6. Use the trackball to move the cursor over the patient folder you want to open, and do one of the following: –

Double-click the file to open.

–

Press Enter and click Open Folder.

–

Press Select, use the trackball to highlight Open Folder, and press Enter.

The studies in the folder are listed. 7. Use the trackball to move the cursor over the study you want to open, and do one of the following: –

Double-click the file to open.

–

Press Enter and click Open Study.

–

Press Select, use the trackball to highlight Open Folder, and then press Enter. HD11 User Reference 4535 611 65311

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Deleting a Patient Folder CAUTION

Deleting a patient folder deletes all of the studies contained in the folder. ➤ To delete a patient folder 1. Press Review to enter Image Review. 2. Click

.

3. In the Search for Folder window, do one of the following: –

To search, type the last name or MRN in the Search for field, and then select Last Name or MRN from the menu.

–

To list all of the patient folders saved on your system, type * (asterisk).

4. Click Search Now. 5. Click a column header to sort by MRN or Patient Name. 6. In the Search for Patient Folder window, use the trackball to move the cursor over the patient folder to delete and press Select. 7. Use the trackball to highlight Delete. 8. Press Enter. 9. Click Yes to confirm.

Deleting a Patient Study ➤ To delete a patient study 1. Press Review to enter Image Review. 2. Click

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3. In the Search for Study window, do one of the following: – Type information you know about the patient, such as the MRN or last name, and click Search. –

To list all patient studies, select All Dates from the Study Date menu, and click Search.

4. Use the trackball to move the cursor over the patient study to delete and press Select. To select more than one study, press and hold Ctrl or Shift. 5. Press Select. 6. Use the trackball to highlight Delete. 7. Press Enter. 8. Click Yes to confirm. 9. Click Close.

Viewing a Previous Study for the Current Patient In Image Review, a tab appears for each patient study in the patient folder. The tab lists the time and date of the study. ➤ To view a previous patient study Click the tab. NOTES

• •

Previous studies are read-only. You cannot modify or add images or data to them. If you are viewing a study that has a system-generated MRN, not all studies on the current patient may appear.

Image Review In Image Review, you can view frames and loops, delete frames and loops from the patient study, edit loops, and close the study. You can also edit Stress Echo loops, specify the preferred Stress Echo loop, and relabel Stress Echo views in Image Review. HD11 User Reference 4535 611 65311

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Working in Image Review In Image Review, you can perform a variety of tasks, including making measurements, playing loops, and working with 3D images.

Entering Image Review ➤ To enter Image Review Do one of the following: •

Press Review.

•

Press Acquire (if you selected Switch to Thumbnails after acquire completes on the Acquisition tab in the Setup window).

•

Acquire all of the loops for a view or a stage in a Stress Echo study.

About Single Images, Thumbnails, and Full-Screen Images In the Image Review window, you can view images in three ways. You can view: •

Several images in a grid format, called Thumbnails, within the Image Review window.

•

A single image within the Image Review window. Use the scroll bars to see the entire image.

•

A single full-screen image with no scroll bars.

➤ To view Thumbnails when you are viewing a single image Click

.

➤ To view a single image when you are viewing thumbnails Do one of the following:

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•

Double-click an image.

•

Move the cursor over an image, press Enter, and then click Play.

•

To view a full-screen image without scroll bars, click

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You cannot make changes to an image in Image Review unless you first reactivate it.

Deleting an Image in Image Review Throughout a study, you can mark images to be deleted. When you save the study, the images are deleted. ➤ To mark or unmark one or more images for deletion 1. To activate thumbnails, in Image Review, click

.

2. Move the cursor over the image. 3. Press Enter. 4. Press Clear. 5. Repeat step 2, step 3, and step 4 for other images you want to mark or unmark for deletion. The images are marked for deletion and are deleted when you save the study.

Adding a Caption or a Flag to an Image You can add a caption or an image flag to an image. Image flags can be helpful when you want to indicate which images will be used, for example, for a teaching demonstration. ➤ To add a caption or an image flag to an image 1. In Image Review, move the cursor over the image. 2. Press Select. 3. Use the trackball to highlight Caption/Flag, and press Enter. 4. Type the caption, or select an image flag from the list. 5. Click OK.

Viewing 3D or Panoramic Images in Image Review In Image Review, you can view 3D data sets and panoramic data sets that you acquired. HD11 User Reference 4535 611 65311

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Viewing a 3D or a Panoramic Data set ➤ To view a 3D data set or a panoramic data set 1. To activate thumbnails in Image Review, click

.

2. Use the trackball to move the cursor over one of the following icons on the bottom left corner of the image: — 3D data set icon — Panoramic data set icon 3. Press Enter. 3D mode or Panoramic Imaging opens and the image is displayed. 4. To close 3D mode or Panoramic Imaging, do one of the following:

NOTE

–

Press 2D.

–

Press 3D/4D (to exit 3D mode only).

–

Press Pano.

The thumbnail of a 3D or a panoramic image is not an accurate representation of the data set.

Printing Images in Image Review ➤ To print a single image 1. Press Review to enter Image Review. 2. If you are viewing a loop: a. Click

to freeze the loop.

b. If necessary, use the Frame Select slide control to choose the frame you want to print. 3. Press the Record key assigned to the printer you want to use.

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➤ To print the Thumbnails view 1. Click

.

2. Press the Record key assigned to the printer you want to use.

About Reactivating Images Reactivating an image in Image Review loads it into a Quick Review mode where you can perform functions as though it were a live image. You can then insert annotations, place body markers, and perform analysis functions, as well as acquire the image.

About Reactivated Images When you reactivate an image, its state depends on the state of the image during Image Review. •

All frames are loaded as they appeared in Image Review but you cannot scroll or replay the loop.

•

If the image was looping in Image Review, the system reloads the image in Replay mode.

•

If the image was stopped in Image Review, the system reloads the image to the frame you selected in Image Review.

When you reactivate an image, the original measurements do not appear on the image.

Restrictions You cannot reactivate the following types of images: •

3D still images or loops

•

Panoramic still images

•

Imported images

•

Non-calibrated images

•

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Reactivating an Image in Image Review ➤ To reactivate an image 1. Select the image to reactivate. 2. Do one of the following: •

Press Caliper, Trace, Calc.

•

Click

to reactivate the image.

The image appears on the display with

in the lower left corner.

3. Perform analysis functions as needed. 4. If needed, acquire a new image. ➤ To return to Image Review Press Review.

Using the Select Key in Image Review ➤ To view the options that are currently available to you in Image Review 1. Press Select. 2. Highlight the option and press Enter. Any of the following options may appear: Option

Description

Put Image in Report

Places the image you are viewing in the report

Loop Edit

Allows editing of the loop start and end points

Export Image

Allows export in PC format of the image in review

Caption/Flag

Associates a flag or adds a comment to the image in review

Relabel View

Displays choices to relabel the view of the image in review

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Option

15

Description

Format Thumbnails

Changes the number of thumbnails displayed across each row

Delete Image

Marks the image in review for deletion

Show/Hide Measurements

Shows or hides the analysis overlay

Specifying the Image Selection You can choose how many images are automatically selected to be played back each time you select an image. ➤ To specify the Image Selection From the Image Select menu, select an option as follows: •

To display only the images you choose, select Random.

•

To display two images simultaneously, select 2 up.

•

To display four images simultaneously, select 4 up.

•

To display six images simultaneously, select 6 up.

•

To display nine images simultaneously, select 9 up.

If you select 2 up, when you select one image, that image and the following image are selected. If you click Play, those two images are played back simultaneously.

Specifying the Image Display You can choose to display only those images that have an image flag, a caption, or a study type. ➤ To specify the image display From the Image Display list, select an option as follows: •

To display all images, select All Images.

•

To display images grouped by study, select By Study Type.

•

To display flagged images, select Flagged Images.

•

To display images with a caption, select Captioned Images.

•

To display only images with the image flags you specify, select Flag Combination. HD11 User Reference 4535 611 65311

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Playing Back Loops in Image Review While viewing loops and frames in Image Review, you can do any of the following: •

View one full-screen frame.

•

Play back one full-screen loop.

•

Play back up to nine images simultaneously.

•

Freeze the playback of a loop and select a frame within the loop.

•

Change the playback speed of a loop.

•

Synchronize the playback of multiple loops.

•

Compare images from different studies for the same patient.

•

Edit the endpoints of a loop.

Controlling the Playback of Loops in Image Review While you are playing back a loop or loops in Image Review, you can control the loop playback.

Freezing and Playing a Loop ➤ To freeze the playback of a loop Click

.

➤ To continue playing back the loop Click

.

Changing the Playback Speed ➤ To change the playback speed Use the Loop Speed slide control. NOTE

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The default playback speed is 100%.

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Selecting a Frame in a Loop ➤ To select a frame in a loop 1. To freeze the playback, click

.

2. To select the frame, use the Frame Select slide control.

Specifying the Synchronization Mode When you are playing back more than one loop simultaneously, you can use the trackball to select the following from the Synchronization Mode menu: •

Free run—The loops play back continuously at the same speed.

•

Synch to both ends—If the loops are different lengths, the speed is adjusted so that the loops all begin and end simultaneously.

•

Synch to beginning—All loops begin simultaneously and play back at the same speed.

Viewing a Full-Screen Frame or Playing Back a Loop in Image Review ➤ To view a full-screen frame or play back a loop when you are in Thumbnails Move the cursor over the image, and do one of the following: •

Double-click.

•

Press Enter, and click Play.

➤ To view the image in a full-screen without scroll bars Click

.

➤ To view the previous loop or frame Click

.

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➤ To view the next loop or frame Click

.

➤ To stop playing the image in review Press Freeze. ➤ To view the previous or next image in the study Press the left arrow or right arrow key. ➤ To view the first or last image in the study Press Home or End.

Playing Back More Than One Image in Image Review You can play back up to nine images simultaneously in Image Review. The Image Selection menu determines how you select the images that are played: •

If you select Random from the Image Selection menu, you can select up to nine individual images to play back at once.

•

If you select 2 up, 4 up, 6 up, or 9 up from the from the Image Selection menu, when you click one image, a series of 2, 4, 6, or 9 sequential images is automatically selected.

Playing Back Images That You Select ➤ To play back more than one image when Random is selected from the Image Selection menu 1. In Image Review in Thumbnail view, move the cursor over the first image. 2. Press Enter. 3. Repeat step 1 and step 2 for additional images. 4. Click Play.

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Playing Back a Series of Sequential Images ➤ To play back more than one image in Image Review when 2 up, 4 up, 6 up, or 9 up is selected from the Image Selection menu 1. In Image Review in Thumbnail view, move the cursor over the first image. 2. Press Enter. One or more additional images are automatically selected. For 2 up, two images are selected, for 4 up, four images are selected, and so on. 3. Click Play. ➤ To view the previous loops or frames Click

.

➤ To view the next loops or frames Click

.

Comparing Images from Two Studies ➤ To compare an image from the current study with an image from a previous study in the same patient folder 1. In Image Review, move the cursor over the first image. 2. Press Enter. 3. Click the tab for the previous study. 4. Use the trackball to move the cursor over the second image. 5. Press Enter. 6. Click Play.

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Editing the Endpoints of a Loop ➤ To edit the beginning or the end of a loop 1. In Image Review, click

to activate the Thumbnail view.

2. Use the trackball to move the cursor over the image. 3. Double-click. 4. Use the trackball to move the cursor over the image. 5. Press Select. 6. Use the trackball to highlight Loop Edit. 7. Press Enter. 8. To adjust the endpoints: a. Use the trackball to move the cursor over the endpoint. b. Press and hold Enter. c. Move cursor with the trackball. 9. Click OK.

Reports A report is automatically generated about a patient while you conduct an exam. At any point during a study, you can view the automatically generated report by pressing Report. A report includes:

416

•

Patient demographic information

•

Measurement and calculation information

•

Images that you add to the report

•

Cardiac wall motion scoring information

•

Obstetric trending graphs

•

Findings

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If the entire report is not visible on the display, you must use the scroll bars to the right of and below the report to view the entire report.

Report Work Area When you press Report, the report appears on the left, and the report work area appears on the right. The report work area displays information about the study and allows you to make changes to patient information, measurements, finding codes, comments, and obstetric graphs.

Displaying and Hiding the Report Work Area The report work area appears to the right of the report. ➤ To hide the report work area Click

.

➤ To display the report work area Click

again.

Changing the Report Work Area You can change the report work area to match the appropriate application package and group. See "Analysis and Reports Application Package/Group List" on page 120. ➤ To change the report work area Select the appropriate preset from the Choose Report Work Area Type list in the top right corner of the work area.

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Measurements and Calculations in a Report When you perform a labeled measurement or calculation, the information is automatically added to the report. All instances of each measurement appear in the report work area. In obstetric presets, the five most recent instances of each measurement appear in the report. The others are enclosed in parentheses in the report work area. NOTE

OB measurements that fall outside of normal guidelines will be inverse highlighted in the report (a black box with white text) to call attention to them.

Finalizing a Report When a report is finalized, you can no longer make changes to it. The next time you open the study, a new version of the report is created. ➤ To finalize a report Do one of the following: •

Save the report.

•

Create a new patient study.

•

Restart a patient study.

•

Open a different patient study.

•

Click

.

Viewing Report Versions When you close a study, you can no longer make changes to the report. Each time you open the study, a new version of the report is created. ➤ To display all of the versions of the report Click

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.

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A tab appears for each version of every report for the current patient. The tabs are labeled with the time and date that the report versions were created and the version number. ➤ To view an earlier version of the report Click the tab.

Printing a Report ➤ To print a report Press Report and the Record key assigned to the printer you want to use. NOTE

You cannot print a report to a networked DICOM printer. However, while viewing the report, you can press Acquire to store an image of a report. See "Saving a Report as a Series of Images" on page 419.

Saving a Report as a Series of Images If you want to be able to export a report in DICOM format, you can save the report as a series of images. ➤ To save a report as a series of images Press Acquire while you are viewing the report. The report appears in Thumbnails as a series of images. When you export the study, these images of the report are exported with all of the other images.

Adding an Image to a Report You can add a still frame to a report. You cannot add a loop to a report. ➤ To add a still frame to a report 1. If you are viewing a loop: a. To freeze the loop, click

.

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b. If necessary, use the Frame Select slide control to choose the frame you want add. NOTE

If needed, you can show or hide measurements. 2. Move the cursor over the image and press Select. 3. Do one of the following: .

–

Click

–

Use the trackball to highlight Put Image in Report, and then press Enter.

4. Type an image caption in the Add Image dialog box, and click OK, or click Cancel.

Manipulating Measurements in a Report You can view the image associated with measurements that appear in a report; edit, delete, and label measurements; and use the measurements in calculations. ➤ To manipulate measurements that appear in a report 1. Press Report. 2. Click the Measure tab. 3. Move the trackball over the measurement you want to manipulate. 4. Press Select. 5. Use the trackball and Enter to highlight one of the following options: –

Delete—Confirms that you want to delete the measurement.

–

Edit—Allows you to type a measurement value.

–

Show Image—Displays the image associated with the selected measurement.

–

Use in Calcs—Allows you to use the measurement in a calculation.

–

Relabel—Allows you to relabel a measurement.

6. Press Enter. 420

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NOTES

• •

You can also delete a measurement from the report work area by using the trackball to highlight the measurement and pressing Clear. You can display an image associated with a measurement only if you acquired the image.

Adding Patient Information to a Report You can add or change information about a patient in a report. ➤ To add or change patient information in a report 1. Press Report. 2. Click the Information tab. 3. Move the cursor over a field and double-click. 4. Type the information. 5. To proceed to the next field, click Next. 6. Click OK.

Adding Interpretations to a Cardiac or a Vascular Report You can select or manually type finding codes for various attributes of cardiac or vascular structures. An interpretation summary determined by the finding code appears in the report. You can use two different methods to add an interpretation to a cardiac report: using the trackball or using the finding code. ➤ To add an interpretation to the report by using the trackball 1. Press Report. 2. Click the Findings tab. 3. Click the button for the structure the interpretation relates to. 4. Move the cursor over a box in the list. 5. Press Select to display a list of finding codes. 6. Highlight the finding code or highlight Manual Text Entry if you want to manually type a interpretation. HD11 User Reference 4535 611 65311

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7. Press Enter. The interpretation appears in the report. ➤ To add an interpretation to the report by using finding codes 1. Press Report. 2. Click the Findings tab. 3. Click the button for the structure the interpretation relates to. 4. Do one of the following: –

Type the finding code in the Finding Code field. Press Return.

–

Type the first letter of the finding code in the Finding Code field. Press Return. Use the trackball to select a code from the list. Press Enter.

The interpretation appears in the report.

Adding Visualizations and Observations to an Obstetric Report When you are in an obstetric preset, you can select or manually type obstetric visualizations and observations, which appear in the report. You can also type biophysical profile values that are used to calculate the biophysical profile total. NOTE

Biophysical profiles do not appear in the report if they have no value.

➤ To add a visualization, an observation, or biophysical profile information to an obstetric report 1. Press Report. 2. Click the Findings tab. 3. Use the trackball to move the cursor over the Anatomy Visualized or the Observations field. 4. For Anatomy Visualized, do one of the following: – Move the cursor over an item and click to select it. – 422

Select the Select All check box.

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5. For Observations, press Select and do one of the following: –

Highlight the observation, select the choice in the dialog box that appears, and click OK.

–

Highlight Manual Text Entry to type free text.

6. Press Enter. The visualization or observation appears in the report. 7. Click Biophysical Profiles. 8. Deselect the appropriate N/A check box. 9. Type the profile number in the empty field. The biophysical profile values appear on the Findings tab and in the report.

Adding Visualizations and Observations to a Gynecologic Report When you are in a gynecologic preset, you can select or manually type gynecologic visualizations and observations, which appear in the report. ➤ To make observations about follicles 1. Click the Findings tab. 2. Click Follicles. 3. Select the appropriate check boxes for each follicle: Crenation or Cumulus. 4. Select Show on report. ➤ To hide follicle observation information from the report Deselect Show on report. You can use two different methods to add a visualization or an observation to a gynecologic report: using the trackball or using the finding code. ➤ To add a visualization or an observation to a gynecologic report by using the trackball 1. Press Report. 2. Click the Findings tab. HD11 User Reference 4535 611 65311

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3. Use the trackball to move the cursor over the Visualizations or the Observations field. 4. For visualizations, press Select. 5. To highlight the visualization, do one of the following: –

Select the choice from the list and click OK.

–

Highlight Manual Text Entry to type a value.

6. Press Enter. The visualization or observation appears in the report. ➤ To add a visualization or an observation to a gynecologic report by using finding codes 1. Press Report. 2. Click the Findings tab. 3. Do one of the following: –

Type the finding code in the Finding Code field and go to step 6.

–

Type the first letter of the finding code.

4. Press Return. 5. Scroll to the appropriate finding code. 6. Press Enter. The interpretation appears in the report.

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Adding Comments to a Report You can use the Comments tab in the report work area to add comments and summary statements to a report. On the Comments tab, you can also view the list of images in the report and delete images from the report. ➤ To add comments to a report 1. Press Report. 2. Click the Comments tab. 3. To make a comment, use the trackball to move the cursor into the Comments area, press Enter, and then type the comment. 4. To add a summary statement, use the trackball to move the cursor into the Summary area. Press Select, use the trackball to highlight the summary statement, and then press Enter. 5. To delete an image from the report, use the trackball and Enter to select the name of the image from the Report Images field, and press one of the two Clear keys.

Generating Obstetric Trending Graphs When you are in an obstetrics preset, you can generate a trending graph for the current study, studies saved on your system, and studies saved on a CD-R. You can display data from up to nine studies on a graph. If you have data from more than one fetus, the biometries are displayed on the trending graphs with different symbols for each fetus. The trending graph appears in the report. ➤ To generate a trending graph 1. Press Report. 2. Click the Trending tab. 3. Select a new value from the Fetal Weight menu, if necessary. 4. To change the x-coordinate for the graph, click AUA or LMP. 5. Select the biometries you want to use for the trending graphs by selecting the appropriate tabs (Basic, Cranium, Long Bones, or Other) and check boxes. HD11 User Reference 4535 611 65311

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NOTE

Some Biometries do not have a fetal growth curve associated with them and therefore will not graph. 6. To import trending data, insert a CD-R that contains the trending data from the previous study or studies. 7. Click Import Data. Trending files from studies with the same MRN are imported from the CD-R. 8. Select the check boxes for the studies you want to use in the trending graph. 9. Click Update report. The trending graph appears in the report. 10. To modify the trending graphs in the report, change the trending settings and click Update report.

NOTE

To export obstetric trending data from the current study to a CD-R, click Export data.

Formulas Used in Reports The following formulas are used in reports. Click the name of any formula to see the complete formula and associated references.

426

•

Average Ultrasound Age

•

Biophysical Profile Total

•

Derived Gestational Age

•

EDC(AUA)

•

EDC(LMP)

•

Weight Percentiles

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Importing and Exporting You can import and export patient studies, images, reports, and obstetric trending data.

Importing and Exporting in DICOM Format DICOM format is used for patient studies that are transferred among computers that make up an information management system and for studies that are accessed by physicians at remote viewing stations. You can export a patient study in DICOM format to an optical disk, to a CD-R, or over a network. You can import from an optical disk or a CD-R one or more studies that were created on an HD11 system and that were saved in DICOM format. NOTES

•

• •

•

If you have the DICOM Media option, you can export studies in DICOM format. Those studies can be viewed on any DICOM viewer. If you do not have the DICOM Media option, exported studies can only be viewed on HD11 systems. Exporting a study over a network is a feature of the DICOM Networking option. The DICOM Media option includes an optical disk drive. Any data that can be exported to a CD-R can also be exported to an optical disk. You cannot delete files from a CD-R, but you can write to it multiple times. The files on an optical disk can be deleted so the optical disk can be used again. You can adjust the brightness of images for viewing on DICOM viewers.

Exporting in PC Format You can export images and reports in PC format: •

Frames are saved as .bmp files.

•

Loops are saved as .avi files.

•

Reports are saved as HTML files.

You can export a frame, images, or a report to a CD-R or an optical disk.

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• • •

You cannot import files saved in PC format (.bmp, .avi, or HTML files). Files in PC format (.bmp, .avi, and HTML) are typically used to make copies of images for training sessions and presentations. You can adjust the brightness of images exported in PC format.

Importing and Exporting Obstetric Trending Data You can import trending data from and export trending data to a CD-R. See "Generating Obstetric Trending Graphs" on page 425.

Importing a Patient Study You can import from an optical disk or a CD-R one or more patient studies that were created on an HD11 system. When you import a study, a new patient study is created. If a patient folder for the MRN already exists, the new study is placed in the existing folder. If a folder does not exist for that MRN, a new folder is automatically created. NOTES

• •

• • •

Importing a study does not open the study. To open a study, see "Searching for a Patient Study" on page 402. If you have the DICOM Media option, you can export studies in DICOM format. Those studies can be viewed on any DICOM viewer. If you do not have the DICOM Media option, exported studies can only be viewed on HD11 systems. Importing a study from an optical disk or a CD-R is a component of the DICOM Media option. You can also import DICOM studies created on the EnVisor system. is displayed on imported images that had their brightness adjusted when exported.

