Sonosite Edge User Manual

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USER GUIDE

Manufacturer FUJIFILM SonoSite, Inc.

21919 30th Drive SE Bothell, WA 98021 USA T: 1-888-482-9449 or 1-425-951-1200 F: 1-425-951-1201

EC Authorized Representative

FUJIFILM SonoSite B.V.

Joop Geesinkweg 140 1114 AB Amsterdam, The Netherlands

Australia Sponsor FUJIFILM SonoSite Australasia Pty Ltd

Suite 9, 13a Narabang Way Belrose, New South Wales 2085 Australia

Caution:

Edge, SiteLink, SonoCalc, SonoHD2, SonoMB, SonoMBe, SonoSite, and the SonoSite logo are registered and unregistered trademarks of FUJIFILM SonoSite, Inc. in various jurisdictions.

DICOM is a registered trademark of the National Electrical Manufacturers Association. All other trademarks are the property of their respective owners. Patents: US 8,439,840; US 8,398,408; US 8,355,554; US 8,216, 146; US 8,213,467; US 8,147,408; US 8,137,278; US 8,088,071; US

8,066,642; US 8,052,606; US 7,819,807; US 7,804,970; US 7,740,586; US 7,686,766; US 7,604,596; US 7,591,786; US 7,588,541; US 7,534,211; US 7,449,640; US 7,169,108; US 6,962,566; US 6,648,826; US 6,575,908 ; US 6,569,101; US 6,471,651; US 6,416,475; US 6,383,139; US 6,364,839; US 6,203,498; US 6,135,961; US 5,893,363; US 5,817,024; US 5,782,769; US 5,722,412; AU: 730822; AU: 727381; CA: 2,372,152; CA: 2,371,711; CN 98108973.9; CN: 98106133.8; CN:97 113678.5; DE: 69831698.3; DE: 69830539.6; DE:

69730563.5; DE: 602004027882.3; DE: 60200402 3816.3; DE: 60034 670.6; DE: 60029 777.2; EP: 15898 78; EP: 1552792; E P: 1180971; EP: 0875203; EP: 0815793; EP 1180970; EP 0881492; ES: 2229318; ES: 159878; ES: 1552792; ES: 0881492; FR: 158978; FR: 155279 2; FR: 1180970; FR: 0881492; FR: 0875203; FR:0815793; GB: 158978; GB: 1552792; GB: 1 180 971; GB: 1180970; GB: 0881492; GB: 0875203; GB: 0815793; IT: 1589878; IT: 1552792; IT: 0881492; IT: 0815793; JP: 4696150; KR: 532359; KR: 528102; NO: 326814; NO: 326202 and pending.

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



0086

Contents

Introduction

Conventions, symbols, and terms ..............................................................................ix

Customer comments .........................................................................................................ix

Chapter 1: Getting Started

About the system ................................................................................................................1

Preparing the system ........................................................................................................1

Installing or removing the battery .....................................................................1

Using AC power and charging the battery ..................................................2

Turning the system on or off ...............................................................................3

Connecting transducers ..........................................................................................3

Inserting and removing USB storage devices ............................................4

System controls ....................................................................................................................6

Screen layout .........................................................................................................................8

General interaction ..............................................................................................................9

Touchpad and cursor ................................................................................................9

On-screen controls ....................................................................................................9

Annotation and text ...............................................................................................10

Preparing transducers ....................................................................................................11

Training videos ...................................................................................................................12

Intended uses ......................................................................................................................13

Chapter 2: System Setup

Displaying the setup pages .........................................................................................15

Restoring default settings .............................................................................................15

A & B Key, Footswitch setup ......................................................................................15

Administration setup .......................................................................................................15

Security settings ......................................................................................................16

User setup ...................................................................................................................16

Exporting or importing user accounts ..........................................................17

Exporting and clearing the Event log ...........................................................17

Logging in as user ...................................................................................................18

Choosing a secure password ............................................................................18

Annotations setup .............................................................................................................18

Audio, Battery setup .......................................................................................................19

Cardiac Calculations setup ..........................................................................................19

Connectivity setup ...........................................................................................................19

Date and Time setup .......................................................................................................20

Display Information setup .............................................................................................20

IMT Calculations setup ...................................................................................................20

Network Status setup .....................................................................................................20

iii

OB Calculations setup .....................................................................................................20

OB Custom Measurements setup ............................................................................21

OB Custom Tables setup ..............................................................................................21

Presets setup .......................................................................................................................22

System Information setup ............................................................................................22

USB Devices setup ...........................................................................................................22

Limitations of JPEG format .................................................................................23

eFilm Lite image-viewer ......................................................................................23

Chapter 3: Imaging

Imaging modes ...................................................................................................................25

2D imaging ..................................................................................................................25

M Mode imaging ......................................................................................................26

CPD and color Doppler imaging ......................................................................27

PW and CW Doppler imaging ...........................................................................28

Adjusting depth and gain ..............................................................................................30

Freezing, viewing frames, and zooming ...............................................................30

Needle visualization .........................................................................................................31

About MBe ..................................................................................................................31

Needle size and angle ...........................................................................................32

MBe subcontrols ......................................................................................................32

Additional recommendations .............................................................................33

Imaging modes and exams available by transducer ......................................33

Annotating images ............................................................................................................35

Patient information form ................................................................................................36

Images and clips .................................................................................................................38

Saving images and clips .......................................................................................38

Reviewing patient exams ..................................................................................39

Printing, exporting, and deleting images and clips ...............................40

ECG Monitoring ..................................................................................................................41

Chapter 4: Measurements and Calculations

Measurements ....................................................................................................................43

Working with calipers ............................................................................................43

2D measurements ..................................................................................................44

M Mode measurements .......................................................................................45

Doppler measurements .......................................................................................45

General calculations .........................................................................................................47

Calculations menu ...................................................................................................47

Performing and saving measurements in calculations ........................47

Displaying, repeating, and deleting

saved measurements in calculations ............................................................48

EMED calculations ...................................................................................................48

Percent reduction calculations .........................................................................48

Volume calculations ................................................................................................50

Volume flow calculations .....................................................................................51

Exam-based calculations ...............................................................................................53

Cardiac calculations ................................................................................................53

Gynecology (Gyn) calculations ......................................................................62

IMT calculations ........................................................................................................62

OB calculations .........................................................................................................65

Small Parts calculations ........................................................................................68

Transcranial Doppler and Orbital calculations ..........................................69

Vascular calculations ..............................................................................................71

Patient report ......................................................................................................................72

Vascular and cardiac patient reports .............................................................72

TCD patient report ..................................................................................................73

OB patient report ....................................................................................................73

EMED and MSK worksheets .............................................................................73

Chapter 5: Measurement References

Measurement accuracy .................................................................................................75

Sources of measurement errors ...............................................................................76

Measurement publications and terminology ......................................................77

Cardiac references ..................................................................................................77

Obstetrical references ..........................................................................................82

Gestational age tables ..........................................................................................83

Growth analysis tables .........................................................................................84

Ratio calculations .....................................................................................................86

General references .................................................................................................86

Chapter 6: Troubleshooting and Maintenance

Troubleshooting .................................................................................................................89

Software licensing ............................................................................................................90

Maintenance ........................................................................................................................90

Cleaning and disinfecting ..............................................................................................91

Cleaning and disinfecting the ultrasound system ..................................92

Cleaning and disinfecting transducers .........................................................92

Cleaning and disinfecting the battery .........................................................94

Cleaning the footswitch .......................................................................................94

Cleaning and disinfecting ECG cables ..........................................................94

Chapter 7: Safety

Ergonomic safety ..............................................................................................................95

Position the system ................................................................................................96

Position yourself .......................................................................................................96

Take breaks, exercise, and vary activities .................................................97

Electrical safety ..................................................................................................................97

Electrical safety classification ............................................................................99

Equipment safety ...........................................................................................................100

Battery safety ...................................................................................................................100

Clinical safety ....................................................................................................................102

Hazardous materials .....................................................................................................103

Electromagnetic compatibility .................................................................................103

Electrostatic discharge .......................................................................................104

Separation distance .............................................................................................106

Compatible accessories and peripherals ..................................................107

Guidance and manufacturer’s declaration ...............................................109

Labeling symbols ............................................................................................................113

Specifications ....................................................................................................................117

Dimensions ...............................................................................................................117

Environmental limits ............................................................................................117

Electrical specifications ......................................................................................118

Battery specifications .........................................................................................118

Standards ............................................................................................................................118

Electrical safety standards ...............................................................................118

EMC standards classification ...........................................................................119

Acoustic standards ...............................................................................................119

Biocompatibility standards ...............................................................................119

Airborne equipment standards .....................................................................120

DICOM standard ....................................................................................................120

HIPAA standard .....................................................................................................120

Chapter 8: Acoustic Output

ALARA principle ..............................................................................................................121

Applying the ALARA principle .......................................................................121

Direct controls ........................................................................................................122

Indirect controls .....................................................................................................122

Receiver controls ..................................................................................................122

Acoustic artifacts .............................................................................................................122

Guidelines for reducing MI and TI ..........................................................................123

Output display .................................................................................................................125

MI and TI output display accuracy ...............................................................126

Factors that contribute to display uncertainty ......................................127

Related guidance documents ........................................................................127

Transducer surface temperature rise ..................................................................128

Acoustic output measurement ................................................................................128

In Situ, derated, and water value intensities .........................................129

Tissue models and equipment survey ......................................................130

Acoustic output tables .................................................................................................131

Terms used in the acoustic output tables ...............................................170

Acoustic measurement precision and uncertainty .............................171

Glossary

Terms ....................................................................................................................................173

Abbreviations ...................................................................................................................175

Index ..................................................................................................................................185

vii

viii

Introduction

Edge Ultrasound System User Guide provides information on preparing and using the Edge ultrasound system and on cleaning and disinfecting the system and transducers. It also provides references for calculations, system specifications, and safety and acoustic output information.

The user guide is intended for a reader familiar with ultrasound techniques and who has received training in sonography and clinical practices. Before using the system, you must receive such training.

See the applicable FUJIFILM SonoSite accessory user guide for information on using accessories and peripherals. See the manufacturer’s instructions for specific information about peripherals.

Conventions, symbols, and terms

The user guide follows these conventions:

•A WARNING describes precautions necessary to prevent injury or loss of life.

•A Caution describes precautions necessary to protect the products.

• Numbered steps in procedures must be performed in order.

• Items in bulleted lists do not require performance in sequence.

• Single-step procedures begin with

Symbols and terms used on the system and transducer are explained in Chapter 1, Chapter 6,

Chapter 7, and Glossary.

.

Customer comments

Questions and comments are encouraged. FUJIFILM SonoSite is interested in your feedback regarding the system and the user guide. Please call FUJIFILM SonoSite at 888-482-9449 in the U.S. Outside the U.S., call the nearest FUJIFILM SonoSite representative.

For technical support, please contact FUJIFILM SonoSite as follows:

FUJIFILM SonoSite Technical Support

Phone (U.S. or Canada):

Phone (Outside U.S. and Canada):

Fax: 425-951-6700

E-mail: service@sonosite.com

Web site: www.sonosite.com

Europe Service Center:

877-657-8118

425-951-1330 Or call your local representative.

Main: +31 20 751 2020 English support:

+44 14 6234 1151 French support:

+33 1 8288 0702 German support:

+49 69 8088 4030 Italian support:

+39 02 9475 3655 Spanish support:

+34 91 123 8451

Asia Service Center:

+65 6380-5589

x Customer comments

Chapter 1: Getting Started

23 4

About the system

The Edge ultrasound system is a portable, software-controlled device using all-digital architecture. The system has multiple configurations and feature sets used to acquire and display high-resolution, real-time ultrasound images. Features available on your system depend on system configuration, transducer, and exam type.

A license key is required to activate the software. See “Software licensing” on page 90. On occasion, a software upgrade may be required. FUJIFILM SonoSite provides a USB device containing the software. One USB device can be used to upgrade multiple systems.

Figure 2 System Back Connectors: (1) DC input connector, (2) Battery, (3) I/O connector, and (4) ECG connector

Basic operating steps

1 Attach a transducer.

2 Turn the system on. (For power switch location,

see “System controls” on page 6.)

Getting Started

Figure 1 System Front Features: (1) Control panel, (2) AC power indicator, (3) Display, (4) USB ports, (5) Handle

3 Press the

information form.

4 Press an imaging mode key: 2

DOPPLER.

PATIENT key, and complete the patient

D, MMODE, COLOR,

Preparing the system

Installing or removing the battery

WARNING:

To avoid injury to the operator and to prevent damage to the ultrasound system, inspect the battery for leaks prior to installing.

To avoid data loss and to conduct a safe system shutdown, always keep a battery in the system.

See also “Battery safety” on page 100.

Chapter 1: Getting Started 1

To install the battery

1 Disconnect the power supply from the

ultrasound system.

To remove the battery

1 Disconnect the power supply from the

ultrasound system.

2 Remove the system from the mini-dock (if

present) and turn it upside down.

3 Place the battery into the battery compartment,

at a slight angle. See Figure 3.

4 Slide the battery forward until it locks into place.

5 Slide the two locking levers outward to secure

the battery.

2 Remove the system from the mini-dock

(if present) and turn it upside down.

3 Pull up the two locking levers.

4 Slide the battery back.

5 Lift the battery from the compartment.

Using AC power and charging the battery

Caution:

The battery charges when the system is connected to the AC power supply. A fully discharged battery recharges in less than five hours.

The system can run on AC power and charge the battery if AC power is connected to the system directly, to a mini-dock, or to a docking system.

The system can run on battery power for up to two hours, depending on the imaging mode and the display brightness. When running on battery power, the system may not restart if the battery is low. To continue, connect the system to AC power.

When using AC power, position the system to allow easy access to disconnect it.

WARNING:

Figure 3 Install the Battery

Caution:

2 Preparing the system

The equipment shall be connected to a center-tapped single phase supply circuit when users in the United States connect the equipment to a 240V supply system.

Verify that the hospital supply voltage corresponds to the power supply voltage range. See

“Electrical specifications” on

page 118.

To operate the system using AC power

1 Connect the DC power cable from the power

supply to the connector on the system. See

Figure 2 on page 1.

Push the cable in firmly to ensure a secure attachment.

2 Connect the AC power cord to the power supply

and to a hospital-grade electrical outlet.

To separate the system (and any connected equipment) from a supply mains

Note: Disconnecting only the DC power cable from the system or dock does not separate the system from the supply mains.

 Disconnect the AC power cord from the power

supply or (alternatively, if using a stand) from the AC adapter on the stand base.

Turning the system on or off

Caution:

Do not use the system if an error message appears on the display. Note the error code and turn off the system. Call FUJIFILM SonoSite or your local representative.

Connecting transducers

WARNING:

Caution:

To connect a transducer

1 Remove the system from the mini-dock

(if present), and turn it upside down.

2 Pull the transducer latch up, and rotate it

clockwise.

3 Align the transducer connector with the

connector on the bottom of the system.

4 Insert the transducer connector into the system

connector.

5 Turn the latch counterclockwise.

6 Press the latch down, securing the transducer

connector to the system.

To avoid injury to the patient, do not place the connector on the patient. Operate the ultrasound system in a docking system or on a flat hard surface to allow air flow past the connector.

To avoid damaging the transducer connector, do not allow foreign material in the connector.

Getting Started

To turn the system on or off

 Press the power switch. (See “System

controls” on page 6.)

To wake up the system

To conserve battery life while the system is on, the system goes into sleep mode if the lid is closed or if the system is untouched for a preset time. To adjust the time for sleep delay, see “Audio, Battery

setup” on page 19.

 Press a key, touch the touchpad, or open the lid.

Chapter 1: Getting Started 3

Inserting and removing USB storage devices

You can use a USB storage device to import and export various logs and setup configurations and to archive images and clips.

Images and clips are saved to internal storage and are organized in a sortable patient list. You can archive the images and clips from the ultrasound system to a PC using a USB storage device or Ethernet connection. Although the images and clips cannot be viewed from a USB storage device on the ultrasound system, you can remove the device and view them on your PC.

There are two USB ports on the system, and one on the mini-dock. For additional USB ports, you can connect a USB hub into any USB port.

Note:

The system does not support

password-protected

sure that the USB storage device you use does not have

password protection enabled. See also

“Troubleshooting”

USB storage devices. Make

on page 89.

WARNING:

Figure 4 Connect the Transducer

To remove a transducer

1 Pull the transducer latch up, and rotate it

clockwise.

2 Pull the transducer connector away from the

system.

4 Preparing the system

Caution:

To avoid damaging the USB storage device and losing patient data from it, observe the following:

• Do not remove the USB storage device or turn off the ultrasound system while the system is exporting.

• Do not bump or otherwise apply pressure to the USB storage device while it is in a USB port on the ultrasound system. The connector could break.

If the USB icon does not appear in the system status area on-screen, the USB storage device may be defective or password-protected. Turn the system off and replace the device.

To insert a USB storage device

 Insert the USB storage device into any USB port

on the system or mini-dock. See Figure 1 on page 1.

The USB storage device is ready when the USB icon appears.

To view information about the device, see

“USB Devices setup” on page 22.

To remove a USB storage device

Removing the USB storage device while the system is exporting to it may cause the exported files to be corrupted or incomplete.

1 Wait five seconds after the USB animation stops.

2 Remove the USB storage device from the port.

Getting Started

Chapter 1: Getting Started 5

System controls

109

1 Control keys Adjust on-screen controls.

2 Alphanumeric keys Enters text and numbers.

3 Annotation keys See “Alphanumeric keyboard” on page 10.

4 Gain

NEAR Adjusts the gain applied to the near field of the image.

FAR In live imaging, adjusts the gain applied to the far field of the image.

On a frozen PW Doppler image, adjusts the angle.

GAIN In live imaging, adjusts the overall gain applied to the entire image.

On a frozen image, moves the cine buffer.

5 AUTO GAIN Adjusts gain automatically.

DEPTH UP,

Decreases and increases imaging depth.

DEPTH DOWN

7 ZOOM Magnifies the image 100%.

6 System controls

8SET

CALIPER

Sets a trace measurement. Displays calipers on-screen for measuring.

9 CALCS Turns the calculations menu on and off.

10 Touchpad Selects, adjusts, and moves items on-screen.

11 FREEZE Stops live imaging and displays a frozen image.

12 SAVE Saves an image to internal storage. If configured, also saves calculations

to the report. See “Presets setup” on page 22.

13 SAVE CALC

CLIP

A & B shortcut keys Keys that you can program to perform common tasks.

Imaging Modes

Saves calculations and their measurements to the patient report. Saves a clip to internal storage.

M MODE Turns M Mode on, toggles between M-line and M Mode trace.

DOPPLER Turns Doppler on, toggles between D-line and Doppler trace.

COLOR Turns CPD/Color on and off.

2D Turns 2D on.

16 UPDATE Toggles between dual and duplex screens and imaging modes in

M Mode and Doppler (for example, between D-line and Doppler spectral trace).

17 SELECT Used with the touchpad to select items on-screen. Also switches

between Color and Doppler controls, calipers for measurement, pictograph-marker position and angle, frozen images in duplex and dual screens, and arrow position and orientation.

Forms

Getting Started

PATIENT Accesses patient information.

EXAM Opens exam menu.

REVIEW Accesses the patient list, saved images, and archiving functions.

REPORT Accesses the patient report and EMED worksheets.

19 Power switch Turns system on and off.

Chapter 1: Getting Started 7

Screen layout

1 Mode Data Area Current imaging mode information (for example, Gen, Res, THI,

and PW).

2 Orientation Marker Indication for image orientation. In dual and duplex images, the

orientation marker is green on the active screen.

3 Text Text entered using keyboard.

4 Pictograph Pictograph to indicate anatomy and transducer position. You can select

anatomy and screen location.

5 Calculations Menu Contains available measurements.

6 Image Ultrasound image.

7 Measurement and

Current data on measurements and calculations.

Calculations Data Area

8 On-screen Controls Controls available in the current context.

9 Patient Header Header details such as current patient name, ID number, user, and

date/time. Specified on the display information setup page.

10 System Status Information on system status (for example, exam type, transducer,

AC connected, battery charging, and USB).

11 Depth Marker Marks in .5 cm, 1 cm, and 5 cm increments depending on depth.

8 Screen layout

General interaction

Touchpad and cursor

Caution:

Use the touchpad to adjust and move objects on-screen. The touchpad controls caliper position, CPD or Color box position and size, the cursor, and more. The arrow keys control much of the same functionality as the touchpad.

The cursor appears in the setup pages, the patient information form, and patient report. You control the cursor through the touchpad. For example, in the patient information form, place the cursor over the last name field and press the activate that field. Additionally, you can use the cursor to select check boxes and items in lists.

Make sure to keep the touchpad dry while in use. Moisture on the touchpad can cause the cursor to respond erratically.

