ACUSON Sequoia™ Ultrasound System VA30 SW release Virtual Touch Auto point shear wave (Auto pSWE)

Quick Reference Card Virtual Touch Auto Point Shear Wave (Auto pSWE) ACUSON Sequoia Ultrasound System VA30 SW release siemens-healthineers.com/ultrasound Using Virtual Touch Auto point shear wave (Auto pSWE) to obtain up to 15 individual shear wave velocity (Vs) measurements in meters per second (m/s) and elasticity (E) measurements in kilopascals (kPa) in the liver Step 1 DAX Step 3 Select compatible transducer1 Abdomen PSWE • • Select pSWE, if needed and Abdomen exam preset Select the Auto pSWE key from Auto pSWE • the touch screen – the pSWE ROI (region-of-interest) will enlarge Step 2 once activated • Press VT (Virtual Touch) located VT • Liver Site 1 is active as the default on control panel measurement label • If desired, select an alternate label Note: If No Label is selected, measurements will appear next to the image but will not be sent to the report or added to the overall statistics. Note: If selected from the touch screen, the Ultrasound Derived Fat Fraction (UDFF) technology can be used simultaneously with Auto pSWE. Measurement values for both technologies will be displayed on screen. 1 Auto pSWE is compatible with the Deep Abdominal Transducer (DAX) on the Abdomen and General exam presets. SIEMENS Healthineers Step 4 Step 7 • Roll trackball to position ROI at least To enter measurement into report: 1.5–2 cm below the liver capsule • Press Image to store image • Ensure the “+” marker on the sample or Image line is parallel with the liver capsule • Press right or left Set key Step 5 Step 8 Update • Instruct the patient to suspend • Unfreeze; repeat steps 5–8 to acquire respiration then press the additional measurements if required Freeze Update key on the control panel to begin acquisition Step 6 Liver Site 1 Step 9 Vs Median=1.05 m/s Report • When acquisition is complete, E Median=3.3 kPa Depth=5.5 cm • Select Report on left side of touch system automatically freezes, screen emits one audible “beep” and Liver Site 1 Measurements Vs(m/s) E(kPa) D(cm) • displays the Vs Median and View, delete, store, print or transfer 1 0.92 2.5 5.5 E Median values for up to 15 2 1.12 3.8 5.5 shear wave measurements 3 0.79 1.9 5.5 individually measured sub-ROIs 0.84 2.1 5.5 1.09 3.5 5.5 in the measurement display 0.98 2.9 5.5 Liver Site 1 Liver Site 2 Liver Site 3 Liver Site 4 on UNA 7 1.05 3.3 5.5 Vs E Depth Vs E Depth Vs E Depth Vs E Depth 8 0.79 1.9 5.5 m/s kPa cm m/s kPa cm m/s kPa cm m/s kPa cm area (MDA) 9 0.93 2.6 5.5 0.80 1.9 2.6 10 1.40 5.9 5.5 0.76 1.7 2.2 1.18 4.2 5.5 0.93 2.6 4.5 0.63 1.2 4.0 • Individual values for each 1.20 4.3 5.5 0.91 2.5 5.5 1.22 4.5 5.5 0.89 2.4 2.6 sub-ROI and associated 1.01 3.1 2.5 1.04 3.2 5.5 0.86 2.2 7.4 statistics will be displayed on 1.22 4.5 5.5 1.07 3.4 6.0 Statistics 1.26 4.7 3.0 0.96 2.8 5.8 the imaging screen left panel Vs(m/s) E(kPa) 1.16 4.0 15.0 Mean 1.05 3.4 1.20 4.3 10.7 0.84 2.1 18.2 once the image is stored or Std Dev 0.18 1.1 1.09 3.6 10.3 Median 1.05 3.3 29 880802288828 0.96 2.8 the Set key has been pressed IQR 0.28 1.8 Std Dev 0.17 1.0 2.4 .44 IQR/Median 0.27 0.5 Median 0.93 2.6 4.4 IQR 0.25 1.5 Note: If Auto pSWE is being used in Overall Statistics : Liver IQR/Median 2.9 0.33 0.6 W88EN Statistics Vs(m/s) E(kPa) conjunction with UDFF, the UDFF value Mean 1.05 3.4 will not be displayed in the left panel. Std Dev 0.18 1.1 Median 1.05 3.3 The UDFF value will only be displayed IQR 0.28 1.8 IQR/Median 0.27 0.5 next to the image and in the patient report. 2 siemens-healthineers.com/ultrasound DAX Liver Site 1 Abdomen Vs Median=0.87 m/s TIB:0.86 E Median=2.3 kPa TIC:2.46 Depth=5.6 cm TIS:0.86 MI:1.38 20fps Auto pSWE 95% 2D H Low 0dB/DR60 c=1540 in the liver PSWE Best Practice Techniques 16cm Cooling 6 Fig. 1: Optimal technique Fasting for at least 4 hours In the non-fasting state, the liver can have falsely elevated values. Position patient supine or slight (30°) Optimal positioning to improve intercostal access and clearly left lateral decubitus position with right visualize an artifact free area of the liver. arm raised above head Ensure the transducer is perpendicular Inaccurate or invalid measurements can result if the transducer is to skin surface and use ample gel not perpendicular to the skin line and/or there is a loss of contact between the transducer and the skin. Optimize the B-mode image and avoid Optimize the B-mode image to maximize the uniformity and rib shadows (Fig. 1) brightness of the parenchyma. Rib shadows on either side of the ROI result in poor generation and propagation of the shear wave from the Acoustic Radiation Force Impulse (ARFI) push pulse. Take measurements in the right lobe of Placing the ROI in an artifact free area devoid of vessels, large ducts, the liver, at least 1.5–2 cm below the and/or fluid filled structures such as cysts, is recommended to liver capsule (Fig. 1) using an intercostal obtain reproducible results. scanning approach Align “+” marker on the sample line Non-parallel alignment can result in inaccurate measurements – parallel to the liver capsule (Fig. 1) tilt or rock transducer to achieve proper alignment. Perform acquisition during suspended Instruct patient to breathe normally and then to momentarily stop respiration; patient may resume normal breathing during acquisition. When acquisition is complete, the breathing after audible “beep” is heard system freezes and emits one audible “beep” and the patient can resume normal breathing. Maintain an Interquartile Range (IQR) / Indicates variability of measurements lie within reasonable Median ratio of ≤ 0.3 for values in variability range. It is the recommended quality control measure kilopascals and ≤ 0.15 for values in for adequate technical quality. The IQR/Median ratio for elasticity meters per second in units of kPa will be twice the IQR/Median ratio for shear wave velocity in units of m/s as the conversion of m/s to kPa is nonlinear. 1 Barr, RG, et al. (2020), “Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement.” Radiology, 00:1-12. doi.org/10.1148/radiol.2020192437. https://pubs.rsna.org/doi/10.1148/radiol.2020192437 siemens-healthineers.com/ultrasound 3 For the proper use of the software or hardware, please always use At Siemens Healthineers, our purpose is to enable healthcare the Operator Manual or Instructions for Use (hereinafter collectively providers to increase value by empowering them on their journey “Operator Manual”) issued by Siemens Healthineers. This material is towards expanding precision medicine, transforming care delivery, to be used as training material only and shall by no means substitute and improving patient experience, all enabled by digitalizing the Operator Manual. 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