➤ To import one or more patient studies 1. In Image Review, click

.

2. Use the trackball and Enter to highlight the study you want to import. 3. To select more than one study, press and hold Ctrl or Shift. 428

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4. Click Import all or Import selected.

Exporting the Current Patient Study in DICOM Format If you have the DICOM Media option, you can export a study to an optical disk or a CD-R. If you have the DICOM Networking option, you can export a study across a network to a DICOM PACS server. When you export a study in DICOM format, the images and information are saved as DICOM files. To export a patient study if you do not have the DICOM Media option, see "Exporting Patient Studies" on page 430. NOTES

•

•

•

If you have the DICOM Media option, studies exported to an optical disk or a CD-R can be viewed on any DICOM viewer. If you do not have the DICOM Media option, exported studies can only be viewed on HD11 systems. When you export a still image, any measurements remain on the image. When you export a loop, all measurements are removed before the loop is exported. When you import the study, you cannot reactivate measurements or perform new measurements. When you export a study, some patient demographic information may not be exported.

➤ To export the current study in DICOM format 1. In Image Review, click

.

2. If necessary, close the study and save your changes when you are prompted. 3. Select the destination for the study by using the Export To Device menu. NOTE

In the Export To Device menu, disk drives are identified with a drive letter and a drive name. Networked DICOM servers and printers are identified as DICOM PACS or DICOM printer. 4. Change the DICOM Image Format and Compression setting, if necessary. 5. Adjust the JPEG quality factor with the slide control, if necessary. 6. Click Start export. HD11 User Reference 4535 611 65311

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Exporting Patient Studies You can export any patient study by using the Search for Study window. If you have the DICOM Media option, studies exported to an optical disk or a CD-R can be viewed on any DICOM viewer. If you do not have the DICOM Media option, exported studies can only be viewed on HD11 systems. If you have the DICOM Networking option, you can export a study across a network to a DICOM PACS server. NOTES

•

•

When you export a still image, any measurements remain on the image. When you export a loop, all measurements are removed before the loop is exported. When you import the study, you cannot reactivate measurements or perform new measurements. When you export a study, some patient demographic information may not be exported.

➤ To export one or more studies 1. In Image Review, click

.

2. In the Search for Study window, click Search. 3. Use the trackball to move the cursor over the patient study you want to export. 4.

To select more than one study, press and hold Ctrl or Shift.

5. Press Select. 6. Highlight Export or Export DICOM. –

If you have the DICOM Media option, Export appears dimmed. If you do not have the DICOM Media option, Export DICOM appears dimmed.

–

If an open study is selected, Export and Export DICOM appear dimmed.

7. Press Enter. 8. Select the destination for the study by using the Export To Device menu.

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On the Export To Device menu, disk drives are identified with a drive letter and a drive name. Networked DICOM servers and printers are identified as DICOM PACS or DICOM printer. 9. Change the DICOM Image Format and Compression setting if needed. 10. Adjust the JPEG quality factor with the slide control if needed. 11. Click Start export.

About the Icons in the Search for Study Window The following icons that appear next to the studies in the Search for Study window indicate the export status of the study: Ico n

NOTE

Name

Description

Study Exported

The study has been exported at least once to an optical disk, to a CD-R, or over a network.

Study Queued for Export

The study is queued to be exported over a network. When the system receives confirmation that the study was exported successfully, the icon changes to the Study Exported icon.

Export Failed

An attempt to export the study was made, but the export failed.

Study Open

The study is currently open. You cannot export a study that is currently open.

Image Added to Study

At least one image as been added to the study since the last time the study was viewed.

If an export fails, exit Image Review and check the DICOM Job Manager window (press Ctrl+J). Delete the failed job, and try to send it again manually from the Search for Studies window. See "Exporting Patient Studies" on page 430. You can also try to ping the server to see if there is a network problem. See "Assigning DICOM Servers" on page 71.

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Setting the Brightness for an Automatic Export If exported images appear too dark on a remote viewing station, you can adjust the brightness by setting the display compensation. You can adjust the brightness for individual manual exports or for all images that are sent in the Batch and Send as you go modes. ➤ To set the brightness for an automatic export NOTE

You must close the study before you set the brightness. 1. Press Setup. 2. Click the System tab. 3. On the System tab, click DICOM. 4. In the DICOM Setup window, click the Servers & Roles tab. 5. On the Servers and Roles window, click Modify in the Roles area. 6. Click the Advanced button to the right of Storage SCP. 7. In the Network Export Preferences window, click the Image Format tab. 8. On the Image Format tab, click Display Compensation.

NOTE

The Number displayed on the Display Compensation button is the current setting. 9. In the Display Compensation window, click the appropriate option:

432

–

No display compensation—for viewing the image at the same brightness as on the HD11 monitor.

–

Optimized for CRT—for viewing on an remote viewing station with a CRT monitor.

–

Optimized for LCD—for viewing on an remote viewing station with a LCD flat panel monitor.

–

Tailor to you individual preference—move the slider to the appropriate number. For information on how to determine the compensation

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number, see "Determining the Display Compensation Number" on page 433. 10. Click OK. ➤ To set the brightness for Batch and Send as you go exports See "Changing the Image Format for DICOM Export" on page 76.

Determining the Display Compensation Number ➤ To determine the display compensation number best for your viewing station 1. Create a study. 2. Export the study in DICOM format. See "Exporting the Current Patient Study in DICOM Format" on page 429. 3. Deselect Use Storage SCP Settings. 4. Click Display Compensation. 5. In the Display Compensation window, select the appropriate monitor (CRT or LCD) option and click OK. 6. View the exported images on the remote viewing station. If the brightness is not acceptable, do one of the following: a.

If the networked PACS is configured to ignore duplicate studies, have your system administrator remove your study from the networked PACS.

b. Export the study in DICOM format. c. Deselect Use Storage SCP Settings. d. Click Display Compensation. e. Click Tailor to your individual preference and adjust the slider to a more acceptable setting. NOTE

The slider is positioned at your previous selection. f. Click OK.

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Exporting an Image in PC Format You can export an individual frame or loop to a CD-R or an optical disk. Frames are saved in .bmp format. Loops are saved in .avi format. ➤ To export a frame or a loop 1. In Image Review, click

to activate the Thumbnails view.

2. Move the cursor over the image and double-click. 3. If you are viewing a loop, click

to freeze the loop.

4. If necessary, use the Frame Select slide control to choose the frame you want to export. 5. Do one of the following: –

Press Select, use the trackball to highlight Export Image, and press Enter.

–

Click

.

6. For a loop, specify whether you want to export the current frame or the whole loop. 7. Change any necessary settings. 8. Click Export. 9. Select the destination. 10. Type the file name for the image. 11. Click Save.

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Exporting Images in PC Format You can export all of the images displayed in Thumbnails or just selected images to an optical disk or a CD-R. The frames are saved in .bmp format. The loops are saved in .avi format. When you export images, you can specify whether you want to export the latest version of the report with the images. ➤ To export images in PC format 1. In Image Review, click

to activate the Thumbnails view.

2. To select one or more images, use the trackball and Enter. 3. Click

.

4. Specify whether you want to export all of the images or only the selected images. 5. Specify whether you want to export the report. 6. Specify the .avi image quality. 7. To change the brightness of the exported images, click Display Compensation, click the appropriate option, and then click OK. 8. Click Export. 9. Select the destination. 10. Type a base file name for the images and click Save.

Exporting a Report in PC Format You can export a report to a CD-R or an optical disk. Reports are saved as HTML files. When you export a report, you can specify whether you want to export all of the images displayed in Thumbnails with the report. NOTE

You cannot export a report over a network or to a DICOM printer.

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➤ To export a report 1. Press Report. 2. Click

.

3. Specify whether to export images with the report and do one of the following: If you export the report with the images, the Export Images in PC Format window opens. a. Click Export. b. Continue with step 4. If you export the report without the images, continue with step 4. 4. Select the destination. 5. Type a file name. 6. Click Save.

Exporting Images and Reports from Patient Studies in PC Format You can export images or images and reports from any patient study in PC format by using the Search for Study window. ➤ To export images and reports from one or more studies 1. In Image Review, click

.

2. In the Search for Study window, click Search. 3. Move the cursor over the patient study that contains the images you want to export. 4. To select more than one study, press and hold Ctrl or Shift. 5. Press Select. 6. Use the trackball to highlight Export PC Format.

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If the open study is selected, Export PC Format appears dimmed. 7. Press Enter. 8. Specify whether you want to export the report. 9. Specify the .avi image quality. 10. Click Export. 11. Select the destination. 12. Type a base file name for the images. 13. Click Save.

Exporting Data to a Third-Party Application You can export data and patient demographic information to a third-party software application in any preset. Before you export data to a third-party application, you must do the following: •

Plug a null modem serial cable into your system to connect your system to the computer that houses the third-party software application.

•

Assign a Record key to serial output. See "Assigning Record Keys" on page 133.

➤ To export the data from the current study to a third-party application Press the Record key assigned to serial output while you are viewing the report. NOTE

For information about the format of the exported data, see the HD11 Getting Started.

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16 Clinical References for Calculations The formula used, inherent approximations and assumptions, and clinical references for each calculation are listed in this section.

Symbols % Area Stenosis The percentage of stenosis, S (%), formula, given a true lumen area, Atrue (cm2), and the residual lumen area, Aresidual (cm2), is

Diagnostic ranges: 0% to 20%, normal; 20% to 60%, mild; 60% to 80%, moderate; 80% to 90%, severe; 90% to 99%, critical; 100%, occluded. Jacobs, Norman M., et al. “Duplex Carotid Sonography: Criteria for Stenosis, Accuracy, and Pitfalls,” Radiology, 154, 385–391, 1985. % Diameter Stenosis The percentage of stenosis, S (%), formula, given a true lumen diameter, Dtrue (cm), and the residual lumen diameter, Dresidual (cm), is

Diagnostic ranges: 0% to 20%, normal; 20% to 60%, mild; 60% to 80%, moderate; 80% to 90%, severe; 90% to 99%, critical; 100%, occluded. Honda, Nobuo, et al. “Echo-Doppler Velocimeter in the Diagnosis of Hypertensive Patients: The Renal Artery Doppler Technique.” Ultrasound in Medicine and Biology, Vol. 12, No. 12, p. 945–952, 1986.

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A A-to-B Ratio The formula for the A/B ratio, r (unitless), given the generic velocity, vA (cm/s), and the generic velocity, vB (cm/s), is

AC (Abdominal Circumference) Abdominal Circumference (cm) can be computed by two means: if AC(traced) is present, then AC = AC(traced). If the two abdominal diameters, ADtrv and ADap, are present, then

Kurtz, Alfred B., Goldberg, Barry B. Obstetrical Measurements in Ultrasound: A Reference Manual, Year Book Medical Publishers, Inc., p. 33, 1988. Shields J.R., et al. “Fetal Head and Abdominal Circumferences: Ellipse Calculations Versus Planimetry,” Journal of Clinical Ultrasound. Vol. 15, 237–239, May 1987. Accel Slope where delta v is the change in Doppler velocity (cm/s) and delta t is the time interval change (sec). Note: Use the maximum possible display magnification for best accuracy. AFI (Amniotic Fluid Index) The Amniotic Fluid Index is Normal range for AFI: 8.1–18.0 cm. Rutherford S., et al. “Four Quadrant Assessment of Amniotic Fluid Volume.” Journal of Reproductive Medicine, Vol. 32, p. 587–589, 1987. Angle

If Ax < 0, then Ax = –Ax

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If Ax > 180, then Ax = 360 – Ax where Ax is the a or b angle, Lx is the a or the b line angle, and Lb is the baseline angle. Schuler, P., Graf, R. “Sonographic Diagnosis of Hip Dysplasia and Hip Dislocation.” 4. Erg.Lig. 7, 1986, Ecomed Verlag. Reprint distributed by Siemens. Aortic HR (Aortic Heart Rate) Dorland’s Illustrated Medical Dictionary, 27th ed., W. B. Sanders Co., Philadelphia, 1988, p. 1425. Aortic Valve Area by the Continuity Equation The valve area, Ax2 (cm2), by the continuity equation, using maximum velocities, Vx1 and Vx2 (cm/s), and flow diameter, Dx1 (cm):

where Aortic Valve Area (Continuity Equation, Max Velocity and Flow Diam) Calculations Ax2

Dx1

Vx1

Vx2

AVA(V,D)

Diam 1

V1 max

V2 max

The valve area, Ax2 (cm2), via the continuity equation [92] [89], using velocity-time integrals, VTIx1 and VTIx2 (cm), and flow diameter, Dx1 (cm):

where: Ax2

Dx1

VTIx1

VTIx2

AVA(I,D)

Diam 1

V1 VTI

V2 VTI

The Merck Manual of Diagnosis and Therapy, ed. 15. Robert Berkow, ed. Merck and Co., Inc., Rahway, N.J., 1987, p. 378. Reichek N, et al. “Anatomic Validation of Left Ventricular Mass Estimates from Clinical Two-dimensional Echocardiography:Initial Results.” Circulation, Vol. 67,No. 2, p.348–52, February 1983. HD11 User Reference 4535 611 65311

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Area

Note: The points on the circumference are assumed to be traced sufficiently close to obtain an accurate result. Area (I,D)

Oh, J.K. “Prediction of the Severity of Aortic Stenosis by Doppler Aortic Valve Area Determination: Prospective Doppler-Catheterization Correlation in 100 Patients.” Journal of the American College of Cardiology, Vol. 11, No. 6, pp. 1227–1234, June 1988. Richards, K.L., et al. “Calculation of Aortic Valve Area by Doppler Echocardiography: A Direct Application of the Continuity Equation.” Circulation, Vol. 73, No. 5, pp. 964–969, May 1986. Area (V,D)

Oh, J.K. “Prediction of the Severity of Aortic Stenosis by Doppler Aortic Valve Area Determination: Prospective Doppler-Catheterization Correlation in 100 Patients.” Journal of the American College of Cardiology, Vol. 11, No. 6, p. 1227–1234 June 1988. Richards, K.L., et al. “Calculation of Aortic Valve Area by Doppler Echocardiography: A Direct Application of the Continuity Equation,” Circulation, Vol. 73, No. 5, p. 964–969, May 1986. AUA (Average Ultrasound Age) The Average Ultrasound Age formula is where n varies from 1 to 12. The Average Ultrasound Age (AUA) is the average of all (with one exception) the gestational ages that were generated during an exam from acquired values. Gestational ages generated from corrected BPD are not included in the AUA calculation. Also, only gestational ages that are generated from measurable values contribute to the AUA. Gestational ages based on fetal biometric parameters only are inputs to the AUA. GA(LMP), for instance, is not an input to AUA.

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You can mark gestational ages for inclusion in, or exclusion from, the AUA. An editable marker field allows you to select which gestational ages should be included in the calculation of the AUA to be included in the report. The gestational age is preceded by a plus sign (+) to indicate that the age will be included in the AUA, or a minus sign (–) to indicate that the age will be excluded from the AUA. This feature allows you to decide during an obstetric exam that a particular gestational age is out of line with the others and would inappropriately skew the AUA calculation. In this case, you can enter the edit mode and deselect the calculation by replacing + with – for that particular gestational age. When the system is powered on or you enter a new patient ID, the gestational ages are marked by default for selection or deselection. All gestational ages are marked for inclusion by default, except for those biometries that have multiple associated authors. In these cases, only one is marked on by default. This ensures that the AUA never includes gestational age calculations based on the same biometry by different authors. The following table lists the gestational age calculations available and their default states in order of precedence: Gestational Age

AUA Default State

GA(FL)Hadlock

+

GA(FL)Jeanty

–

GA(FL)Tokyo

–

GA(FL)Osaka

–

GA(HL)Jeanty

+

GA(HL)Osaka

–

GA(TL)Jeanty

+

GA(UL)Jeanty

+

GA(TC)Nimrod

+

GA(CRL)Robinson

+

GA(CRL)Jeant

–

GA(CRL)Remp

–

GA(CRL)Tokyo

–

GA(CRL)Osaka

–

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GA(BPD)Hadlock

+

GA(BPD)Jeanty

–

GA(BPD)Tokyo

–

GA(BPD)Osaka

–

GA(HC)Hadlock

+

GA(AC)Hadlock

+

GA(MSD)Hellman

+

GA(GSD)Remp

+

GA(GSD)Tokyo

–

GA(AA)Osaka

+

GA(VL)Tokyo

+

If you choose to override the defaults, the system enforces mutual exclusion when necessary. For example, three gestational ages based on biparietal diameter are available, one by Hadlock, one by Jeanty, and one by Rempen. The default is the Hadlock calculation. If you choose to override the Hadlock calculation, and use the Jeanty calculation, the system automatically deselects the Hadlock calculation and marks it with a minus sign (–).

B Biophysical Profile Total The Biophysical Profile Total formula is (Movement) + (Tone) + (Breathing) + (Amniotic Fluid Volume) Category ranges: 0–2 or NA (NA indicates that the category will not contribute to the biophysical profile total.) Manning, F.A., et al. “Fetal Assessment Based on Fetal Biophysical Profile Scoring.” American Journal of Obstetrical Gynecology, Vol.162, p. 703–709, 1990. Bladder and PV Bladder Volume The equation for ellipse volume, vol (cm3) from its three perpendicular axes, length (Dimension 1), l, width (Dimension 2), w, and height (Dimension 3), h.

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C CI (Cephalic Index) The Cephalic Index (unitless) formula is The CI(BPD,OFD) values for a normal human are 75.9–81.0. Bezjian, Alex A. “Normal and Abnormal Fetal Growth,” presented at the Advanced Ultrasound Seminar, Lake Buena Vista, Florida, January 1982. Dorland’s Illustrated Medical Dictionary, 27th ed. W. B. Sanders Co., Philadelphia 1988, p. 830. Hadlock F.P. et al. “Estimating Fetal Age: Effects on Head Shape on BPD.” American Journal of Roentgenology, Vol. 137 p. 83–851981. Circumference

where Li,j,j is the line segment length between point i and point j, and where N is the total number of points in the enclosed shape. Note: The points on the circumference are assumed to be traced sufficiently close so that the traced contour closely approximates the real circumference. CO (Cardiac Output) (2D Mode and MMode) The cardiac output, COx (normal range: 4 to 8 l/min), using the x volume method, given the heart rate, HRx, and the stroke volume, SVx, is

where SVx = EDVx – ESVx and COx

SVx

EDVx

ESVx

CO(sp-el)

SV(sp-el)

EDV(sp-el)

ESV(sp-el)

CO(bp-el)

SV(bp-el)

EDV(bp-el)

ESV(bp-el)

CO(Bullet)

SV(Bullet)

EDV(Bullet)

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CO(MOD-sp2)

SV(MOD-sp2)

EDV(MOD-sp2)

ESV(MOD-sp2)

CO(MOD-sp4)

SV(MOD-sp4)

EDV(MOD-sp4)

ESV(MOD-sp4)

CO(MOD-bp)

SV(MOD-bp)

EDV(MOD-bp)

ESV(MOD-bp)

CO(mod-Simp)

SV(mod-Simp)

EDV(mod-Simp)

ESV(mod-Simp)

CO(Cubed)

SV(Cubed)

EDV(Cubed)

ESV(Cubed)

CO(Teich)

SV(Teich)

EDV(Teich)

ESV(Teich)

Belenkie, Israel, et al. “Assessment of Left Ventricular Dimensions and Function by Echocardiography.” American Journal of Cardiology, Vol. 31, June 1973. CO (Cardiac Output) (Doppler) The cardiac output, COx (l/min), using the Doppler velocity-time integral, VTIx (cm), flow area, Ax (cm2), and heart rate, HRx (BPM), is

where VTIx CO(LVOT)

LV VI VTI

Ax LVOT area

HRx Aortic HR

Calafiore, P., Stewart, W.J. “Doppler Echocardiographic Quantitation of Volumetric Flow Rate.” Cardiology Clinics, Vol. 8, No. 2, p. 191–202, May 1990.

D D-to-S Ratio The formula for the diastolic-to-systolic ratio, r (unitless), given the systolic velocity, vs (cm/s), and the end-diastolic velocity, vd (cm/s), is

Neumyer, Marsha M. et al. “The Differentiation of Renal Artery Stenosis from Renal Parenchymal Disease by Duplex Ultrasonography.” Journal of Vascular Technology, Scientific Article, p. 205–216, October 1989.

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Decel Slope where delta v is the change in vertical dimension Doppler velocity (cm/s) and delta t is the time interval change (sec). Note: Use the maximum possible display magnification for the most accurate calculation. Derived GA (Gestational Age) The gestational age computed from that of an earlier exam, where PrevExamGA is in weeks, and the dates are in days, is

E EDC(AUA) The estimated date of confinement (date) given the average ultrasound age (date) formula is Hagen-Ansert, Sandra L. Textbook of Diagnostic Ultrasonography, 3rd ed. The C. V. Mosby Co., 1989, p. 408. EDC(LMP) The estimated date of confinement (date) given the last menstrual period (date) formula is Hagen-Ansert, Sandra L., Textbook of Diagnostic Ultrasonography, 3rd ed., The C. V. Mosby Co., 1989, p. 408. EDV (Left Ventricular Volume at End Diastole) Biplane Ellipse Formula

Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography.” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Bullet Formula

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Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography.” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Cubed Formula

LVIDd 3

Dodge, H.T. Sandler, D.W., et al. “The Use of Biplane Angiography for the Measurement of Left Ventricular Volume in Man.” American Heart Journal Vol. 60, pp. 762–776, 1960. Belenkie, Israel, et al. “Assessment of Left Ventricular Dimensions and Function by Echocardiography.” American Journal of Cardiology, pg. 31, June 1973. Method of Discs, Biplane

where adi is the i-th disk diameter of LVAd ap2 MOD, bdi is the i-th disk diameter of LVAd ap4 MOD, and L is the maximum length from LVAd ap2 MOD or LVAd ap4 MOD. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 364, Sept–Oct 1989. Method of Discs, Single-Plane, Four-Chamber

where bdi is the i-th disk diameter of LVAd ap4 MOD and L is the length from LVAd ap4 MOD. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 364, Sept–Oct 1989.

448

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16

Method of Discs, Single-Plane, Two-Chamber

where adi is the i-th disk diameter of LVAd ap2 MOD and L is the length from LVAd ap2 MOD. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiology, Vol. 2, No. 5, p. 364, Sept–Oct 1989. Modified Simpson’s Formula

Weyman, Arthur E. Cross-Sectional Echocardiography. Lea & Febiger, 1985, p. 295. Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography.” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Single-Plane Ellipse Formula

Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography.” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Teichholz Formula

Teichholz, L.E., et al. “Problems in Echocardiographic Volume Determinations: Echocardiographic-Angiographic Correlations in the Presence or Absence of Asynergy.” American Journal of Cardiology, Vol. 37, p. 7–11, January 1976. EF (Ejection Fraction) Pombo, J.F., “Left Ventricular Volumes and Ejection by Echocardiography,” Circulation, Vol. 43, pp. 480–490, 1971.