SELECT key to

On-Off Turns a feature on or off. You can press either key. In forms, you can instead select the control by using the touchpad and the

Action Performs an action. You can press either key. Or you can instead select the control by using the touchpad and the

Figure 5 On-screen controls (2D imaging shown)

SELECT key.

Getting Started

On-screen controls

The on-screen controls let you make adjustments and select settings. The controls available depend on context.

Each control is controlled by the pair of keys below it. Depending on the control, the keys function in one of four ways:

Cycle Moves through a list of settings continuously. The upper key cycles upward. The lower key cycles downward.

Up-Down Moves through a list of settings, stopping at the top or bottom. The upper key moves upward. The lower key moves downward. By default, a beep sounds when you reach either end of the range. (See “Audio, Battery setup” on page 19.)

Chapter 1: Getting Started 9

Annotation and text

56 8 97

Alphanumeric keyboard

1 TAB Moves cursor among fields in

the forms, and tabs between text position in dual screens.

CAPS LOCK

Sets the keyboard to capital letters.

7 SPACEBAR Turns the keyboard on for

text entry. In text entry, adds a space.

8 DELETE Removes all text from the

screen during text entry and when not measuring.

SHIFT Allows entry of capitalized

characters and international characters.

9Arrow

Keys

Move highlighted selection in calculations menu, move cursor one space when entering text, move caliper position, move cine buffer forward and backward, and move among pages in image review and reports.

TEXT Turns the keyboard on and

off for text entry.

10 BACKSPACE Removes the character left

of the cursor in text-entry mode.

PICTO Turns pictographs on and off. 11 ENTER Moves cursor among fields

in forms and saves calculations to report.

ARROW Displays an arrow graphic

that can be moved and rotated within the image area.

10 General interaction

Symbols

You can enter symbols and special characters in select fields and forms. The symbols and special characters available depend on context.

Patient information form: Last, First, Middle, Patient ID, Accession, Indications, Procedure ID, User, Reading Dr., Referring Dr., and Institution fields

DICOM or SiteLink configuration page: Alias and AE Title fields

A & B Key, Footswitch setup page: Text field

Text mode (imaging): Annotation field

Figure 6 Symbols Dialog Box

To enter symbols or special characters

1 Select the field, and then select Symbols.

2 Select the desired symbol or character.

Preparing transducers

WARNING:

Caution:

Some transducer sheaths contain natural rubber latex and talc, which can cause allergic reactions in some individuals. Refer to 21 CFR 801.437, User labeling for devices that contain natural rubber.

Some gels and sterilants can cause an allergic reaction on some individuals.

To avoid damage to the transducer, use only gels recommended by FUJIFILM SonoSite. Using gels other than the one recommended by FUJIFILM SonoSite can damage the transducer and void the warranty. If you have questions about gel compatibility, contact FUJIFILM SonoSite or your local representative.

FUJIFILM SonoSite recommends that you clean transducers after each use. See “Cleaning and

disinfecting transducers” on

page 92.

Getting Started

You can also press the keys on the keyboard.

3 Select OK.

Acoustic coupling gel must be used during exams. Although most gels provide suitable acoustic coupling, some gels are incompatible with some transducer materials. FUJIFILM SonoSite recommends Aquasonic with the system.

For general use, apply a liberal amount of gel between the transducer and the body. For invasive or surgical use, apply a transducer sheath.

gel and provides a sample

Chapter 1: Getting Started 11

4 Select the Videos tab.

WARNING:

To prevent contamination, the use of sterile transducer sheaths and sterile coupling gel is recommended for clinical applications of an invasive or surgical nature. Do not apply the transducer sheath and gel until you are ready to perform the procedure.

To apply a transducer sheath

FUJIFILM SonoSite recommends the use of market-cleared, transducer sheaths for intracavitary or surgical applications.To lessen the risk of contamination, apply the sheath only when you are ready to perform the procedure.

1 Place gel inside the sheath.

2 Insert the transducer into the sheath.

3 Pull the sheath over the transducer and cable

until the sheath is fully extended.

4 Secure the sheath using the bands supplied

with the sheath.

5 Check for and eliminate bubbles between the

face of the transducer and the sheath.

Bubbles between the face of the transducer and the sheath may affect the ultrasound image.

6 Inspect the sheath to ensure that there are no

holes or tears.

5 If the list does not appear, select the correct USB

device:

a Select Select USB.

b In the Select USB device for media

playback dialog box, select the Education

Key USB device (“Training” appears under Type), and then select Select.

Note: Image Gallery is an unsupported feature.

To view a video

1 Display the list of videos.

2 Select the video.

3 Select View on-screen.

The video begins playing.

4 Select any of the following, as needed:

• Adjusts the volume. The higher the number, the louder the sound. Zero is mute.

• Back Rewinds the video 10 seconds.

• Pause Pauses the video.

• Play Resumes playing of a paused video.

• Forward Advances the video 10 seconds.

To exit a video

 Select one of the following:

• List to return to the video list.

• Done to return to 2D imaging.

Training videos

The SonoSite® Education Key™ training videos are an optional feature.

To display the list of videos

1 Insert the Education Key USB device into a USB

port on the system.

2 Press the

3 If there is an active exam, select List on-screen.

12 Training videos

REVIEW key.

Intended uses

The system is used with a transducer attached and is powered either by battery or by AC electrical power. The clinician is positioned beside the patient and places the transducer onto (or into for invasive procedures) the patient’s body where needed to obtain the desired ultrasound image.

The system transmits ultrasound energy into the patient’s body to obtain ultrasound images as listed below.

For the intended transducer and imaging modes for each exam type, see “Imaging modes and exams

available by transducer” on page 33.

Abdominal Imaging Applications You can assess

the liver, kidneys, pancreas, spleen, gallbladder, bile ducts, transplanted organs, abdominal vessels, and surrounding anatomical structures for the presence or absence of pathology transabdominally.

Cardiac Imaging Applications You can assess the heart, cardiac valves, great vessels, surrounding anatomical structures, overall cardiac performance, and heart size for the presence or absence of pathology.

In addition, you can identify the presence and location of fluid around the heart and lungs, use to assist in pericardiocentesis and thoracentesis procedures, visualize blood flow through cardiac valves, and detect normal lung motion for the presence or absence of pathology.

You can obtain the patient’s electrocardiogram (ECG). The ECG is used for timing of cardiac events.

WARNING:

The ECG is not used to diagnose cardiac arrhythmias and is not designed for long term cardiac rhythm monitoring.

Gynecology and Infertility Imaging Applications You can assess the uterus, ovaries,

adnexa, and surrounding anatomical structures for the presence or absence of pathology transabdominally or transvaginally.

Interventional Imaging Applications You can use the system for ultrasound guidance in biopsy and drainage procedures, vascular line placement, peripheral nerve blocks, spinal nerve blocks and taps, ova harvesting, amniocentesis and other obstetrical procedures, and provide assistance during abdominal, breast, and neurological surgery.

Obstetrical Imaging Applications You can assess the fetal anatomy, viability, estimated fetal weight, gestational age, amniotic fluid, and surrounding anatomical structures for the presence or absence of pathology transabdominally or transvaginally. CPD and Color imaging are intended for high-risk pregnant women. High-risk pregnancy indications include, but are not limited to, multiple pregnancy, fetal hydrops, placental abnormalities, as well as maternal hypertension, diabetes, and lupus.

WARNING:

To prevent injury or misdiagnosis, do not use this system for Percutaneous Umbilical Blood Sampling (PUBS) or in vitro Fertilization (IVF) The system has not been validated to be proven effective for these two uses.

CPD or Color images can be used as an adjunctive method, not as a screening tool, for the detection of structural anomalies of the fetal heart and as an adjunctive method, not as a screening tool, for the diagnosis of Intrauterine Growth Retardation (IUGR).

Getting Started

Chapter 1: Getting Started 13

Pediatric and Neonatal Imaging Applications

You can assess the pediatric and neonatal abdominal, pelvic and cardiac anatomy, pediatric hips, neonatal head, and surrounding anatomical structures for the presence or absence of pathology.

Superficial Imaging Applications You can assess the breast, thyroid, testicle, lymph nodes, hernias, musculoskeletal structures, soft tissue structures, ophthalmic structures, and surrounding anatomical structures for the presence or absence of pathology. You can use the system for ultrasound guidance in biopsy and drainage procedures, vascular line placement, peripheral nerve blocks, and spinal nerve blocks and taps.

Vascular Imaging Applications You can assess the carotid arteries, deep veins, and arteries in the arms and legs, superficial veins in the arms and legs, great vessels in the abdomen, and various small vessels feeding organs for the presence or absence of pathology.

WARNING:

To avoid injury to the patient, use only an Orbital (Orb) or Ophthalmic (Oph) exam type when performing imaging through the eye. The FDA has established lower acoustic energy limits for ophthalmic use. The system will not exceed these limits only if the Orb or Oph exam type is selected.

Transcranial Imaging Applications You can assess the anatomical structures and vascular anatomy of the brain for presence or absence of pathology. You can use imaging temporally, trans-occipitally, or trans-orbitally.

WARNING:

14 Intended uses

Chapter 2: System Setup

The system setup pages let you customize the system and set preferences.

Displaying the setup pages

To display a setup page

1 Press the SETUP key.

2 Select the setup page under Setup Pages.

To return to imaging from a setup page, select

Done on-screen.

Restoring default settings

To restore default settings for a setup page

 On the setup page, select Reset on-screen.

To restore all default settings

1 Turn the system off.

2 Connect the system to AC power. (See “To

operate the system using AC power” on

page 3.)

3 Simultaneously press 1 and the power key.

The system beeps several times.

A & B Key, Footswitch setup

Footswitch (L), Footswitch (R) The function of the left and right footswitches: Save Clip, Freeze, Save Image, or Print. See also “To connect the

footswitch.”

To connect the footswitch

The FUJIFILM SonoSite footswitch allows hands-free operation with a customizable two-pedal footswitch. The footswitch is an optional feature.

WARNING:

1 Connect the footswitch USB cable to the USB

port on the system or mini-dock.

2 On the A & B Key, Footswitch setup page, select

a function for the left and right footswitches.

To avoid contamination, do not use the footswitch in a sterile environment. The footswitch is not sterilized.

Administration setup

On the Administration setup page, you can configure the system to require users to log in and enter passwords. Required login helps protect patient data. You can also add and delete users, change passwords, import and export user accounts, and view the event log.

Setup

On the A & B Key, Footswitch setup page, you can program the shortcut keys and footswitch to perform common tasks. Select from the following lists:

A Key, B Key The function of the shortcut keys. By default, the A shortcut key is set to Print and the B shortcut key is set to none. The shortcut keys are below the alphanumeric keypad.

Chapter 2: System Setup 15

Security settings

WARNING:

Health care providers who maintain or transmit health information are required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the European Union Data Protection Directive (95/46/EC) to implement appropriate procedures: to ensure the integrity and confidentiality of information; to protect against any reasonably anticipated threats or hazards to the security or integrity of the information or unauthorized uses or disclosures of the information.

2 In the User Login list, select On.

• On requires a user name and password at startup.

• Off allows access to the system without a user name and password.

To change the administrator password or let users change passwords

1 Log in as Administrator.

2 Under User List, select Administrator.

3 Do any of the following:

• Change the administrator password: Under User Information, type the new password in the Password box and Confirm box. (See “Choosing a secure password” on page 18.)

Security settings on the system allow you to meet the applicable security requirements listed in the HIPAA standard. Users are ultimately responsible for ensuring the security and protection of all electronic protected health information collected, stored, reviewed, and transmitted on the system.

To log in as Administrator

1 On the Administration setup page, type

Administrator in the Name box.

2 Type the administrator password in the

Password box.

If you don’t have the administrator password, contact FUJIFILM SonoSite. (See “FUJIFILM

SonoSite Technical Support” on page ix.)

3 Select Login.

To log out as Administrator

 Turn off or restart the system.

To require user login

You can set the system to display the User Login screen at startup.

1 Log in as Administrator.

• Let users change their passwords: Select the Password changes check box.

4 Select Save.

User setup

To add a new user

1 Log in as Administrator.

2 Select New.

3 Under User Information, fill in the Name,

Password, and Confirm boxes. (See

“Choosing a secure password” on page 18.)

4 (Optional) In the User box, type the user’s

initials to display them in the patient header and the User field in the patient information form.

5 (Optional) Select the Administration Access

check box to allow access to all administration privileges.

6 Select Save.

To modify user information

1 Log in as Administrator.

2 Under User List, select the user.

16 Administration setup

3 Under User Information, make changes as

desired.

4 Select Save.

3 Select Import on-screen.

4 Select the USB storage device, and select

Import.

Any change to the user name replaces the previous name.

To delete a user

1 Log in as Administrator.

2 Under User List, select the user.

3 Select Delete.

4 Select Yes.

To change a user password

1 Log in as Administrator.

2 In the User List, select the user.

3 Type the new password in the Password box

and Confirm box.

4 Select Save.

Exporting or importing user accounts

The export and import commands let you configure multiple systems and back up user account information.

To export user accounts

1 Insert a USB storage device.

2 Log in as Administrator.

3 Select Export on-screen. A list of USB devices

appears.

4 Select the USB storage device, and select

Export.

All user names and passwords are copied to the USB storage device. Passwords are encrypted.

To import user accounts

1 Insert the USB storage device that contains the

accounts.

5 Restart the system.

All user names and passwords on the system are replaced with the imported data.

Exporting and clearing the Event log

The Event log collects errors and events and can be exported to a USB storage device and read on a PC.

To display the Event log

1 Log in as Administrator.

2 Select Log on-screen.

The Event log appears.

To return to the previous screen, select Back.

To export the Event log

The Event log and the DICOM network log have the same file name (log.txt). Exporting either one to a USB storage device overwrites any existing log.txt file.

1 Insert a USB storage device.

2 Select Log and then select Export on-screen.

A list of USB devices appears.

3 Select the USB storage device, and select

Export.

The Event log is a text file that you can open in a text-editing application (for example, Microsoft Word or Notepad).

To clear the Event log

1 Display the Event log.

2 Select Clear on-screen.

3 Select Yes.

Setup

2 Log in as Administrator.

Chapter 2: System Setup 17

Logging in as user

If user login is required, the User Login screen appears when you turn on the system. (See “To

require user login” on page 16.)

To log in as user

1 Turn on the system.

2 In the User Login screen, type your name and

password, and select OK.

To log in as guest

Guests can scan but can’t access system setup and patient information.

1 Turn on the system.

2 In the User Login screen, select Guest.

To change your password

1 Turn on the system.

2 In the User Login screen, select Password.

3 Type your old and new passwords, confirm the

new password, and then select OK.

Choosing a secure password

To ensure security, choose a password that contains uppercase characters (A-Z), lowercase characters (a-z), and numbers (0-9). Passwords are case-sensitive.

Annotations setup

On the Annotations setup page, you can customize predefined labels and set the preference for managing text when unfreezing images.

1 In the Exam list on the Annotations setup page,

select the exam type whose labels you want to specify.

2 For Group, select A, B, or C for the label group

you want associated with that exam.

The preset labels appear for the selected group.

3 Do any of the following:

• Add a custom label to the group: Type the label in the Text box, and select Add.

• Rename a label: Select the label, type the new name in the Text box, and select Rename.

• Move a label within the group: Select the label, and then select the on-screen up or down arrow.

• Delete a label from a group: Select the label, and select Delete.

You can use symbols in labels. See “Symbols” on page 11.

To specify text retention when unfreezing

You can specify which text to keep when you unfreeze an image or change the imaging layout.

 In the Unfreeze list on the Annotations setup

page, select Keep All Text, Keep Home Text, or Clear All Text.

The default setting is Keep All Text. For information on setting the home position, see

“To reset the home position” on page 36.

To export predefined label groups

1 Insert a USB storage device.

For instructions to annotate images, see

“Annotating images” on page 35.

To predefine a label group

You can specify which labels are available for an exam type when annotating an image. (See “To

place text on an image” on page 35.)

18 Annotations setup

2 On the Annotations setup page, select Export.

A list of USB devices appears.

3 Select the USB storage device, and select

Export.

A copy of all predefined label groups for all exams saves to the USB storage device.

To import predefined label groups

1 Insert the USB storage device that contains the

label groups.

2 On the Annotations setup page, select Import

on-screen.

3 Select the USB storage device, and then select

Import.

4 Select Done in the dialog box that appears.

All predefined label groups for all exams are replaced with those from the USB storage device.

Audio, Battery setup

On the Audio, Battery setup page, you can select options in the following lists:

Connectivity setup

On the Connectivity setup page, you specify options for using non-USB devices and for alerts when internal storage is full. You also import wireless certificates and specify settings (including Transfer Mode and Location) for SiteLink™ Image Manager and DICOM For SiteLink issues, refer to the SiteLink Image Manager user guide. For DICOM issues, such as storage commitment, archivers, and MPPS refer to Sending and Receiving DICOM Data.

To configure the system for a printer

1 Set up the printer hardware. (See instructions

included with the printer or docking system.)

2 In the Printer list on the Connectivity setup

page, select the printer.

, which are optional features.

Setup

Key click Select On or Off for keys to click when

pressed.

Beep alert Select On or Off for the system to beep when saving, warning, starting, or shutting down.

Sleep delay Select Off, or 5 or 10 minutes to specify the period of inactivity before the system goes into sleep mode.

Power delay Select Off, or 15 or 30 minutes to specify the period of inactivity before the system automatically turns off.

Cardiac Calculations setup

On the Cardiac Calculations setup page, you can specify measurement names that appear in the Tissue Doppler Imaging (TDI) calculations menu and on the report page.

See also “Cardiac calculations” on page 53.

To specify cardiac measurement names

 Under TDI Walls on the Cardiac Calculations

setup page, select a name for each wall.

To configure the system to export data to aPC

You can send patient report data as ASCII text from the system to a PC. The PC must have third-party software to acquire, view, or format the data into a report. Check the compatibility of your software with FUJIFILM SonoSite Technical Support. (See also “To send a patient report to a PC” on page 72.)

1 In the Serial Port list on the Connectivity setup

page, select Computer (PC).

2 Restart the system.

3 Attach a serial cable (RS-232) from the serial

port on the mini-dock or docking system to the peripheral.

To receive storage alerts

 On the Connectivity setup page, select Internal

Storage Capacity Alert.

The system displays a message if internal storage is near capacity when you end an exam. The system then deletes archived patient exams if specified in DICOM setup.

Chapter 2: System Setup 19

Date and Time setup

WARNING:

To obtain accurate obstetrics calculations, an accurate date and time are critical. Verify that the date and time are accurate before each use of the system. The system does not automatically adjust for daylight saving time changes.

•Under IMT Calculations, select measurement names from the lists, or select None.

The selected names appear in the calculations menu and in the patient report.

• Type the desired width in the Region width

(mm) box.

Network Status setup

To set the date and time

 On the Date and Time setup page, do the

following:

•In the Date box, type the current date.

•In the Time box, type the current time in 24 hour format (hours and minutes).

Display Information setup

On the Display Information setup page, you can specify which details appear on-screen during imaging. You can select settings in the following sections:

Patient Header Information that appears in the patient header.

Mode Data Imaging information.

System Status System status information.

IMT Calculations setup

On the IMT Calculations setup page, you can customize the IMT calculations menu. You can specify up to eight measurement names for both right side and left side calculations. The measurement names also appear in the patient report.

The Network Status setup page displays information on system IP address, Location, Ethernet MAC address, and the wireless connection if any.

OB Calculations setup

On the OB Calculations setup page, you select authors for OB calculation tables. You can also import or export additional OB calculation tables.

See also “OB calculations” on page 65.

To specify gestational age and growth analysis

1 On the OB Calculations setup page, select the

desired OB authors (or select None) in the measurement lists under Gestational Age and Growth Analysis.

Selecting an author places the associated measurement on the calculations menu.

2 (Optional) Select More to display the list of

user-defined custom measurements and to associate a custom table for the custom measurement.

This option is available only when a user-defined custom table has been created for the custom measurement.

See also “IMT calculations” on page 62.

To customize the IMT calculations menu

 On the IMT Calculations setup page, do the

following:

20 Date and Time setup

To export OB calculation tables

1 Insert a USB storage device.

2 On the OB Calculations setup page, select

Export. A list of USB devices appears.

3 Select the USB storage device, and select

Export.

All user-defined tables and measurements are copied to the USB storage device.

1 On the OB Custom Measurements setup page,

highlight the measurement in the Custom

Measurements list.

2 Select Delete Last.

To import OB calculation tables

Tables that you import are added to those already on the system.

1 Insert the USB storage device that contains the

tables.

2 On the OB Calculations setup page, select

Import on-screen.

3 Select the USB storage device, and then select

Import.

4 Select OK in the dialog box that appears.

The system restarts.