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449

16

Clinical References for Calculations

EFW(AC,BPD) via Hadlock The formula for the estimated fetal weight (g) via Hadlock, using abdominal circumference (range: 15.5 to 40.0 cm) and biparietal diameter (range: 3.1 to 10.0 cm) is

Hadlock F.P., et al. “Sonographic Estimation of Fetal Weight,” Radiology, Vol. 150, p. 535– 540, 1984. EFW(AC,BPD) via Shephard The formula for the estimated fetal weight (g) via Shephard, using abdominal circumference (range: 15.0 to 40.0 cm) and biparietal diameter (range: 3.1 to 10.0 cm) is

Shephard M.J., et al. “An Evaluation of Two Equations for Predicting Fetal Weight by Ultrasound.” American Journal of Obstetrics and Gynecology, Vol. 142, No. 1, p. 47–54, January 1982. EFW(AC,FL) via Hadlock The formula for the estimated fetal weight (g) via Hadlock, using abdominal circumference (range: 15.0 to 40.0 cm) and femur length (range: 1.0 to 8.0 cm) is

Hadlock F.P., et al. “Estimation of Fetal Weight with the Use of Head, Body, and Femur Measurements: A Prospective Study.” American Journal of Obstetrics and Gynecology, Vol. 151, No. 3,p. 333–337, 1985. EFW(AC,HC,FL) via Hadlock The formula for the estimated fetal weight (g) via Hadlock, using abdominal circumference (range: 10.0 to 37.0 cm), head circumference (range: 10.0 to 40.0 cm), and femur length (range: 1.0 to 8.0 cm) is

Hadlock, F.P., et al. “Estimation of Fetal Weight with the Use of Head, Body, and Femur Measurements: A Prospective Study,” American Journal of Obstetrics and Gynecology, Vol. 151, No. 3,p. 333–337, 1985. EFW(BPD,AD,FL) via Tokyo The formula for the estimated fetal weight (g) via Tokyo University, using biparietal diameter (range: 3.1 to 10.0 cm), abdominal diameter (anterior-posterior) (range: 5.0 to 450

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Clinical References for Calculations

16

15.0 cm), abdominal diameter (transverse) (range: 5.0 to 15.0 cm), and femur length (range: 1.0 to 8.0 cm) is

Norio Shinozuka, et al. “Formulas for Fetal Weight Estimation by Ultrasound Measurements Based on Neonatal Specific Gravities and Volumes.” American Journal of Obstetrics and Gynecology, Vol. 157, No, 5, p. 1140–5, 1987. EFW(BPD,FTA,FL) via Osaka The formula for the estimated fetal weight (g) via Osaka University, using biparietal diameter (range: 3.1 to 10.0 cm), fetal trunk abdominal area (range: 20.0 to 180.0 cm2), and femur length (range: 1.0 to 8.0 cm) is

Nobuaki Mitsuda, et al. “Image Diagnosis of Fetal Growth.” Obstetrical and Gynecological Practice (in Japanese), Vol.37, No. 10, p 459–70, 1988. EFW(BPD,HC,AC,FL) via Hadlock The formula for the estimated fetal weight (g) via Hadlock, using biparietal diameter (range: 3.1 to 10.0), head circumference (range: 10.0 to 40.0 cm), abdominal circumference (range: 15.0 to 40.0 cm), and femur length (range: 1.0 to 8.0 cm) is

Hadlock F.P., et al. “Sonographic Estimation of Fetal Weight.” Radiology, Vol. 150, p. 535– 540, 1984. ESV (Left Ventricular Volume at End Systole) Biplane Ellipse Formula

Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography,” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Bullet Formula

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451

16

Clinical References for Calculations

Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography,” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Cubed Formula

Dodge, H.T., Sandler, D.W., et al. “The Use of Biplane Angiography for the Measurement of Left Ventricular Volume in Man.” American Heart Journal, Vol. 60, p. 762–776, 1960. Belenkie, Israel, et al. “Assessment of Left Ventricular Dimensions and Function by Echocardiography.” American Journal of Cardiology, pg. 31, June 1973. Method of Discs, Biplane

where asi is the i-th disk diameter of LVAs ap2 MOD, bsi is the i-th disk diameter of LVAs ap4 MOD, and L is the maximum length from LVAs ap2 MOD or LVAs ap4 MOD. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 364, Sept–Oct 1989. Method of Discs, Single-Plane, Four-Chamber

where bsi is the i-th disk diameter of LVAs ap4 MOD and L is the length from LVAs ap4 MOD. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 364, Sept–Oct 1989. Method of Discs, Single-Plane, Two-Chamber

452

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Clinical References for Calculations

16

where asi is the i-th disk diameter of LVAs ap2 MOD and L is the length from LVAs ap2 MOD. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 364, Sept–Oct 1989. Modified Simpson’s Formula

Weyman, Arthur E. Cross-Sectional Echocardiography. Lea & Febiger, Philadelphia, 1985, p. 295. Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography,” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Single-Plane Ellipse Formula

Folland, E.D., et al. “Assessment of Left Ventricular Ejection Fraction and Volumes by Real-Time, Two-Dimensional Echocardiography,” Circulation, Vol. 60, No. 4, p. 760–766, October 1979. Teichholz Formula

Teichholz, L.E., et al. “Problems in Echocardiographic Volume Determinations: Echocardiographic-Angiographic Correlations in the Presence or Absence of Asynergy.” American Journal of Cardiology, Vol. 37, p. 7–11, January 1976.

F FAC (Fractional_Area_Change_Percentage) The fraction area change percentage, FAC, given the end-diastolic area, EDA (cm2), and the end-systolic area, ESA (cm2) is FAC = ((EDA – ESA) / EDA) x 100 Lui et al. “Comparison between Radionuclide Ejection Fraction and Fractional Area Changes Derived from Transesophageal Echocardiography Using Automated Border Detection.” Anesthesiology, Vol. 85, No. 3, p. 468, September 1996. HD11 User Reference 4535 611 65311

453

16

Clinical References for Calculations

Fetal Heart Rate The formula for heart rate, r (BMP), given the peak-to-peak interval over two beats, t (sec), is r = 120/t FL-to-AC Ratio The ratio (unitless) of femur length (cm) to abdominal circumference (cm) is

Hadlock F.P., et al. “A Date-Independent Predictor of Intrauterine Growth Retardation: Femur Length/Abdominal Circumference Ratio.” American Journal of Roentgenology, Vol. 141, p. 979–984, 1983. Hadlock F.P., et al. “Use of Femur Length/Abdominal Circumference Ratio in Detecting the Macrosomic Fetus.” Radiology, Vol. 154, p. 503–505, 1985. FL-to-BPD Ratio The ratio (unitless) of femur length (cm) to biparietal diameter (cm) is The typical range for FL/BPD is 0.776 (23 weeks gestational age) to 0.81 (40 weeks gestational age). Hohler, C., Quetal, T. “Comparison of Fetal Femur Length and Biparietal Diameter in Late Pregnancy.” American Journal of Obstetrics and Gynecology, Vol. 141, No. 7, p. 759–762, December 1981. Flow Volume (Diameter) The flow volume V (l/min) formula, given the flow diameter D (cm2) and the 2) and the flow mean velocity MeanV (cm/s), is

Burns, P.N. “The Physical Principles of Doppler and Spectral Analysis.” Journal of Clinical Ultrasound, Vol. 15, No. 9, P. 587, November/December 1987. Follicle Volume 0.523 = D x D x D where D = follicular distance

454

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Clinical References for Calculations

16

Penzias A.S., et al. “Ultrasound Prediction of Follicle Volume: Is the Mean Diameter Reflective?” Fertility and Sterility, Vol. 62, No. 6, p. 1274–6, December 1994. FS (Fractional Shortening)

Belenkie, Israel, et al. “Assessment of Left Ventricular Dimensions and Function by Echocardiography.” American Journal of Cardiology, Vol. 31, June 1973.

G GA(AC) via Hadlock The formula for gestational age (wk+day) via Hadlock, using abdominal circumference (AC range: 5.0 cm (12.0 weeks) to 38.0 cm (42.0 weeks)) is

Hadlock F.P., et al. “ Estimating Fetal Age: Computer Assisted Analysis of Multiple Growth Parameters.” Radiology, Vol. 152, p. 497–501, 1984. GA(BPD) via Hadlock The formula for gestational age (wk+day) via Hadlock, using biparietal diameter (BPD range: 1.5 cm to 10.1 cm) is

Hadlock F.P., et al. “ Estimating Fetal Age: Computer Assisted Analysis of Multiple Growth Parameters.” Radiology, Vol. 152, p. 497–501, 1984. GA(BPD) via Jeanty Gestational age (wk+day) via Jeanty, using biparietal diameter (BPD range: 2.8 to 7.9 cm). The following table lists the percentiles in weeks for each value: BPD

5th% 50th% 95th%

2.8

11.3

14.0

16.5

2.9

11.5

14.1

16.9

3.0

11.9

14.5

17.1

3.1

12.1

14.9

17.4

3.2

12.3

15.1

17.7 HD11 User Reference 4535 611 65311

455

16

456

Clinical References for Calculations

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3.3

12.5

15.3

18.0

3.4

12.9

15.5

18.3

3.5

13.1

15.9

18.5

3.6

13.5

16.1

18.9

3.7

13.7

16.4

19.1

3.8

14.0

16.7

19.4

3.9

14.3

17.0

19.7

4.0

14.5

17.3

19.9

4.1

14.9

17.5

20.1

4.2

15.1

17.9

20.5

4.3

15.4

18.1

20.9

4.4

15.7

18.4

21.1

4.5

16.0

18.7

21.4

4.6

16.3

19.0

21.7

4.7

16.5

19.3

22.0

4.8

16.9

19.5

22.3

4.9

17.1

19.9

22.5

5.0

17.5

20.3

22.9

5.1

17.9

20.5

23.1

5.2

18.1

20.9

23.5

5.3

18.5

21.1

23.9

5.4

18.9

21.5

24.1

5.5

19.1

21.9

24.5

5.6

19.5

22.1

24.9

5.7

19.9

22.5

25.1

5.8

20.1

22.9

25.5

5.9

20.5

23.1

25.9

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Clinical References for Calculations

6.0

20.9

23.5

26.1

6.1

21.1

23.9

26.5

6.2

21.5

24.1

26.6

6.3

21.9

24.5

27.1

6.4

22.1

24.9

27.5

6.5

22.5

25.3

27.9

6.6

22.9

25.5

28.3

6.7

23.3

26.0

28.5

6.8

23.9

26.4

29.0

6.9

24.0

26.7

29.4

7.0

24.4

27.1

29.9

7.1

24.9

27.5

30.1

7.2

25.1

27.9

30.5

7.3

25.5

28.3

30.9

7.4

26.0

28.7

31.3

7.5

26.4

29.1

31.7

7.6

26.9

29.5

32.1

7.7

27.1

29.9

32.5

7.8

27.5

30.3

33.0

7.9

28.0

30.7

33.4

Jeanty, Philippe. Obstetrical Ultrasound. McGraw Hill, 1983, p. 58. GA(BPD) via Osaka Gestational age (wk+day) via Osaka University, using biparietal diameter (BPD range: 1.3 to 9.4 cm). BPD

GA

BPD

GA

BPD

GA

BPD

GA

1.33

10

4.20

18

6.67

26

8.62

34

1.72

11

4.53

19

6.95

27

8.80

35

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Clinical References for Calculations

2.09

12

4.85

20

7.23

28

8.96

36

2.46

13

5.17

21

7.49

29

9.10

37

2.82

14

5.48

22

7.74

30

9.21

38

3.18

15

5.79

23

7.98

31

9.30

39

3.52

16

6.09

24

8.21

32

9.36

40

3.86

17

6.39

25

8.43

33

Nobuaki Mitsuda, et al. “Image Diagnosis of Fetal Growth.” Obstetrical and Gynecological Practice (in Japanese), Vol. 37, No, 10, p. 1459–70, 1988. GA(BPD) via Tokyo Gestational age (wk+day) via Tokyo University, using biparietal diameter (BPD range: 2.0 to 9.47 cm). BPD

GA

BPD

GA

BPD

GA

BPD

GA

2.00

12

4.71

20

7.12

28

8.92

36

2.40

13

5.04

21

7.38

29

9.08

37

2.76

14

5.35

22

7.64

30

9.23

38

3.10

15

5.67

23

7.88

31

9.36

39

3.38

16

5.97

24

8.12

32

9.47

40

3.72

17

6.27

25

8.34

33

4.05

18

6.56

26

8.55

34

4.39

19

6.84

27

8.74

35

Masahiko Mizuno, et al. “Assessment of Fetal Growth Using Ultrasound Measurements.” Nichidoku Iho (Japanisch-Deutsche Medizinische Berichte) (in Japanese), Vol. 34, No. 3, p. 537–544, 1989.

458

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Clinical References for Calculations

16

GA(CRL) via Jeanty Gestational age (wk+day) via Jeanty, using crown-rump length (CRL range: 0.5 to 5.4 cm). CRL

GA

CRL

GA

CRL

GA

0.5

6.3

2.5

9.4

4.5

11.3

0.6

6.5

2.6

9.5

4.6

11.4

0.7

6.7

2.7

9.5

4.7

11.5

0.8

6.8

2.8

9.7

4.8

11.5

0.9

7.1

2.9

9.9

4.9

11.7

1.0

7.3

3.0

9.9

5.0

11.9

1.1

7.4

3.1

10.0

5.1

11.9

1.2

7.5

3.2

10.1

5.2

11.9

1.3

7.8

3.3

10.1

5.3

12.0

1.4

7.8

3.4

10.3

5.4

12.1

1.5

8.1

3.5

10.4

1.6

8.1

3.6

10.6

1.7

8.4

3.7

10.6

1.8

8.5

3.8

10.7

1.9

8.5

3.9

10.9

2.0

8.9

4.0

10.9

2.1

8.9

4.1

11.0

2.2

9.0

4.2

11.1

2.3

9.1

4.3

11.1

2.4

9.1

4.4

11.1

Jeanty, Philippe, Obstetrical Ultrasound, McGraw Hill, 1983, p. 56.

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459

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Clinical References for Calculations

GA(CRL) via Osaka Gestational age (wk+day) via Osaka University, using crown-rump length (CRL range: 0.8 to 6.5 cm). The following table lists the standard deviation in days: CRL

GA

0.87

7

1.30

8

2.04

9

3.00

10

4.12

11

5.30

12

6.49

13

Nobuaki Mitsuda, et al. “Image Diagnosis of Fetal Growth.” Obstetrical and Gynecological Practice (in Japanese), Vol. 37, No, 10, p. 1459–70, 1988. GA(CRL) via Rempen Gestational age (wk+day) via Rempen, using crown-rump length (CRL range: 0.27 to 0.8 cm). The following table lists the standard deviation (SD) in days for each value:

460

CRL

GA

SD

CRL

GA

SD

0.2

6.0

6

3.8

10.4

6

0.3

6.1

6

3.9

10.5

6

0.4

6.3

6

4.1

10.7

6

0.5

6.4

6

4.2

10.9

6

0.6

6.5

6

4.4

11.0

6

0.7

6.7

6

4.5

11.1

6

0.8

6.9

6

4.7

11.3

6

0.9

7.0

6

4.8

11.4

6

1.0

7.1

6

5.0

11.6

6

1.1

7.3

6

5.2

11.7

6

1.2

7.4

6

5.3

11.9

6

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Clinical References for Calculations

1.3

7.5

6

5.5

12.0

6

1.4

7.7

6

5.7

12.1

6

1.6

7.9

6

5.8

12.3

6

1.7

8.0

6

6.0

12.4

6

1.8

8.1

6

6.2

12.6

6

1.9

8.3

6

6.4

12.7

6

2.0

8.4

6

6.6

12.9

6

2.1

8.5

6

6.8

13.0

6

2.3

8.7

6

7.0

13.1

6

2.4

8.9

6

7.2

13.3

6

2.5

9.0

6

7.4

13.4

6

2.6

9.1

6

7.7

13.6

6

2.7

9.3

6

7.8

13.7

6

2.9

9.4

6

3.0

9.5

6

3.1

9.7

6

3.3

9.9

6

3.4

10.1

6

3.7

10.3

6

16

German Society for Gynecology and Obstetrics, Issue 15, Vol. 1, p. 23–28, March 1991. GA(CRL) via Robinson The formula for gestational age (wk+day) via Robinson, using crown-rump length (CRL range: 0.67 cm (6.3 weeks) to 8.2 cm (14.0 weeks)) is Robinson, H.P., Fleming, J.E. “A Critical Evaluation of Sonar Crown-Rump Length Measurements.” British Journal of Obstetrics and Gynecology, Vol. 82, p. 702–710, September 1975.

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Clinical References for Calculations

GA(CRL) via Tokyo Gestational age (wk+day) via Tokyo University, using crown-rump length (CRL range: 1.4 to 8.8 cm). The following table lists the associated standard deviation in days for each value: CRL

GA

CRL

GA

CRL

GA

CRL

GA

1.4

8

2.9

10

4.6

12

7.1

14

2.1

9

3.7

11

5.7

13

8.8

15

Masahiko Mizuno, et al. “Assessment of Fetal Growth Using Ultrasound Measurements.” Nichidoku Iho (Japanisch-Deutsche Medizinische Berichte) (in Japanese), Vol. 34, No. 3, p. 537–544, 1989. GA(FL) via Hadlock The formula for gestational age (wk+day) via Hadlock, using femur length (FL range: 0.7 to 8.2 cm) is

Hadlock F.P., et al. “Estimating Fetal Age: Computer Assisted Analysis of Multiple Growth Parameters.” Radiology, Vol. 152, p. 497–501, 1984. GA(FL) via Jeanty The formula for gestational age (wk+day) via Jeanty, using femur length (FL range: 1.0 to 8.0 cm) is

The following table lists the percentiles in weeks for each value:

462

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FL

5th% 50th% 95th%

1.0

10.4

12.5

14.9

1.1

10.7

12.9

15.1

1.2

11.1

13.3

15.5

1.3

11.4

13.5

15.9

1.4

11.7

13.9

16.1

1.5

12.0

14.1

16.4

1.6

12.4

14.5

16.9

Clinical References for Calculations

1.7

12.7

14.9

17.1

1.8

13.0

15.1

17.4

1.9

13.4

15.5

17.9

2.0

13.7

15.9

18.1

2.1

14.1

16.3

18.5

2.2

14.4

16.5

18.9

2.3

14.7

16.9

19.1

2.4

15.1

17.3

19.5

2.5

15.4

17.5

19.9

2.6

15.9

18.0

20.1

2.7

16.1

18.3

20.5

2.8

16.5

18.7

20.9

2.9

16.9

19.0

21.1

3.0

17.1

19.4

21.5

3.1

17.5

19.9

22.0

3.2

17.6

20.1

22.3

3.3

18.3

20.5

22.7

3.4

18.7

20.9

23.1

3.5

19.0

21.1

23.1

3.6

19.4

21.5

23.9

3.7

19.9

22.0

24.1

3.8

20.1

22.4

24.5

3.9

20.5

22.7

24.9

4.0

20.9

23.1

25.3

4.1

21.3

23.5

25.7

4.2

21.7

23.9

26.1

4.3

22.1

24.3

26.5

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463

16

464

Clinical References for Calculations

HD11 User Reference 4535 611 65311

4.4

22.5

24.7

26.9

4.5

22.9

25.0

27.1

4.6

23.1

25.4

27.5

4.7

23.5

25.9

28.0

4.8

24.0

26.1

28.4

4.9

24.4

26.5

28.9

5.0

24.9

27.0

29.1

5.1

25.1

27.4

29.5

5.2

25.5

27.9

30.0

5.3

26.0

28.1

30.4

5.4

26.4

28.5

30.9

5.5

26.9

29.1

31.3

5.6

27.3

29.5

31.7

5.7

27.7

29.9

32.1

5.8

28.1

30.3

32.5

5.9

28.5

30.7

32.9

6.0

28.9

31.1

33.3

6.1

29.4

31.5

33.9

6.2

29.9

32.0

34.1

6.3

30.1

32.4

34.5

6.4

30.7

32.9

35.1

6.5

31.1

33.3

35.5

6.6

31.5

33.7

35.9

6.7

32.0

34.1

36.4

6.8

32.4

34.5

36.9

6.9

32.9

35.0

37.1

7.0

33.3

35.5

37.7

16

Clinical References for Calculations

7.1

33.7

35.9

38.1

7.2

34.1

36.4

38.5

7.3

34.5

36.9

39.0

7.4

35.1

37.3

39.5

7.5

35.5

37.7

39.9

7.6

36.0

38.1

40.4

7.7

36.4

38.5

40.9

7.8

36.9

39.1

41.3

7.9

37.3

39.5

41.3

8.0

37.9

40.0

42.1

Jeanty, Philippe, et al. “Estimation of Gestational Age from Measurements of Fetal Long Bones.” Journal of Ultrasound Medicine, Vol. 3, p. 75–79, February 1984. GA(FL) via Osaka Gestational age (wk+day) via Osaka University, using femur length (FL range: 0.9 to 7.2 cm). FL

GA

FL

GA

FL

GA

FL

GA

0.94

13

3.03

20

4.78

27

6.19

34

1.26

14

3.30

21

5.01

28

6.36

35

1.57

15

3.57

22

5.22

29

6.53

36

1.88

16

3.83

23

5.43

30

6.69

37

2.18

17

4.08

24

5.63

31

6.84

38

2.47

18

4.32

25

5.82

32

6.98

39

2.75

19

4.56

26

6.01

33

7.12

40

Nobuaki Mitsuda, et al. “Image Diagnosis of Fetal Growth.” Obstetrical and Gynecological Practice (in Japanese), Vol. 37, No, 10, p. 1459–70, 1988.

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Clinical References for Calculations

GA(FL) via Tokyo Gestational age (wk+day) via Tokyo University, using femur length (FL range: 3.2 to 7.1 cm). FL

GA

FL

GA

FL

GA

FL

GA

3.23

20

4.64

26

5.82

32

6.82

38

3.44

21

4.76

27

6.01

33

6.93

39

3.65

22

4.98

28

6.19

34

7.04

40

3.87

23

5.19

29

6.37

35

4.09

24

5.41

30

6.53

36

4.31

25

5.61

31

6.68

37

Masahiko Mizuno, et al. “Assessment of Fetal Growth Using Ultrasound Measurements.” Nichidoku Iho (Japanisch-Deutsche Medizinische Berichte) (in Japanese), Vol. 34, No. 3, p. 537–544, 1989. GA(FTA) via Osaka Gestational age (wk+day) via Osaka University, using fetal trunk area (FTA range: 5.6 to 87.0 cm2). FTA

GA

FTA

GA

FTA

GA

FTA

GA

5.6

14

21.0

21

43.4

28

69.5

35

7.3

15

23.8

22

47.1

29

73.2

36

9.2

16

26.8

23

50.8

30

76.8

37

11.3

17

29.9

24

54.5

31

80.2

38

13.5

18

33.1

25

58.3

32

83.5

39

15.8

19

36.5

26

62.1

33

86.6

40

18.4

20

39.9

27

65.8

34

Nobuaki Mitsuda, et al. “Image Diagnosis of Fetal Growth.” Obstetrical and Gynecological Practice (in Japanese), Vol. 37, No, 10, p. 1459–70, 1988.