OB Custom Measurements setup

On the OB Custom Measurements setup page, you can define measurements that appear in the OB calculations menu and OB report. OB Custom Measurements is an optional feature.

See also “OB calculations” on page 65.

To set up OB custom measurements

You can save up to five custom measurements that appear in the OB calculations menu and OB report.

1 On the OB Custom Measurements setup page,

select New.

2 In the Name box, type a unique name.

3 In the Type list, select the desired measurement

type.

4 Select Save.

To delete an OB custom measurement

If you delete an OB custom measurement during an exam, the exam ends.

3 Select Yes.

The exam ends, and any tables and report data associated with the measurement are removed from the system.

OB Custom Tables setup

On the OB Custom Tables setup pages, you can customize growth tables that appear in the calculations menu and patient report.

Gestational Age Table Measurements The system provides gestational age measurements by selected authors for GS, CRL, BPD, OFD, HC, TTD, APTD, AC, FTA, FL, EFW, Tibia, HL, and 5 additional custom measurement labels.

Growth Analysis Table Measurements The system provides growth graphs or curves for BPD, HC, AC, FL, EFW, and HC/AC.

WARNING:

To view OB tables

1 On the OB Calculations or OB Custom

Measurements setup page, select Tables on-screen.

2 Select the desired table and

measurement/author.

To create a new OB custom table

You can create two custom tables for each OB measurement.

1 On the OB Calculations or OB Custom

Measurements setup page, select Tables on-screen.

Prior to use, verify that custom table data entries are correct. The system does not confirm the accuracy of the custom table data entered by the user.

Setup

Chapter 2: System Setup 21

2 Select the desired table (Gestational Age or

Growth Analysis).

3 In the Measurement list, select the

measurement for the custom table.

4 Select New on-screen.

5 In the Author box, type a unique name.

6 Enter the data.

Save Key Behavior of the

saves the image to internal storage. Image/Calcs saves the image to internal storage and saves the current calculation to the patient report.

Dynamic Range Settings include -3, -2, -1, 0, +1, +2, or +3. Negative numbers show higher

contrast images, and positive numbers show lower contrast images.

SAVE key. Image Only

7 Select Save on-screen.

To display the measurement for the custom table in the calculations menu, see “To specify

gestational age and growth analysis” on

page 20.

To edit or delete an OB custom table

1 On the OB Calculations or OB Custom

Measurements setup page, select Tables on-screen.

2 Select the OB custom table.

3 Select one of the following on-screen:

• Edit Enter data, and then select Save on-screen.

• Delete to remove the custom table. Select

Yes.

Presets setup

The Presets setup page has settings for general preferences. You can select from the following lists:

Doppler Scale Select cm/s or kHz.

Duplex The layout for displaying M Mode trace and Doppler spectral trace:1/3 2D, 2/3 Trace; 1/2 2D, 1/2 Trace; or Full 2D, Full Trace.

Live Trace Select Peak or Mean.

Thermal Index You can select TIS, TIB, or TIC. The

default setting is based on exam type: OB is TIB, TCD is TIC, and all others are TIS.

Units Units for patient height and weight in cardiac exams: in/ft/lbs or cm/m/kg.

Color Scheme The background color of the display.

Auto save Pat. Form Automatically saves the

patient information form as an image in the patient’s file.

System Information setup

The System Information setup page displays system hardware and software versions, patents, and license information.

See also “To enter a license key” on page 90.

To display patents

 On the System Information setup page, select

Patents.

USB Devices setup

On the USB Devices setup page, you can view information about connected USB devices, including space availability. You can also specify a file format for images and clips in patient exams that you export to a USB storage device. (See “To

export patient exams to a USB storage device”

on page 41.)

To specify a file format for exported images

1 On the USB Devices setup page, select Export.

22 Presets setup

2 Under USB Export, select an export type:

• SiteLink organizes files in a SiteLink-style folder structure. Clips export in H.264 video saved as MP4 files. To view them, FUJIFILM SonoSite recommends QuickTime 7.0 or later.

• DICOM creates files readable by a DICOM reader. DICOM is an optional feature.

3 Select an image format for your export type. For

JPEG image format, also select a JPEG compression. (See also “Limitations of JPEG

format.”)

A high compression has a smaller file size but less detail.

For SiteLink export type, the image format affects only still images. For DICOM export type, the image format affects both still images and clips.

4 For SiteLink export type, select a sort order

under Sort By.

To return to the previous screen, select Devices.

To include private tags

If you use DICOM export type and a FUJIFILM SonoSite software product, include private tags on the images.

 On the USB Devices setup page, select Include

private tags.

Note: Because the tags may be incompatible with some earlier archivers, keep this check box unselected unless you use FUJIFILM SonoSite software products. For more information, see the Edge system’s DICOM conformance statement.

Limitations of JPEG format

When transferring or exporting images in JPEG format, the system uses lossy compression. Lossy compression may create images that have less absolute detail than BMP format and that don’t render identically to the original images.

In some circumstances, lossy-compressed images may be inappropriate for clinical use. For example, if you use images in SonoCalc® IMT software, you should transfer or export them using BMP format. SonoCalc IMT software uses a sophisticated algorithm to measure images, and lossy compression may cause errors.

For more information on using lossy-compressed images, consult the industry literature, including the following references:

“Physics in Medicine and Biology, Quality Assessment of DSA, Ultrasound and CT Digital Images Compressed with the JPEG Protocol,” D Okkalides et al 1994 Phys Med Biol 39 1407-1421 doi: 10.1088/0031-9155/ 39/9/008 www.iop.org/EJ/abstract/ 0031-9155/39/9/008

“Canadian Association of Radiologists, CAR Standards for Irreversible Compression in Digital Diagnostic Imaging within Radiology,” Approved: June 2008. www.car.ca/Files/%5CLossy_Compression. pdf

eFilm Lite image-viewer

You can include a copy of the eFilm Lite image-viewer with exams that you export to a USB memory stick in DICOM format. eFilm Lite lets you view DICOM-formatted images on a computer running Windows.

eFilm Lite is a licensed feature.

WAR NIN G:

Russian characters may appear incorrectly in eFilm Lite. FUJIFILM SonoSite recommends that you do not use the eFilm Lite image-viewer to view exams exported in Russian.

Setup

Chapter 2: System Setup 23

To start eFilm Lite image-viewer after exporting exams

1 Insert the USB memory stick into your

computer.

2 Display the USB memory stick’s contents.

3 Double-click eFilmLite.bat.

eFilmLite.bat starts the executable file in the

eFilmLite folder. The eFilmLite folder contains the eFilm Lite software and related files. See also the eFilm Lite User’s Guide, a PDF file in the eFilmLite folder.

24 USB Devices setup

Chapter 3: Imaging

Imaging modes

The system has a high-performance display and advanced image-optimization technology that simplifies user controls. Imaging modes available depend on the transducer and exam type. See

“Imaging modes and exams available by transducer” on page 33.

2D imaging

2D is the system's default imaging mode. The system displays echoes in two dimensions by assigning a brightness level based on the echo signal amplitude. To achieve the best possible image quality, properly adjust the display brightness, gain, depth settings, viewing angle, and exam type. Also, select an optimization setting that best matches your needs.

To display the 2D image

1 Do any of the following:

• Turn on the system.

•Press the 2

2 Adjust controls as desired. See “2D controls.”

2D controls

In 2D imaging, you can select the following on-screen controls.

Optimize Settings are as follows:

D key.

• Res provides the best possible resolution.

• Gen provides a balance between resolution and penetration.

• Pen provides the best possible penetration.

Some of the parameters optimized to provide the best image include focal zones, aperture size, frequency (center and bandwidth), and waveform. They cannot be adjusted by the user.

Dynamic Range

Dual Displays side-by-side 2D images.

LVO On, LVO Off

Orientation Select from four image orientations:

Adjusts the grayscale range: -3, -2,

-1, 0, +1, +2, +3.

The positive range increases the number of grays displayed, and the negative range decreases the number of grays displayed.

Select Dual, and then press the

UPDATE key to display the second

screen and to toggle between the screens. With both images frozen, press the between the images.

To return to full-screen 2D imaging, select Dual or press the 2

LVO On turns on Left Ventricular Opacification. LVO Off turns off this control.

Use LVO for cardiac exams in 2D imaging mode. LVO lowers the mechanical index (MI) of the system.

This control depends on transducer and exam type.

U/R (Up/Right), U/L (Up/Left), D/L (Down/Left), D/R

(Down/Right).

UPDATE key to toggle

D key.

Imaging

Chapter 3: Imaging 25

Brightness Adjusts the display brightness.

Settings range from 1 to 10. The display brightness affects

battery life. To conserve battery life, adjust brightness to a lower setting.

Guide Turns guidelines on and off.

Guidelines are for needle guidance, are an optional feature, and depend on transducer type.

For transducers with a single-angle or multi-angle bracket, the touchpad moves the depth cursor.

If the transducer uses a multi-angle bracket, select Guide and then select the angle: A, B, or C. To exit angle selection, select Back. To clear the guides, do either of the following:

• Select the angle again (A, B, or C).

• Exit angle selection and press Guide.

See also the needle guide’s user documentation.

Guide is not available when the ECG cable is connected.

ECG Displays the ECG trace. See “ECG

Monitoring” on page 41.

This feature is optional and requires a FUJIFILM SonoSite ECG cable.

Clips Displays the clip controls. See “To

capture and save a clip” on

page 38.

THI Turns Tissue Harmonic Imaging on

and off. When on, THI appears in the upper

left-hand screen. This feature depends on transducer and exam type.

Page x/x Indicates which page of controls is

displayed. Select to display the next page.

M Mode imaging

Motion mode (M Mode) is an extension of 2D. It provides a trace of the 2D image displayed over time. A single beam of ultrasound is transmitted, and reflected signals are displayed as dots of varying intensities, which create lines across the screen.

Sector (Cardiac exam) Specifies the

sector width. SonoMB On is available only for

Sector Full.

SonoMB (MB)

MBe See “Needle visualization” on

26 Imaging modes

MB On and MB Off turn SonoMB® multi-beam imaging technology on and off. When SonoMB is on, MB appears in the upper left-hand screen.

SonoMB depends on transducer and exam type.

page 31.

To display the M-line

1 Press the MMODE key.

Note: If the M-line does not appear, make sure that the image isn’t frozen.

2 Use the touchpad to position the M-line where

desired.

3 Set controls as desired.

Many optimization and depth controls available in 2D imaging are also available in M Mode imaging. See “2D controls” on page 25.

To display the M Mode trace

1 Display the M-line.

2 Adjust the depth if necessary. (See “To adjust

depth” on page 30.)

3 Press the MMODE key.

The time scale above the trace has small marks at 200ms intervals and large marks at one-second intervals.

on the left-hand screen shows which touchpad function is active.

4 Adjust controls as desired. See “CPD and

Color controls.”

4 Do any of the following as needed:

• Select the sweep speed (Slow, Med, or Fast).

•Press the

UPDATE key to toggle between the

M-line and M-Mode trace.

• If using a duplex layout, press the

MMODE

key to toggle between the full-screen M-line and the duplex layout.

To set a duplex layout, see “Presets

setup” on page 22.

CPD and color Doppler imaging

Color power Doppler (CPD) and color Doppler (Color) are optional features.

CPD is used to visualize the presence of detectable blood flow. Color is used to visualize the presence, velocity, and direction of blood flow in a wide range of flow states.

To display the CPD or Color image

1 Press the COLOR key.

A ROI box appears in the center of the 2D image.

2 Select CPD or Color.

The current selection also appears in the upper left-hand screen.

The Color indicator bar on the upper left-hand screen displays velocity in cm/s in Color imaging mode only.

CPD and Color controls

In CPD or Color imaging, you can set the following on-screen controls.

Color, CPD Toggle between CPD and Color.

The current selection appears in the upper left-hand screen.

Color Suppress

Flow Sensitivity

PRF Scale Select the desired pulse repetition

Wall Filter Settings include Low, Med, and

Shows or hides color information. You can select Show or Hide while in live or frozen imaging. The setting shown on-screen is the current selection.

The current setting appears on-screen.

• Low optimizes the system for low flow states.

• Med optimizes the system for medium flow states.

• High optimizes the system for high flow states.

frequency (PRF) setting by pressing the control keys.

There is a wide range of PRF settings for each Flow Sensitivity setting (Low, Med, and High).

Available on select transducers.

High. Available on select transducers.

Imaging

3 Using the touchpad, position or resize the ROI

box as needed. Press the

SELECT key to toggle

between position and size.

While you position or resize the ROI box, a green outline shows the change. The ROI box indicator

Steering Select the steering angle setting of

the color ROI box (-15, 0, or

+15). If adding PW Doppler, see

“PW Doppler controls” on

page 29. Available on select transducers.

Chapter 3: Imaging 27

Variance Turns variance on and off.

Available only for cardiac exam.

2 Do any of the following as needed:

• Adjust controls. See “PW Doppler

controls” on page 29.

Invert Switches the displayed direction of

flow. Available in Color imaging.

Sector (Cardiac exam) Specifies the

sector width.

Page x/x Indicates which page of controls is

displayed. Select to display the next page.

PW and CW Doppler imaging

Pulsed wave (PW) Doppler and continuous wave (CW) Doppler imaging modes are optional features.

PW Doppler is a Doppler recording of blood flow velocities in a range specific area along the length of the beam. CW Doppler is a Doppler recording of blood flow velocities along the length of the beam.

You can use PW/CW Doppler and CPD/Color simultaneously. If CPD/Color imaging is on, the color ROI box is tied to the D-line. The among color ROI box position; color ROI box size; the D-line and gate location; and (in PW Doppler) angle correction. The active selection is green. Also, the indicator on the left-hand screen shows which touchpad function is active.

To display the D-line

The default Doppler imaging mode is PW Doppler. In cardiac exams, you can select the CW Doppler on-screen control.

1 Press the

Note: If the D-line does not appear, make sure that the image isn’t frozen.

DOPPLER key.

SELECT key cycles

• Using the touchpad, position the D-line and gate where desired. Horizontal movements position the D-line. Vertical movements position the gate.

• (PW Doppler) To correct the angle manually, do one of the following:

•Press the

SELECT key and then use the

touchpad. The

SELECT key toggles between the

D-line and angle correction.

• Freeze the image, and then press the

keys.

You can adjust the angle in 2° increments from -74° to +74°.

To display the spectral trace

1 Display the D-line.

2 Press the

The time scale above the trace has small marks at 200 ms intervals and large marks at one-second intervals.

3 Do any of the following as needed:

• Adjust controls. See “Spectral trace

•Press the

• If using a duplex layout, press the

DOPPLER key.

controls” on page 29.

UPDATE key to toggle between the

D-line and spectral trace.

DOPPLER

key to toggle between the full-screen D-line and the duplex layout.

To set a duplex layout, see “Presets

setup” on page 22.

28 Imaging modes

PW Doppler controls

In PW Doppler imaging, you can set the following on-screen controls.

Page x/x Indicates which page of controls is

displayed. Select to display the next page.

PW, CW (Cardiac exam only) Toggle

between PW Doppler and CW Doppler.

The current selection appears in the upper left-hand screen.

Angle Correction

Gate Size Settings depend on transducer and

TDI On, TDI Off

Corrects the angle to 0°, +60°, or

-60°.

exam type. In TCD or Orb exams, use the

touchpad to specify the Doppler gate depth (the depth of the center of the gate in the Doppler image). The Doppler gate depth indicator is on the lower right-hand screen.

Select TDI On to turn on tissue Doppler imaging. When on, TDI appears in the upper left-hand screen. The default is TDI off.

Available only in cardiac exams.

Spectral trace controls

In spectral trace imaging, you can set the following on-screen controls.

Scale Select the desired scale (pulse

repetition frequency [PRF]) setting.

(To change the Doppler scale to cm/s or kHz, see “Presets

setup” on page 22.)

Line Sets the baseline position.

(On a frozen trace, the baseline can be adjusted if Live Trace is off.)

Invert Vertically flips the spectral trace.

(On a frozen trace, Invert is available if Live Trace is off.)

Volume Increases or decreases Doppler

speaker volume (0-10).

Wall Filter Settings include Low, Med, High.

Imaging

Steering Select the desired steering angle

setting. Settings available depend on the transducer. The PW Doppler angle correction automatically changes to the optimum setting.

• -15 and -20 have an angle correction of -60°.

• 0 has an angle correction of 0°.

• +15 and +20 have an angle correction of +60°.

You can manually correct the angle after selecting a steering angle setting. (See “To display the

D-line” on page 28.)

Available on select transducers.

Sweep Speed

Live Trace Displays a live trace of the peak or

Page x/x Indicates which page of controls is

Settings include Slow, Med, Fast.

mean. (See “Presets setup” on page 22 to specify peak or mean.)

displayed. Select to display the next page.

Chapter 3: Imaging 29

Adjusting depth and gain

Freezing, viewing frames,

To adjust depth

You can adjust the depth in all imaging modes but the trace modes. The vertical depth scale is marked in 0.5 cm, 1 cm, and 5 cm increments, depending on the depth.

 Press the following keys:

•

UP DEPTH key to decrease the displayed

depth.

•

DOWN DEPTH key to increase the displayed

depth.

As you adjust the depth, the maximum depth number changes in the lower right screen.

To adjust gain automatically

 Press the AUTO GAIN key. The gain adjusts each

time you press this key.

To adjust gain manually

 Press the gain keys :

In each pair of gain keys, the left key decreases gain, and the right key increases gain.

•

NEAR adjusts the gain applied to the near

field of the 2D image.

and zooming

To freeze or unfreeze an image

 Press the FREEZE key.

On a frozen image, the cine icon and frame number appear in the system status area.

To move forward or backward in the cine buffer

 Freeze the image, and do one of the following:

• Press the keys. The left key moves backward, and right key moves forward.

• Use the touchpad. Left moves backward, and right moves forward.

•Press the

The frame number changes as you move forward or backward. The total number of frames in the buffer appears on-screen in the system status area.

To zoom in on an image

You can zoom in 2D and Color imaging. You can freeze or unfreeze the image or change the imaging mode at any time while zooming.

LEFT ARROW and RIGHT ARROW keys.

•

FAR adjusts the gain applied to the far field of

the 2D image.

•

GAIN adjusts the overall gain applied to the

entire image. In CPD or Color imaging, the

GAIN keys affects the color gain applied to

the region of interest (ROI) box. In PW and CW Doppler imaging, the

GAIN keys affect

Doppler gain.

Near and far correspond to the time gain compensation (TGC) controls on other ultrasound systems.

30 Adjusting depth and gain

1 Press the

ZOOM key. A ROI box appears.

2 Using the touchpad, position the ROI box as

desired.

3 Press the

ZOOM key again.

The image in the ROI box is magnified by 100%.

4 (Optional) If the image is frozen, use the

touchpad or arrow keys to pan the image up, down, left, and right. (You cannot pan in Dual.)

To exit zoom, press the

ZOOM key again.

Needle visualization

WARNING:

About MBe

The MBe control turns on SonoMBe™ imaging, which enhances linear structures within a selected angle range and can facilitate needle guidance during catheter placement and nerve-block procedures. A three- or four-sided outline indicates the enhancement area. (See Figure 1 on page 31.)

To avoid incorrect needle placement when MBe is on:

• Using movement and fluid injection, verify the needle-tip location and trajectory. MBe enhances linear structures within a selected angle range on the ultrasound plane. Linear structures outside the selected angle range or the ultrasound plane

—such as a bent

needle

—may be less apparent.

• Note that linear structures are enhanced only in an outlined portion of the image. The area outside the outline remains unchanged. (See Figure 1 on page 31.)

• Note that the beam divergence of a curved array transducer may prevent a segment of the needle shaft from showing in the image. (See Figure 2 on page 32.) The needle tip may not show.

The MBe control is available in full-screen imaging only and on the following:

• Transducers: C60x, HFL38x, HFL50x, L25x, L38xi

• Exams: Breast, Musculoskeletal, Nerve, Small Parts, Vascular (L25x only), Venous (L25x only)

Figure 1 Image with MBe on (linear transducer):

1 - Needle 2 - Outlined area enhanced by MBe 3 - Dotted line 4 - Unenhanced area

Imaging

For curved array transducers, MBe can help identify the direction of the needle, although only segments of the needle shaft may show in the image. (See

Figure 2 on page 32.) Use movement and fluid

injection to help verify the needle-tip location.

Chapter 3: Imaging 31

Figure 2 With a curved array transducer, only

0 - 50°

segments of the needle shaft may show:

1 - Upper needle shaft 2 - Unshown segment of needle shaft (unshown segment or segments depend on specific image) 3 - Needle tip

Needle size and angle

Use a 17-gauge to 25-gauge needle (recommended). Enhancement results can depend on the type and brand of needle used. For more information, consult the medical literature on needle visibility in ultrasound-guided procedures.

You can angle the needle up to 50° from the transducer surface. (See Figure 3 on page 32.) Beyond 50°, the needle may be less enhanced. (MBe has little or no benefit to out-of-plane procedures. MBe is intended for in-plane procedures only.)

Figure 3 For best results, angle the needle only up to 50° from the transducer surface:

1 - Needle 2 - Transducer

MBe subcontrols

When MBe is on, additional controls are available:

• L/R Flip flips the affected area (the outline) horizontally on the image.

For reorienting the entire image, use the

orientation control . See “2D controls” on page 25.

• Shallow, Medium, or Steep sets the outline’s sloped edge, which is indicated by a dotted line. The current selection is highlighted green.

Linear transducer: provides a perpendicular intersection with the dotted line. Within the enhancement area, the more perpendicular that a linear structure is to the dotted line, the more it is enhanced. Similarly, the less perpendicular (and more parallel) that a linear structure is to the dotted line, the less it is enhanced.

Curved array transducer: angled 30° or less from the transducer surface, use Shallow for best enhancement. For a linear structure angled 30-40°, use Medium. For a linear structure angled 40° or greater, use Steep.

Use whichever setting best

For a linear structure

• Off turns off MBe. Temporarily turning off MBe can help you identify artifacts and other structures not of interest.

32 Needle visualization

• Back returns to the previous screen. If MBe is on, MBe is highlighted green and MBe appears in the mode data area. Pressing MBe again redisplays the MBe controls.

The transducer you use determines which exam types are available. In addition, the exam type you select determines which imaging modes are available.

If MBe is on, the MB control is unavailable.

Additional recommendations

Avoid setting the gain too high when using MBe, as unnecessarily high gain can cause artifacts in the image. Also, respiratory and cardiac movement in the image may cause bright pulsating artifacts.

If you use MBe frequently, consider using a shortcut key to turn on the MBe control. For instructions to program a shortcut key, see “A & B Key,

Footswitch setup” on page 15.

Imaging modes and exams available by transducer

WARNING:

To prevent misdiagnosis or harm to the patient, understand your system’s capabilities prior to use. The diagnostic capability differs for each transducer, exam type, and imaging mode. In addition, transducers have been developed to specific criteria depending on their physical application. These criteria include biocompatibility requirements.

To avoid injury to the patient, use only an Orbital (Orb) or Ophthalmic (Oph) when performing imaging through the eye. The FDA has established lower acoustic energy limits for ophthalmic use. The system will not exceed these limits only if the Orb or Oph exam type is selected.

To change the exam type

 Do one of the following:

•Press the menu.

• On the patient information form, select from the Type list under Exam. (See “Patient

information form” on page 36.)

Imaging modes and exams available by transducer

Transducer

C8x Pro 

C11x Abd 

C60x Abd 

EXAM key, and select from the

Imaging Mode

Exam Type

CPD

M Mode

Color

PW Doppler

Neo 

Nrv 

Vas 

Gyn 

Msk 

Nrv 

OB 

CW Doppler

—

Imaging

Chapter 3: Imaging 33

Imaging Mode

Color

PW Doppler

Transducer

D2x Crd

CPD

M Mode

Exam Type

————

HFL38x Bre 

IMT 

Msk 

Nrv 

SmP 

Vas 

Ven 

HFL50x Bre 

MSK 

Nerve 

Color

PW Doppler

CW Doppler

—

CPD

CW Doppler



—

Transducer

Exam Type

ICTx Gyn 

OB 

L25x Msk 

Nrv 

Oph 

Sup 

Vas 

Ven 

L38x Bre 

IMT 

Nrv 

M Mode

SmP 

—

SmP 

Vas 

Ven 

L38xi Bre 

IMT 

Msk 

Nrv 

SmP 

Vas 

Ven 

—

34 Imaging modes and exams available by transducer

Imaging Mode

Color

PW Doppler

Transducer

CPD

M Mode

Exam Type

P10x Abd 

Crd 

—

 

Neo 

P11x* Vas 

Ven 

P21x Abd 

Crd 

—

 

OB 

Orb 

TCD 

SLAx Msk 

Nrv 

Sup 

Vas 

Ven 

TEEx Crd 

—

 

Color

PW Doppler

CW Doppler

Imaging

CPD

CW Doppler

—

Transducer

*For information about the P11x transducer, see the P11x

Transducer User Guide, included with the P11x

transducer.

1. Exam type abbreviations are as follows: Abd = Abdomen, Bre = Breast, Crd = Cardiac, Gyn = Gynecology, IMT = Intima Media Thickness, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb = Orbital, Pro = Prostate SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Vas = Vascular, Ven = Venous.

2. The optimization settings for 2D are Res, Gen, and Pen.

3. The optimization settings for CPD and Color are low, medium, and high (flow sensitivity) with a range of PRF settings for Color depending on the setting selected.

4. For the cardiac exam type, PW TDI is also available. See

“PW Doppler controls” on page 29.

Exam Type

M Mode

Annotating images

—

You can annotate live images as well as frozen images. (You cannot annotate a saved image.) You can place text (including predefined labels), an

—

arrow, or a pictograph. To set preferences for annotations, see “Annotations setup” on page 18.

To place text on an image

You can place text in the following imaging layouts: full-screen 2D, full-screen trace, dual, or duplex. You can place text manually or add a predefined label.

1 Press the

TEXT key. A green cursor appears.

2 Move the cursor where desired:

• Use the touchpad or arrow keys.

• Select Home to move the cursor to the home position.

Chapter 3: Imaging 35

The default home position depends on the imaging screen layout. You can reset the home position. See “To reset the home

position” on page 36.

3 Using the keyboard, type text.

• The arrow keys move the cursor left, right, up, and down.

•The

DELETE key deletes all text.

• Word removes a word.

• Symbols lets you enter special characters. See “Symbols” on page 11.

4 (Optional) To add a predefined label, select

Label, and then select the desired label group:

, , or . Select the group again for

the desired label.

The first number shows which label in the group is selected. The second number is the number of labels available.

See “Annotations setup” on page 18.

To turn off text entry, press the

TEXT key.

4 Press the

ARROW key to set the arrow.

The arrow changes from green to white.

To remove the arrow, press the

ARROW key and

then select Hide.

To place a pictograph on an image

The pictograph set available depends on transducer and exam type.

1 Press the

2 Select x/x to display the desired

pictograph, and then press the

The first number shows which pictograph in the set is selected. The second number is the number of pictographs available.

3 Using the touchpad, position the pictograph

marker.

4 (Optional) To rotate the pictograph marker,

press the

5 Select a screen location for the pictograph: U/L

(Up/Left), D/L (Down/Left), D/R (Down/Right), U/R (Up/Right).

PICTO key.

SELECT key.

SELECT key and then use the touchpad.

To reset the home position

1 Press the TEXT key.

2 Using the touchpad or arrow keys, position the

In a duplex layout, the pictograph is restricted to upper left. In Dual, all four positions are available.

To remove the pictograph, select Hide.

cursor where desired.

3 Select Home/Set.

To place an arrow on an image

You can add an arrow graphic to point out a specific part of the image.

1 Press the

ARROW key .

Patient information form

The patient information form lets you enter patient identification, exam, and clinical information for the patient exam. This information automatically appears in the patient report.

When you create a new patient information form, all images, clips, and other data you save during the

2 If you need to adjust the arrow's orientation,

press the When the orientation is correct, press the

SELECT key and then use the touchpad.

SELECT

key again.

3 Using the touchpad, position the arrow where

exam are linked to that patient. (See “Patient

report” on page 72.)

To create a new patient information form

1 Press the PATIENT key.

desired.

2 Select New/End.

36 Patient information form

3 Fill in the form fields. See “Patient information

form fields” on page 37.

4 Select Done.

See also “To append images and clips to a

patient exam” on page 40.

To enable bar code lookup of patient data

You can query the worklist for patient data by scanning a Patient ID bar code with the bar code scanner. The patient data are then automatically entered into the patient information form.

 Select Bar Code Auto Lookup on the

Connectivity setup page.

For more information about the bar code scanner, see Bar Code Scanner User Guide.

To edit a patient information form

You can edit patient information if the exam has not been archived or exported and if the information is not from a worklist.

See also “To edit patient information from the

patient list” on page 40.

1 Press the

PATIENT key.

2 Make changes as desired.

3 Select one of the following:

• Cancel to undo changes and return to imaging.

• Done to save changes and return to imaging.

To end the exam

1 Make sure that you have saved images and

other data you want to keep. (See “Saving

images and clips” on page 38.)

2 Press the

PATIENT key.

3 Select New/End.

A new patient information form appears.

Patient information form fields

The patient information form fields available depend on exam type. In some fields you can select Symbols to enter symbols and special characters. See “Symbols” on page 11

Patient

• Last, First, Middle Patient name

• ID Patient identification number

• Accession Enter number, if applicable.

•Date of birth

• Gender

• Indications Enter desired text

• User User initials

• Procedure (button) Available if the DICOM worklist feature is licensed and configured. See the document Sending and Receiving DICOM

Data on SonoSite Systems.

Select Back to save entries and return to the previous screen.

Exam

• Type Exam types available depend on transducer. See “Imaging modes and exams

available by transducer” on page 33.

• LMP Estab. DD (OB or Gyn exam) In an OB exam, select LMP or Estab. DD and then enter either the date of the last menstrual period or the established due date. In a Gyn exam, enter the date of the last menstrual period. The LMP date must precede the current system date.

• Twins (OB exam) Select the Twins check box to display Twin A and Twin B measurements on the calculations menu and for access to Twin A and Twin B screens for previous exam data.

Imaging

Chapter 3: Imaging 37

• Previous Exams (button) (OB exam) Displays fields for five previous exams. The date for a previous exam must precede the current system date. For twins, select Twin A/B to toggle between Twin A and Twin B screens. (If the Twin A/B control does not appear, select Back, and make sure that the Twins check box is selected.)

The percentage icon in the system status area shows the percentage of space used in internal storage. If you try to save an image or clip when no space remains, the system alerts you that internal storage is full. To resolve this issue, archive images and clips that you wish to save, and then delete them from the system to free up space. See “To

delete images and clips” on page 41.

Select Back to save changes and return to the previous screen.

• BP (Cardiac, IMT, Orbital, Transcranial, or Vascular exam) Blood Pressure

• HR (Cardiac, Orbital, Transcranial, or Vascular exam) Heart Rate. Enter the beats per minute. Saving the heart rate using a measurement overwrites this entry.

• Height (Cardiac exam) The patient height in feet and inches or meters and centimeters. (To change the units, see “Presets setup” on page 22.)

• Weight (Cardiac exam) The patient weight in pounds or kilos. (To change the units, see

“Presets setup” on page 22.)

• BSA (Cardiac exam) Body Surface Area. Automatically calculated after you enter height and weight.

• Ethnicity (IMT exam) Ethnic origin

•Reading Dr.

• Referring Dr.

• Institution

• Department ID

To receive alerts when storage is near capacity, see

“To receive storage alerts” on page 19.

To access saved images and clips, open the patient list. See “Reviewing patient exams” on page 39.

To save an image

 Press the SAVE key.

The image saves to internal storage.

By default, the shortcut during calculations, the both the image to internal storage and the calculation to the patient report. See “Presets

setup” on page 22.

SAVE key saves only the image. As a

SAVE key can save

To capture and save a clip

Clips lets you capture, preview, and save clips.

1 Set Clips controls. (See “To set Clips

controls” on page 39.)

2 Press the

One of the following occurs:

•If Prev/Off is selected, the clip saves

•If Prev/On is selected, the clip plays back in

CLIP key.

directly to internal storage.

preview mode. You can select any of the following on-screen:

Images and clips

Saving images and clips

When you save an image or clip, it saves to internal storage. The system beeps afterward if Beep Alert is on, and the percentage icon flashes. (See

“Audio, Battery setup” on page 19.)

38 Images and clips

• A playback speed (1x, 1/2x, 1/4x)

• Pause to interrupt playback

• Left: x or Right: x to remove frames from the left or right sides of the clip (where x is the beginning or ending frame number)

• Save to save the clip to internal storage

• Delete to delete the clip

To set Clips controls

Setting Clips controls ensures that clips are captured to your specifications.

1 In 2D imaging mode, select Clips on-screen.

2 Set controls as desired.

Reviewing patient exams

Caution:

If the internal storage icon does not appear in the system status area, internal storage may be defective. Contact FUJIFILM SonoSite Technical Support. (See

“FUJIFILM SonoSite Technical Support” on page ix.)

Clips controls

Time, ECG Time and ECG share the same

location on-screen.

•With Time, capturing is based on number of seconds. Select the time duration.

•With ECG, capturing is based on the number of heart beats. Select the number of beats.

Preview On, Preview Off

Prospective, Retrospective

PrevOn and PrevOff turn the

preview feature on and off.

•With Prev/On, the captured clip automatically plays on-screen. The clip can be trimmed, saved, or deleted.

•With Prev/Off, the clip saves to internal storage, and the trim and delete controls are not available.

Pro and Retro determine how clips are captured:

•With Pro, a clip is captured prospectively, after you press the

CLIP key.

•With Retro, a clip is captured retrospectively, from pre-saved data before you press the

CLIP key.

The patient list organizes saved images and clips in patient exams. You can delete, view, print, or archive exams. You can also copy them to a USB storage device.

Imaging

Figure 4 Patient List

To display the patient list

1 Press the REVIEW key.

2 If there is an active exam, select List on-screen.

To sort the patient list

After the system starts, the patient list is arranged by date and time, with the most recent patient file first. You can re-sort the patient list as needed.

 Select the column heading that you want to sort

by. Select it again if sorting in reverse order.

Note: The column heading is selectable.

Chapter 3: Imaging 39

To select patients in the patient list

 Using the touchpad, select the check box for

one or more patients. Select All selects all patients.

To deselect patients, select checked boxes or

Clear All.

To edit patient information from the patient list

You can edit the patient name and ID from the patient list instead of from the patient information form if the exam is ended but has not been exported or archived.

1 In the patient list, select the patient.

4 (Clip Only) Select Play.

The clip plays automatically after loading. The load time depends on clip length.

You can select Pause to freeze the clip and can

select a playback speed

5 Select x/x to cycle to the next image or clip

you want to view.

To return to the patient list, select List. To return to imaging, select Done.

1x, 1/2x, 1/4x.

Printing, exporting, and deleting images and clips

2 Select Edit.

3 Fill in the form fields, and select OK.

To append images and clips to a patient exam

Although you cannot add images and clips to a patient exam that is ended, you can automatically start a new patient exam that has the same patient information. Depending on your archiver, the two exams appear as one study when exported or archived.

1 Select the exam in the patient list.

2 Select Append on-screen.

A new patient information form appears. The form has the same information as the exam you selected.

To review images and clips

You can review images and clips in only one patient exam at a time.

1 In the patient list, highlight the patient exam

whose images and clips you want to review.

2 Select Review on-screen.

3 Select x/x to cycle to the image or clip you

want to review.

WARNING:

To avoid damaging the USB storage device and losing patient data from it, observe the following:

• Do not remove the USB storage device or turn off the ultrasound system while the system is exporting.

• Do not bump or otherwise apply pressure to the USB storage device while it is in a USB port on the ultrasound system. The connector could break.

To print an image

1 Verify that a printer is selected. See “To

configure the system for a printer” on

page 19.

2 Do one of the following:

• In the patient list, review the patient’s images. Select Print when the image appears.

• With the image displayed, press the shortcut key.

By default, the reprogram the

“Presets setup” on page 22.

A shortcut key prints. To A and B shortcut keys, see

40 Images and clips

To print multiple images

1 Verify that a printer is selected. See “To

configure the system for a printer” on

page 19.

2 Do one of the following:

To delete images and clips

1 In the patient list, do one of the following:

• If deleting a single image or clip, display it. (See “To review images and clips” on page 40.)

• Print all images for multiple patients: Select one or more patients in the patient list. Then select Print.

• Print all images for one patient: Highlight the patient in the patient list, and then select Print.

Each image appears briefly on-screen while printing.

To export patient exams to a USB storage device

You can export patient exams if they are ended. (See “To end the exam” on page 37.)

A USB storage device is for temporary storage of images and clips. Patient exams should be archived regularly. To specify file format, see “USB Devices

setup” on page 22.

1 Insert the USB storage device.

2 In the patient list, select the patient exams you

want to export.

3 Select Exp. USB on-screen. A list of USB

devices appears.

4 Select the USB storage device. If you want to

hide patient information, deselect Include patient information on images and clips.

Only available USB devices are selectable.

5 Select Export.

The files are finished exporting approximately five seconds after the USB animation stops. Removing the USB storage device or turning off the system while exporting may cause exported files to be corrupted or incomplete. To stop in-progress exporting, select Cancel Export.

• If deleting entire patient exams, select them.

2 Select Delete.

A confirmation screen appears.

To manually archive images and clips

You can send patient exams to a DICOM printer or archiver, or to a PC using SiteLink Image Manager. DICOM and SiteLink Image Manager are optional features. For more information about archiving, see the DICOM and SiteLink Image Manager documentation.

1 Select one or more patients in the patient list.

2 Select Archive.

To display information about a patient exam

1 On the patient list, select the exam.

2 Select Info.

ECG Monitoring

ECG Monitoring is an optional feature and requires a FUJIFILM SonoSite ECG cable.

WARNING:

To prevent misdiagnosis, do not use the ECG trace to diagnose cardiac rhythms. The FUJIFILM SonoSite ECG control is a non-diagnostic feature.

To avoid electrical interference with aircraft systems, do not use the ECG cable on aircraft. Such interference may have safety consequences.

Imaging

Chapter 3: Imaging 41

Caution:

Use only accessories recommended by FUJIFILM SonoSite with the system. Your system can be damaged by connecting an accessory not recommended by FUJIFILM SonoSite.

To monitor ECG

1 Connect the ECG cable to the ECG connector on

the ultrasound system, mini-dock, or docking system.

ECG Monitoring turns on automatically.

Note: An external ECG monitor may cause a lag in the timing of the ECG trace, corresponding with the 2D image. Biopsy guidelines are not available when ECG is connected. The ECG signal may take up to one minute to restabilize after defibrillator use on the patient.

2 Select ECG on-screen. (ECG may be on

another page. It appears only if the ECG cable is connected.)

3 Adjust controls as desired.

ECG Monitoring controls

Show/Hide Turns on and off ECG trace.

Gain Increases or decreases ECG gain.

Settings are 0-20.

Position Sets the position of the ECG trace.

Sweep

Settings are Slow, Med, and Fast.

Speed

Delay Displays Line and Save for clip

acquisition delay. (For instructions to capture clips, see “To capture

and save a clip” on page 38.)

Line The position of the delay line on

the ECG trace. The delay line indicates where the clip acquisition is triggered.

Save Saves the current position of the

delay line on the ECG trace. (You can change the position of the delay line temporarily. Starting a new patient information form or cycling system power reverts the delay line to the most recently saved position.)

Select Delay to display these controls.

42 ECG Monitoring

Chapter 4: Measurements and Calculations

You can measure for quick reference, or you can measure within a calculation. You can perform general calculations as well as calculations specific to an exam type.

Measurements are performed on frozen images. For references used, see Chapter 5,

“Measurement References.”

Measurements

You can perform basic measurements in any imaging mode and can save the image with the measurements displayed. (See “To save an

image” on page 38.) Except for the M Mode HR

measurement, the results do not automatically save to a calculation and the patient report. If you prefer, you can first begin a calculation and then measure. See “Performing and saving measurements in

calculations” on page 47.

Some features may not apply to your system. Features available depend on your configuration, transducer, and exam type.

To save a measurement to a calculation and patient report

1 With the measurement active (green), press

the

CALCS key.

2 From the calculations menu, select a

measurement name.

Working with calipers

When measuring, you work with calipers, often in pairs. Results based on the calipers’ position appear at the bottom of the screen. The results update as you reposition the calipers by using the touchpad. In trace measurements, the results appear after you complete the trace.

Outside a calculation, you can add calipers by pressing the of calipers and can switch from one set to another, repositioning them as needed. Each set shows the measurement result. The active calipers and measurement result are highlighted green. A measurement is complete when you finish moving its calipers.

Within a calculation, calipers appear when you select from the calculations menu. (See “To select

from the calculations menu” on page 47.)

For an accurate measurement, accurate placement of calipers is essential.

To switch the active calipers

 Do one of the following:

• To switch the active caliper within a set,

• To switch the active set when measuring

CALIPER key. You can have multiple sets

press the

outside a calculation, select Switch on-screen.

SELECT key.

Measurements

Only measurement names available for the imaging mode and exam type are selectable.

3 Save the calculation. (See “To save a

calculation” on page 47.)

To start a calculation before measuring, see

“Performing and saving measurements in calculations” on page 47.

To delete or edit a measurement

 With the measurement active (highlighted), do

one of the following:

•To delete, select Delete on-screen.