466

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Clinical References for Calculations

16

GA(GSD) via Rempen Gestational age (wk+day) via Rempen, using gestational sac diameter (GSD1 range: 0.2 to 7.3 cm). The following table lists the standard deviation (SD) in days: GSD

GA

SD

GSD

GA

SD

GSD

GA

SD

GSD

GA

SD

0.2

4.9

10

2.1

7.0

10

3.8

9.1

10

5.6

11.6

10

0.3

5.0

10

2.2

7.1

10

3.9

9.4

10

5.8

11.9

10

0.4

5.1

10

2.3

7.3

10

4.0

9.4

10

5.9

12.0

10

0.6

5.3

10

2.4

7.4

10

4.1

9.6

10

6.0

12.1

10

0.7

5.4

10

2.6

7.6

10

4.2

9.7

10

6.2

12.4

10

0.8

5.6

10

2.7

7.7

10

4.4

9.9

10

6.3

12.6

10

1.0

5.7

10

2.8

7.9

10

4.5

10.0

10

6.4

12.7

10

1.1

5.9

10

2.9

8.0

10

4.7

10.3

10

6.5

12.9

10

1.2

6.0

10

3.0

8.1

10

4.8

10.4

10

6.6

13.0

10

1.3

6.1

10

3.1

8.3

10

4.9

10.5

10

6.8

13.3

10

1.4

6.3

10

3.3

8.4

10

5.0

10.7

10

6.9

13.4

10

1.6

6.4

10

3.4

8.6

10

5.1

10.9

10

7.0

13.5

10

1.7

6.6

10

3.5

8.7

10

5.2

11.0

10

7.1

13.7

10

1.8

6.7

10

3.6

8.9

10

5.4

11.3

10

7.2

14.0

10

2.0

6.9

10

3.7

9.0

10

5.5

11.4

10

7.3

14.1

10

German Society for Gynecology and Obstetrics, Issue 15, Vol. 1, p. 23–28, March 1991. GA(GSD) via Tokyo Gestational Age (wk+day) via Tokyo University, using Gestational Sac Diameter (GSD1 range: 1.0 to 6.7 cm). The following table lists the associated standard deviation in days: GSD

GA

1.0

4

1.6

5

2.2

6

2.7

7 HD11 User Reference 4535 611 65311

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Clinical References for Calculations

3.4

8

4.1

9

4.8

10

5.7

11

6.7

12

Masahiko Mizuno, et al. “Assessment of Fetal Growth Using Ultrasound Measurements.” Nichidoku Iho (Japanisch-Deutsche Medizinische Berichte) (in Japanese), Vol. 34, No. 3, p. 537–544, 1989. GA(HC) via Hadlock Given the Head Circumference (HC range: 5.6–35.7 cm), Gestational Age via Hadlock, GA(HC)Hadl (in weeks) is 8.96 + 0.540(HC) + 0.0003(HC3) Hadlock F.P., et al. “Estimating Fetal Age: Computer Assisted Analysis of Multiple Growth Parameters.” Radiology, Vol. 152, p. 497–501, 1984. GA(HL) via Jeanty Gestational Age (wk+day) via Jeanty using Humerous Length (HL range: 1.0–6.9 cm) equation is 9.6519438 + 2.6200391(HL) + 0.26105367(HL2) The following table lists the associated percentiles in weeks for each value: HL

468

5th% 50th% 95th%

HL

5th% 50th% 95th%

1.0

9.9

12.5

15.3

4.0

21.5

24.3

27.1

1.1

10.1

12.9

15.5

4.1

22.0

24.9

27.5

1.2

10.4

13.1

15.9

4.2

22.5

25.3

28.0

1.3

10.9

13.5

16.1

4.3

23.0

25.7

28.5

1.4

11.1

13.9

16.5

4.4

23.5

26.1

29.0

1.5

11.4

14.1

16.9

4.5

24.0

26.7

29.5

1.6

11.9

14.5

17.3

4.6

24.5

27.1

30.0

1.7

12.1

14.9

17.5

4.7

25.0

27.7

30.5

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Clinical References for Calculations

1.8

12.5

15.1

18.0

4.8

25.5

28.1

31.0

1.9

12.9

15.5

18.3

4.9

26.0

28.9

31.5

2.0

13.1

15.9

18.7

5.0

26.5

29.3

32.0

2.1

13.5

16.3

19.1

5.1

27.1

29.9

32.5

2.2

13.9

16.7

19.4

5.2

27.5

30.3

33.1

2.3

14.3

17.1

19.9

5.3

28.1

30.9

33.5

2.4

14.7

17.4

20.1

5.4

28.7

31.4

34.1

2.5

15.1

17.9

20.5

5.5

29.1

32.0

34.7

2.6

15.5

18.1

21.0

5.6

29.9

32.5

35.3

2.7

15.9

18.5

21.4

5.7

30.3

33.1

35.9

2.8

16.3

19.0

21.9

5.8

30.9

33.5

36.5

2.9

16.7

19.4

22.1

5.9

31.4

34.1

36.9

3.0

17.1

19.9

22.5

6.0

32.0

34.9

37.5

3.1

17.5

20.3

23.0

6.1

32.5

35.3

38.1

3.2

18.0

20.7

23.5

6.2

33.1

35.9

38.7

3.3

18.4

21.1

23.9

6.3

33.9

36.5

39.3

3.4

18.9

21.5

24.3

6.4

34.4

37.1

39.9

3.5

19.3

22.0

24.9

6.5

35.0

37.7

40.5

3.6

19.7

22.5

25.1

6.6

35.5

38.3

41.1

3.7

20.1

22.9

25.7

6.7

36.1

38.9

41.7

3.8

20.5

23.4

26.1

6.8

36.9

39.5

42.3

3.9

21.1

23.9

26.5

6.9

37.4

40.1

42.9

16

Jeanty, Philippe, Rodesch, Frederic, Delbeke, Dominique, and Dumont, Jacques E. “Estimation of Gestational Age from Measurements of Fetal Long Bones.” Journal of Ultrasound Medicine, Vol. 3,p. 75-79, Feb 1984.

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GA(HL) via Osaka Gestational Age (wk+day) via Osaka University using Humorous Length (HL range: 1.01– 6.16 cm). The following table lists the associated standard deviation in days:

470

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HL

GA

1.01

13w0d

1.31

14w0d

1.59

15w0d

1.87

16w0d

2.15

17w0d

2.41

18w0d

2.67

19w0d

2.91

20w0d

3.15

21w0d

3.38

22w0d

3.61

23w0d

3.82

24w0d

4.03

25w0d

4.23

26w0d

4.42

27w0d

4.60

28w0d

4.78

29w0d

4.94

30w0d

5.10

31w0d

5.25

32w0d

5.39

33w0d

5.53

34w0d

5.65

35w0d

5.77

36w0d

Clinical References for Calculations

5.88

37w0d

5.98

38w0d

6.08

39w0d

6.16

40w0d

16

Aoki, Mineo. “The Diagnosis and Treatment of IUGR.” (in Japanese). Perineitaru Kea (Japanese Journal of Perinatal Care), Vol. 9, No. 5, p. 407-422, 1990. Mitsuda, Nobuaki; Ohtsuki, Yoshiro; Sugita, Nagatoshi; Takagi, Tetsu; and Tanizawa, Osamu. “Image Diagnosis of Fetal Growth.” (in Japanese). Sanfujinka No Jissai (Obstetrical and Gynecological Practice), Vol. 37, No. 10, p. 459-70, 1988. GA(MSD) via Hellman Gestational Age (wk+day) via Hellman using Mean Gestational Sac diameter (Gestational Sac Diameter range: 1.0 cm (5.0 weeks) to 6.0 cm (12.2 weeks)) equation is (10((GSD1 + GSD2 + GSD3) / 3) + 25.43) / 7.02 Hellman LM, Kobayashi M, Fillisti L, Lavenhar M, and Cromb E. “Growth and development of the Human Fetus Prior to the Twentieth Week of Gestation.” American Journal of Obstetrics and Gynecology, Vol. 103, p. 789-800, 1969. GA(SL) via Tokyo Gestational Age (wk+day) via Tokyo University using Spine Length (SL range: 4.05–8.47 cm). The following table lists the associated standard deviation in days: SL

GA

4.05

21

4.39

22

4.71

23

5.01

24

5.30

25

5.57

26

5.82

27

6.06

28

6.30

29 HD11 User Reference 4535 611 65311

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Clinical References for Calculations

6.51

30

6.72

31

6.93

32

7.13

33

7.32

34

7.51

35

7.70

36

7.89

37

8.08

38

8.27

39

8.47

40

Masahiko Mizuno, et al. “Assessment of Fetal Growth Using Ultrasound Measurements.” Nichidoku Iho (Japanisch-Deutsche Medizinische Berichte) (in Japanese), Vol. 34, No. 3, p. 537–544, 1989. GA(TC) via Nimrod Gestational Age (wk+day) via Nimrod using Thoracic Circumference (TC range: 13.0– 35.0 cm) equation is (TC + 0.44) / 0.79 Nimrod, C, et al. “Ultrasound Prediction of Pulmonary Populaces.” Obstetrics and Gynecology, Vol. 68, p. 495-498, 1986. GA(TL) via Jeanty Gestational Age (wk+day) via Jeanty using Tibia Length (TL range: 1.0–6.9 cm) equation is 10.055043 + 3.1317668 x TL + 0.16814056 x (TL)2 The following table lists the associated percentiles in weeks for each value:

472

TL

5th% 50th% 95th%

TL

5th% 50th% 95th%

1.0

10.5

13.4

16.3

4.0

22.4

25.3

28.1

1.1

10.9

13.7

16.5

4.1

22.9

25.7

28.5

1.2

11.1

14.1

17.0

4.2

23.3

26.1

29.1

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Clinical References for Calculations

1.3

11.5

14.4

17.3

4.3

23.7

26.5

29.5

1.4

11.9

14.9

17.7

4.4

24.1

27.1

30.0

1.5

12.1

15.1

18.0

4.5

24.5

27.5

30.5

1.6

12.5

15.5

18.4

4.6

25.1

28.0

30.6

1.7

13.0

15.9

18.9

4.7

25.5

28.5

31.4

1.8

13.2

16.1

19.1

4.8

26.1

29.0

31.9

1.9

13.7

16.5

19.5

4.9

26.5

29.4

32.3

2.0

14.1

17.0

19.9

5.0

27.0

29.9

32.9

2.1

14.5

17.4

20.3

5.1

27.5

30.4

33.3

2.2

14.9

17.9

20.7

5.2

28.0

30.9

33.9

2.3

15.1

18.1

21.1

5.3

28.5

31.4

34.3

2.4

15.5

18.5

21.4

5.4

29.0

31.9

34.9

2.5

16.0

18.9

21.9

5.5

29.5

32.4

35.3

2.6

16.4

19.3

22.1

5.6

30.0

32.9

35.9

2.7

16.9

19.7

22.5

5.7

30.5

33.4

36.3

2.8

17.1

20.1

23.0

5.8

31.0

33.9

36.9

2.9

17.5

20.5

23.5

5.9

31.5

34.4

37.3

3.0

18.1

21.0

23.9

6.0

32.0

34.9

37.9

3.1

18.5

21.4

24.3

6.1

32.5

35.4

38.3

3.2

18.9

21.9

24.7

6.2

33.0

35.9

38.9

3.3

19.3

22.1

25.1

6.3

33.5

36.5

39.4

3.4

19.7

22.5

25.5

6.4

34.1

37.0

39.9

3.5

20.1

23.1

26.0

6.5

34.5

37.5

40.4

3.6

20.5

23.5

26.4

6.6

35.1

38.0

41.0

3.7

21.0

23.9

26.9

6.7

35.7

38.5

41.5

3.8

21.5

24.4

27.3

6.8

36.1

39.1

42.0

3.9

21.9

24.9

27.7

6.9

36.9

39.7

42.5

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473

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Clinical References for Calculations

Jeanty, Philippe, Rodesch, Frederic, Delbeke, Dominique, and Dumont, Jacques E. “Estimation of Gestational Age from Measurements of Fetal Long Bones.” Journal of Ultrasound Medicine, Vol. 3,p. 75-79, Feb 1984. GA(UL) via Jeanty Gestational Age (wk+day) via Jeanty using Ulna Length (UL range: 1.0–6.4 cm) equation is 10.034368 + 2.8625722 x UL + 0.2912470 x (UL)2 The following table lists the associated percentiles in weeks for each value:

474

UL

5th% 50th% 95th%

UL

5th% 50th% 95th%

1.0

10.1

13.1

16.1

4.0

23.1

26.1

29.1

1.1

10.5

13.5

16.5

4.1

23.5

26.7

29.7

1.2

10.9

13.9

16.9

4.2

24.1

27.1

30.3

1.3

11.1

14.1

17.3

4.3

24.7

27.7

30.9

1.4

11.5

14.5

17.7

4.4

25.1

28.3

31.3

1.5

11.9

15.0

18.0

4.5

25.9

28.9

31.9

1.6

12.3

15.4

18.4

4.6

26.3

29.4

32.4

1.7

12.7

15.7

18.9

4.7

26.9

29.9

33.0

1.8

13.1

16.1

19.1

4.8

27.4

30.5

33.5

1.9

13.5

16.5

19.5

4.9

28.0

31.1

34.1

2.0

13.9

16.9

20.0

5.0

28.5

31.5

34.7

2.1

14.3

17.3

20.4

5.1

29.1

32.1

35.3

2.2

14.7

17.7

20.9

5.2

29.7

32.9

35.9

2.3

15.1

18.1

21.1

5.3

30.3

33.4

36.4

2.4

15.5

18.5

21.5

5.4

30.9

34.0

37.0

2.5

16.0

19.0

22.1

5.5

31.5

34.5

37.7

2.6

16.4

19.4

22.5

5.6

32.1

35.1

38.3

2.7

16.9

19.9

22.9

5.7

32.9

35.9

38.9

2.8

17.3

20.3

23.4

5.8

33.4

36.4

39.5

2.9

17.7

20.9

23.9

5.9

34.0

37.1

40.1

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3.0

18.1

21.1

24.3

6.0

34.5

37.7

40.9

3.1

18.5

21.7

24.9

6.1

35.3

38.3

41.4

3.2

19.1

22.1

25.1

6.2

35.9

39.0

42.0

3.3

19.5

22.7

25.7

6.3

36.5

39.5

42.7

3.4

20.1

23.1

26.1

6.4

37.1

40.3

43.3

3.5

20.5

23.6

26.7

3.6

21.1

24.1

27.1

3.7

21.5

24.5

27.7

3.8

22.1

25.1

28.1

3.9

22.5

25.5

28.7

16

Jeanty, Philippe, Rodesch, Frederic, Delbeke, Dominique, and Dumont, Jacques E. “Estimation of Gestational Age from Measurements of Fetal Long Bones.” Journal of Ultrasound Medicine, Vol. 3,p. 75-79, Feb 1984.

H HC-to-AC Ratio The ratio (unitless) of Head Circumference (cm) to Abdominal Circumference (cm) is HC / AC The typical range for HC/AC is 0.96 (13 weeks Gestational Age) to 1.23 (41 weeks Gestational Age). Campbell S, Thoms A. “Ultrasound Measurement of Fetal Head-to-Abdomen Circumference ratio in the Assessment of Growth Retardation.” British Journal of Obstetrics and Gynecology, Vol. 84, p. 165–174, 1977. Head Circumference Head Circumference (cm) (normal range: 8.0 cm to 36.0 cm) may be computed by two means: If HC(traced) is present, then 2

2

BPD + OFD -) Π × (---------------------------------------2 HD11 User Reference 4535 611 65311

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Clinical References for Calculations

HC = HC(traced) If the two head diameters, BPD and OFD, are present, then Shields JR, et al. “Fetal Head and Abdominal Circumferences: Ellipse Calculations Versus Planimetry.” Journal of Clinical Ultrasound, Vol. 15, p. 237–239May 1987. Kurtz, Alfred B., Goldberg, Barry B. Obstetrical Measurements in Ultrasound: A Reference Manual. Year Book Medical Publishers, Inc., 1988, p. 33. HrtC-to-TC Ratio The ratio (unitless) of heart circumference (HrtC) (cm) to thoracic circumference (TC) (cm) is HrtC/TC

I ICA-to-CCA Ratio The formula for the ICA/CCA ratio, r (unitless), given the internal carotid artery systolic velocity, vICA (cm/s), and the common carotid artery systolic velocity, vCCA (cm/ s), is

Garth K., Carroll B., et al. “Duplex Ultrasound Scanning of the Carotid Arteries with Velocity Spectrum Analysis.” Radiology, Vol. 147, p. 826, June 1983.

L LA-to-AO Ratio

Roelandt, Joseph, Practical Echocardiology, vol. 1 of Ultrasound in Medicine Series, ed. Denis White, Research Studies Press, 1977, p. 270. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 364, Sept–Oct 1989.

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Length

where (X1,Y11) and (X2,Y2) are the endpoint coordinates of the line segment. Note: When making small length measurements, use the maximum permissible display magnification for the most accurate calculations. LVLd % diff LVLd % diff is the MOD long-axis (at end diastole) length percentage difference between apical 4 and apical 2 views.

Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 358–367, Sept–Oct 1989. LVLs % diff LVLs % diff is the MOD long-axis length at end systole percentage difference between apical 4 and apical 2 views.

Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 358–367, Sept–Oct 1989. LVmass(AL)d

where A1 represents LVAd sax epi, the LV epicardial SAX area at the level of the papillary muscle tips at end diastole A2 represents LVAd sax PM, the LV endocardial SAX cavity area at the level of the papillary muscle tips at end diastole L represents LVLd apical, the LV long-axis length at end diastole (via apical four-chamber or two-chamber views) HD11 User Reference 4535 611 65311

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Clinical References for Calculations

t is a representative myocardial wall thickness with the formula

Reichek, N., et al. “Anatomic Validation of Left Ventricular Mass Estimates from Clinical Two-Dimensional Echocardiography: Initial Results.” Circulation, Vol. 67, No. 2, p. 348– 352, February 1983. Schiller, N.B., et al. “Recommendations for Quantification of the LV by Two-Dimensional Echocardiography.” Journal of the American Society of Echocardiography, Vol. 2, No. 5, p. 358–367, Sept–Oct 1989. Wyatt, H.L., et al. “Cross-sectional Echocardiography: Analysis of Models for Quantifying Mass in the Left Ventricle in Dogs.” Circulation, Vol. 60, p. 1104–1113, 1979. LVmass(AL)dI

LVmass(C)d Left Ventricular Mass (grams) via the cubic equation (with the Devereux anatomic correction) using ASE M-mode measurements (at end-diastole). Reference: Devereux et al The measurements of the interventricular septal thickness (IVSd), posterior wall thickness (LVPWd), and left ventricular inner dimension (LVIDd) are made at end-diastole using leading-edge to leading-edge method as recommended by the American Society of Echocardiography (ASE).

Devereux, R.B., et al. “Echocardiographic Assessment of Left Ventricular Hypertrophy: Comparison to Necropsy Findings,” American Journal of Cardiology, Vol. 57, p. 450–458, 1986. Sahn, D., et al. The Committee on MMode Standardization of the American Society of Echocardiography, “Recommendations Regarding Quantitation in MMode Echocardiography: Results of a Survey of Echocardiographic Measurements.” Circulation, Vol. 58, No. 6, p. 1072–1083, 1978.

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LVmass(C)dI

LVOT Area The calculated area, LVOTArea (cm2), of the Left Ventricular Outflow Tract is LVOTArea = (pi/4) x (LVOTDiam) Hagen-Ansert, Sandra L. Textbook of Diagnostic Ultrasound, ed. 3. The C.V. Mosby CO., 1989, p. 73.

M Mass Volume The equation for ellipse volume, vol (cm3) from its three perpendicular axes, length (Dimension 1), l, width (Dimension 2), w, and height (Dimension 3), h.

Maximum Pressure Gradient Short form:

where V2 is the maximum distal velocity (in cm/s). The short form is clinically applicable in the case of stenosis where V2 > 4V1. Yoganathan, Ajit P., et al. “Review of Hydrodynamic Principles for the Cardiologist: Applications to the Study of Blood Flow and Jets by Imaging Techniques.” Journal of the American College of Cardiology, Vol. 12, p. 1344–1353, 1988. Maximum Pressure Gradient (Aortic Flow) (Full Bernoulli)

Yoganathan, Ajit P., et al. “Review of Hydrodynamic Principles for the Cardiologist: Applications to the Study of Blood Flow and Jets by Imaging Techniques.” Journal of the American College of Cardiology, Vol. 12, p. 1344–1353, 1988.

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Clinical References for Calculations

Maximum Pressure Gradient (Aortic Flow) (Simplified Bernoulli)

Yoganathan, Ajit P., et al. “Review of Hydrodynamic Principles for the Cardiologist: Applications to the Study of Blood Flow and Jets by Imaging Techniques.” Journal of the American College of Cardiology, Vol. 12, p. 1344–1353, 1988. Maximum Pressure Gradient (Aortic Insufficiency)

Callahan, Mark J., et al. “Validation of Instantaneous Pressure Gradients Measured by Continuous-Wave Doppler in Experimentally Induced Aortic Stenosis.” American Journal of Cardiology, Vol. 56, p. 989–993, 1985. Maximum Pressure Gradient (Mitral Regurgitation)

Stamm, R. Brad, et al. “Quantification of Pressure Gradients Across Stenotic Valves by Doppler Ultrasound.” Journal of the American College of Cardiology, Vol. 2, No. 4, p. 707– 718, 1983. Maximum Pressure Gradient (Mitral Valve)

Yoganathan, Ajit P., et al. “Review of Hydrodynamic Principles for the Cardiologist: Applications to the Study of Blood Flow and Jets by Imaging Techniques.” Journal of the American College of Cardiology, Vol. 12, p. 1344–1353, 1988. Maximum Pressure Gradient (Pulmonary Insufficiency)

Masuyama, T. et al. “Continuous-wave Doppler Echocardiographic Detection of Pulmonary Regurgitation and Its Application to Noninvasive Estimation of Pulmonary Artery Pressure.” Circulation, Vol. 74, No. 3, p. 484–492, 1986.