• To edit, use the touchpad to move the calipers.

Chapter 4: Measurements and Calculations 43

Note: Trace measurements cannot be edited once set.

To improve precision of caliper placement

 Do any of the following:

• Adjust the display for maximum sharpness.

• Use leading edges (closest to the transducer) or borders for starting and stopping points.

• Maintain a consistent transducer orientation for each type of measurement.

• Make sure that the area of interest fills as much of the screen as possible.

• (2D) Minimize the depth, or zoom.

2D measurements

The basic measurements that you can perform in 2D imaging are as follows:

•Distance in cm

•Area in cm

• Circumference in cm

You can also measure area or circumference by tracing manually.

You can perform a combination of distance, area, circumference, and manual trace measurements at one time. The total number possible depends on their order and type.

To measure distance (2D)

You can perform up to eight distance measurements on a 2D image.

1 On a frozen 2D image, press the

CALIPER key.

A pair of calipers appears, connected by a dotted line.

2 Using the touchpad, position the first caliper,

and then press the

SELECT key.

The other caliper becomes active.

3 Using the touchpad, position the other caliper.

If you move the calipers close together, they shrink and the dotted line disappears.

See “To save a measurement to a calculation

and patient report” on page 43.

To measure area or circumference (2D)

1 On a frozen 2D image, press the CALIPER key.

2 Select Ellipse on-screen.

Note: If you exceed the allowed number of measurements, Ellipse is not available.

3 Use the touchpad to adjust the size and position

of the ellipse. The

SELECT key toggles between

position and size.

See “To save a measurement to a calculation

and patient report” on page 43.

To trace manually (2D)

1 On a frozen 2D image, press the CALIPER key.

2 Select Manual on-screen.

Note: If you exceed the allowed number of measurements, Manual is not available.

Figure 1 2D image with two distance and one circumference measurement

44 Measurements

3 Using the touchpad, position the caliper where

you want to begin.

4 Press the SELECT key.

5 Using the touchpad, complete the trace, and

press the

SET key.

See “To save a measurement to a calculation

and patient report” on page 43.

M Mode measurements

The basic measurements that you can perform in M Mode imaging are as follows:

5 Using the touchpad, position the second vertical

caliper at the peak of the next heartbeat.

See “To save a measurement to a calculation

and patient report” on page 43. Saving the heart

rate measurement to the patient report overwrites any heart rate entered on the patient information form.

See also “To measure fetal heart rate (M

Mode)” on page 67.

• Distance in cm/Time in seconds

• Heart Rate (HR) in beats per minute (bpm)

The time scale above the trace has small marks at 200 ms intervals and large marks at one-second intervals.

To measure distance (M Mode)

You can perform up to four distance measurements on an image.

1 On a frozen M Mode trace, press the

CALIPER

key.

A single caliper appears.

2 Using the touchpad, position the caliper.

3 Press the

SELECT key to display the second

caliper.

4 Using the touchpad, position the second caliper.

See “To save a measurement to a calculation

and patient report” on page 43.

To measure heart rate (M Mode)

1 On a frozen M Mode trace, press the CALIPER

key.

2 Select HR on-screen.

A vertical caliper appears.

3 Using the touchpad, position the vertical caliper

at the peak of the heartbeat.

4 Press the

A second vertical caliper appears.

SELECT key.

Doppler measurements

The basic measurements that you can perform in Doppler imaging are Velocity (cm/s), Pressure Gradient, Elapsed Time, +/x Ratio, Resistive Index (RI), and Acceleration. You can also trace manually or automatically.

For Doppler measurements, the Doppler scale must be set to cm/s. See “Presets setup” on page 22.

To measure Velocity (cm/s) and Pressure Gradient (Doppler)

1 On a frozen Doppler spectral trace, press the

CALIPER key.

A single caliper appears.

2 Using the touchpad, position the caliper to a

peak velocity waveform.

This measurement involves a single caliper from the baseline.

See “To save a measurement to a calculation

and patient report” on page 43.

To measure Velocities, Elapsed Time, +/x Ratio, Resistive Index (RI), and Acceleration (Doppler)

RI appears only if the velocity associated with the

first caliper is greater than the velocity associated with the second caliper.

ACC appears only when the velocity associated with the second caliper is greater than the velocity associated with the first caliper.

Measurements

Chapter 4: Measurements and Calculations 45

1 On a frozen Doppler spectral trace, press the

CALIPER key.

A single caliper appears.

2 Using the touchpad, position the caliper to a

peak systolic waveform.

3 Press the

SELECT key.

A second caliper appears.

4 Using the touchpad, position the second caliper

at the end diastole on the waveform.

See “To save a measurement to a calculation

and patient report” on page 43.

To measure time duration (Doppler)

1 On a Doppler spectral trace, press the CALIPER

key.

2 Press Time on-screen.

A vertical caliper appears.

5 Press the

SET key.

The measurement results appear.

See “To save a measurement to a calculation

and patient report” on page 43.

To trace automatically (Doppler)

After tracing automatically, confirm that the system-generated boundary is correct. If you are not satisfied with the trace, obtain a high-quality Doppler spectral trace image, or trace manually. (See “To trace manually (Doppler)” on page 46.)

1 On a frozen Doppler spectral trace, press the

CALIPER key.

2 Select Auto on-screen.

A vertical caliper appears.

3 Using the touchpad, position the caliper at the

beginning of the waveform.

3 Using the touchpad, position the caliper where

desired, and press the

SELECT key.

A second caliper appears.

4 Using the touchpad, position the second caliper

where desired, and press the

SELECT key.

To trace manually (Doppler)

1 On a frozen Doppler spectral trace, press the

CALIPER key.

2 Select Manual on-screen.

A single caliper appears.

3 Using the touchpad, position the caliper at the

beginning of the desired waveform, and press the

SELECT key.

If calipers are not positioned correctly, the result is inaccurate.

4 Using the touchpad, trace the waveform.

To make a correction, select Undo on-screen, backtrack with the touchpad, or press the

BACKSPACE key.

If calipers are not positioned correctly, the calculation result is inaccurate.

4 Press the

SELECT key.

A second vertical caliper appears.

5 Using the touchpad, position the second caliper

at the end of the waveform.

6 Press the

SET key.

The measurement results appear.

See “To save a measurement to a calculation

and patient report” on page 43.

Automatic trace results

Depending on the exam type, the results from automatic tracing include the following:

• Velocity Time Integral (VTI)

• Peak Velocity (Vmax)

• Mean Pressure Gradient (PGmean)

• Mean Velocity on Peak Trace (Vmean)

• Pressure Gradient (PGmax)

46 Measurements

• Cardiac Output (CO)

• Peak Systolic Velocity (PSV)

• Time Average Mean (TAM)*

• +/× or Systolic/Diastolic (S/D)

• Pulsatility Index (PI)

• End Diastolic Velocity (EDV)

• Acceleration Time (AT)

• Resistive Index (RI)

• Time Average Peak (TAP)

•Gate Depth

To select from the calculations menu

1 On a frozen image, press the CALCS key.

The calculations menu appears.

2 Using the touchpad or arrow keys, highlight the

desired measurement name.

To display additional measurement names, highlight Next, Prev, or a measurement name that has ellipses (. . .). Then press the key.

Only measurement names available for the imaging mode are selectable.

3 Press the

SELECT key.

SELECT

General calculations

Within calculations, you can save measurement results to the patient report. You can display, repeat, and delete measurements from a calculation. Some measurements can be deleted directly from the patient report pages. See

“Patient report” on page 72.

Calculation packages depend on exam type and transducer.

Calculations menu

The calculations menu contains measurements available for the imaging mode and exam type. After you perform and save a measurement, the result saves to the patient report. (See “Patient

report” on page 72.) Also, a check mark appears

next to the measurement name in the calculations menu. If you highlight the checked measurement name, the results appear below the menu. If you repeat the measurement, the results below the menu reflect either the last measurement or the average, depending on the measurement.

To close the calculations menu, press the

CALCS key

once (if the menu is active) or twice (if the menu is inactive).

Performing and saving measurements in calculations

In performing a measurement within a calculation, you select from the calculations menu, position the calipers that appear, and then save the calculation. Unlike measurements performed outside a calculation, the calipers appear by selecting from the calculations menu, not by pressing the key. The type of calipers that appear depends on the measurement.

To save a calculation

 Do one of the following:

• Save the calculation only: Press the

SAVE CALC key, or select Save on-screen.

The calculation saves to the patient report. To save the image with the measurements displayed, see “To save an image” on page 38.

CALIPER

Measurements

Menu items followed by ellipses (. . .) have subentries.

• Save both the image and calculation: Press the

SAVE key if the SAVE key functionality is

set to Image/Calcs. (See “Presets

setup” on page 22.)

Chapter 4: Measurements and Calculations 47

The calculation saves to the patient report, and the image saves to internal storage with the measurements displayed.

Some measurements can be deleted directly from the patient report pages. See “Patient report” on page 72.

Displaying, repeating, and deleting saved measurements in calculations

To display a saved measurement

 Do one of the following:

• Highlight the measurement name in the calculations menu. The result appears below the menu.

• Open the patient report. See “Patient

report” on page 72.

To repeat a saved measurement

1 Highlight the measurement name in the

calculations menu.

2 Press the

3 Perform the measurement again.

The new results appear on-screen in the measurement and calculations data area. (See

“Screen layout” on page 8.) You can

compare them to the saved results below the menu.

4 To save the new measurement, press the

SAVE CALC key.

The new measurement saves to the patient report and overwrites the previously saved measurement.

To delete a saved measurement

1 Select the measurement name from the

calculations menu.

2 Select Delete on-screen.

The measurement last saved is deleted from the patient report. If it is the only measurement, the check mark is deleted from the calculations menu.

SELECT key or the CALIPER key.

EMED calculations

The results from EMED calculations automatically appear in the EMED worksheets. All EMED calculations are available for each exam type.

To perform an EMED calculation:

1 Press the CALCS key.

2 Select EMED on-screen.

The calculations menu becomes the EMED calculations menu.

3 Select the calculation name.

4 Perform a distance measurement.

5 Save the measurement.

To return to the calculations menu, select Calcs on-screen.

Percent reduction calculations

WARNING:

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

To avoid misdiagnosis or harming the patient outcome, start a new patient information form before starting a new patient exam and performing calculations. Starting a new patient information form clears the previous patient’s data. The previous patient’s data will be combined with the current patient if the form is not first cleared. See

“To create a new patient information form” on page 36.

48 General calculations

2 Do the following for A

and then for A2:

Transducer Exam Types

C11x Abdomen, Vascular

C60x Abdomen, Msk

HFL38x IMT, Small Parts, Vascular

HFL50x Msk, Small Parts

L25x Msk, Vascular

L38x IMT, Small Parts, Vascular

L38xi IMT, Msk, Small Parts, Vascular

P10x Abdomen

P21x Abdomen

SLAx Msk, Vascular

a From the calculations menu, select the

measurement name under Area Red.

b Using the touchpad, move the caliper to the

trace starting point, and press the

SELECT

key.

c Using the touchpad, trace the desired area.

To make a correction, select Undo on-screen or press the

d Complete the trace, and press the

BACKSPACE key.

SET key.

e Save the calculation. See “To save a

calculation” on page 47.

The percent area reduction result appears on-screen in the measurement and calculation data area and in the patient report.

To calculate percent diameter reduction

1 On a frozen 2D image, press the CALCS key.

2 Do the following for D

a From the calculations menu, select the

measurement name under Dia Red.

and then for D2:

Figure 2 Percent area reduction calculation of right carotid bulb

To calculate percent area reduction

The percent area reduction calculation involves two manual trace measurements.

1 On a frozen 2D image, press the

CALCS key.

b Position the calipers. (See “Working with

calipers” on page 43.)

c Save the calculation. See “To save a

calculation” on page 47.

The percent diameter reduction result appears in the measurement and calculation data area and in the patient report.

Chapter 4: Measurements and Calculations 49

Measurements

Volume calculations

WARNING:

Transducer Exam Types

C8x Prostate

C11x Abdomen, Neonatal, Nerve,

C60x Abdomen, Gyn, Msk, Nerve

HFL38x Breast, Nerve, Small Parts,

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

“To create a new patient information form” on page 36.

Vascular,

Vascular

Transducer Exam Types

P21x Abdomen

SLAx Msk, Nerve, Superficial,

Vascular

To calculate volume

The volume calculation involves three 2D distance measurements: D measurements are saved, the result appears on-screen and in the patient report.

 Do the following for each image you need to

measure: a On the frozen 2D image, press the

key.

b Do the following for each measurement you

need to take:

i From the calculations menu, select the

measurement name under Volume. (If Volume is not available in a Gyn exam, select Gyn and then select Volume.)

ii Position the calipers. (See “Working

with calipers” on page 43.)

iii Save the measurement. See “To save a

calculation” on page 47.

, D2, and D3. After all

CALCS

HFL50x Breast, Msk, Nerve, Small

Parts

ICTx Gyn

L25x Msk, Nerve, Superficial,

Vascular

L38x Breast, Nerve, Small Parts,

Vascular

L38xi Breast, Msk, Nerve, Small

Parts, Vascular

P10x Abdomen, Neonatal

50 General calculations

Volume flow calculations

WARNING:

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

The following table shows the measurements required to complete the volume flow calculation. For definitions of acronyms, see “Glossary” on page 173.

Volume Flow Calculations

WARNING:

“To create a new patient information form” on page 36.

Transducer Exam Types

C11x Abdomen, Vascular

C60x Abdomen

HFL38x Vascular

L25x Vascular

L38x Vascular

L38xi Vascular

P10x Abdomen

P21x Abdomen

SLAx Vascular

Menu Heading

Vol Flow D (2D)*

Measurement (Imaging Mode)

TAM or TAP

Calculation Result

VF (Volume Flow ml/min)

(Doppler)

* Required if measuring the diameter instead of using the gate size

Both a 2D and a Doppler measurement are required for the volume flow calculation. For the 2D measurement, you can do either of the following:

• Measure the diameter of the vessel. This approach is more precise. The measurement overrides the gate size.

• Use the gate size. If you do not measure the diameter of the vessel, the system automatically uses the gate size and “(gate)” appears in the calculation results.

The Doppler sample volume should completely insonate the vessel. You can measure either the time average mean or time average peak. To specify the live trace setting, see “Presets

setup” on page 22.

Consider the following factors when performing volume flow measurements:

• Users should follow current medical practice for volume flow calculation applications.

• The accuracy of the volume flow calculation largely depends on the user.

Measurements

• The factors identified in the literature that affect the accuracy are as follows:

• Using the diameter method for 2D area

• Difficulty ensuring uniform insonation of the

vessel.

Chapter 4: Measurements and Calculations 51

The system is limited to the following sample volume sizes:

b From the calculations menu, select TAM or

TAP under Vol Flow.

• C11x transducer: 1, 2, 3 Gate Size (mm)

• C60x and P10x transducers: 2, 3, 5, 7, 10, 12 Gate Size (mm)

• HFL38x, L25x, and SLAx transducers: 1, 3, 5, 6, 7, 8, 10, 12 Gate Size (mm)

• L38x transducer: 1, 3, 5, 7, 10, 12 Gate Size (mm)

• L38xi transducer: 1, 3, 5, 6, 7, 8, 10, 12 Gate Size (mm)

• P21x transducer: 2, 3, 5, 7, 11.5, 14 Gate Size (mm)

• Precision in placing the caliper

• Accuracy in angle correction

The considerations and degree of accuracy for volume flow measurements and calculations are discussed in the following reference:

Allan, Paul L. et al. Clinical Doppler Ultrasound, 4th Ed., Harcourt Publishers Limited, (2000) 36-38.

A vertical caliper appears.

c Using the touchpad, position the vertical

caliper at the beginning of the waveform.

If calipers are not positioned correctly, the calculation result is inaccurate.

d Press the

SELECT key to display a second

vertical caliper.

e Using the touchpad, position the second

vertical caliper at the end of the waveform.

f Press the

SET key to complete the trace and

to display the results.

g Save the calculation. See “To save a

calculation” on page 47.

Results appear at the bottom of the screen as well as save to the patient report.

To calculate volume flow

1 If measuring the diameter instead of using the

gate size, perform the 2D measurement:

a On a frozen full-screen 2D image or duplex

image, press the

b From the calculations menu, select D

(distance) under Vol Flow.

c Position the calipers. (See “Working with

calipers” on page 43.)

d Save the calculation. See “To save a

calculation” on page 47.

2 Perform the Doppler measurement:

a On a frozen Doppler spectral trace, press the

CALCS key.

52 General calculations

CALCS key.

Exam-based calculations

In addition to the general calculations, there are calculations specific to the Cardiac, Gynecology (Gyn), IMT, OB, Orbital, Small Parts, Transcranial Doppler (TCD), and Vascular exam types.

Cardiac Calculations

Cardiac Menu Heading

Measurements

(Imaging

Mode)

Calculation Results

Cardiac calculations

WARNING:

Transducer Exam Type

D2x Cardiac

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

“To create a new patient information form” on page 36.

LV…LVd RVW (2D)

RVD (2D)

IVS (2D)

LVD (2D)

LVPW (2D)

…LVs RVW (2D)

RVD (2D)

IVS (2D)

LVD (2D)

LVPW (2D)

needed for

CO & CI

Ao/LA Ao (2D or

MMode)

AAo (2D) AAo

LA (2D or

MMode)

LVOT D (2D) LVOT D

CO EF SV LVESV LVEDV IVSFT LVPWFT LVDFS CI SI

Ao LA/Ao

LA LA/Ao

LVOT area

P10x Cardiac

P21x Cardiac

TEEx Cardiac

The following table shows the measurements required to complete different cardiac calculations. For definitions of acronyms, see “Glossary” on page 173.

ACS (M Mode) ACS

LVET (M Mode) LVET

MV EF:Slope

(M Mode)

EPSS (M Mode) EPSS

Chapter 4: Measurements and Calculations 53

EF SLOPE

Measurements

Menu Heading

Cardiac Measurements (Imaging Mode)

Calculation Results

Menu Heading

Cardiac Measurements (Imaging Mode)

Calculation Results

LV…LVd RVW (M Mode)

RVD (M Mode) IVS (M Mode) LVD (M Mode) LVPW

(M Mode)

…LVs RVW (M Mode)

RVD (M Mode) IVS (M Mode) LVD (M Mode) LVPW

CO EF SV LVESV LVEDV IVSFT LVPWFT LVDFS CI SI LV Mass

(M Mode)

Area AV (2D) AV Area

MV (2D) MV Area

LV Vol (EF)

A4Cd (2D) A4Cs (2D) A2Cd (2D) A2Cs (2D)

LV Vol LV Area EF CO SV CI SI Biplane

LV mass Epi (2D)

Endo (2D) Apical (2D)

LV Mass Epi Area Endo Area D Apical

PISA Ann D (2D)

Radius (Color) MR/VTI

(Doppler) MV/VTI

(Doppler)

Qp/Qs LVOT D (2D)

RVOT D (2D) LVOT VTI

(Doppler) RVOT VTI

(Doppler)

CO LVOT D (2D)

— (Doppler)

TDI (Wall) e’ and a’

(Doppler) (Wall) e’ and a’

(Doppler) (Wall) ‘e and a’

(Doppler)

PISA Area ERO MV Rate Regurgitant

Volume Regurgitant

Fraction

D VTI VMax PGmax Vmean PGmean SV Qp/Qs

CO SV CI SI VTI HR LVOT D

E(MV)/e’ ratio

54 Exam-based calculations

Menu Heading

Cardiac Measurements (Imaging Mode)

Calculation Results

Menu Heading

Cardiac

Measurements

(Imaging

Mode)

Calculation Results

P. Vein A (Doppler) VMax

Adur (Doppler) time

S (Doppler) VMax

D (Doppler)

MV E (Doppler)

A (Doppler)

S/D ratio

E E PG A A PG E:A

Adur (Doppler) time

PHT (Doppler) PHT

MVA Decel time

VTI (Doppler) VTI

Vmax PGmax Vmean PGmean

IVRT (Doppler) time

MV…MR

dP:dT

(CW

dP:dT

Doppler)

AV Vmax (Doppler) Vmax

PGmax

VTI (Doppler) VTI

Vmax PGmax Vmean PGmean

VTI or Vmax from

AVA

LVOT (Doppler)

VTI or Vmax from

AV (Doppler)

Ao/LA LVOT D (2D)

AV VTI (Doppler) SV

Ao/LA LVOT D (2D)

AV VTI (Doppler) CO

Ao/LA LVOT D (2D)

LVOT Vmax (Doppler) Vmax

PGmax

VTI (Doppler) VTI

Vmax PGmax Vmean PGmean

Measurements

AV…AI PHT (slope)

(Doppler)

Chapter 4: Measurements and Calculations 55

AI PHT AI slope

Cardiac Menu Heading

Measurements

(Imaging

Calculation Results

Mode)

TV TRmax

(Doppler)

E (Doppler)

A (Doppler)

Vmax PGmax

E E PG A A PG E:A

PHT (Doppler) PHT

MVA Decel time

VTI (Doppler) VTI

Vmax PGmax Vmean PGmean

RA pressure

RVSP

PV Vmax (Doppler) Vmax

PGmax

VTI (Doppler)

AT (Doppler)

VTI Vmax PGmax Vmean PGmean AT

a. You can enter the HR measurement three ways: Patient

information form, Doppler measurement (See “To

calculate Heart Rate (HR)” on page 60), or M Mode

measurement (See “To measure heart rate (M

Mode)” on page 45).

b. Performed at 100 cm/s and 300 cm/s. c. Specified on the cardiac patient report. See “To delete

a vascular or cardiac measurement” on page 72.

To measure LVd and LVs

1 On a frozen 2D image or M Mode trace, press

the

CALCS key.

2 From the calculations menu, select the

measurement name.

3 Position the active (green) caliper at the

starting point. (See “Working with calipers” on page 43.)

4 Press the

SELECT key, and position the second

caliper.

5 Press the

SELECT key.

Another caliper appears, and the calculations menu highlights the next measurement name.

6 Position the caliper, and press the

SELECT key.

Repeat for each measurement name in the calculation group.

Each time you press the

SELECT key, another

caliper appears, and the calculations menu highlights the next measurement name.

7 Save the calculation. (See “To save a

calculation” on page 47.)

To measure Ao, LA, AAo, or LVOT D

1 On a frozen 2D image or M Mode trace, press

the

CALCS key.

2 From the calculations menu, select the

measurement name.

3 Position the calipers. (See “Working with

calipers” on page 43.)

4 Save the calculation. (See “To save a

calculation” on page 47.)

To calculate LV Volume (Simpson’s Rule)

1 On a frozen 2D image, press the CALCS key.

2 Do the following for each measurement:

a From the calculations menu, select the

desired view and phase.

b Position the caliper at the mitral annulus, and

press the

56 Exam-based calculations

SELECT key to start the trace.

c Using the touchpad, trace the left ventricular

(LV) cavity.

To make a correction, select Undo on-screen or press the

BACKSPACE key.

5 Positioning the calipers, measure the ventricular

length. (See “Working with calipers” on page 43.)

6 Save the calculation.

d Complete the trace, and press the

SET key.

e Save the calculation. (See “To save a

calculation” on page 47.)

To calculate MV or AV area

1 On a frozen 2D image, press the CALCS key.

2 In the calculations menu, locate Area, and then

select MV or AV.

3 Position the caliper where you want to begin the

trace, and press the

SELECT key.

4 Using the touchpad, trace the desired area.

To make a correction, select Undo on-screen or press the

5 Complete the trace, and press the

BACKSPACE key.

SET key.

6 Save the calculation. (See “To save a

calculation” on page 47.)

To calculate LV Mass

1 On a frozen 2D image, press the CALCS key.

2 In the calculations menu, locate LV Mass.

To measure peak velocity

For each cardiac measurement, the system saves up to five individual measurements and calculates their average. If you take more than five measurements, the most recent measurement replaces the fifth one. If you delete a saved measurement from the patient report, the next measurement taken replaces the deleted one in the patient report. The most recently saved measurement appears at the bottom of the calculations menu.

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select MV, TV, TDI,

or P. Vein.

3 Do the following for each measurement you

want to take:

a Select the measurement name from the

calculations menu.

b Position the calipers. (See “Working with

calipers” on page 43.)

3 Do the following for EPI and then for Endo:

a Select the measurement name from the

calculations menu.

b Position the caliper where you want to begin

the trace, and press the

SELECT key.

c Using the touchpad, trace the desired area.

To make a correction, select Undo on-screen or press the

d Complete the trace, and press the

BACKSPACE key.

SET key.

e Save the calculation. (See “To save a

calculation” on page 47.).

4 Select Apical from the calculations menu.

c Save the calculation. (See “To save a

calculation” on page 47.)

To calculate Velocity Time Integral (VTI)

Note: This calculation computes other results in addition to VTI. See the table “Cardiac

Calculations” on page 53.

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select VTI under

MV, AV, TV, PV, or LVOT.

3 Position the caliper at the start of the waveform,

and press the

Chapter 4: Measurements and Calculations 57

SELECT key to start the trace.

Measurements

4 Using the touchpad, trace the waveform.

4 Position the second caliper:

To make a correction, select Undo on-screen, backtrack with the touchpad, or press the

BACKSPACE key.

5 Press the

SET key to complete the trace.

6 Save the calculation. (See “To save a

calculation” on page 47.)

For information on the automatic trace tool, see

“To trace automatically (Doppler)” on

page 46.

To calculate Right Ventricular Systolic Pressure (RVSP)

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select TV and then

select TRmax.

3 Position the caliper. (See “Working with

calipers” on page 43.)

4 Save the calculation. (See “To save a

calculation” on page 47.)

5 To adjust the RA pressure, see “To delete a

vascular or cardiac measurement” on

page 72.

Changing the RA pressure from the default 5 affects the RVSP calculation in the patient report.

• In MV, position the caliper along the EF slope.

• In AV, position the caliper at the end diastole.

5 Save the calculation. (See “To save a

calculation” on page 47.)

To calculate Proximal Isovelocity Surface Area (PISA)

The PISA calculation requires a measurement in 2D, a measurement in Color, and two measurements in Doppler spectral trace. After all measurements are saved, the result appears in the patient report.

1 Measure from Ann D (2D):

a On a frozen 2D image, press the

b From the calculations menu, locate PISA,

and then select Ann D.

c Position the calipers. (See “Working with

calipers” on page 43.)

d Save the calculation. (See “To save a

calculation” on page 47.)

2 Measure from Radius (Color):

a On a frozen Color image, press the

key.

b From the calculations menu, select Radius.

CALCS key.

CALCS

To calculate Pressure Half Time (PHT) in MV, AI, or TV

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select MV, AV, or

TV, and then select PHT.

3 Position the first caliper at the peak, and press

the

SELECT key.

A second caliper appears.

c Position the calipers.

d Save the calculation.

3 On a frozen Doppler spectral trace, press the

CALCS key.

4 Do the following to measure from MR VTI and

again to measure from MV VTI (Doppler):

a From the calculations menu, select PISA and

then select MR VTI or MV VTI.

b Position the caliper at the start of the

waveform, and press the

SELECT key to start

the trace.

58 Exam-based calculations

c Using the touchpad, trace the waveform.

To make a correction, select Undo on-screen, backtrack with the touchpad, or press the

d Press the

BACKSPACE key.

SET key to complete the trace.

3 Position the first caliper along the waveform at

100 cm/s.

4 Press the

SELECT key.

A second horizontal dotted line with an active caliper appears at 300 cm/s.

e Save the calculation.

For information on the automatic trace tool, see

“To trace automatically (Doppler)” on

page 46.

To calculate Isovolumic Relaxation Time (IVRT)

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select MV and then

select IVRT.

A vertical caliper appears.

3 Using the touchpad, position the caliper at the

aortic valve closure.

4 Press the

SELECT key.

A second vertical caliper appears.

5 Using the touchpad, position the second caliper

at onset of mitral inflow.

6 Save the calculation. (See “To save a

calculation” on page 47.)

To calculate Delta Pressure: Delta Time (dP:dT)

To perform the dP:dT measurements, the CW Doppler scale must include velocities of 300 cm/s or greater on the negative side of the baseline. (See “Spectral trace controls” on page 29.)

1 On a frozen CW Doppler spectral trace, press

the

CALCS key.

2 From the calculations menu, select MV, and

then select dP:dT.

A horizontal dotted line with an active caliper appears at 100 cm/s.

5 Position the second caliper along the waveform

at 300 cm/s.

6 Save the calculation. (See “To save a

calculation” on page 47.)

To calculate Aortic Valve Area (AVA)

The AVA calculation requires a measurement in 2D and two measurements in Doppler. After the measurements are saved, the result appears in the patient report.

1 Measure from LVOT (2D):

a On a frozen 2D image, press the

CALCS key.

b From the calculations menu, select LVOT D.

c Position the calipers. (See “Working with

calipers” on page 43.)

d Save the calculation. (See “To save a

calculation” on page 47.)

2 Measure from LVOT, and then measure from AV

(Doppler):

•For Vmax, see “To measure peak

velocity” on page 57. From the

calculations menu, select AV, select sample site, and then select Vmax.

• For VTI, see “To calculate Velocity Time

Integral (VTI)” on page 57. From the

calculations menu, select AV, select sample site, and then select VTI.

To calculate Qp/Qs

The Qp/Qs calculation requires two measurements in 2D and two measurements in Doppler. After the measurements are saved, the result appears in the patient report.

1 On a frozen 2D image, press the

CALCS key.

Measurements

Chapter 4: Measurements and Calculations 59

2 Do the following to measure from LVOT D and

again to measure from RVOT D:

a From the calculations menu, locate Qp/Qs

and then select LVOT D or RVOT D.

b Position the calipers. (See “Working with

calipers” on page 43.)

c Save the calculation. (See “To save a

calculation” on page 47.)

3 On a frozen Doppler spectral trace, press the

CALCS key.

4 Do the following to measure from LVOT VTI and

again to measure from RVOT VTI:

a From the calculations menu, select Qp/Qs

and then select LVOT VTI or RVOT VTI.

b Press the

SELECT key to start the trace.

c Using the touchpad, trace the waveform.

To make a correction, select Undo on-screen, backtrack with the touchpad, or press the

d Press the

BACKSPACE key.

SET key to complete the trace.

e Save the calculation. (See “To save a

calculation” on page 47.)

For information on the automatic trace tool, see

“To trace automatically (Doppler)” on

page 46.

b From the calculations menu, select LVOT D.

c Position the calipers. (See “Working with

calipers” on page 43.)

d Save the calculation. (See “To save a

calculation” on page 47.)

3 Measure from aorta (Doppler). See “To

calculate Velocity Time Integral (VTI)” on

page 57. From the calculations menu, select AV and then select VTI.

For information on the automatic trace tool, see

“To trace automatically (Doppler)” on

page 46.

To calculate Heart Rate (HR)

Heart Rate is available in all cardiac packages. The Heart Rate is not calculated using the ECG trace.

Saving the heart rate to the patient report overwrites any heart rate entered on the patient information form.

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select HR.

A vertical caliper appears.

3 Using the touchpad, position the first vertical

caliper at the peak of the heartbeat.

4 Press the

SELECT key.

To calculate Stroke Volume (SV) or Stroke Index (SI)

The SV and SI calculations require a measurement in 2D and a measurement in Doppler. SI also requires Body Surface Area (BSA). After the measurements are saved, the result appears in the patient report.

1 (SI Only) Fill in the Height and Weight fields on

the patient information form. The BSA is calculated automatically. (See “To create a

new patient information form” on page 36.)

2 Measure from LVOT (2D):

a On a frozen 2D image, press the

60 Exam-based calculations

CALCS key.

A second vertical caliper appears. The active caliper is highlighted green.

5 Using the touchpad, position the second vertical

caliper at the peak of the next heartbeat.

6 Save the calculation. (See “To save a

calculation” on page 47.)

To calculate Cardiac Output (CO) or Cardiac Index (CI)

The CO and CI calculations require Stroke Volume and Heart Rate calculations. CI also requires Body Surface Area (BSA). After the measurements are saved, the result appears in the patient report.

1 (CI Only) Fill in the Height and Weight fields on

the patient information form. The BSA is calculated automatically. (See “To create a

new patient information form” on page 36.)

2 Calculate SV. See “To calculate Stroke

Volume (SV) or Stroke Index (SI)” on

page 60.

3 Calculate HR. See “To calculate Heart Rate

(HR)” on page 60.

To calculate Cardiac Output automatically

WARNING:

1 Make sure that the flow rate is 1 L/min or

greater.

The system can maintain accuracy of the measurements only if the flow rate is 1 L/min or greater.

2 Measure from LVOT (2D):

a On a frozen 2D image, press the

b From the calculations menu, select CO, and

then select LVOT D.

c Position the calipers. (See “Working with

calipers” on page 43.)

To avoid incorrect calculation results, make sure that the Doppler signal does not alias.

To avoid an incorrect diagnosis:

• Do not use automatic Cardiac Output calculations as the sole diagnostic criteria. Use them only in conjunction with other clinical information and patient history.

• Do not use automatic Cardiac Output calculations in neonatal patients.

To avoid inaccurate velocity measurements if you use PW Doppler, make sure that Angle Correction is set to zero.

CALCS key.

d Save the calculation. (See “To save a

calculation” on page 47.)

3 Trace automatically (Doppler):

The automatic trace tool always measures the peak regardless of the Live Trace setting in Presets setup.

a Display the Doppler spectral trace

(waveform).

b Select Trace on-screen, and then select

Above or Below for the position of the

automatic trace tool relative to the baseline.

The automatic trace tool appears in yellow.

The results appear at the bottom of the screen.

c Freeze the image.

If you want to change the waveform measured, move each vertical caliper by pressing touchpad. Press

SELECT and then using the

SET to update the results.

If you invert the frozen image or move the baseline, results are cleared.

If you want to hide the results, select Trace.

d Save the calculation.

To measure a Tissue Doppler Imaging (TDI) waveform

1 Ensure that TDI is on. (See “PW Doppler

controls” on page 29.)

2 On a frozen Doppler spectral trace, press the

CALCS key.

3 From the calculations menu, select TDI, and

then do the following for each measurement you want to take:

a From the calculations menu, select the

measurement name.

b Position the calipers. (See “Working with

calipers” on page 43.)

Measurements

Chapter 4: Measurements and Calculations 61

c Save the calculation. (See “To save a

calculation” on page 47.)

b Position the calipers. (See “Working with

calipers” on page 43.)

Gynecology (Gyn) calculations

Gynecology (Gyn) calculations include Uterus, Ovary, Follicle, and Volume. For instructions to calculate volume, see “Volume calculations” on page 50.

WARNING:

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

“To create a new patient information form” on page 36.

c Save the calculation. (See “To save a

calculation” on page 47.)

To measure follicles

On each side, you can save up to three distance measurements on a follicle, for up to 10 follicles.

If you measure a follicle twice, the average appears in the report. If you measure a follicle three times, the average and a volume calculation appear in the report.

1 On a frozen 2D image, press the

2 From the calculations menu, select Follicle.

3 Do the following for each measurement you

want to take:

a From the calculations menu, select the

follicle number under Right Fol or Left Fol.

b Position the calipers. (See “Working with

calipers” on page 43.)

c Save the calculation. (See “To save a

calculation” on page 47.)

CALCS key.

IMT calculations

WARNING:

Transducer Exam Type

C60x Gyn

WARNING:

ICTx Gyn

To measure uterus or ovary

1 On a frozen 2D image, press the CALCS key.

2 From the calculations menu, select Gyn.

WARNING:

3 Do the following for each measurement you

want to take:

a Select the measurement name from the

calculations menu.

62 Exam-based calculations

To ensure high quality images, all patient images must be obtained by qualified and trained individuals.

To avoid patient injury, IMT results should not be used as a sole diagnostic tool. All IMT results should be interpreted in conjunction with other clinical information or risk factors.

To avoid measurement errors, all measurements must be of the common carotid artery (CCA). This tool is not intended for measuring the bulb or the internal carotid artery (ICA).

WARNING:

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

IMT Calculations (2D)

Menu Heading Available Measurements

WARNING:

“To create a new patient information form” on page 36.

Transducer Exam Type

L38x IMT

L38xi IMT

HFL38x IMT

The following table shows available measurements for IMT calculations. The IMT measurement names are specified on the IMT setup page. See “IMT

Calculations setup” on page 20.

Right-IMT Left-IMT

Ant N (Anterior Near Wall) Ant F (Anterior Far Wall) Lat N (Lateral Near Wall) Lat F (Lateral Far Wall) Post N (Posterior Near

Wall) Post F (Posterior Far Wall) IMT 1 IMT 2 IMT 3 IMT 4 IMT 5 IMT 6 IMT 7 IMT 8

Plaque Plaq 1

Plaq 2

To calculate IMT automatically

1 On a frozen 2D image, press the CALCS key.

2 From the calculations menu, select the

measurement.

3 Using the touchpad or arrow keys, position the

IMT tool over the area of interest until the measurement results appear.

4 Adjust the tool, and edit as needed. See “IMT

tool controls” on page 64.

5 Save the calculation. (See “To save a

calculation” on page 47.)

Chapter 4: Measurements and Calculations 63

Measurements

IMT tool controls

When using the IMT tool, you can select the following controls on-screen.

To trace IMT manually

In manually tracing IMT, the user defines the location.

Control Description

Hide Use to check results. Hides the

measurement results and trace line. Select Show to redisplay them.

Move Repositions the tool horizontally

by several pixels. The upper key moves the tool right, and the lower key moves the tool left.

Width Adjusts the tool width by 1 mm.

The upper key increases the width, and the lower key decreases the width.

Edit Displays Smooth, Adven, and

Lumen.

Smooth Adjusts the IMT line smoothing.

Select Edit to display this control.

Adven Adjusts the adventitia-media

line. The upper key moves the line upward. The lower key moves the line downward.

Select Edit to display this control.

Lumen Adjusts the lumen-intima line.

The upper key moves the line upward. The lower key moves the line downward.

Each of the two IMT lines can be adjusted independently.

Select Edit to display this control.

1 On a frozen 2D image, press the

CALCS key

2 From the calculations menu, select a

measurement name.

3 Select Edit on-screen, and then select Manual,

and then select Sketch.

A single caliper appears, and Trace appears next to the measurement.

4 Do the following for the desired

adventitia-media boundary and then for the lumen-intima boundary:

a Position the caliper at the beginning of the

boundary, and press the

SELECT key.

b Using the touchpad, mark points by moving

the caliper to the next desired point and pressing the

SELECT key.

To make a correction, select Undo on-screen or press the

BACKSPACE key to delete the last

segment.

c Press the

SET key to complete the trace line.

5 Save the calculation. (See “To save a

calculation” on page 47.)

To sketch IMT

The IMT sketch measurement involves two user-defined sketch lines that you can adjust manually.

1 On a frozen 2D image, press the

2 From the calculations menu, select a

measurement name.

3 Select Edit on-screen, and then select Manual.

A single caliper appears on-screen, and Sketch appears next to the measurement.

CALCS key

64 Exam-based calculations

4 Do the following for the desired

adventitia-media boundary and then for the lumen-intima boundary:

a Position the caliper at the beginning of the

boundary and press the

SELECT key.

b Using the touchpad, mark points by moving

the caliper to the next desired point and pressing the

SELECT key.

To make a correction, select Undo on-screen or press the

BACKSPACE key to delete the last

segment.

c Press the

SET key to complete the trace line.

d If necessary, adjust or edit the measurement.

See “IMT tool controls” on page 64.

e Save the calculation. (See “To save a

calculation” on page 47.)

WARNING:

“To create a new patient information form” on page 36.

Prior to use, verify that OB custom table data entries are correct. The system does not confirm the accuracy of the custom table data entered by the user.

OB calculations

EFW is calculated only after appropriate measurements are completed. If any one of these parameters results in an EDD greater than what the OB calculation tables provide, the EFW is not displayed.

WARNING:

Make sure that you have selected the OB exam type and the OB author for the OB calculation table you intend to use. See “Results

from System-Defined OB Measurements and Table Authors” on page 66.

To avoid incorrect obstetrics calculations, verify with a local clock and calendar that the system’s date and time settings are correct before each use of the system. The system does not automatically adjust for daylight savings time changes.

Transducer Exam Type

C60x OB

ICTx OB

P21x OB

If you change the calculation author during the exam, the common measurements are retained.

The following table shows the system-defined measurements available for OB calculations by author. For definition of the acronyms, see

“Glossary” on page 173. To select authors, see “OB Calculations setup” on page 20.

See also “OB Custom Measurements setup” on page 21 and “OB Custom Tables setup” on page 21.

Measurements

Chapter 4: Measurements and Calculations 65

Results from System-Defined OB Measurements and Table Authors

Calculation Result

Gestational OB Measurements

Table Authors

Calculation Result

Gestational

Age

Gestational OB Measurements

YS —

GS Hansmann,

CRL Hadlock,

BPD Chitty,

OFD Hansmann

HC Chitty,

TTD Hansmann,

APTD

AC Hadlock,

FTA Osaka

FL Chitty,

HL Jeanty

Tibia Jeanty

TCD —

CM —

Lat V —

CxLen —

Table Authors

Nyberg, Tokyo U.

Hansmann, Osaka, Tokyo U.

Hadlock, Hansmann, Osaka, Tokyo U.

Hadlock, Hansmann

Tokyo U.

Hansmann, Tokyo U.