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Mean Pressure Gradient (Full Bernoulli) Yoganathan, Ajit P., et al. “Review of Hydrodynamic Principles for the Cardiologist: Applications to the Study of Blood Flow and Jets by Imaging Techniques.” Journal of the American College of Cardiology, Vol. 12, p. 1344–1353, 1988. Mean Pressure Gradient (Simplified Bernoulli) Short form:

The short form is clinically applicable in the case of stenosis where V2 > 4V1. Yoganathan, Ajit P., et al. “Review of Hydrodynamic Principles for the Cardiologist: Applications to the Study of Blood Flow and Jets by Imaging Techniques.” Journal of the American College of Cardiology, Vol. 12, p. 1344–1353, 1988. MM HR (MMode or 2D Heart Rate)

Dorland’s Illustrated Medical Dictionary, 27th ed., Philadelphia:W. B. Sanders Co., 1988, p. 1425. MV E/A (Mitral Valve E-to-A Ratio)

Maron, Barry J., et al. “Noninvasive Assessment of Left Ventricular Diastolic Function by Pulsed Doppler Echocardiography in Patients with Hypertrophic Cardiomyopathy.” Journal of the American College of Cardiology, Vol. 10, p. 733–742, 1987. MV Flow Area The calculated Mitral Valve Flow area, MVFlowArea (cm2) is MVFlowArea = (pi/4) x (MVDiam1 x MVDiam2) Hagen-Ansert, Sandra L. Textbook of Diagnostic Ultrasound, ed. 3. The C.V. Mosby CO., 1989, p. 73.

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Clinical References for Calculations

MV P1/2t

where MV max vel is the peak velocity on the spectrum and MV Decel slope is the slope of the spectrum as it declines from the max velocity. Note: Position the crosshair along the deceleration slope as far away as possible from the peak velocity point for the most accurate calculation. Hatle, L., et al. “Non-invasive Assessment of Atrioventricular Pressure Halftime by Doppler Ultrasound.” Circulation, Vol. 60, p. 1096–1104, 1979. MVA (P1/2t)

Note: Use points as far apart as possible on the deceleration slope and the maximum permissible strip chart speed for the most accurate calculation. Goldberg, Barry B., Kurtz, Alfred B. Atlas of Ultrasound Measurements. Year Book Medical Publishers, Inc., 1990, p. 65. Stamm, R. Brad, et al. “Quantification of Pressure Gradients Across Stenotic Valves by Doppler Ultrasound.” Journal of the American College of Cardiology, Vol. 2, No. 4, p. 707– 718, 1983.

O Ovarian Volume Length x Width x Thickness x 0.523 Andolf, Ellika, et al, “Ultrasound Measurement of the Ovarian Volume,” Acta Obstet Gynecol Scand, 1987; 66:387–389. Qp-to-Qs Ratio

where DP represents the diameter of the effective flow area of the main pulmonary artery, DS represents the diameter of the effective flow area of the aortic valve, VP rep482

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resents maximum velocity of the pulmonary flow, and VS represents the maximum velocity of the aortic flow. Cloez J.L., Schmidt, et al. “Determination of Pulmonary to Systemic Blood Flow Ratio in Children By a Simplified Doppler Echocardiographic Method.” Journal of the American College of Cardiology, Vol. 11, No. 4, p. 825–830, April 1988.

P PI (Pulsatility Index Using Time-Averaged Mean of the Peaks) The formula for pulsatility index, PI, given a maximum velocity, (Vmax in cm/s), a minimum velocity (Vmin in cm/s), and a mean velocity (Vmean in cm/s), is

Burns, Peter N. “The Physical Principles of Doppler and Spectral Analysis.” Journal of Clinical Ultrasound, Vol. 15, No. 9, p. 585, November/December 1987. Pressure Half-Time

where max vel is the peak velocity on the spectrum and Decel slope is the slope of the spectrum as it declines from one of the values for max vel listed in the following table: Pressure Half-Time

Max Vel

Decel Slope

Flow

Ao P1/2t

AI max vel

AI dec slope

Aortic flow

MV P1/2t

MV P1/2t max v

MV dec slope

Mitral flow

PI P1/2t

PI max vel

PA dec slope

Pulmonic flow

TV P1/2t

TV P1/2t max v

TV dec slope

Tricuspid flow

P1/2t

Dec max vel

Decel slope

Other flow

Note: Position the crosshair along the deceleration slope as far away as possible from the peak velocity point for the most accurate calculation. Hatle, L., et al. “Non-invasive Assessment of Atrioventricular Pressure Halftime by Doppler Ultrasound.” Circulation, Vol. 60, p. 1096–1104, 1979. HD11 User Reference 4535 611 65311

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Prostate Volume The equation for ellipse volume, vol (cm3) from its three perpendicular axes, length (Dimension 1), l, width (Dimension 2), w, and height (Dimension 3), h.

Proximal Isovelocity Surface Area (PISA) MR ERO (Mitral valve effective regurgitant orifice area) (cm2)

MR flow rate (Mitral valve regurgitation flow rate) (cm3/s) MR PISA (Mitral valve regurgitation proximal isovolumic surface area) (cm2)

MR RF (Mitral valve regurgitant fraction) (%)

MR volume (Mitral valve regurgitant volume) (ml)

Enriquez-Sarano, M. “Effective Regurgitant Orifice Area: A Noninvasive Doppler Development of an Old Hemodynamic Concept.” Journal of the American College of Cardiology, Vol. 23, No. 2, p. 443–51, 1994. Gardin, J. “Doppler Color Flow Proximal Isovelocity Surface Area (PISA): An Alternative Method of Estimating Volume Flow Across Narrowed Orifices, Regurgitant valves, and Intracardiac Shunt Lesions.” Echocardiography, Vol. 9, No. 1, p. 39–41, 1992. Shandas, R., et al. “Experimental Studies to Define the Geometry of the Flow Convergence Region.” Echocardiography, Vol. 9, No. 1 p. 43–50, 1992. Utsunomiya, T., et al. “Regurgitant volume estimation in patients with mitral regurgitation: initial studies using the Color Doppler Proximal isovelocity surface area method.” Echocardiography, Vol. 9, No. 1, p. 63–74, 1992.

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R RAR (Renal-to-Aortic Ratio) The equation for the RAR ratio, r (unitless), given the renal end-systolic velocity, R (cm/ s), and the aortic end-systolic velocity, A (cm/s), is:

RI (Resistivity Index) The formula for resistivity index, RI (unitless), given a maximum velocity, Vmax (cm/s), and a minimum velocity, Vmin (cm/s), for a vessel is

Burns, P.N. “The Physical Principles of Doppler and Spectral Analysis.” Journal of Clinical Ultrasound, Vol. 15, No. 9, p. 586, November/December 1987. RV Sys Press

Stevenson, J.G. “Comparison of Several Noninvasive Methods for Estimation of Pulmonary Artery Pressure.” Journal of the American Society of Echocardiography, Vol. 2, p. 157– 171, June 1989. Yock, Paul G. and Popp, Richard L. “Noninvasive Estimation of Right Ventricular Systolic Pressure by Doppler Ultrasound in Patients with Tricuspid Regurgitation.” Circulation, Vol. 70, No. 4, p. 657–662, 1984.

S S-to-D Ratio The formula for the systolic-to-diastolic ratio, r (unitless), given the systolic velocity, vs (cm/s), and the end-diastolic velocity, vd (cm/s), is

Ameriso, S., et al. “Pulseless Transcranial Doppler Finding in Takayasu’s Arteritis.” Journal of Clinical Ultrasound, Vol. 18, p. 592–6, September 1990. HD11 User Reference 4535 611 65311

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Stroke Volume (2D)

where the stroke volume, SVx (ml); the end-diastolic volume, x (ml); the end-diastolic volume, EDVx (ml); and the end-systolic volume, ESVx (ml), are SVx

EDVx

ESVx

SV(sp-el)

EDV(sp-el)

ESV(sp-el)

SV(bp-el)

EDV(bp-el)

ESV(bp-el)

SV(Bullet)

EDV(Bullet)

ESV(Bullet)

SV(MOD-sp2)

EDV(MOD-sp2)

ESV(MOD-sp2)

SV(MOD-sp4)

EDV(MOD-sp4)

ESV(MOD-sp4)

SV(MOD-bp)

EDV(MOD-bp)

ESV(MOD-bp)

SV(mod-Simp)

EDV(mod-Simp)

ESV(mod-Simp)

SV(Cubed)

EDV(Cubed)

ESV(Cubed)

SV(Teich)

EDV(Teich)

ESV(Teich)

Gorge, G., et al. “High Resolution Two-dimensional Echocardiography Improves the Quantification of Left Ventricular Function.” Journal of the American Society of Echocardiography, Vol. 5, p. 125–34, 1992. Roelandt, Joseph. Practical Echocardiology, vol. 1 of Ultrasound in Medicine Series. ed. Denis White, Research Studies Press, 1977, p. 124. Stroke Volume (Doppler)

where the stroke volume, SVx x (ml), using Doppler flow, given a velocity-time integral, VTIxx (cm), and the flow area, Axx (cm2), are SVx

486

VTIx

Ax

SV

V2 VTI

Flow area

SV(Ao)

Ao V2 VTI

Ao root area

SV(LVOT)

LV V1 VTI

LVOT area

SV(MV)

MV V2 VTI

MV flow area

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SV(PV)

PA V2 VTI

MPA area

SV(MV)

MV V2 VTI

MV flow area

SV(TV)

TV V2 VTI

TV flow area

16

Hatle, Liv, Angelsen, Bjorn. Doppler Ultrasound in Cardiology: Physical Principles and Clinical Applications, 2nd ed. Lea and Febiger, Philadelphia, 1985, p. 306. Systolic Ratio The formula for the systolic ratio, r (unitless), given the end-systolic velocity for vessel 1, v1 (cm/s), and the end-systolic velocity for vessel 2, v2 (cm/s), is

Garth, K., et al. “Duplex Ultrasound Scanning of the Carotid Arteries with Velocity Spectrum Analysis.” Radiology, Vol. 147, p. 826, June 1983.

T Testicle Volume The equation for ellipse volume, vol (cm3) from its three perpendicular axes, length (Dimension 1), l, width (Dimension 2), w, and height (Dimension 3), h.

Thoracic Circumference Thoracic Circumference (cm) may be computed by two means: If TC(traced) is present, then TC = TC(traced) If the two thoracic diameters, TDtrv and TDap, are present, then 2

2

TDtrv + TDap -) Π × (--------------------------------------------2 Shields JR, et al. “Fetal Head and Abdominal Circumferences: Ellipse Calculations Versus Planimetry.” Journal of Clinical Ultrasound, Vol. 15, p. 237–239, May 1987. Kurtz, Alfred B., Goldberg, Barry B. Obstetrical Measurements in Ultrasound: A Reference Manual. Year Book Medical Publishers, Inc., 1988, p. 33. HD11 User Reference 4535 611 65311

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U Uterine Volume Length x Width x Thickness Goldstein, S.R., et al. “Estimation of Nongravida Uterine Volume Based on a Nomogram of Gravid Uterine Volume: Its Value in Gynecologic Uterine Abnormalities.” Obstetrics and Gynecology, Vol, 72, No. 1, P. 86–90, July 1988. Levine, Sandra, Filly, Roy, Creasy, Robert K. “Identification of Fetal Growth Retardation by Ultrasonographic Estimation of Total Intrauterine Volume.” Journal of Clinical Ultrasound, Vol. 7, p. 21–26, 1979.

V Velocity-Time Integral The velocity-time integral (or flow integral) is the integral of the Doppler spectral instantaneous velocity (Vi) over the total time interval (T). The integral is approximated by the following formula:

where T is the total time interval (the sum of all ti time increments). Volume (Ellipsoid Three-Axis) The formula for ellipse volume, vol (cm3), from its three perpendicular axes: length, l; width, w; and height, h, is Jeanty, Philippe. “Measurement of Fetal Kidney Growth on Ultrasound.” Radiology, Vol, 144, p. 159–162, July 1982. Emamian, S.A., et al. “Kidney Dimensions at Sonography: Correlation with Age, Sex, and Habitus in 665 Adult Volunteers,” American Journal of Radiology, Vol. 160, p. 83–86, 1993.

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W Weight Percentiles To aid the clinician in diagnosing fetal weight discrepancies and discordant growth, weight percentiles are available for each estimated fetal weight on the obstetrics report. These indicate where the fetus lies in relation to the normal range of values, based on both clinical (expected GA or LMP) and ultrasound (AUA) data. The fetal weight value is displayed within a shaded box (inverse video) if the percentile is less than 10% or greater than 90%. In Analysis Setup, you can turn off weight percentiles so they are not included in the report. The following table of fetal weight smoothed percentiles (Brenner) is used by the system to determine weight percentiles. The weights in the table are represented in grams: Gestational Age (wks)

10%

25%

50%

8

6.1

9

7.3

10

8.1

11

11.9

75%

90%

12

11.1

21.1

34.1

13

22.5

35.3

55.4

14

34.5

51.4

76.8

15

51.0

76.7

108

16

79.8

117

151

17

125

166

212

18

172

220

298

19

217

283

394

20

255

325

460

21

280

330

410

570

860

22

320

410

480

630

920

23

370

460

550

690

990

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Clinical References for Calculations

24

420

530

640

780

1080

25

490

630

740

890

1180

26

570

730

860

1020

1320

27

660

840

990

1160

1470

28

770

980

1150

1350

1660

29

890

1100

1310

1530

1890

30

1030

1260

1460

1710

2100

31

1180

1410

1630

1880

2290

32

1310

1570

1810

2090

2500

33

1480

1720

2010

2280

2690

34

1670

1910

2220

2510

2880

35

1870

2130

2430

2730

3090

36

2190

2470

2650

2950

3290

37

2310

2580

2870

3160

3470

38

2510

2770

3030

3320

3610

39

2680

2910

3170

3470

3750

40

2750

3010

3280

3590

3870

41

2800

3070

3360

3680

3980

42

2830

3110

3410

3740

4060

43

2840

3110

3420

3780

4100

44

2790

3050

3390

3770

4110

Brenner, William, et al. “A Standard of Fetal Growth for the United States of America.” American Journal of Obstetrics and Gynecology, Vol. 126, p. 555–564, November 1976.

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17 Glossary Symbols 2D 1) A grayscale, real time, two-dimensional imaging mode. 2) A hard key that activates 2D imaging. Pressing 2D when in any other imaging mode also exits that mode and returns to 2D mode, clearing all other modes and imaging features in use. Only the 2D control has this functionality. 2D/M-mode Gain A control panel knob that adjusts the gain, or overall brightness, of a 2D or an M-mode image. 2D Hold A Triggering mode soft key. If 2D Hold is off, then 2D image triggering is always in effect in CW Spectral or in PW Spectral with Duplex/Triplex turned off. 2D Reference Image The grayscale ultrasound image. 3D An imaging mode in which a series of 2D images are acquired and then rendered into a 3-dimensional volume. Color and CPA modes can be used in 3D mode. 3D/4D A hard key that activates the 3D/4D application. 3D/4D Mode A soft key that enables you to change between acquisition modes. The modes available depend on installed system options and what prove is selected. 3D Data Set A series of 2D images from which a 3D volume is rendered. 3D Render The mode in which you review and manipulate rendered 3D volumes and the associated MPR images.

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Glossary

3D Volume A 3D, 4D, or Fetal STIC image that has been constructed from a series of 2D images. 4D Acquisition An imaging mode in which a stream of 3D volumes are acquired and rendered live.

A Accept ROI In 3D Render, a soft key that turns the Edit ROI feature off and accepts the changes you made to the ROI. Acquire A hard key that starts image and loop acquisition. In 3D Render and Volume Cine, pressing Acquire saves a still image or Cine loop without the volume data set. Acquire 3D Data A soft key in 3D Render, 3D Swivel, and Volume Cine that acquires the 3D volume data set. Acquire Time A soft key in Fetal STIC Preview that enables you to change the time of image acquisition from the default. Acquisition Icon A small open box that appears on the bottom right corner of the display to the right of the transducer frequency and depth when it is possible to acquire an image. Activate body marker during Freeze and Dual A setting on the System tab in the Setup window that enables you to have a body marker automatically appear on the display during Dual Imaging and Freeze. Adaptive Doppler A feature of PW and CW Doppler that reduces the background noise in the spectral trace and in the audio. Adaptive Flow A feature that changes the flow frequency to an optimal frequency for the selected transducer in the selected focal zone.

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Glossary

Adjust In 3D/4D Imaging, an Image Control soft key that enables you to select whether changes to the Image Controls and Render Controls affect the grayscale or the color settings. This soft key selects between the Color Vision setting and the Grayscale Vision setting. Angio Box A box that appears on the image in Color Power Angio mode. The amplitude (intensity) of flow in the angio box is represented with different hues. Angle 1) In 3D/4D imaging, a soft key that adjusts the elevation angle of the 3D volume to be acquired. With mechanical transducers, tells the system how far to go. With Freehand FAN Geometry, tell the system how far the probe will tilt. 2) A control panel knob that positions the angle-to-flow arrow parallel to and in the same direction as the blood flow in PW Doppler. For a linear transducer, controls BW/Color/CPA steering direction. Angle-to-Flow Arrow An arrow that appears on the display in PW or CW Doppler along with the Doppler cursor line. Use the Angle knob to position the angle-to-flow arrow parallel to and in the same direction as the blood flow. Archive In Panoramic Imaging, a soft key that saves the panoramic data set or still image to the patient’s study. The title is saved with the data set. The title, labels, and measurements are saved with the still image. Arrow A soft key available in image annotation that places an arrow on the display. Assign Value A soft key to assign the current measurement value to a labeled measurement of the same type. Audio A soft key that turns Doppler audio on or off. Available only in PW Doppler Preview. Auto Trace A feature that automatically traces a frozen Doppler spectrum and uses the trace to calculate and display the results of Doppler measurements and calculations.

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Glossary

Autotrace Evaluation A setting that determines whether the system should automatically trace spectral data above the baseline, below the baseline, or both. Automatic DICOM Export A feature that automatically exports images over a network when you press Acquire or when you save or close a study. Automatic DICOM Printing A feature that automatically sends images to a DICOM printer when you press Acquire or when you save or close a study. Automatic DICOM Study Deletion A feature that automatically deletes a study as soon as all of its images are exported over a network. Automatic DICOM study deletion is associated with automatic DICOM export. Autotrace Evaluation setting A setting that enables you to specify how much of the waveform is evaluated and used by Doppler Auto Trace and High Q Doppler. Axis Icon In 3D/4D and 3D Fetal Heart STIC, an icon that appears in the bottom left corner of each view and that illustrates the relationship of the view to the X-Y-Z axes as the view is manipulated.

B B/W Suppress 1) A soft key that forces the width and position of the 2D scanning window to match the width and position of the Color, Color Power Angio, or Color Tissue Doppler window. Reducing the size of the window increases the frame rate. 2) A soft key that activates B/ W Suppress functionality. Available only with sector and curved linear array transducers in Color, CPA, and Color Tissue Doppler modes. Back A soft key in 3D/4D Render and Swivel that exits the current mode and returns you to 3D Preview.

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Back to Preview A soft key available during 3D sand Fetal STIC acquisition. Exits acquisition and returns to the appropriate Preview mode. Background Color A setting on the System tab in the Setup window that allows you to choose either a black or gray background color for the display. Backlight Level A setting on the System tab in the Setup window that controls the backlight illumination level for the control panel. Options are Low, Medium, and High. You can also adjust the backlight level by pressing Ctrl+B. Baseline A key used in PW Doppler and CW Doppler that adjusts the spectral baseline position. Beats A soft key available in Physio and Trigger setup. Specifies how often (in number of R-waves) the 2D image is updated. Biopsy Guide A feature that displays guide lines on the display to assist you in performing biopsies. Available only with non-cardiac presets in 2D Mode and when using a transducer that supports biopsy. Biopsy A soft key that activates the Biopsy Guide feature. The Biopsy soft key displays the biopsy setting (Needle or Gun). If the selected transducer supports more than one needle position, a separate soft key (labeled with the transducer name) allows selection of the crossover depth. Available only when you are in 2D Mode and a non-cardiac preset and are using a transducer that supports biopsy. Body Marker 1) A graphic that you can place on the display to indicate the part of the anatomy that you are scanning. When you place the body marker, a transducer icon also appears. 2) A feature that enables you to add body marker graphics to the display. 3) A soft key available when the Body Marker feature is active. It is the far left soft key on the display, and pressing it cycles through the body markers in the selected body marker set.

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Body Marker Set A soft key available when the Body Marker feature is active that enables you to specify the set of body markers (grouped by exam type) from which you want to choose a single marker to display on the display. Alternatively, you can change the body marker set by changing the preset. Border and Prompts On the System tab in the Setup window, a button that opens a new window that allows you to change the information that appears on the top of your display and other settings. Also allows you to enable or disable the system prompts. Box Position A soft key to position the results box on the display. Brightness 1)In 3D/4D imaging, a Render Controls soft key that creates a brighter image as the setting is increased. 2)The monitor Brightness control. You set the monitor brightness on the Setup Window with the Monitor Adjust button. Buffer A temporary memory where images are accumulated for display.

C Calc A control panel hard key that activates the calculation features. Calc Results A soft key to display in the results box all measurements currently on the image, the last measurement you performed, or no measurements. Caliper A control panel key that places a caliper on the display so that you can make measurements. Cancel Acquire A soft key that discontinues the acquisition of a panoramic data set. CD Drive A CD-R/RW drive on the front panel of the system, above the ECG connector.

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Chroma 1) A feature that improves image contrast resolution by replacing the grayscale map with a color map. Choices are Off, Wheat, Beige, Sepia, Candle, Rose, Thallium, Slate, and Rainbow. In M-mode and Doppler Mode, Chroma affects the spectrum when Trace is highlighted on the bottom right corner of the display. It affects the reference image when Image is highlighted. In 3D imaging, the Chroma map applied to the 3D volume can change with the Vision setting. The Chroma map applied to the MPR views will always match the 2D Chroma map and will not change with the Vision setting. 2) A soft key that is used to select a color map to replace the grayscale map. Clear A soft key that erases measurements and annotations. Color 1) An imaging mode in which the velocity and direction of flow are represented with different colors for direction and different shades for velocity. The colors being used appear in the color bar in the upper right corner of the display. 2) A hard key that activates Color mode. Color Box A box that appears on the image in Color Mode. The velocity and direction of flow in the color box are represented with different colors for direction and different shades for velocity. Color Compare A feature that enables you to view two versions of the same live image side by side. One image is displayed in color; the other image is color suppressed. Color Gain A control panel knob that adjusts the intensity of the color in Color mode. Also adjusts angio intensity in CPA mode and Doppler gain in Doppler modes. Color M-mode Working in Color and M-mode at the same time. Color Power Angio (CPA) A real-time, two-dimensional imaging mode that shows the amplitude (intensity) of flow in color overlaying a grayscale image. The colors being used appear in the color bar on the upper right corner of the display.

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Color Power Angio (CPA) Compare A feature that enables you to view two versions of the same live image side by side when working in CPA mode. The image on the right shows angio flow and the image on the left is flow-suppressed. Color Power Angio Gain A control panel knob that adjusts the intensity of the angio in CPA mode. Also adjusts color intensity in Color mode, Doppler gain in Doppler modes, and the spectral trace in Triplex. Color Power Angio Suppress A feature in CPA mode that temporarily removes angio data from a frozen angio image without exiting CPA mode. Color Power Angio Zoom A feature that shows angio flow in a magnified image. Color Suppress A feature in Color mode that temporarily removes color data from a frozen color image without exiting Color mode. Color Zoom A feature that shows color flow in a magnified image. Compress 1) A feature that adjusts the compression of returning echoes, which affects the grayscale display. Increasing Compress softens the image. Decreasing Compress produces a high-contrast image. Not available in Freeze mode. 2) A soft key adjusts image compression. Contrast The monitor Contrast control. You set the monitor contrast on the Setup Window with the Monitor Adjust button. Contrast Harmonic Imaging A type of harmonic imaging that is optimized for imaging with contrast agents. You can use Contrast Harmonic Imaging with any imaging mode and preset. Contrast Icon An icon that appears on the lower left corner of the display and that summarizes information about the fusion settings in Contrast Harmonic Imaging. 498

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Contrast Option Key A hard key that turns Contrast Harmonic Imaging on, enables three rows of soft keys, and cycles through the Contrast fusion recipes. Contrast Timer 1) In Contrast Harmonic Imaging, an on-screen timer measures the time elapsed since the beginning of the delivery of a contrast bolus or infusion. 2) A soft key that displays, starts, stops, and hides the Contrast Timer. Control Panel The main panel on the system that contains the imaging mode controls, a keyboard, a trackball, and other frequently used controls. CPA 1) Color Power Angio. 2) A hard key that activates Color Power Angio mode. Crossover Depth When Biopsy Guide is on, the vertical distance from the center of the transducer face to the intersection of the needle path. CW 1) Continuous-wave Doppler. 2) A hard key that activates continuous-wave Doppler. CW Focus Diamond A diamond shape that lies on the CW reference line. Use the trackball to place the CW focus diamond over the area of interest. CW Reference Line A reference line that appears on the reference image. Use the trackball to place the CW focus diamond on the CW reference line over the area of interest.

D D Time A soft key that moves the Diastolic point left or right. D Velocity A soft key that moves the Diastolic point up or down.

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Date/Time On the System tab in the Setup window, a button that launches a calendar, enabling you to set the correct day and time. Default Position A soft key available when the Body Marker feature is active. Places a body marker that you moved back in its default position on the display. Default Preset A preset that is installed with an imaging application package and that cannot be modified or deleted. Delay A soft key available in Trigger setup. Specifies the number of milliseconds after the last 2D image update to trigger the next one. Delete Preset A soft key that permanently deletes the current preset. You can only delete presets that you created, not default presets. Available after you press Preset. Depth A control panel key that increases or decreases the distance from the face of the transducer to the deepest point in the displayed image. The current imaging depth is displayed on the right side of the display. Depth Marking A setting on the System tab in the Setup window that controls whether and where the depth markings appear. Density 1) A feature that specifies the number of Color or Angio scan angles. 2) A soft key that adjusts density. Use Density in conjunction with Packet. Increasing Density increases resolution and decreases the frame rate. Decreasing Density decreases resolution and increases the frame rate. DICOM 1) Digital Imaging and Communications in Medicine (DICOM), a standard developed by the American College of Radiology and the National Electrical Manufacturers Association (ACR-NEMA) to allow medical images to be exchanged between instruments, computers, and hospitals. It includes a number of image file format options with respect to pixel form and format, palette, compression, and so on. 2) On the System tab in the Setup 500

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window, a button that launches a new window where you can customize the system’s DICOM settings. Display Dialog A soft key available in Physio setup. Hides and displays the Setup window on the display. Display Name A soft key that hides or displays the name of the current preset on the display. Available after you press Preset. Distance Ruler In 3D Render mode, a white bracket with calibration marks that appears on the lateral edge of the active MPR or volume view, if it is from a motorized acquisition. You can turn the ruler on and off by using the Setup window. Doppler Auto Trace Automatically traces a frozen Doppler spectrum over one heart cycle and uses the trace to calculate and display the results of key Doppler measurements and calculations. Doppler Gain A control panel knob that adjusts the brightness of the spectral display in PW Doppler and CW Doppler. Adjusting the Doppler Gain also affects the volume of the audio output. In Triplex, the Doppler Gain knob affects spectral trace when Gate is highlighted on the Select menu. It affects the color or the angio gain when Size or Position is highlighted. Doppler iSCAN Doppler iSCAN Intelligent Optimization. A feature that automatically optimizes key imaging settings during Doppler Trace acquisition. Available only when the system is in PW or CW Doppler mode and the spectral trace is live. Doppler Modes Imaging modes that measure blood flow or tissue motion from detected frequency shifts in returning sound waves. The frequency shifts can be used to produce audio signals, or they can be displayed graphically in a Doppler spectral trace. Doppler modes are often used to detect leaks, regurgitation, stenosis, and flow changes. Doppler Scale Units The units in which the Doppler spectrum is measured.

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Dual 1) A hard key that turns dual imaging on and off. 2) A screen format in 3D/4D Render and 4D and Fetal STIC acquisition in which two images are displayed side by side. 3) On the System tab in the Setup window, a button that launches a window that allows you to set your Dual Imaging buffer to Single Buffer dual or Two Buffer Dual. Dual Imaging A feature that allows you display two images side by side so that you can compare them. You can choose which image is active and which is inactive, or you can freeze both images and choose which one is active so that you can review the frames by using Quick Review. Duplex 1) A feature that enables you to simultaneously display a live 2D image and a PW spectral trace. Only available with transducers that support PW Doppler. 2) A soft key that turns Duplex on and off. When On, forces Doppler iSCAN optimization off. Dynamic Range Also called compression. Controlled with the Compress soft key. Determines the amount of acoustic dynamic range that appears on the screen. As the Compress setting is lowered, the lower intensity signals get mapped to black, making them visually and quantitatively undetectable.

E ECG Gain or Aux Gain A soft key available in Physio setup. Adjusts the display size of the ECG or auxiliary trace. ECG Invert or Aux Invert A soft key available in Physio setup. Inverts the displayed ECG or auxiliary input trace. ECG Position or Aux Position A soft key available in Physio setup. Moves the ECG or auxiliary trace higher or lower on the display. Edit End A Quick Review soft key that repositions the end of a loop being reviewed. Not available in PW Doppler, CW Doppler, or M-mode. Edit ROI 1) A feature that allows you to edit the size and position of the ROI of a 3D volume. 2) A soft key that turns the Edit ROI feature on. To turn Edit ROI off, press Accept ROI. 502

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When Edit ROI is on, the Select menu displays two options: Size and Pan. Size adjusts the size of the ROI. Pan adjusts the position of the image within the ROI. Edit Start A Quick Review soft key that repositions the starting point of a loop being reviewed. Not available in PW Doppler, CW Doppler, or M-mode. Elevation Angle In 3D/4D imaging, the angle through which the transducer will pass in fanned mode. The minimum and maximum values are transducer dependent for automated transducers. Elevation angle can be adjusted with the Angle soft key. Enable Prompts A System Setup setting that controls whether or not system prompts will appear on the bottom left corner of the display. End Acquire A soft key that ends the acquisition of the loop for the current Stress Echocardiography stage. Available only during a multi-cycle acquisition stage when acquisition is paused. Enter A control panel key that is used in conjunction with the trackball to click an item or choose a menu option. Use the trackball to highlight the item or option and press the Enter key. Also used for a variety of other mode and feature-specific functions. Erase Marker A soft key available when the Body Marker feature is active. Removes the body marker from the display and exits Body Markers. Exam Type A category of related presets. Expanded A display format in 3D Render, 4D acquisition, and Volume Cine in which one image is displayed on the left side of the display, and the three other images are displayed on the right side of the display. The expanded image on the left is larger than the other three images. Explain Text A soft key to display a short definition of the current measurement. The Explain Text soft key is only available when you are performing a labeled measurement. HD11 User Reference 4535 611 65311

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F Fetal STIC An imaging application within the 3D/4D application that acquires multiple fetal heart cycles in a single sweep of a motorized transducer. Then it creates a volume Cine loop of the fetal heart through a single composite heart cycle. The fetal heart rate is calculated and displayed for confirmation. If the calculated heart rate is not approved, the STIC loop is discarded and the system returns to Preview. Fetus A, B, C, D A soft key to identify the fetus to which the measurement value applies. Filter 1) A feature that removes extraneous information (audible signals and Doppler displays of frequencies below the selected level and color information due to tissue motion rather than blood flow). In Doppler, Filter is only available when the spectral trace is live. Increasing Filter decreases low-velocity information and noise. Decreasing Filter increases sensitivity to low-velocity information. 2) A soft key that adjusts the Filter setting. 3) A Color mode soft key that removes extraneous color information caused by tissue motion rather than blood flow. Finding Code A predefined diagnostic code based on the assessment and diagnosis of a study. Flash In Contrast Harmonic Imaging, a soft key that, when pressed, momentarily destroys the contrast agent in order to observe reperfusion. Focal Caret A caret that defines a focal zone, an area where the image is most clearly focused. Focal Zone 1) A feature that enables you to add areas where the image is most clearly focused. You can choose up to eight focal zones, depending on the imaging depth and transducer. Not available with sector transducers. Up to four focal zones are available in Trapezoidal Imaging. Using multiple focal zones decreases the frame rate. 2) A soft key that offers up to eight focal zones. Each time you press the Focal Zones soft key, you increase the number of focal zones or the space between them. When you reach the maximum number of focal zones, pressing the Focal Zones soft key gives you one focal zone. In Zoom, pressing the up arrow on the Focal Zones soft key adds focal zones; it does not increase the space between focal zones. 504

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Focus A control panel key that you use to select the area where the image will be most clearly focused. Focus Diamond In CW Doppler mode, a diamond that lies on the CW reference line. Use the trackball to place the CW focus diamond over the area of interest. Foot Switch A switch near the bottom of the system that you operate with your foot. It has three pedals, each one corresponding to a key on the system control panel. The foot switch pedals have different functions in different situations. Format 1) A predefined display layout in 3D/4D Render and 4D and Fetal STIC acquisition. Four formats are available: Single, Dual, Quad, and Expanded. 2) A soft key that allows you to change the screen layout in 3D Render and 4D and Fetal STIC acquisition. In OB presets and the cardiac fetal heart preset, it also activates the Volume view. For all other presets, the view that was active remains active in Full format. Freehand 3D Imaging 3D image acquisition that is performed with standard imaging transducer and that requires the user to move the transducer over the anatomy of interest in either a pivot or dragging motion. Freeze A control panel key that freezes a live image and initiates Quick Review, which allows you to scroll through the frames by using the trackball. Press the Freeze key again to unfreeze an image. Unfreezing an image removes all measurements and calculations from the image. Frequency 1) The transducer frequency used for color or angio data. Frequency is available only for transducers with multiple flow or Doppler frequencies. The Adaptive Freq setting is available if the transducer supports Adaptive Flow. Adaptive Flow changes the flow frequency to an optimal frequency for that transducer for the selected focal zone. 2) A soft key that adjusts the transducer frequency for Color or CPA data. Full A display format in 3D Render and 4D Acquisition in which only one image is displayed on the screen at a time. HD11 User Reference 4535 611 65311

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Fusion A hard key that cycles through the available fusion recipes in 2D mode. In Tissue Harmonic Imaging or Contrast Harmonic Imaging, pressing Fusion turns those modes off and returns the system to 2D imaging. The fusion icon on the lower left corner of the display summarizes information about the fusion setting. Fusion Icon An icon that appears on the lower left corner of the display and that summarizes information about the fusion settings in 2D mode, Tissue Harmonic Imaging, and Contrast Harmonic Imaging. Fusion Recipe A predetermined group of settings that control the transmit and receive frequencies for the transducer. Available in 2D mode, Tissue Harmonic Imaging, and Contrast Harmonic Imaging. Also called fusion settings. Fusion Settings A pre-determined group of settings that control the transmit and receive frequencies for the transducer. Available in 2D, Tissue Harmonic Imaging, and Contrast Harmonic Imaging. Also called fusion recipes.

G Gain A control panel knob that controls the image brightness. Gain Save A Stress Echo feature that saves the settings for each view in the current state and restores them when you acquire the same view in the other stages. Gate A soft key that adjusts the width of the PW sample volume gate. There are 15 gate widths available. Geometry 1) In 3D/4D, a soft key that sets the type of freehand scanning motion you want to use. When scanning with a standard imaging transducer, you can use Geometry to select Fan or Linear. If you are using Fan, use Angle to specify the approximate angle you will tilt the transducer during the acquisition of the 3D data set. If you are using Linear, use Length to specify the approximate distance that you will move the transducer during the acquisition of the 3D data set. 506

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Glass Body A highly transparent grayscale Vision setting used in conjunction with a Color Vision setting. Grayscale Surface A 3D Vision setting in Grayscale render mode that shows the surface of the first tissue structure encountered when projecting an image, such as a baby face in amniotic fluid.

H Height/Weight Units A setting on the System tab in the Setup window that controls whether the height and weight units are displayed in metric or English. Help A hard key that launches the system Help application. Hide ROI A soft key that removes the region of interest (ROI) box from the image. Switches between Hide ROI and Show ROI, which displays the ROI box on the image. High Q Automatic Doppler Analysis An automatic quantification on a live spectral image that analyzes the Doppler spectrum and returns quantitative information on the speed and time duration of the spectrum at various event points. It can perform this analysis over a single heart cycle, or over multiple heart cycles. Available in PW spectral mode. High PRF (HPRF) A system-mediated Doppler mode based on PW Doppler. Pulse repetition frequency (PRF) and the transducer frequency determine the maximum velocity that can be measured using PW Doppler. HPRF extends the system’s ability to accurately measure high velocity at a given depth by establishing additional gates with echoes that coincide with the selected gate echoes. Home 1) The default position on the display for annotations, typically the top left corner. 2) A soft key available during text, label, and arrow annotation that moves the cursor to the default position.

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Hospital Information System (HIS) The institution’s network. Ultrasound systems and other devices are connected to the HIS so that information can be shared between them and stored on servers.

I Image Caption In Image Review, a feature that enables you to add a caption to an image. Image Controls 1) A set of controls that are used to modify a rendered 3D image. 2) A soft key that activates a set of controls used to modify a rendered 3D image. Image Flag In Image Review, a feature that enables you to add a flag to an image. Image flags can be helpful when you want to indicate which images will be used, for example, for a teaching demonstration. Image Invert A feature that enables you to reverse the order of the 2D frames and construct a new 3D image. Image Invert reverses the left/right orientation of the image. Image Review A mode in which you view the images you acquired. You can view frames and loops, delete frames and loops from the patient study, edit loops, and close the study. Image Size A setting on the System tab in the Setup window that controls the size of the image displayed on the display. Settings are Large and Medium. Intelligent Doppler A feature that helps you maintain an optimum cursor angle between the angle-to-flow arrow and the PW cursor line by automatically moving the PW cursor line whenever the angle-to-flow arrow is moved. iSCAN Optimization iSCAN Intelligent Optimization. A feature that allows you to automatically optimize the TGC, Gain, and Compression settings for the current image.

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iSCAN Gain A soft key available in the Setup window. Adjusts the default brightness of 2D iSCAN generated images.

J Job Manager A user interface that shows the status of active DICOM network and print jobs. You can access the Job Manager by pressing Ctrl+J.

K Keyboard The keyboard on the system control panel, which is used for typing information into fields and for typing labels, titles, and Quick Text onto the display. To type a character that appears on the bottom right corner of a keyboard key, press the World key (labeled with a globe) and the keyboard key simultaneously. To type a character that appears on the top right corner of a keyboard key, press the World key, the Shift key, and the keyboard key simultaneously. Keyboard Entry A soft key that enables you to enter a measurement value by using the keyboard.

L L/R Invert 1) A feature that reverses the left/right orientation of the image. If you are in a non-cardiac preset, a small open circle called a transducer orientation dot appears in the upper left corner of a noninverted image. A transducer orientation dot appears on the right of an inverted image. In cardiac presets, the location of the transducer orientation dot is reversed. Available only in live imaging. 2) A soft key that controls the left/right orientation of the image. Label A hard key that brings up a menu of text labels that you can drag and drop onto the display. Left 1) A hard key that makes the image on the left side of the display the active image when in dual imaging. 2) A soft key that is available when both the Body Marker feature and dual imaging are active. It manipulates the body marker on the left-hand image. HD11 User Reference 4535 611 65311

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Length 1) In freehand 3D imaging, a soft key that adjusts the approximate distance you move the transducer when the Linear Geometry soft key is selected. 2)Measurement of a distance between two points. LGC Slide Controls Lateral Gain Control slide controls. They adjust the amplification of a returning 2D signal. Use the left LGC slide control to control the left half of the image area. Use the right LGC slide control to control the right half of the image area. LGC Profile Display A setting on the System tab in the Setup window that controls whether or not a horizontal line, the LGC profile, appears on upper right corner of the display to indicate the LGC setting. Locale On the System tab in the Setup window, a button that opens a window that enables you to change settings, such as language or currency, for your location. Long/Trans A soft key available during image annotation that cycles through the words Long and Trans at the current cursor position on the display. If one of these words already appears in the selected label, the Long/Trans soft key changes that word to the other word (Long or Trans), rather than duplicating the word on the display. Lt/Mid/Rt A soft key available during image annotation that cycles through the words Lt, Mid, and Rt at the current cursor position on the display. But if one of these words already appears in the selected label, the Lt/Mid/Rt soft key changes that word to another word in the list (Lt, Mid, or Rt). LVO Left ventricular opacification.

M Magnify A feature that enables you to incrementally enlarge the entire image, regardless of the area you are interested in. It offers lower image quality but faster results than Zoom because it does not require the same user actions that are required by Zoom. Magnify can be performed on live and frozen images. Turn the Zoom knob to enable Magnify. 510

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Manual Doppler Trace An imaging feature in which you manually trace the Doppler spectrum over one heart cycle. The results of key Doppler measurements and calculations are displayed in the results box. Map 1) The postprocessing grayscale, color, or CPA map. 2) A soft key that allows you to specify the postprocessing grayscale, color, or CPA map, depending upon the active mode. (In 3D/4D rendering modes, the map is controlled with the Vol Map soft key.) Map Invert A soft key that reverses the colors that represent flow direction, switching from the BART (Blue-Away, Red-Toward) format when Map Invert is off to the RABT (Red-Away, Blue-Toward) format when Map Invert is on. Marker A hard key that activates the Body Marker feature and that places a body marker on the display. Max Angle A soft key in 3D Swivel that shows the rightmost angle (vertical axis) or most upward angle (horizontal axis). Mic The system microphone, located on the top left corner of the system monitor. Min Angle A soft key in 3D Swivel that shows the leftmost angle (vertical axis) or most downward angle (horizontal axis). M-mode A grayscale time-motion display with a selectable scroll rate. Sometimes paired with a 2D image, depending upon the display layout. M-mode Format A setting on the Mode tab in the Setup window that selects the screen format used when an M-mode trace is displayed. M-mode Preview The initial system state after entering M-mode. Enables you to position the M-mode reference line before displaying the M-mode trace. HD11 User Reference 4535 611 65311

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M-mode Reference Line A reference line that appears on the reference image in M-mode. Information about the movement along the M-mode reference line appears in the M-mode trace. M-mode Trace Displays information about the movement along the M-mode reference line. M-mode Zoom 1) In M-mode, the ability to magnify a portion of the reference image. In M-mode Zoom, the M-mode trace represents only the information in the zoom box. 2) A control panel knob that allows you to control M-mode Zoom. Mmode A control panel key that activates M-mode imaging. MOD Magneto-optical disk. MOD Drive Magneto-optical disk drive, included in you HD11 system if you purchased the DICOM Media option. The MOD is reusable media that you can use to manually transfer studies to a PACS system (if your network is down). Modality Performed Procedure Step (MPPS) A DICOM server setting that enables your system to send notification that the patient procedure has been performed to the hospital information system (HIS). Modality Worklist A list of scheduled patients. You can choose a patient from the list, which appears in the Patient Selection window. Available only if your system is connected to the hospital information system (HIS). After you select a patient from the list, the Patient Identification window opens, populated with the patient's demographic information. Monitor The color video monitor included with the system. You can adjust the monitor’s brightness and contrast to best suit your environment. You can also raise, lower, and swivel the control panel and monitor to make using the HD11 system as comfortable as possible. Monitor Adjust On the System tab in the Setup window, a button that launches a display that explains how to adjust the monitor brightness and contrast for the current lighting conditions. 512

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Motorized 3D Imaging 3D image acquisition that is performed with a motorized transducer and that requires the user to hold the transducer still, perpendicular to the anatomy of interest. MPPS Modality Performed Procedure Step. A feature associated with Modality Worklist. If you specify an MPPS server, your system notifies the hospital information system when a patient study is complete. The list of scheduled patients and patient billing information can then be updated. MPR Multiplanar Reformatted view image. MPR Chroma In 3D/4D Imaging, in Grayscale render mode, an Image Controls soft key that enables you to change the chroma setting for the MPR views. MPR Graphics A soft key available in 3D Render and 4D and Fetal STIC acquisition that allows you to change the navigational crosshairs on the MPR view. Settings include the default partial view to a full crosshair view or off completely. The navigational crosshairs display the orientation of the MPR view in relation to the volume view. MRN Medical record number. A unique alphanumeric identifier assigned to a specific patient. Multi-Cycle Acquisition In a Stress Echocardiography exam, a stage in which up to 200 loops (one per heart cycle) are continuously acquired and saved to the study, allowing you to continuously acquire loops for all views in a particular stage. Multiplanar Reformatted (MPR) View A view of a slice through a volume. The three MPR views show mutually perpendicular slices and the point where the three views cross is the center point of the cross hairs. You control which slices are shown by moving the crosshairs.

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N Name Format On the System tab in the Setup window, a button that opens a window that allows you to change the format for displaying the patient name on the top border of the display and in the patient report. Needle Length A text display when Biopsy Guide is on. It indicates the distance from the top of the needle guide to the needle length crosshair, which indicates the final location of the needle. Needle Length Crosshair A crosshair that appears on the display when Biopsy Guide is on. It indicates the presumed final location of the biopsy needle point. It can be moved with the trackball when Needle is selected on the Select menu. Next A hard key in the center of the soft key panel that activates a different level of soft keys for the active imaging mode.

O Opacity in 3D/4D imaging, a Render Controls soft key that controls the opacity map used to generate the volume projection. The opacity map varies the transparency as a function of signal amplitude or velocity. On/Off The hard key that turns the system on and off. Optical Disk A magneto optical disk, or optical disk, is a medium density, medium cost storage device. MODs are available in several densities (1x, 2x, 4x, 8x, 12x) where 1x is equivalent to 325 MB per side. Optimum Cursor Angle Allows selection of the preferred angle that the system should try to maintain between the PW cursor line and the angle-to-flow arrow when a linear transducer is selected and the PW Steer control is set to Auto. Selections are: 0°, 50°, 55°, 60°, or 65°.