Hadlock, Hansmann, Osaka, Tokyo U.

Estimated Fetal Weight (EFW)

Ratios HC/AC Campbell

Amniotic Fluid Index

Growth Analysis

Tables

a. The Gestational Age is automatically calculated and

displayed next to the OB measurement you selected. The average of the results is the AUA.

b. For Tokyo U., APTD and TTD are used only to calculate EFW.

No age or growth tables are associated with these measurements.

HC, AC, FL Hadlock 1

BPD, AC, FL Hadlock 2

AC, FL Hadlock 3

BPD, TTD Hansmann

BPD, FTA, FL Osaka U.

BPD, AC Shepard

BPD, TTD, APTD, FL Tokyo U.

FL/AC Hadlock

FL/BPD Hohler

FL/HC Hadlock

, Q2, Q3, Q

BPD Chitty,

HC Chitty,

AC Chitty,

FL Chitty,

EFW Brenner,

HC/AC Campbell

Jeng

Hadlock, Jeanty

66 Exam-based calculations

c. The Estimated Fetal Weight calculation uses an equation that

consists of one or more fetal biometry measurements. The author for the OB tables, which you choose on a system setup page, determines the measurements you must perform to obtain an EFW calculation. (See “OB

Calculations setup” on page 20.)

Individual selections for Hadlock’s EFW equations 1, 2, and 3 are not determined by the user. The selected equation is determined by the measurements that have been saved to the patient report with priority given to the order listed above.

d. The Growth Analysis tables are used by the Report Graphs

feature. Three growth curves are drawn using the table data for the selected growth parameter and published author. Growth tables are only available with a user-entered LMP or Estab. DD.

To measure gestational growth (2D)

For each 2D OB measurement (except AFI), the system saves up to three individual measurements and their average. If you take more than three measurements, the earliest measurement is deleted.

1 In the patient information form, select OB exam

type, and select LMP or Estab.DD. Select

Twins if appropriate.

2 On a frozen 2D image, press the

CALCS key.

3 Do the following for each measurement you

want to take:

a From the calculations menu, select the

measurement name. For twins, select Twin A or Twin B, and then select the measurement name.

The caliper tool may change depending on the measurement selected, but the position remains constant.

b Position the calipers. (See “Working with

calipers” on page 43.)

c Save the calculation. (See “To save a

calculation” on page 47.)

To measure fetal heart rate (M Mode)

1 On a frozen M Mode trace, press the CALCS key.

2 Select FHR from the calculations menu.

A vertical caliper appears.

3 Using the touchpad, position the vertical caliper

at the peak of the heartbeat.

4 Press the

SELECT key.

A second vertical caliper appears.

5 Using the touchpad, position the second vertical

caliper at the peak of the next heartbeat.

6 Save the calculation. (See “To save a

calculation” on page 47.)

OB Doppler Calculations

Menu Heading

MCA (Middle Cerebral

OB Calculation

S/D, RI

Results

Artery)

RI PI

Umb A (Umbilical

S/D, RI, PI*

S/D, RI

Artery)

S/D, RI, PI*

*Calculation requires a trace measurement.

RI PI

To calculate MCA or Umba (Doppler)

Note: The system does not provide an MCA/UmbA ratio from the PI (Pulsatility Index).

1 Select OB exam type, and select LMP or

Estab.DD in the patient information form.

2 On a frozen Doppler spectral trace, press the

CALCS key.

Measurements

Chapter 4: Measurements and Calculations 67

3 Do the following for each measurement you

need to take:

a From the calculations menu, select the

measurement name under MCA (Middle Cerebral Artery) or UmbA (Umbilical Artery).

b Position the calipers:

•For S/D, RI, position the first caliper at the peak systolic waveform. Press the

SELECT key, and position the second

caliper at the end diastole on the waveform.

•For S/D, RI, PI, position the caliper at the beginning of the desired waveform, and press the

SELECT key. Use the

touchpad to manually trace the desired area. Press the

SET key.

If calipers are not positioned correctly, the calculation result is inaccurate.

c Save the calculation. (See “To save a

calculation” on page 47.)

Only one calculation (S/D, RI or S/D, RI, PI) can be saved.

Small Parts calculations

Small Parts calculations include volume, hip angle, and d:D ratio. For instructions to calculate volume, see “Volume calculations” on page 50.

3 Select Baseline under Hip Angle.

A baseline appears on-screen.

4 Position the baseline, and press the

SET key.

(See “Working with calipers” on page 43.)

Line A (alpha line) appears on-screen, and Line

A is selected in the calculations menu.

5 Position Line A, and save the measurement.

(See “To save a calculation” on page 47.)

Line B (beta line) appears on-screen, and Line

B is selected in the calculations menu.

6 Position Line B, and save the measurement.

To calculate d:D ratio

1 On a frozen 2D image, press the CALCS key.

2 From the calculations menu, select Right or

Left.

3 Under d:D Ratio, select Fem Hd (femoral

head).

4 Using the touchpad, position and resize the

circle. The and size.

5 Press the

The baseline automatically appears with the left caliper active.

6 Position the caliper. (See “Working with

calipers” on page 43.)

SELECT key toggles between position

SET key.

Transducer Exam Type

7 Save the measurement. (See “To save a

calculation” on page 47.)

HFL38x Small Parts

HFL50x Small Parts

L38x Small Parts

L38xi Small Parts

To calculate hip angle

1 On a frozen 2D image, press the CALCS key.

2 From the calculations menu, select Right or

Left.

68 Exam-based calculations

Transcranial Doppler and Orbital calculations

WARNING:

Transducer Exam Types

P21x Transcranial (TCD), Orbital

The following table shows the measurements required to complete Transcranial Doppler (TCD) and Orbital (Orb) calculations. For definitions of acronyms, see “Glossary” on page 173.

To avoid injury to the patient, use only an Orbital (Orb) exam type when performing imaging through the eye.

Verify that the patient information, date, and time settings are accurate.

“To create a new patient information form” on page 36.

(Orb)

Transcranial and Orbital Calculations

Menu Heading

MCA

TO OA

SM ECICA TAP

TCD and Orb Measurements

Dist Mid Prox

Bifur* ACA ACoA* TICA

PCAp1 PCAp2 PCoA

Siphon

Results

TAP PSV EDV PI RI S/D Gate Size

PSV EDV PI RI S/D Gate Size

Measurements

FM VA TAP

BA Prox

Mid Dist

Chapter 4: Measurements and Calculations 69

PSV EDV PI RI S/D Gate Size

AL ECVA TAP

PSV EDV PI RI S/D Gate Size

b Do one of the following:

• For a manual trace measurement, use the touchpad to position the caliper. Press the

SELECT key. Use the touchpad

to trace the waveform. If you need to make a correction, select Undo on-screen or press the

BACKSPACE

key.

*Available but not required

WARNING:

To avoid injury to the patient, use only an Orbital (Orb) or Ophthalmic (Oph) exam type when performing imaging through the eye. The FDA has established lower acoustic energy limits for opthalmic use. The system will not exceed these limits only if the Orbital or Ophthalmic exam type is selected.

To perform a Transcranial Doppler or Orbital calculation

1 Select the correct exam type:

• Orbital (Orb) to measure Opthalmic Artery and Siphon

• Transcranial (TCD) for other measurements

• For an auto trace measurement, select Auto on-screen, and use the touchpad to position the first caliper at the beginning of the waveform. Press the

SELECT key, and position the second

caliper at the end of the waveform.

Confirm that the system-generated boundary is correct. If you are not satisfied with the trace, obtain a higher quality Doppler spectral trace image, or trace manually.

c Press the

SET key.

d Save the calculation. (See “To save a

calculation” on page 47.)

See “To change the exam type” on page 33.

2 On a frozen Doppler spectral trace, press the

CALCS key.

3 From the calculations menu, select Left or

Right.

4 Do the following for each measurement you

want to take:

a From the calculations menu, select the

measurement. (You may need to select Next or Prev to locate the measurement.)

70 Exam-based calculations

Vascular calculations

WARNING:

Transducer Exam Type

C11x Vascular

HFL38x Vascular

L25x Vascular

L38x Vascular

“To create a new patient information form” on page 36.

To avoid incorrect calculations, verify that the patient information, date, and time settings are accurate.

Vascular Calculations

Menu Heading

Vascular Measurement

Calculation Results

CCA Prox s (systolic),

d (diastolic)

Mid s (systolic),

d (diastolic)

Dist s (systolic),

d (diastolic)

Bulb s (systolic),

d (diastolic)

ICA Prox s (systolic),

d (diastolic)

Mid s (systolic),

d (diastolic)

Dist s (systolic),

d (diastolic)

ECA Prox s (systolic),

d (diastolic)

Mid s (systolic),

d (diastolic)

L38xi Vascular

SLAx Vascular

The vascular measurements that you can save to the patient report are listed in the following table. For definitions of acronyms, see “Glossary” on page 173

Dist s (systolic),

d (diastolic)

VArty s (systolic),

d (diastolic)

To perform a Vascular calculation

After you perform vascular measurements, values in the ICA/CCA ratios are selectable on the vascular page of the patient report.

1 On a frozen Doppler spectral trace, press the

CALCS key.

2 From the calculations menu, select Left or

Right.

Chapter 4: Measurements and Calculations 71

Measurements

3 Do the following for each measurement you

want to take:

To exit the patient report and return to imaging, select Done.

a From the calculations menu, select the

measurement name.

b Using the touchpad, position the caliper at

the peak systolic waveform.

c Press the

A second caliper appears.

d Using the touchpad, position the second

caliper at the end diastole on the waveform.

e Save the calculation. (See “To save a

calculation” on page 47.)

SELECT key.

Patient report

The patient report contains calculation results and patient information. For Cardiac, OB, Transcranial, and Vascular exams, the patient report has additional details and features.

You can display the patient report at any time during the exam.

The value for a calculation appears only if the calculation is performed. The pound symbol (###) indicates a value that is out of range (for example, too large or small). Calculation values that are out of range are not included in derived calculations (for example, mean).

To display a patient report

1 Press the REPORT key.

2 Do any of the following:

• To display additional pages, select 1/x on-screen.

• (Cardiac, Vascular, or TCD) Select Details or Summary on-screen. The mean of the detail entries is used in the summary.

To send a patient report to a PC

You can send a patient report to a PC as a text file.

1 Ensure correct configuration. See “To

configure the system to export data to aPC” on page 19.

Make sure to use the connection cable supplied by FUJIFILM SonoSite. Other connection cables may cause audio interference, including an inaudible Doppler signal.

2 Select Send Rep. on-screen.

Vascular and cardiac patient reports

To delete a vascular or cardiac measurement

1 On the Details page of the patient report, select

the measurement by using the touchpad. (The selected measurement is green.)

2 Select Delete on-screen.

Deleting some measurements also deletes related measurements. Deleted measurements are not included in the summary information.

(Vascular) To modify the ICA/CCA ratio

 In the Ratio list in the vascular patient report,

select measurements for the ICA/CCA ratio for both the right and left sides.

(Cardiac) To adjust the RA pressure

 On the Summary page of the cardiac patient

report, select from the RA list.

Changing the RA pressure from the default 5 affects the RVSP calculation result.

3 (Optional) Press the

current page of the patient report.

72 Patient report

SAVE key to save the

TCD patient report

The maximum values for the TAP calculation appear on the summary page.

To delete a row of TCD measurements

1 On the Details page of the TCD patient report,

select the row’s TAP measurement using the touchpad. (The selected measurement is green.)

2 Select Delete on-screen.

Deleted measurements are not included in the summary information.

OB patient report

The OB patient report pages have a space for signing printed reports.

To display the OB Twins patient report

 On the OB patient report, select one of the

following on-screen:

• Twin A/B for individual twin patient reports

• Compare for both twins in one patient report

To complete the OB biophysical profile

 On page 2 of the OB patient report, select

values under BPP. The total is calculated when values are selected.

NST (non-stress test) is optional.

To display OB graphs

You can display OB graphs if the LMP or Estab. DD fields are complete in the patient information form.

1 On the OB patient report, select Graphs

on-screen.

2 In the Graphs list, select the desired

measurement/author.

The graph for the selected measurement appears. You can select another

measurement/author or select 1/x on-screen.

For twins, both measurement sets are plotted on the same graph.

3 (Optional) Press the

current graph page.

4 Select one of the following on-screen:

SAVE key to save the

To delete an OB measurement

1 On the OB patient report, select the OB

measurement by using the touchpad.

The selected measurement is green.

2 Select Delete on-screen.

To delete all measurements, select the measurement label and press the

SELECT key

and then select Delete on-screen.

To fill out the OB anatomy checklist

You can document reviewed anatomy.

 On the Anatomy Checklist page in the OB

patient report, select the check boxes. Press the

the checklist.

TAB key to move between fields and

SPACEBAR to select and deselect items in the

• Report to return to the previous patient report page

• Done to return to live imaging.

EMED and MSK worksheets

This feature is optional.

To display an EMED worksheet

The EMED worksheets contain results from EMED calculations and checklists that you can complete.

1 After or during the exam, press the

2 Select EMED on-screen.

3 Select the worksheet from the Worksheet list

or by selecting x/x on-screen.

Chapter 4: Measurements and Calculations 73

REPORT key.

Measurements

To display an MSK worksheet

The MSK worksheets have lists from which you can select and a field for entering comments.

1 After or during the exam, press the

REPORT key.

2 Select MSK on-screen.

3 Select the worksheet from the Worksheet list.

To display additional pages in the worksheet,

select x/x on-screen. Each worksheet has its own Comments field, which remains on-screen even if you display another page in the worksheet.

If you want to save a worksheet page, press the

SAVE key.

74 Patient report

Chapter 5: Measurement References

Measurement accuracy

The measurements provided by the system do not define a specific physiological or anatomical parameter. Rather, the measurements are of a physical property such as distance for evaluation by the clinician. The accuracy values require that you can place the calipers over one pixel. The values do not include acoustic anomalies of the body.

The 2D linear distance measurement results are displayed in centimeters with one place past the decimal point, if the measurement is ten or greater; two places past the decimal point, if the measurement is less than ten.

The linear distance measurement components have the accuracy and range shown in the following tables.

Table 1: 2D Measurement Accuracy and

Range

Accuracy

2D Measure

Axial Distance

Lateral Distance

Diagonal Distance

Area

Circumfer-

ence

System

and Range

< ±2% plus 1% of full scale

< ±4% plus (2% of full scale/smallest dimension) * 100 plus

0.5%

< ±3% plus (1.4% of full scale/ smallest dimension) * 100 plus

0.5%

Tolerance

Accuracy

Test Method

Acquisition Phantom 0-26 cm

Acquisition Phantom 0-35 cm

Acquisition Phantom 0-44 cm

Acquisition Phantom 0.01-72

0 cm

Acquisition Phantom 0.01-96

Range (cm)

a. Full scale for distance implies the maximum depth of the

image.

b. An RMI 413a model phantom with 0.7 dB/cm MHz

attenuation was used.

c. The area accuracy is defined using the following equation:

% tolerance = ((1 + lateral error) * (1 + axial error) – 1) * 100 + 0.5%.

d. The circumference accuracy is defined as the greater of the

lateral or axial accuracy and by the following equation:

% tolerance = ( (maximum of 2 errors) * 100) + 0.5%.

References

Chapter 5: Measurement References 75

Table 2: M Mode Measurement and

Calculation Accuracy and Range

Table 3: PW Doppler Mode Measurement

and Calculation Accuracy and Range

Range

Accuracy By

Accuracy and Range

M Mode Measurement

Distance < +/-

Time < +/-

Heart Rate < +/-

a. Full scale for distance implies the maximum depth of the

image.

b. An RMI 413a model phantom with 0.7 dB/cm MHz

attenuation was used.

c. Full scale for time implies the total time displayed on the

scrolling graphic image.

d. FUJIFILM SonoSite special test equipment was used.

System Tolerance

2% plus 1% of full scale

2% plus (Full Scale Heart Rate/1

00) %

Acquisition

Test Method

Phantom

0-26 cm

0.01-10 sec

5-923 bpm

Measurement

Doppler Mode

System

Tolerance

Test

Method

Accuracy By

Range

Accuracy and Range

Velocity cursor

Frequency cursor

Time < +/- 2%

a. FUJIFILM SonoSite special test equipment was used. b. Full scale for frequency or velocity implies the total frequency

or velocity magnitude, displayed on the scrolling graphic image.

c. Full scale for time implies the total time displayed on the

scrolling graphic image.

< +/- 2% plus 1% of

full scale

< +/- 2% plus 1% of

full scale

plus 1% of

full scale

Acquisition Phantom 0.01

cm/sec550 cm/ sec

Acquisition Phantom 0.01kHz

-20.8 kHz

Acquisition Phantom 0.01-10

sec

Sources of measurement errors

In general, two types of errors can be introduced into the measurement:

Acquisition Error Includes errors introduced by the ultrasound system electronics relating to signal acquisition, signal conversion, and signal processing for display. Additionally, computational and display errors are introduced by the generation of the pixel scale factor, application of that factor to the caliper positions on the screen, and the measurement display.

76 Sources of measurement errors

Algorithmic Error The error introduced by measurements, which are input to higher order calculations. This error is associated with floating-point versus integer-type math, which is subject to errors introduced by rounding versus truncating results for display of a given level of significant digit in the calculation.

Measurement publications and terminology

The following sections list the publications and terminology used for each calculation result.

Terminology and measurements comply with AIUM published standards.

Cardiac references

Acceleration (ACC) in cm/s

Zwiebel, W.J. Introduction to Vascular Ultrasonography. 4th ed., W.B. Saunders Company,

(2000), 52.

ACC = abs (delta velocity/delta time)

Acceleration Time (AT) in msec

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999),

219.

Aortic Valve Area (AVA) by Continuity Equation in cm

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 393, 442.

= A1 * V1/V

where: A2 = Ao valve area

= LVOT area; V1 = LVOT

velocity; V LVOT = Left Ventricular Outflow

Tract

= Ao valve velocity

AVA (PV

AVA (VTI

Body Surface Area (BSA) in m

/PVAO) * CSA

LVOT

/VTIAO) * CSA

LVOT

Grossman, W. Cardiac Catheterization and Angiography. Philadelphia: Lea and Febiger,

(1980), 90.

BSA = 0.007184 * Weight

0.425

* Height

0.725

Weight = kilograms

Height = centimeters

Cardiac Index (CI) in l/min/m

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd Edition, Boston: Little, Brown and Company, (1999), 59.

CI = CO/BSA

where: CO = Cardiac Output

BSA = Body Surface Area

Cardiac Output (CO) in l/min

Oh, J.K., J.B. Seward, A.J. Tajik The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999),

59.

CO = (SV * HR)/1000

where: CO = Cardiac Output

SV = Stroke Volume HR = Heart Rate

Cross Sectional Area (CSA) in cm

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 383.

CSA = 0.785 * D

where: D = diameter of the anatomy of

interest

References

Chapter 5: Measurement References 77

Deceleration Time in msec

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 453.

Ejection Fraction (EF), percent

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999),

40.

|time a - time b|

Delta Pressure: Delta Time (dP:dT) in mmHg/s

Otto, C.M. Textbook of Clinical Echocardiography. 2nd ed., W.B. Saunders Company, (2000), 117,

118.

32 mmHg/time interval in seconds

E:A Ratio in cm/sec

E:A = velocity E/velocity A

E/Ea Ratio

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 225.

E Velocity/Ea velocity

where: E velocity = Mitral Valve E velocity

Ea = annular E velocity, also known as: E prime

Effective Regurgitant Orifice (ERO) in

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 455.

ERO = 6.28 (r

where: r = radius

) * Va/MR Vel

Va = aliasing velocity

EF = ((LVEDV – LVESV)/LVEDV) * 100%

where: EF = Ejection Fraction

LVEDV = Left Ventricular End Diastolic Volume

LVESV = Left Ventricular End Systolic Volume

Elapsed Time (ET) in msec

ET = time between velocity cursors in milliseconds

Heart Rate (HR) in bpm

HR = 3 digit value input by user or measured on M Mode and Doppler image in one heart cycle

Interventricular Septum (IVS) Fractional Thickening, percent

Laurenceau, J. L., M.C. Malergue. The Essentials of Echocardiography. Le Hague: Martinus Nijhoff,

(1981), 71.

IVSFT = ((IVSS – IVSD)/IVSD) * 100%

where: IVSS = Interventricular Septal

Thickness at Systole IVSD = Interventricular Septal

Thickness at Diastole

Isovolumic Relaxation Time (IVRT) in msec

Reynolds, Terry. The Echocardiographer’s Pocket Reference. School of Cardiac Ultrasound, Arizona

Heart Institute, (1993), 146.

|time a - time b|

Left Atrium/Aorta (LA/Ao)

Feigenbaum, H. Echocardiography. Philadelphia: Lea and Febiger, (1994), 206, Figure 4-49.