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Option Keys Hard keys, labeled Option 1 and Option 2, that you can assign to certain applications before using the applications for the first time. Output Power The output power is displayed on the display. The output power is made up of the power index (MI, TIS, TIC, or TIB) followed by the power level (displayed numerically).

P Packet A soft key available in Color and CPA modes that specifies the flow packet size, which determines the number of times each color or angio scan angle is interrogated. Increasing Packet increases color or angio sensitivity and decreases the frame rate. Decreasing Packet decreases color or angio sensitivity and increases the frame rate. PACS Picture archiving and communication system. A server that stores DICOM-compliant data. Panoramic Data Set In Panoramic Imaging, the series of 2D images that is compiled to show a larger area of anatomy. Panoramic Imaging A 2D imaging feature in which you acquire a series of images, called the panoramic data set, that are compiled to show a larger area of anatomy. Panoramic Preview The initial mode in Panoramic Imaging. You optimize and acquire the panoramic data set in this mode. Panoramic Render In Panoramic Imaging, the post-acquisition mode that displays the rendered panoramic image. You can manipulate the rendered image in this mode. Patient A hard key that opens the Patient Identification window or, if you are connected to the Hospital Information System (HIS), the Patient Selection window.

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Patient Folder The location where all the studies for one patient are stored. Patient Identification A window that opens when you press the Patient key, and into which you enter patient information before starting a study. If your system is connected to Modality Worklist, then the Patient Selection window opens instead. Patient Selection A window that opens when you press the Patient key, if your system is connected to Modality Worklist. You choose the patient from the list before starting the study. Patient Study A compilation of demographic information, images, quantitative values, and a summary of findings for a specific patient. Patient Temp A soft key that enables you to enter the patient’s temperature. Patient Temp is only available when a TEE transducer is selected. Pause Protocol A soft key available in Stress Echocardiography that enables you to temporarily leave the Stress Echo protocol so that you can acquire additional loops or frames outside it. When a protocol is paused, the soft key label changes to Unpause Protocol. Press it to resume the protocol. Penetration A fusion setting that is used to achieve image information at deeper depths. The Penetration setting can be helpful in scanning patients with larger body habitus. Persist 1) A feature that averages consecutive frames to provide a smoother appearance with less noise. Use lower persistence values for fast moving organs or tissues and higher persistence values for slower moving organs or tissues. Not available in triggered mode imaging. 2) A soft key that allows you to choose the Persist value to provide a smoother image with less noise. Physio Panel The panel, located on the front left side of the HD11 system, where you connect physios to the system.

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Play/Resume/Stop Soft keys in 3D Swivel. Reads Play if the Frameset must be calculated from scratch and starts the swivel at the min angle. Reads Resume if renderings in the current Frameset can be reused and starts from the angle current when Stop was pressed. Stop stops the swivel at the current angle. Play Direction A soft key in 3D Swivel that determines whether the playing swivel angle sequences one way or two way. One way steps from the min angle, in positive step size increments to the max angle. Two way, the default, steps back and forth through the angle range. Pointer A hard key that enables you to place arrows on the display. Power In Contrast Harmonic Imaging, a soft key that allows you to fine tune the transmit power relative to the maximum power of an individual system for a specific contrast agent. Provides a finer control of power than what is shown for the MI. Preset A group of settings that optimizes the system for a specific type of exam. Presets establish many initial settings, such as gain value, color map, filter, and items on the Label and Measurement menus. Preset Menu A menu that is displayed when you press Preset and from which you select the preset you want. The active exam type is displayed at the top of the menu; the presets that belong to that exam type are listed underneath. Preview The initial mode after you activate 3D, 4D, and Fetal STIC applications. Enables you to manipulate and optimize the live 2D image before acquiring the 3D data set. Preview ROI In 3D/4D imaging, the region of interest that you can optimize in Preview mode, before beginning image acquisition. Printer A peripheral device that prints images.

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Priority A soft key that you use to give priority to color data over grayscale data. Turn Priority on when imaging small vessels and trickle flow. Turn Priority off to eliminate color that is bleeding over vessel walls, but only when the lumen of the vessel is clearly seen in grayscale. Probe A hard key that you press to choose one of the transducers connected to the system. Probe Size A soft key that is available when the Body Marker feature is active. Changes the size and shape of the transducer icon. Choices are: Large T, Small T, Arrow, Small Crosshair. PW 1) Pulsed Wave Doppler. 2) A hard key that activates PW Doppler mode. PW Sample Volume Gate The area in which the velocity is measured in PW Doppler. The information is displayed in the PW spectral trace.

Q Quad In 3D Render and 4D and Fetal STIC acquisition, a screen layout with four images on it, the three MPR images and the rendered 3D image. Quad-Cycle Acquisition In a Stress Echocardiography exam, an acquisition stage in which four consecutive loops (one per heart cycle) are acquired and saved to the study. Quick Calc Calculations that are computed based on one unlabeled measurement primitive and are then displayed in the results box with their unlabeled primitives. Quick Calcs are nonspecific, have no anatomic labeling, and are not averaged. Quick Review A feature that allows you to interrupt live imaging and scroll through a loop, scroll through a trace, or to play back a loop.

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Quick Review Icon In Quick Review, an icon that illustrates the start and end points of the loop as well as how far through the loop you have scrolled. Quick Text A feature that enables you to type a text label on the display at any time. Simply position the cursor with the four keyboard arrow keys and start typing.

R Re-Acquire In Panoramic Render, a soft key that returns the system to Panoramic Preview mode so you can begin the acquisition of a new panoramic data set. Reactivate The term used to view and edit an acquired image in Acquired Image Review. Rec 1, 2, 3 The label on the three Record keys. Record Key One of three hard keys that you can configure to control a peripheral, such as a printer or VCR. Redo In Sculpt/Erase, a soft key that switches between Redo and Undo. Undo cancels the last image manipulation. You can cancel up to the last 16 image manipulations by repeatedly pressing Undo. Redo restores the last manipulation canceled by Undo. Reject A soft key in Doppler modes that is used to darken background noise in the spectrum. Increase Reject for strong Doppler signals; decrease Reject for weak signals. Render Controls In 3D Render, a soft key that activates a sublevel of soft keys that enable you to modify the individual settings that make up a Vision setting. Render Mode 1) In 3D/4D imaging, one of three settings that determine which information to display in the rendered 3D volume. Grayscale shows only grayscale with no color. Color shows only color vessels with no grayscale. Color/Gray shows grayscale and color vessels. HD11 User Reference 4535 611 65311

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Color can be Color Velocity or CPA (Angio), depending on which was selected prior to acquisition. Within each render mode, several Vision settings are available to choose from. 2) A soft key that enables you to change the render mode. Replay A Quick Review and Volume Cine soft key that starts the play back of a loop and that changes the playback speed. The selected playback speed appears on the soft key label. Not available in PW Doppler, CW Doppler, or M-mode. Report A hard key that opens and closes the report window. Report Work Area The area that appears to the right of the patient report. It includes several tabs that allow you to edit information that appears in the report. Reported Calculations Calculations that are not available in the Analysis menu but that are included in the patient report. Reset 1) A soft key that restores a 3D, a 4D, or a Panoramic image to its original state. In 3D Render with Edit ROI on, the 3D volume is returned to its original, post-acquisition state. If Edit ROI is off, the volume is returned to its last saved Edit ROI state. 2) In 3D Render, an Image Controls soft key that restores all Render Controls and Image Controls soft key settings to their original values for the selected Vision setting. 3) In Sculpt/Erase, a soft key that eliminates all sculptures and erasures, restoring the original volume contents. Resize A soft key that changes the z-scale of freehand acquisitions. The scale can be resized from 0 to 100. Resolution 1) In 3D/4D imaging, a setting that trades off the time it takes to acquire a volume against the detail present in the volume. The values are: High, Med, and Low. 2) A soft key that allows you to change the resolution setting in 3D imaging. Review A hard key that launches the image review feature.

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Right 1) A hard key that makes the image on the right side of the display the active image when in dual imaging. 2) A soft key that is available when both the Body Marker feature and Dual Imaging are active. It manipulates the body marker on the right-hand image. Right/Left/Mid/Main A soft key to specify the part of the anatomy being measured. The values depend on the selected measurement or calculation. ROI Region of Interest. ROI Box 1) In Panoramic Imaging, a rectangular Region of Interest box that appears on an image. The area in the ROI box is the portion of the image that is acquired. The area in the ROI box is the portion of the image that is acquired. 2) In 3D/4D Preview modes, a four-sided ROI that is annular except when using freehand acquisitions with linear probes, when it is rectangular. Rotate In 3D and 4D, a soft key that spins the image clockwise in 90-degree increments. Rotate Probe A soft key available when the Body Marker feature is active that rotates the transducer icon. You can also rotate the transducer icon with the Angle knob.

S S Time A soft key to move the Systolic point left or right. S Velocity A soft key to move the Systolic point up or down. S1 Time A soft key to move the Systolic1 point left or right. S1 Velocity A soft key to move the Systolic1 point up or down.

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Save Preset A soft key that you use to create a new preset or make changes to a preset that you created. Save to CD In Panoramic Imaging, a soft key that saves the displayed image as a .bmp file to CD. Scale A key used in CPA, Color, CW Doppler and PW Doppler modes that changes the pulse repetition frequency (PRF). Adjust the Scale setting to display velocities and frequencies. Scan Direction In Panoramic Imaging, a soft key that specifies the direction the transducer will move during the acquisition of the data set: L to R (left to right) or R to L (right to left). Scrolling Trace A setting on the Mode tab on the Setup window that allows selection of the scrolling style of Doppler spectral refresh instead of the erase bar style. SCP Service Class Provider. A server on a network. Sculpt/Erase In 3D Render and 4D Volume Cine, a soft key that enables you to remove unwanted data from the 3D volume. Security On the System tab in the Setup window, a button that provides access to the system security settings, which you can configure. You can password protect access to certain system features and establish automatic logoff behavior. Select A hard key that changes the active function of the trackball. The possible functions of the trackball for the current mode, transducer, and preset are listed on the bottom right corner of the display on the Select menu. The active trackball function is highlighted. Select Menu A list of functions that can be assigned to the trackball on the bottom right corner of the display. The possible functions in the menu depend upon the current mode, transducer, and preset. The active trackball function is highlighted. You can change the active function by pressing the Select key. 522

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Select ECG or Select Aux A soft key available in Physio setup. Changes the Gain, the Position, and the Invert soft keys from ECG to Aux. Selection Bracket A four-cornered white bracket placed around the active view, which indicates that the view can be manipulated with the system controls. Set Home A soft key available during image annotation that makes the current cursor position the default position. Setup 1) A feature that allows you to customize your system settings. 2) A hard key that activates the Setup feature and opens the Setup window. Setup Window A tabbed window that allows you to change system settings and settings for modes, applications, options, peripherals, and so on. Show ROI A soft key that displays the region of interest (ROI) box on the image. Switches between Show ROI and Hide ROI, which removes the ROI box from the image. Single Buffer A system setting that allocates the number of memory buffers in which to store image frames. In live 2D imaging, Single Buffer stores images in one buffer. When Dual mode is activated, the single buffer is reduced in size and another buffer is added for the second image. See also Two Buffer. Single-Cycle Acquisition In a Stress Echocardiography exam, a stage in which one loop is acquired and saved to the study. Skeletal A 3D Vision setting in Grayscale render mode that shows the brightest structures in the grayscale image. Smooth 1) A soft key in 2D and 3D/4D modes that allows you to sharpen or soften an image. In 2D mode, Smooth is available for black-and-white images. In 3D/4D Preview modes, HD11 User Reference 4535 611 65311

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affecting the 2D image and in 3D Render modes for the volume. 2) In Doppler modes, a soft key that allows you to change the appearance of the Doppler spectrum. Soft Key Level Indicator A vertical set of circles centered on the bottom of the display. The circles indicate how many soft key levels are available and which level is active. The number of circles indicates the number of available soft key levels, up to three. When only one soft key level is available, no indicator appears. The solid circle indicates the active soft key level. For Soft Key sublevels in green, the circles are replaced by green double up arrows. Soft Key Panel The angled panel located below the system monitor that contains round buttons and soft key controls. The functions of the soft keys change depending on the mode, the application, the preset, and the transducer. The function of each soft key is described above the soft key on the bottom of the display. To use a soft key, press the up or the down arrow on the key to choose or change the selection that appears above the key on the display. Soft Key Sublevel In 3D/4D and Fetal Echo Imaging, an additional set of soft keys that are available for some features (for example, Swivel and Sculpt/Erase). A (>>) on the soft key label indicates that a sublevel will become available when the soft key for that feature is pressed. Sublevel soft key labels are green, as are the soft key level indicators. Soft Keys The keys above the system control panel and below the monitor. The functions of the soft keys change depending on the mode, the application, the preset, and the transducer. The function of each soft key is described above the soft key on the bottom of the display. To use a soft key, press the up or the down arrow on the key to choose or change the selection that appears above the key on the display. SonoCT Imaging SonoCT Real-time Compound Imaging reduces speckle and improves image smoothness, enhances contrast resolution, and improves contrast and definition of tissues interfaces. It takes successive frames at different steering angles and blends them together. Speed A soft key in 3D Swivel that specifies the frame rate of the 3D volume swiveling. Speed choices are Slow and Normal.

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Spectral Format A setting on the Mode tab on the Setup window that allows selection of the screen format used in PW or CW Doppler Spectral modes. Spectral Invert A soft key that inverts the spectral display so that positive values (representing blood movement toward the transducer) are shown beneath the Doppler baseline and negative values (representing blood movement away from the transducer) are shown above. Spectral Invert also swaps the stereo audio channels. Spectral Invert is available only when the spectral trace is live. Stage A soft key available in Stress Echocardiography protocols that advances to the next stage while you are acquiring loops. Available only after you have acquired at least one loop per view in the current stage. Not available if you have acquired any loops in the next stage. Stage-View Label In Stress Echocardiography, the stage-view label lists the name of the current stage and view on the display. Steer A soft key available in PW Doppler that specifies the PW cursor line angle for linear transducers. When Left or Right is selected, the PW sample gate position is restricted to a subset of the full image area determined by the PW cursor line angle. When Center is selected, the PW cursor line runs vertically through the Doppler gate. When Auto is selected, Intelligent Doppler is on. This automatically moves the PW cursor line, whenever the angle-to-flow arrow is moved, to maintain an optimum cursor angle between the angle-to-flow arrow and the direction of the PW cursor line. Step Size A soft key in 3D Swivel that offers 3 step sizes (1°, 3°, and 6°) with both left-right rotation and up-down rotation Stop/Play A soft key in 3D Swivel that stops and starts the swiveling of the 3D volume. If you pause swirling, the soft key is labeled with Resume as long as the images are reusable. Storage Bin A compartment on the system in which you can store extra bottles of gel or other materials. HD11 User Reference 4535 611 65311

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Stress Echocardiography A protocol-driven exam that allows a cardiologist to assess cardiac wall motion at various heart rates by acquiring views of the heart at different stages of the exam. A Stress Echo study consists of two to eight stages during which loops are acquired for up to eight anatomical views. Each loop is a sequence of frames captured at systole starting at the R-wave. Surface A 3D Vision setting in both Color and Color Only Render Modes that is opaque, showing the surface of a vessel and hiding what is behind it. A 3D Vision setting in Grayscale Render mode that shows the first surface encountered by a projection and hides what is behind it. Sweep 1) A soft key that controls the travel speed of the scrolling trace. Only available when the trace is live. 2) A soft key available in Physio and Trigger setup. Controls the travel speed of the ECG or the auxiliary trace. Swivel In 3D Render and 4D Volume Cine, a soft key that enables you to gyrate the 3D volume around the x-axis or y-axis. The images produced can be stored as a cine loop or still image. Synchronization Mode In Image Review, when you are playing back more than one loop simultaneously, you can specify the synchronization mode, that is, whether and how the loops are synchronized when they are played back. System Handle A part on the front of the system control panel, allowing you to move the system and adjust the monitor system.

T TDI Tissue Doppler Imaging. Text A hard key that enables you to type text labels on the display.

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Texture A fusion setting that is used to achieve image information at average depths. The Texture setting optimizes the tissue texture at these depths. TGC Time Gain Control. On the HD11 system, you adjust TCC using the TCG slide controls on the system control panel. TGC Profile Display A setting on the System tab in the Setup window that controls whether or not a vertical line, the TGC profile, appears on the upper right corner of the display to indicate the TGC setting. TEE Temperature Units A setting on the System tab in the Setup window that controls whether the TEE temperature is displayed in Celsius or Fahrenheit. Thermal Index A setting on the System tab in the Setup window that controls the way the output power is measured and displayed. THI 1) Tissue Harmonic Imaging. 2) A hard key that enables Tissue Harmonic imaging and changes the Tissue Harmonics recipe setting. Threshold A 3D Vision setting that removes the weakest pixels from the image. Accessible in the Render Controls soft key sublevel. Thumbnails In Image Review, the presentation of the images in a grid format, called Thumbnails. Timer A soft key available in Stress Echocardiography protocols that starts the timer. If the timer is running, pressing Timer hides the timer. Elapsed time is maintained while the timer is hidden. Title In Panoramic Imaging, a soft key that enables you to add a title to image. Title is only available after you press Label.

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Tissue Doppler Imaging An imaging mode that optimizes settings to measure the movement of tissue, rather than blood, using color or pulsed-wave Doppler. Tissue Harmonic Imaging A 2D imaging mode in which the transducer receives at twice the transmit frequency. Tissue Harmonic Imaging clears clutter from the image and can be helpful when imaging areas that are filled with fluid, such as the gallbladder or heart chambers. Trace A control panel key. In CW Doppler Preview or PW Doppler Preview, it displays the CW or the PW spectral trace, respectively. Otherwise, it displays the PW spectral trace. When a Doppler spectral trace is displayed, press Trace to choose whether the spectral trace or the image is live. The soft keys change depending on which element is live, and they affect the element that is live. Trackball The possible functions of the trackball for the current mode, transducer, and preset are listed on the Select menu on the bottom right corner of the display. The active trackball function is highlighted. To change the active trackball function, press the Select key. Transducer Connector Panel The panel on the front of the system that contains the transducer connectors, into which you plug the transducers. Transducer and Gel Holders The molded containers on either side of the control panel that hold the transducers and bottles of gel while they are not in use. Transducer Orientation Dot A dot that appears at the upper left corner of a noninverted image. Translucent A 3D Color Vision setting in both Color and Color Gray Render Modes that displays vessels with sufficient transparency to see their inner flow streams. A highly transparent “glass body” grayscale Vision setting is used with this Color Vision setting. Transparency A 3D Vision setting that creates a more transparent image, allowing you to view far field structures behind near field structures. Accessible by the Render Controls soft key sublevel. 528

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Trap A hard key that a turns Trapezoidal Imaging on or off. Trapezoidal Imaging An imaging feature that adds additional imaging area by changing a linear transducer's rectangular image to a trapezoidal shape. The extended field of view is often useful in vascular and small parts presets. Turned on and off with the Trap soft key. Available in the Vascular and General Imaging application packages with most linear transducers. Triplex 1) A feature that enables you to simultaneously display a live 2D image with color or angio and a PW Doppler trace. 2) A soft key that turns Triplex on and off. Two Buffer A system setting that allocates the number of memory buffers in which to store image frames. In Two Buffer mode, two buffers are allocated, a Right buffer and a Left buffer. You can work with two different images at once, without having to be in dual imaging. You view these images in full screen and use the Left and Right hard keys to switch between the images. To view these two images side by side, you must turn on Dual imaging. See also Single Buffer.

U U/D Invert A soft key that reverses the up/down orientation of the image. A small open circle called a transducer orientation dot appears at the top of a noninverted image. An orientation dot appears on the bottom of an inverted image. Available only in live imaging. Not available with linear or TEE transducers. Undo A Sculpt/Erase soft key that switches between Redo and Undo. Undo cancels the last image sculpting or erasure. You can cancel up to the last 16 image manipulations by repeatedly pressing Undo. Redo restores the last manipulation canceled by Undo. Unpause Protocol In Stress Echocardiography, a soft key that returns to the Stress Echo protocol after you acquired additional loops or frames outside of the protocol. Update 1) A control panel key used in Doppler modes. If Doppler is off or PW Preview is on when Update is pressed, the system enters PW Spectral Doppler mode with Doppler HD11 User Reference 4535 611 65311

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2D Live off. If CW Preview is on when Update is pressed, the system enters CW Spectral Doppler mode with Doppler 2D Live off. If the system is in PW Spectral or CW Spectral mode when Update is pressed, Doppler 2D Live is switched between off and on. 2) A soft key available in Doppler modes that you use to specify how often (in 500-ms increments from 500 to 7000 ms) the reference image is updated. Available only when no ECG trace appears on the display and the spectral trace is live. Not available in Duplex or Triplex or with a nonimaging transducer. If you do not want the reference image to be updated, press Update and choose the 2D Hold On setting. 3) A soft key available in Trigger setup. Sets the time interval (in milliseconds) between image updates when Trigger is set to Timer. User-Defined Calculation You can create your own calculations when you are in an OB/GYN preset. You can add those calculations to the Calculations menu for OB/GYN presets.

V View 1) A soft key available 3D Render, 4D Acquisition, and Volume Cine. Selects the viewpoint for the image display in the rendered 3D image. The View direction can be any of the following: Front, Back, Right, Left, Top, or Bottom. 2) A soft key available in Stress Echocardiography. Specifies the view you plan to acquire next. View All A soft key available when the Body Marker feature is active. Opens the Body Markers dialog box that organizes the body markers by exam type. You can choose the body marker that you want from the dialog box. View Icon In Stress Echocardiography, a rectangular view icon appears on the upper right corner of the display that indicates how many views have been acquired for the current stage. The rectangle contains four or eight squares, one for each possible view. Vision 1) In 3D/4D imaging, a set of predefined values for the selected Render Mode. Vision settings control the aesthetics, or “look,” of the data set. The available Vision settings depend upon the selected Render Mode. You can change the default Vision settings and save them as a preset. 2) In 3D/4D imaging, a soft key that allows you to select a Vision setting.

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Vol Chroma In 3D/4D Imaging, in Grayscale render mode, an Image Controls soft key that enables you to change the chroma setting for the rendered 3D image. Vol Map 1) The postprocessing grayscale, color, or CPA map in 3D/4D imaging. The map applied to the rendered 3D image can change with the Vision setting. The map applied to the MPR views will always match the 2D map and will not change with the Vision setting. 2) A soft key that allows you to specify the postprocessing grayscale, color, or CPA map in 3D/ 4D imaging. Volume 1) A control panel knob that controls the sound level in audio applications. 2) A 3D image that has been rendered from 2D images. 3) A view that shows the rendered 3D image. Volume Cine In 4D and Fetal STIC, a feature that enables you to play back acquired volumes as loops. You can scroll through a set of volumes to choose one to manipulate.

W Waveform A soft key to display or hide an outline of the maximum and mean of a PW spectral trace. The Waveform soft key is only available when the spectral trace is frozen. The High Q Doppler settings determine whether the peak trace, the mean trace, or both are displayed. Without High Q Doppler, both traces are displayed. Wheel Controls Locking devices on the front two system wheels that allow you to lock the wheels in place, limit them to moving front and back, or to release them so they swivel and move in any direction. Wheels The HD11 system is mounted on four swivel wheels for ease of portability. World keys On the system keyboard, two World keys are labeled with a globe. They appear on either side of the spacebar. Use a World key to type the characters that appear on the right side of some keys on the keyboard. HD11 User Reference 4535 611 65311

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X X A knob on the system control panel that enables you to rotate a 3D volume around the x-axis. This knob is also used to adjust Volume and Power in other imaging modes. XRES Adaptive Image Processing A feature that enhances images without altering the image resolution. Improves contrast resolution, reduces artifacts, improves visibility of tissue texture patterns, and improves border definition and continuity. XRES A soft key that turns XRES Adaptive Image Processing on and off.

Y Y A knob on the system control panel that enables you to rotate a 3D volume around the y-axis. This knob is also used to adjust the Gain in other imaging modes.

Z Z A knob on the system control panel that enables you to rotate a 3D volume around the z-axis. This knob is also used to adjust the Angle in other imaging modes. Zoom 1) A feature that enlarges a selected portion of a live image. The zoomed area has high resolution because the patient anatomy is re-examined, not simply enlarged. 2) A knob that controls Zoom and Magnify functionality. Pressing the control once displays the acoustic zoom preview box. Pressing the control twice activates acoustic zoom. Rotating the control activates video zoom. Zoom Box A box that appears on the image when you press the Zoom knob. The area in the zoom box is magnified the second time you press the Zoom knob.

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Index Numbers 1-point depth or velocity measurements, 299 2D mode, 153 imaging tips, 239 physio cardiac calculations, 380 Quick Calculations, 305 soft keys, 155 2-point measurement, 300 3D Fetal Echo STIC, 176, 203 3D mode, 176 acoustic artifacts, 177 acquiring a freehand data set, 180 acquiring a motorized data set, 181 changing orientation of volume, 188 changing view direction of volume, 189 data sets, 176 editing volumes, 192 freehand, 178 Image Controls soft keys, 195 image review, 183 motorized imaging, 178 Render, 183 Render display, 184 Render soft keys, 184 review fetal echo images in volume cine, 202 saving cine loop, 191 soft keys, 182 swiveling volume, 190 working in preview modes, 180 3D/4D mode activating, 179 control functionality, 179 display layouts, 185 Render Mode options, 196

settings, 128 vision settings, 197 zooming and magnifying images, 194 4D mode, 199 acquiring images, 200 review images in volume cine, 201 saving cine loop, 202 soft keys, 200

A Abdomen calculations, 369 measurements, 349 Accessories, 26 Acoustic output tables, 23 Acquiring, 151 4D images, 200 fetal echo images, 203 freehand 3D data set, 180 images outside of stress echo protocol, 264 loops for a multi-cycle acquisition stage, 264 motorized 3D data set, 181 Acquisition settings, 126 specifying preferences, 126 Stress Echo methods, 258 Activating body markers, 109 Adaptive Doppler, 111, 163 Aliased signals, unwrapping, 250 Aliased spectrum, unwrapping in PW Doppler, 244 Analysis, 279 Annotation, 271 moving or deleting, 273 HD11 User Reference 4535 611 65311

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Index

Application-package options, 99 Approving measurements, 296 Artifacts 3D imaging, 177 about ECG, 258 Contrast Harmonic Imaging, 214 minimizing ECG, 259 reducing, 244, 247 Attaching ECG leads, 140 Autotrace evaluation, changing, 112

B Background color, changing, 108 Backing up presets and settings, 131 Backlight Level, 103 Beginning an exam, 150 Biopsy moving needle length crosshair, 209 Biopsy Guide, 207 Body markers, 275 activating, 109 activating during freeze and dual, 103 choosing, 275 moving, 276 placing on display, 275 soft keys, 277 using in dual imaging, 278 Boxes, resizing and repositioning, 171 Breast calculations, 375 measurements, 356

C Cables, 140 Calculations, 298 abdomen, 369 accuracy, 281 breast, 375 534

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by exam type, 368 cardiac, 380 creating user-defined by using a formula, 121 customizing menu, 119 deleting user-defined, 124 gynecology, 389 hip angle, 380 obstetric, 386 performing, 121, 299 PISA, 286 prostate, 371 superficial, 378 testicular, 376 thyroid, 374 vascular, 391 volume methods, 284 Calipers, 296 specifying line type, 116 Cancelling DICOM print jobs, 88 Cardiac calculations, 380 Doppler Quick Calculations, 306 measurements, 316 CD drive, 44 CD, user information, 23 CDs backing up presets and settings, 131 browsing contents, 63 erasing, 64 loading and ejecting, 63 restoring presets and settings, 132 choosing an option on the display, 54 CIVCO, 26 clicking an item on the display, 54 Closing patient studies, 401 Color Compare, 172 Color M-mode, 159 Color mode, 170 artifacts, 177

Index

compare, 172 imaging tips, 248 improving filling, 249, 252 troubleshooting, 248 using Color Compare, 172 using color suppress, 172 Color Power Angio mode, 173 artifacts, 177 imaging tips, 251 soft keys, 175 suppress, 174 using Compare, 175 Comments, 425 Compare Color Power Angio mode, 175 images from two studies, 415 Configuring foot switch, 134 Connecting ECG cables and attaching leads, 140 Contrast agent, improving visibility, 212 Contrast Harmonic Imaging, 210 acoustic artifacts, 214 principles, 214 settings, 212 soft keys, 211 Control panel, 43 positioning, 52 control panel, using, 54 Conventions user information, 24 CPA. See Color Power Angio mode Cursor tracking, controlling, 114 Customer comments, 25 Customizing your system, 95 CW Doppler mode, 167 imaging tips, 245 increasing sensitivity, 246 troubleshooting, 245 viewing audible signals, 246

D Data sets acquiring Panoramic, 223 saving Panoramic, 228 Date, setting, 52 Deleting images, 407 labels or arrows, 273 measurements, 298 patient folders, 404 patient studies, 404 presets, 98 user-defined calculations, 124 Demographics, editing patient, 400 Depth markings, 104 Diagnostic applications for system, 37 DICOM assigning servers, 71 cancelling print jobs, 88 changing printer settings, 86 changing the image export format, 76 entering settings, 68 features, 67 Networking option, 99 setting up automatic export, 74 setting up automatic printing, 83 Disks backing up presets and settings, 131 specifying disk full strategy, 128 Display placing arrows on, 273 placing body markers on, 275 placing labels on, 271 removing preset names from, 98 resizing and repositioning images, 152 Doppler Auto Trace, 289 changing Autotrace evaluation setting, 112 defaulting to, 116 HD11 User Reference 4535 611 65311

535

Index

multi-cycle, 291 soft keys, 291 Doppler mode alignment, 281 cardiac calculations, 380 changing settings, 110, 163 CW, 167 iSCAN Intelligent Optimization, 164 nonimaging, 164 performing manual trace measurements, 292 physio cardiac calculations, 380 Quick Calculations, 308 setting trigger type, 142 soft keys, 160 Tissue, 169 turning Intelligent Doppler on or off, 163 using PW, 161 Drivers, installing peripheral software, 135 Dual Imaging, 215 indicators, 217 selecting type, 106 using body markers, 278 using Quick Review, 219 Duplex, 165 soft keys, 166 Dynamic range, decreasing, 213

E ECG artifacts description, 258 minimizing, 259 ECG cables and leads, 140 Echoes, reducing, 242 Ejecting CDs and MODs, 63 Ellipse measurements, 301 Enter key, 54 Erasing CDs and MODs, 64 536

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Exam beginning, 150 performing basic, 145 Exam type calculations, 368 labeled measurements, 316 presets and, 96 Exporting, 427 images from patient studies in PC format, 436 images in PC format, 434 patient studies, 430 setting up automatic DICOM, 74

F Fetal echo acquiring images, 203 soft keys, 204 Fetal growth graphs, selecting, 125 Fetal heart rate, 205 Fetal weight options, setting, 125 Finding codes, 421 Finding help topics, 31 Foot switch, configuring, 134 Formatting MODs, 64 Formulas report, 426 sources of measurement error, 281 Frame rate increasing, 250 increasing in Color Mode, 253 Freehand 3D, 178 acquiring 3D data set, 180 imaging technique, 178 Fusion icons, 154 settings, 154

Index

G Gain adjusting, 213 default iSCAN, 221 Graphs, 425 Gynecology calculations, 389 measurements, 365

H Height/Weight Units, 103 Help, 23, 29 Help viewer, 30 High Pulse Repetition Frequency (HPRF) Doppler, 163 High Q feature, 293 changing Autotrace Evaluation settings, 290 changing setting, 117 Hip angle calculations, 380 performing measurements, 313

I Icons fusion, 154 Search for Study window, 431 transducer, 275 View, 262 Image acquisition modes, 38 Image Review, 405 3D, 183 adding an image to a report, 419 adding captions or flags to images, 407 controlling loop playback, 415 deleting an image, 407 editing loops, 416 Panoramic, 224

playing back loops, 414 viewing full-screen loops or frames, 412 Images acquiring, 151 acquiring 4D, 200 acquiring fetal echo, 203 acquiring outside of stress echo protocol, 264 adding a caption or flag, 407 adding to reports, 419 changing size, 108 comparing, 415 deleting, 407 exporting in PC format, 434 making measurements on 2D MPR, 188 printing, 408 reducing contrast or grain, 241 specifying selection, 411 updating 2D reference in CW Doppler, 247 updating 2D reference in PW Doppler, 245 Imaging features, 207 Imaging modes, 149 Imaging tips, 239 2D mode, 239 Color Mode, 248 Color Power Angio, 251 CW Doppler, 245 M-mode, 242 PW Doppler, 243 Importing, 427 IMT measurements, performing trace, 315 Increasing frame rate, 253 Indicators, Dual Imaging, 217 Input method editor, 139 Installing options, 101 peripheral software drivers, 135 Intelligent Doppler, turning on or off, 163 HD11 User Reference 4535 611 65311

537

Index

Interpretations, 421 iSCAN Intelligent Optimization, 220 live 2D and, 220

J Japanese characters, 138

K keyboard shortcuts, 55

L Labeled measurements, 311 by exam type, 316 performing, 311 soft keys, 312 Labels, 271 changing, 272 changing settings, 115 deleting, 273 modifying, 272 moving, 273 placing on display, 271 placing on Panoramic images, 228 Stage-View, 262 typing a label, 272 using soft keys, 274 Language input, 137 changing, 137 Leads, 140 LGC Profile Display, 104 Limb deficit artifacts, 177 Live 3D. See 4D mode Live imaging, printing in, 151 Loading and ejecting CDs and MODs, 63 Loops acquiring, 151 acquiring for a multi-cycle acquisition stage, 264 538

HD11 User Reference 4535 611 65311

acquiring for a single-cycle or quad-cycle acquisition stage, 263 editing, 416 playing back in Image Review, 414 playing back Quick Review, 230 playing back Stress Echo, 269 selecting preferred Stress Echo, 267 setting acquisition preferences, 126 setting duration, 127 setting length, 127 viewing full-screen, 412 Low-velocity signals displaying, 247 displaying in PW Doppler, 245

M Magnify, 235 Magnifying images in 3D/4D, 194 live and frozen images, 236 Panoramic images, 226 rendered 3D images, 194 Measurements, 295 1-point depth or velocity, 299 2D MPR images, 188 2-point, 300 abdominal, 349 accuracy, 281 approving, 296 assigning values, 313 breast, 356 cardiac meta-measurements, 325 customizing menu, 119 deleting, 298 displaying values, 297 ellipse, 301 gynecology, 365 labeled, 311 manipulating in a report, 420

Index

manual Doppler trace, 292 Method of Disk, 303 musculoskeletal, 368 pediatric hip, 361 performing hip angle, 313 performing IMT linear, 315 performing IMT trace, 315 performing on Panoramic images, 226 performing protocol, 312 PISA, 286 primitives, 283 prostate, 352 protocol, 312 reactivating, 297 sources of errors, 281 specifying circumference method, 115 specifying the caliper connection, 116 superficial, 359 testicular, 357 thyroid, 354 trace, 302 unlabeled, 299 vascular, 326 measurements meta-measurements, 325 Method of Disks measurements, 117, 303 M-mode, 156 cardiac calculations, 380 changing format settings, 110 color, 159 format, 158 imaging tips, 242 increasing size in M-mode trace, 243 physio cardiac calculations, 380 Quick Calculations, 305 reducing noise in M-mode trace, 242 soft keys, 158 trace scrolling, 158 turning reference line on or off, 114 using Zoom, 237

MOD drive, 44 Modality worklist, 89 changing settings, 92 setting up, 91 Mode settings, changing, 109 Modem, connecting, 58 MODs browsing contents, 63 erasing, 65 formatting, 64 loading and ejecting, 63 settings, 129 Monitor, video, 43 Motion artifacts, 177 Motorized 3D data set, acquiring, 181 Moving 2D reference line in Stress Echo, 265 arrows, 273 body markers, 276 labels, 273 reference lines, 152 transducer icons, 276 Moving the system, 60 MPR images, 188 views, 188 Multi-cycle Doppler Auto Trace, 291 Musculoskeletal measurements, 368

N Name representation, 138 Needle, moving crosshair, 209 Noise reducing in M-mode trace, 242 reducing in the spectrum, 247 Nonimaging Doppler, 164

HD11 User Reference 4535 611 65311

539

Index

O OB/GYN creating user-defined calculations by table, 122 creating using-defined calculations by formula, 121 Obstetric calculations, 386 changing settings, 121 measurements, 362 trending graphs, 425 OmniPlane transducer adapter, 58 On/Off button, 42, 51 On-Board Diagnostics option, 99 Opening Help, 29 Option keys assigning, 102 Options 3D/4D Render Mode, 196 clinical, 39 imaging and connectivity, 40 installing, 101 packages, 99 Output tables, acoustic, 23

P Panoramic accuracy of images, 222 acquiring a data set, 223 Image Review, 224 imaging, 222 magnifying images, 226 moving images around the display, 225 performing measurements on images, 226 placing a title above an image, 227 placing labels on images, 228 Render soft keys, 225 540

HD11 User Reference 4535 611 65311

saving images, 228 Patient folders deleting, 404 editing demographics, 400 searching for, 403 viewing previous studies, 405 Patient studies, 399 beginning an exam, 150 closing, 401 creating, 399 deleting, 404 exporting, 430 restarting, 401 saving, 400 searching for, 402 viewing previous, 405 Pediatric hip measurements, 361 Performing 1-point depth or velocity measurements, 299 2-point measurements, 300 basic exam, 145 calculations, 299 ellipse measurements, 301 labeled measurements, 311 Method of Disks (MOD) measurements, 117 Method of Disks measurements, 303 protocol measurements, 312 Stress Echo studies, 261 trace measurements, 302 wall motion scoring, 269 Physio changing settings, 141 panel, 46 Quick Calculations, 306 settings, 139 soft keys, 141 PISA measurements and calculations, 286 Postprocessing map, specifying, 213

Index

Presets, 95 application-package options, 99 backing up to a disk, 131 backing up to CD, 131 creating, 97 creating Stress Echo, 256 deleting, 98 modifying, 97 modifying Stress Echo, 257 removing name from display, 98 restoring, 132 selecting, 96 using soft keys, 98 Preview modes, 180 Printers changing DICOM printer settings, 86 types of, 46 Printing cancelling DICOM print jobs, 88 Help topics, 34 reports, 419 setting up automatic DICOM, 83 Prostate calculations, 371 measurements, 352 Protocol measurements, 312 Pseudoclefting and pseudonarrowing artifacts, 178 Pulsatility index, 287 PW Doppler mode, 160 imaging tips, 243 increasing sensitivity, 243 troubleshooting, 243 turning Adaptive Doppler on or off, 111 viewing audible signals, 244 PW sample volume gate, repositioning, 162

Q Quick Calcs, 304 choosing, 117 Quick Guide, 23 Quick Review, 229 playing back a loop, 230 soft keys, 230 using in Dual Imaging, 219 Quick Text, 271

R Reactivating measurements, 297 Record keys, assigning, 133 Reference line moving, 152 moving in Stress Echo, 265 Render Mode, changing, 196 Reports, 416 adding comments, 425 adding finding codes, 421 adding images, 419 adding interpretations, 421 formulas, 426 manipulating measurements in, 420 printing, 419 viewing versions, 418 Repositioning and resizing images, 152 Resistivity index, 287 Resizing Help panes, 31 Resizing images, 152 Restarting a patient study, 401 Restoring presets and settings, 132 Resuming a Stress Echo study, 266 ROI editing, 187 using in Stress Echo, 265 Rotating arrows, 273 HD11 User Reference 4535 611 65311

541

Index

transducer icon, 277

S Saving patient studies, 400 Screen pixel resolution, 281 Scrolling controlling spectral trace, 169 spectral trace, 168 Searching for patient folders, 403 for studies, 402 Select key, 54 Sensitivity increasing CW Doppler, 246 increasing PW Doppler, 243 Servers, assigning DICOM, 71 Settings 3D/4D, 128 3D/4D vision, 197 Acquisition, 126 backing up, 131 CDs, 129 changing Autotrace Evaluation, 112 changing default Tissue Doppler, 113 Contrast Harmonic Imaging, 212 DICOM printer, 86 Doppler, 163 entering DICOM, 68 fetal weight options, 125 fusion, 154 High Q, 117 loop duration, 127 modality worklist, 92 peripherals, 129 physio, 141 restoring, 132 stress, 139 system, 105 542

HD11 User Reference 4535 611 65311

triggering, 143 Signals displaying low-velocity, 247 displaying low-velocity in PW Doppler, 245 viewing audible CW Doppler, 246 viewing audible PW Doppler, 244 Single Buffer, 216 Size, increasing in M-mode trace, 243 Slice, 188 soft key levels, 53 soft key sublevel, 54, 183 Soft keys 2D, 155 3D, 182 3D Image Controls, 195 3D Render, 184 4D, 200 Annotation, 274 Body Marker, 277 Color Power Angio, 175 Contrast Harmonic Imaging, 211 Doppler Auto Trace, 291 Doppler freeze, 161 Doppler Preview, 160 Doppler Spectral, 160 Duplex, 166 Fetal Echo, 204 Labeled Measurement, 312 M-mode, 158 Physio, 141 Preset, 98 preset, 98 Quick Review, 230 Stress Echo, 262 Swivel, 192 Triggering, 144 Triplex, 167 using, 53 Soft tissue, increasing visibility of, 241

Index

SonoCT icon, 231 SonoCT imaging modes, 232 SonoCT Real-time Compound Imaging, 231 special characters, 55 Spectral M-mode trace scrolling, 111 Spectral trace, 169 about scrolling, 168 changing the format, 112 controlling the scrolling, 169 Spectrum unwrapping aliased, 250 unwrapping aliased in PW Doppler, 244 Sphygmomanometer errors, 281 Stage-View label, 262 Stopping a Stress Echo study, 266 Stress Echo, 255 acquiring images outside the protocol, 264 acquisition, 261 acquisition methods, 258 creating a preset, 256 modifying a preset, 257 moving the 2D reference line, 265 option, 99 performing studies, 261 playing back loops, 269 protocols, 257 relabeling views, 268 review, 267 setup, 256 soft keys, 262 stopping and resuming a study, 266 using a VCR during a study, 260 using soft keys, 262 using the ROI box, 265 using the timer, 260 viewing loops for a view, 268 Studies comparing images from two, 415

creating new, 399 creating patient, 399 deleting, 404 performing Stress Echo, 261 restarting, 401 saving, 400 searching for, 402 setting up automatic deletion, 80 stopping and resuming Stress Echo, 266 using a VCR during Stress Echo, 260 using the timer during Stress Echo, 260 viewing previous, 405 Superficial calculations, 378 measurements, 359 Supplies, 26 Suppress Color, 172 Color Power Angio, 174 Sweep speed, 281 Swivel soft keys, 192 System changing system-wide settings, 102 moving, 60 preparing, 51 System settings backing up, 131 changing, 105 time and date, 52

T Tables, acoustic output, 23 TEE temperature units, 103 Testicular calculations, 376 measurements, 357 TGC profile display, 104 Thermal Index, 104 Thyroid HD11 User Reference 4535 611 65311

543

Index

calculations, 374 measurements, 354 Time and time zone, setting, 52 Timers during stress echo studies, 260 Tissue Doppler, 169 changing default settings, 113 Tissue Harmonic Imaging, 232 using, 233 Titles, placing above Panoramic image, 227 Trace performing measurements, 117, 302 reducing noise in M-mode, 242 scrolling of spectral, 169 trackball function, 54 Transducers by type, 47 connecting, 56 connector panel, 44 moving icons, 276 removing, 57 rotating icons, 277 specifying icon shape, 277 using OmniPlane Adapter, 58 Trapezoidal Imaging, 233 Trending graphs, 425 Triggering, 142 changing settings, 143 setting type in Doppler modes, 142 soft keys, 144 using in Contrast Harmonic Imaging, 214 Triplex, 165 soft keys, 167 Troubleshooting, 239 2D mode, 239 Color Mode, 248 Color Power Angio, 251 CW Doppler, 245 M-mode, 242 PW Doppler, 243 544

HD11 User Reference 4535 611 65311

Turning system on and off, 51 Two Buffer, 216

U Unlabeled measurements, 299 Unwrapping aliased signals, 250 Unwrapping aliased spectrum in PW Doppler, 244 Updating 2D reference image in CW Doppler, 247 Updating 2D reference image in PW Doppler, 245 Upgrades, system, 25 User-defined calculations creating by formula, 121 creating by table, 122 deleting, 124 editing, 123

V Values, assigning measurement, 313 Vascular calculations, 391 measurements, 326 VCRs model numbers, 46 options, 99 recalibrating an image in playback, 65 using during Stress Echo studies, 260 Velocity, end-diastolic vs. minimum, 287 Video monitor, 43 positioning, 52 View icon, 262 Viewing frames, 412 full-screen loops, 412 previous studies for current patient, 405

Index

report versions, 418 Vision settings 3D/4D, 197 changing, 198 Volume calculations, 286 changing the orientation of 3D, 188 changing view direction of 3D, 189 editing 3D, 192 swiveling 3D, 190

W Wall motion scoring, 269 Wheels, 61 World keys, 55

X XRES Adaptive Image Processing, 234

Z Zoom, 235 M-mode, 237 using Color and Color Power Angio, 236 using during live imaging, 235 Zooming images in 3D/4D, 194 live images, 194

HD11 User Reference 4535 611 65311

545

Index

546

HD11 User Reference 4535 611 65311