78 Measurement publications and terminology

Left Ventricular End Volumes (Teichholz)

-- -





aib

-- -





i 1=



-- -





-- -





i 1=



in ml

Teichholz, L.E., T. Kreulen, M.V. Herman, et. al. “Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy.” American Journal of Cardiology, (1976), 37:7.

LVESV = (7.0 * LVDS

)/(2.4 + LVDS)

where: LVESV = Left Ventricular End

Systolic Volume LVDS = Left Ventricular Dimension

at Systole

LVEDV = (7.0 * LVDD

)/(2.4 + LVDD)

where: LVEDV = Left Ventricular End

Diastolic Volume LVDD = Left Ventricular

Dimension at Diastole

Left Ventricular Mass in gm for 2D

Schiller, N.B., P.M. Shah, M. Crawford, et.al. “Recommendations for Quantification of the Left Ventricle by Two-Dimensional Echocardiography.” Journal of American Society of Echocardiography. September-October 1998, 2:364.

LV Mass = 1.05 * {[(5/6) * A1 * (a + d + t)] - [(5/6) * A2 * (a + d)]}

where: A1 = Short axis area, diastole (Epi)

A2 = Short axis area, diastole (Endo)

a = Long or semi major axis d = Truncated semi major axis from

the widest short axis diameter to mitral annulus plane

t = Myocardial thickness

Left Ventricular Mass in gm for M Mode

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd Edition, Boston: Little, Brown and Company, (1999), 39.

LV Mass = 1.04 [(LVID + PWT + IVST)

– LVID3] *

0.8 + 0.6

where: LVID = Internal Dimension

PWT = Posterior Wall Thickness IVST = Interventricular Septal

Thickness

1.04 = Specific gravity of the myocardium

0.8 = Correction factor

Left Ventricular Volume: Biplane Method in ml

Schiller, N.B., P.M. Shah, M. Crawford, et.al. “Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography.” Journal of American Society of Echocardiography. September-October 1989, 2:362.

where: V = Volume in ml

a = Diameter b = Diameter n = Number of segments (n=20) L = Length i = Segment

Left Ventricular Volume: Single Plane Method in ml

References

Chapter 5: Measurement References 79

where: V = Volume

a = Diameter n = Number of segments (n=20) L = Length i = Segment

Note: 220 is an empirical derived constant and may not accurately predict mitral valve area in mitral prosthetic heart valves. The mitral valve area continuity equation may be utilized in mitral prosthetic heart valves to predict effective orifice area.

Left Ventricular Dimension (LVD) Fractional Shortening, percent

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. Boston: Little, Brown and Company, (1994), 43-44.

LVDFS = ((LVDD – LVDS)/LVDD) * 100%

where: LVDD = Left Ventricle Dimension

at Diastole LVDS = Left Ventricle Dimension

at Systole

Left Ventricular Posterior Wall Fractional Thickening (LVPWFT), percent

Laurenceau, J. L., M.C. Malergue. The Essentials of Echocardiography. Le Hague: Martinus Nijhoff,

(1981), 71.

LVPWFT = ((LVPWS – LVPWD)/LVPWD) * 100%

where: LVPWS = Left Ventricular

Posterior Wall Thickness at Systole

LVPWD = Left Ventricular Posterior Wall Thickness at Diastole

MV Flow Rate in cc/sec

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 396.

Flow = 6.28 (r

) * Va

where: r = radius

Va = aliasing Velocity

Pressure Gradient (PGr) in mmHG

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999),

64.

PGr = 4 * (Velocity)

Peak E Pressure Gradient (E PG)

EPG = 4 * PE

Peak A Pressure Gradient (A PG)

APG = 4 * PA

Peak Pressure Gradient (PGmax)

PGmax = 4 * PV

Mean Pressure Gradient (PGmean)

Mean Velocity (Vmean) in cm/s

Vmean = mean velocity

Mitral Valve Area (MVA) in cm

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 391, 452.

MVA = 220/PHT

where: PHT = pressure half time

80 Measurement publications and terminology

PGmean = Average of pressure gradients/Duration of flow

Pressure Half Time (PHT) in msec

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 391.

PHT = DT * 0.29

where: DT = deceleration time

Proximal Isovelocity Surface Area (PISA)

in cm

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Boston: Little, Brown and Company, (1999), 125.

PISA = 2 r

where: 2 = 6.28

r = aliasing radius

Qp/Qs

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 400.

Qp/Qs = SV Qp site/SV Qs site

SV sites will vary depending upon the location of the shunt.

S/D

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 217.

S velocity/ D velocity

where: S velocity = Pulmonary vein S

wave D velocity= Pulmonary vein D

wave

Stroke Index (SI) in cc/m

Mosby’s Medical, Nursing, & Allied Health Dictionary, 4th ed., (1994), 1492.

SI = SV/BSA

where: SV = Stroke Volume

BSA = Body Surface Area

Regurgitant Fraction (RF) in percent

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. Boston: Little, Brown and Company, (1999), 125.

RF = RV/ MV SV

where: RV = Regurgitant Volume

MV SV = Mitral Stroke Volume

Regurgitant Volume (RV) in cc

Reynolds, Terry. The Echocardiographer’s Pocket Reference. School of Cardiac Ultrasound, Arizona

Heart Institute, (2000), 396, 455.

RV = ERO * MR VTI

Right Ventricular Systolic Pressure (RVSP) in mmHg

Reynolds, Terry. The Echocardiographer’s Pocket Reference. School of Cardiac Ultrasound, Arizona

Heart Institute, (1993), 152.

RVSP = 4 * (Vmax TR)

where: RAP = Right Atrial Pressure

+ RAP

Stroke Volume (SV) Doppler in ml

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), 40, 59, 62.

SV = (CSA * VTI)

where CSA = Cross Sectional Area of the

orifice (LVOT area) VTI = Velocity Time Integral of the

aortic valve

Tricuspid Valve Area (TVA)

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 55, 391, 452.

TVA = 220 / PHT

References

Chapter 5: Measurement References 81

Stroke Volume (SV) 2D and M Mode in ml

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Boston: Little, Brown and Company, (1994), 44.

SV = (LVEDV – LVESV)

where: SV = Stroke Volume

LVEDV = End Diastolic Volume LVEDSV = End Systolic Volume

Velocity Time Integral (VTI) in cm

Reynolds, Terry. The Echocardiographer’s Pocket Reference. 2nd ed., School of Cardiac Ultrasound,

Arizona Heart Institute, (2000), 383.

VTI = sum of abs (velocities [n])

where: Auto Trace – distance (cm) blood

travels with each ejection period. Velocities are absolute values.

Obstetrical references

Amniotic Fluid Index (AFI)

Jeng, C. J., et al. “Amniotic Fluid Index Measurement with the Four Quadrant Technique During Pregnancy.” The Journal of Reproductive Medicine, 35:7 (July 1990), 674-677.

Average Ultrasound Age (AUA)

The system provides an AUA derived from the component measurements from the measurement tables.

EDD = LMP date + 280 days

Estimated Fetal Weight (EFW)

Hadlock, F., et al. “Estimation of Fetal Weight with the Use of Head, Body, and Femur Measurements, A Prospective Study.” American Journal of Obstetrics and Gynecology, 151:3 (February 1,

1985), 333-337.

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 154.

Osaka University. Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 103-105.

Shepard M.J., V. A. Richards, R. L. Berkowitz, et al. “An Evaluation of Two Equations for Predicting Fetal Weight by Ultrasound.” American Journal of Obstetrics and Gynecology, 142:1 (January 1,

1982), 47-54.

University of Tokyo, Shinozuka, N. FJSUM, et al. “Standard Values of Ultrasonographic Fetal Biometry.” Japanese Journal of Medical Ultrasonics, 23:12 (1996), 880, Equation 1.

Gestational Age (GA) by Last Menstrual Period (LMP)

The gestational age derived from the LMP date entered on the patient information form.

Results are displayed in weeks and days, and is calculated as follows:

GA(LMP) = System date – LMP date

Estimated Date of Delivery (EDD) by Average Ultrasound Age (AUA)

Results are displayed as month/day/year.

EDD = system date + (280 days – AUA in days)

Estimated Date of Delivery (EDD) by Last Menstrual Period (LMP)

The date entered into the patient information for LMP must precede the current date.

Results are displayed as month/day/year.

82 Measurement publications and terminology

Gestational Age (GA) by Last Menstrual Period (LMPd) Derived from Established Due Date (Estab. DD)

Same as GA by Estab. DD.

The gestational age derived from the system derived LMP using the Established Due Date entered on the patient information form.

Results are displayed in weeks and days, and is calculated as follows:

GA(LMPd) = System Date – LMPd

Last Menstrual Period Derived (LMPd) by Established Due Date (Estab. DD)

Results are displayed as month/day/year.

LMPd(Estab. DD) = Estab. DD – 280 days

Gestational age tables

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 440.

Abdominal Circumference (AC)

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431.

University of Tokyo, Shinozuka, N. FJSUM, et al. “Standard Values of Ultrasonographic Fetal Biometry.” Japanese Journal of Medical Ultrasonics, 23:12 (1996), 885.

WARNING:

The gestational age calculated by your FUJIFILM SonoSite system does not match the age in the aforementioned reference at the

20.0 cm and 30.0 cm abdominal circumference (AC) measurements. The implemented algorithm extrapolates the gestational age from the slope of the curve of all table measurements, rather than decreasing the gestational age for a larger AC measurement indicated in the referenced table. This results in the gestational age always increasing with an increase in AC.

Biparietal Diameter (BPD)

Chitty, L. S. and D.G. Altman. “New charts for ultrasound dating of pregnancy.” Ultrasound in Obstetrics and Gynecology 10: (1997), 174-179, Table 3.

Osaka University. Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 98.

University of Tokyo, Shinozuka, N. FJSUM, et al. “Standard Values of Ultrasonographic Fetal Biometry.” Japanese Journal of Medical Ultrasonics, 23:12 (1996), 885.

Cisterna Magna (CM)

Mahony, B.; P. Callen, R. Filly, and W. Hoddick. “The fetal cisterna magna.” Radiology, 153: (December

1984), 773-776.

Crown Rump Length (CRL)

Hadlock, F., et al. “Fetal Crown-Rump Length: Re-evaluation of Relation to Menstrual Age (5-18 weeks) with High-Resolution, Real-Time Ultrasound.” Radiology, 182: (February 1992), 501-505.

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 439.

Osaka University. Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 20 and 96.

Tokyo University. “Gestational Weeks and Computation Methods.” Ultrasound Imaging Diagnostics, 12:1 (1982-1), 24-25, Table 3.

Femur Length (FL)

Chitty, L. S. and D.G. Altman. “New charts for ultrasound dating of pregnancy.” Ultrasound in Obstetrics and Gynecology 10: (1997), 174-179, Table 8, 186.

References

Chapter 5: Measurement References 83

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431.

Osaka University. Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 101-102.

University of Tokyo, Shinozuka, N. FJSUM, et al. “Standard Values of Ultrasonographic Fetal Biometry.” Japanese Journal of Medical Ultrasonics, 23:12 (1996), 886.

Fetal Trunk Cross-Sectional Area (FTA)

Osaka University. Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 99-100.

Gestational Sac (GS)

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York:

Springer-Verlag, (1986).

Nyberg, D.A., et al. “Transvaginal Ultrasound.” Mosby Yearbook, (1992), 76.

Gestational sac measurements provide a fetal age based on the mean of one, two, or three distance measurements; however, Nyberg’s gestational age equation requires all three distance measurements for an accurate estimate.

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431.

Humerus (HL)

Jeanty, P.; F. Rodesch; D. Delbeke; J. E. Dumont. “Estimate of Gestational Age from Measurements of Fetal Long Bones.” Journal of Ultrasound in Medicine. 3: (February 1984), 75-79

Occipito-Frontal Diameter (OFD)

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York:

Springer-Verlag, (1986), 431.

Tibia

Jeanty, P.; F. Rodesch; D. Delbeke; J. E. Dumont. “Estimate of Gestational Age from Measurements of Fetal Long Bones.” Journal of Ultrasound in Medicine. 3: (February 1984), 75-79

Transverse Trunk Diameter (TTD)

Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York:

Springer-Verlag, (1986), 431.

Growth analysis tables

Tokyo University. “Gestational Weeks and Computation Methods.” Ultrasound Imaging Diagnostics, 12:1 (1982-1).

Head Circumference (HC)

Chitty, L. S. and D.G. Altman. “New charts for ultrasound dating of pregnancy.” Ultrasound in Obstetrics and Gynecology 10: (1997), 174-191, Table 5, 182.

84 Measurement publications and terminology

Abdominal Circumference (AC)

Chitty, Lyn S. et al. “Charts of Fetal Size: 3. Abdominal Measurements.” British Journal of Obstetrics and Gynaecology 101: (February

1994), 131, Appendix: AC-Derived.

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Jeanty P., E. Cousaert, and F. Cantraine. “Normal Growth of the Abdominal Perimeter.” American Journal of Perinatology, 1: (January 1984), 129-135.

(Also published in Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 179, Table 7.13.)

Biparietal Diameter (BPD)

Chitty, Lyn S. et al. “Charts of Fetal Size: 2. Head Measurements.” British Journal of Obstetrics and Gynaecology 101: (January 1994), 43, Appendix: BPD-Outer-Inner.

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Jeanty P., E. Cousaert, and F. Cantraine. “A Longitudinal Study of Fetal Limb Growth.” American Journal of Perinatology, 1: (January

1984), 136-144, Table 5.

(Also published in Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 176, Table 7.8.)

Estimated Fetal Weight (EFW)

Brenner, William E.; D. A. Edelman; C. H. Hendricks. “A standard of fetal growth for the United States of America,” American Journal of Obstetrics and Gynecology, 126: 5 (November 1, 1976), 555-564; Table II.

Hadlock F., et al. “In Utero Analysis of Fetal Growth: A Sonographic Weight Standard.” Radiology, 181: (1991), 129-133.

Jeanty, Philippe, F. Cantraine, R. Romero, E. Cousaert, and J. Hobbins. “A Longitudinal Study of Fetal Weight Growth.” Journal of Ultrasound in

Medicine, 3: (July 1984), 321-328, Table 1.

Obstetrics and Gynecology. Springer-Verlag,

New York, (1986), 186, Table 7.20.)

Femur Length (FL)

Chitty, Lyn S. et al. “Charts of Fetal Size: 4. Femur Length.” British Journal of Obstetrics and Gynaecology 101: (February 1994), 135.

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Jeanty P, E. Cousaert, and F. Cantraine. “A Longitudinal Study of Fetal Limb Growth.” American Journal of Perinatology, 1: (January

1984), 136-144, Table 5.

(Also published in Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 182, Table 7.17.)

Head Circumference (HC)

Chitty, Lyn S., et al. “Charts of Fetal Size: 2. Head Measurements.” British Journal of Obstetrics and Gynaecology 101: (January 1994), 43, Appendix: HC-Derived.

Hadlock, F., et al. “Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters.” Radiology, 152: (1984), 497-501.

Jeanty P, E. Cousaert, and F. Cantraine. “A longitudinal study of Fetal Head Biometry.” American J of Perinatology, 1: (January 1984), 118-128, Table 3.

(Also published in Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 176, Table 7.8.)

References

(Also published in Hansmann, Hackeloer, Staudach, and Wittman. Ultrasound Diagnosis in

Chapter 5: Measurement References 85

Head Circumference (HC)/Abdominal Circumference (AC)

Campbell S., Thoms Alison. “Ultrasound Measurements of the Fetal Head to Abdomen Circumference Ratio in the Assessment of Growth Retardation,” British Journal of Obstetrics and Gynaecology, 84: (March 1977), 165-174.

Ratio calculations

FL/AC Ratio

Hadlock F.P., R. L. Deter, R. B. Harrist, E. Roecker, and S.K. Park. “A Date Independent Predictor of Intrauterine Growth Retardation: Femur Length/Abdominal Circumference Ratio,” American Journal of Roentgenology, 141: (November 1983), 979-984.

FL/BPD Ratio

Hohler, C.W., and T.A. Quetel. “Comparison of Ultrasound Femur Length and Biparietal Diameter in Late Pregnancy,” American Journal of Obstetrics and Gynecology, 141:7 (Dec. 1 1981), 759-762.

FL/HC Ratio

Hadlock F.P., R. B. Harrist, Y. Shah, and S. K. Park. “The Femur Length/Head Circumference Relation in Obstetric Sonography.” Journal of Ultrasound in Medicine, 3: (October 1984), 439-442.

HC/AC Ratio

General references

+/x or S/D Ratio

+/x = abs (Velocity A/Velocity B)

where A = velocity cursor +

B = velocity cursor x

Acceleration Index (ACC)

Zwiebel, W.J. Introduction to Vascular Ultrasonography, 4th ed., W.B. Saunders Company,

(2000), 52.

ACC = abs (delta velocity/delta time)

Elapsed Time (ET)

ET = time between velocity cursors in milliseconds

Hip Angle/d:D Ratio

Graf, R. “Fundamentals of Sonographic Diagnosis of Infant Hip Dysplasia.” Journal of Pediatric Orthopedics, Vol. 4, No. 6: 735-740, 1984.

Morin, C., Harcke, H., MacEwen, G. “The Infant Hip: Real-Time US Assessment of Acetabular Development.” Radiology 177: 673-677, December 1985.

Intima Media Thickness (IMT)

Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, et al. “Carotid Artery Intima-Medial Thickness Distribution in General Populations As Evaluated by B-Mode Ultrasound.” ARIC Investigators. Atherosclerosis Risk in Communities. Stroke. (1993), 24:1297-1304.

O’Leary, Daniel H., MD and Polak, Joseph, F., MD, et al. “Use of Sonography to Evaluate Carotid Atherosclerosis in the Elderly. The Cardiovascular Health Study.” Stroke. (September 1991), 22,1155-1163.

Redberg, Rita F., MD and Vogel, Robert A., MD, et al. “Task force #3—What is the Spectrum of Current and Emerging Techniques for the Noninvasive Measurement of Atherosclerosis?” Journal of the American College of Cardiology. (June 4, 2003), 41:11, 1886-1898.

Percent Area Reduction

Taylor K.J.W., P.N. Burns, P. Breslau. Clinical Applications of Doppler Ultrasound, Raven Press,

N.Y., (1988), 130-136.

86 Measurement publications and terminology

Zwiebel W.J., J.A. Zagzebski, A.B. Crummy, et al. “Correlation of peak Doppler frequency with lumen narrowing in carotid stenosis.” Stroke, 3: (1982), 386-391.

% Area Reduction = (1 - A2(cm

)/A1(cm2)) *

100

where: A1 = original area of the vessel in

square cm A2 = reduced area of the vessel in

square cm

Percent Diameter Reduction

Handa, Nobuo et al., “Echo-Doppler Velocimeter in the Diagnosis of Hypertensive Patients: The Renal Artery Doppler Technique,” Ultrasound in Medicine and Biology, 12:12 (1986), 945-952.

% Diameter Reduction = (1 - D2(cm)/D1(cm)) * 100

where: D1 = original diameter of the

vessel in cm D2 = reduced diameter of the

vessel in cm

Pressure Gradient (PGr) in mmHG

Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999),

64.

4 * (Velocity)

Peak E Pressure Gradient (E PG)

EPG = 4 * PE

Peak A Pressure Gradient (A PG)

APG = 4 * PA2

Peak Pressure Gradient (PGmax)

PGmax = 4 * PV2

Mean Pressure Gradient (PGmean)

PGmean = 4 * Vmax

Pulsatility Index (PI)

Kurtz, A.B., W.D. Middleton. Ultrasound-the Requisites. Mosby Year Book, Inc., (1996), 469.

PI = (PSV – EDV)/V

where PSV = peak systolic velocity

EDV = end diastolic velocity V = mean flow velocity throughout

the entire cardiac cycle

Resistive Index (RI)

Kurtz, A.B., W.D. Middleton. Ultrasound-the Requisites. Mosby Year Book, Inc., (1996), 467.

RI = abs ((Velocity A – Velocity B)/Velocity A) in measurements

where A = velocity cursor +

B = velocity cursor x

Time Averaged Mean (TAM) in cm/s

TAM = mean (mean Trace)

Time Averaged Peak (TAP) in cm/s

TAP = peak (peak Trace)

Volume (Vol)

Beyer, W.H. Standard Mathematical Tables, 28th ed., CRC Press, Boca Raton, FL, (1987), 131.

Volume cm3= (4/3) * π * Length/2 * Width/2 * Height/2

Volume Flow (VF) in ml/m

Allan, Paul L. et al. Clinical Doppler Ultrasound, 4th ed., Harcourt Publishers Limited. (2000), 36-38.

One of the following, depending on the Live Trace setting:

VF = CSA * TAM * .06

VF = CSA * TAP * .06

References

Chapter 5: Measurement References 87

88 Measurement publications and terminology

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