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M-Turbo Ultrasound System User Guide

1. TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 4 a 23 Pr3 MPa 1 92 Wo mW 171 53 S min of W 3 z dla 320 mW 3 5 Z cm E z Zpp cm fs s Zsp cm 5 1 s a 8 deqZsp cm lt fe MHz 1 93 1 94 Dim of Aaprt X cm E 1 9 Y cm 13 PD usec 0 842 S PRF Hz 4000 pr Pll max MPa 2 53 9 deqGPlli a cm Focal Length FL cm 18 46 oO c 5 FLy cm 5 5 Ipa 3 M max W cm 355 1 Control 1 Exam Type Card Card o 4 Control 2 Optimization Res Pen cx c 9 E Control 3 Depth 4 7 7 5 Ces 27cm Goo cm Qu S O Q Control 4 THI On Off Control 5 Sector Width Narrow Narrow a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 124 Table 25 Transducer Model P21x 5 1 Operating Mode M Mode TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 5 a 1 4 1 1 Pr3 MPa
2. Batch code date code or lot code type of control number LOT Jp ON Biological risk V 134 Table 34 Labeling Symbols Continued Symbol Definition NE e REF TL STERILE S Corrugated Recycles Lo DIE e DO DIE 9 Device complies with relevant Brazilian regulations for electro medical devices Canadian Standards Association The C and US indicators next to this mark signify that the product has been evaluated to the applicable CSA and ANSI UL Standards for use in Canada and the US respectively Catalog number Collect separately from other household waste see European Commission Directive 93 86 EEC Refer to local regulations for disposal Contents sterilized using ethylene oxide process Corrugated recycle Dangerous voltage Date of manufacture Direct Current DC Do not get wet Do not stack over 2 high Do not stack over 5 high Chapter 6 Safety 135 Ayayes 136 Table 34 Labeling Symbols Continued Symbol Definition LE 10 a ary O m E STERILE amp peb IPX7 IPX8 Do not stack over 10 high Electrostatic sensitive devices Device complies with relevant FCC regulations for electronic devices Fragile Gel sterilized by radiation Hot Indoor use only Device emits a static DC magnetic field Non ionizing radiation Paper recycle
3. An indication of the likelihood of mechanical bioeffects occurring the higher the MI the greater the likelihood of mechanical bioeffects See Chapter 6 Safety for a more complete description of MI See mechanical index MI and thermal index TI National Television Standards Committee A video format setting See also PAL Phase Alternating Line A video format setting See also NTSC A transducer designed primarily for cardiac scanning Forms a sector image by electronically steering the beam direction and focus Glossary 157 Kaesso 5 skinline SonoHD SonoMB Tissue Doppler Imaging TDI thermal index TI TIB bone thermal index TIC cranial bone thermal index TIS soft tissue thermal index Tissue Harmonic Imaging transducer variance A depth on the display that corresponds to the skin transducer interface A subset of the 2D imaging mode in which the 2D image is enhanced by reducing speckle noise artifact at tissue margins and improving contrast resolution by reducing artifacts and improving visualization of texture patterns within the image A subset of the 2D imaging mode in which the 2D image is enhanced by looking at a target from multiple angles and then merging or averaging the scanned data together to improve overall image quality and in parallel reducing noise and artifacts A pulsed wave Doppler technique used to detect myocardial motion The ratio of total acousti
4. Caliper x Caliper Ratio A Wave Peak Velocity A Wave Peak Pressure Gradient Apical 2 Chamber diastolic Apical 2 Chamber systolic Apical 4 Chamber diastolic Apical 4 Chamber systolic Abdominal Aortic Aneurysm Ascending Aorta Abdomen Absolute value Abdominal Circumference Anterior Cerebral Artery Acceleration Index Anterior Communicating Artery Aortic Valve Cusp Separation A wave duration Amniotic Fluid Index Aortic Insufficiency Aortic Insufficiency Pressure Half Time Atlas Loop Annulus Diameter Anterior Far Anterior Near Glossary 159 K esso 5 160 Abbreviations in User Interface Continued Abbreviation Definition Ao Aorta AoD Aortic Root Diameter Apical Apical View APTD Anteroposterior Trunk Diameter AT Acceleration Deceleration Time AUA Average Ultrasound Age Calculated by averaging the individual ultrasound ages for the fetal biometry measurements performed during the exam The measurements used to determine the AUA are based on the selected OB calculation authors AV Aortic Valve AV Area Aortic Valve Area AVA Aortic Valve Area BA Basilar Artery Bifur Bifurcation BP Blood Pressure BPD Biparietal Diameter BPM Beats per Minute Bre Breast BSA Body Surface Area CCA Common Carotid Artery CI Cardiac Index CO Cardiac Output CPD Color Power Doppler Crd Cardiac CRL Crown Rump Length CW Continuous Wave Doppler Abbreviations in User Interface Continued
5. 1999 39 LV Mass 1 04 LVID PWT IVST 3 LVID3 0 8 0 6 LVID Internal Dimension PWT Posterior Wall Thickness IVST Interventricular Septal Thickness 1 04 Specific gravity of the myocardium where 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 v Dr i l 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 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 vest i l where V Volume a Diameter n Number of segments n 20 L Length i Segment 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 LVDD Left Ventricle Dimension at Diastole LVDS Left Ventricle Dimension at Systole where Left Ventricular Posterior Wall Fractional Thickening LVPWFT percent Laurenceau J L M C Malergue The Esse
6. 45 CFR 164 Security and Privacy Chapter 8 Specifications 155 suone yiodg 156 HIPAA standard Glossary Terms For ultrasound terms not included in this glossary refer to Recommended Ultrasound Terminology Second Edition published in 1997 by the American Institute of Ultrasound in Medicine AIUM as low as reasonably The guiding principle of ultrasound use which states that you should achievable ALARA curved array transducer depth in situ LCD linear array transducer mechanical index MI MI TI NTSC PAL phased array keep patient exposure to ultrasound energy as low as reasonably achievable for diagnostic results Identified by the letter C curved or curvilinear and a number 60 The number corresponds to the radius of curvature of the array expressed in millimeters The transducer elements are electrically configured to control the characteristics and direction of the acoustic beam For example C15 C60e Refers to the depth of the display A constant speed of sound of 1538 5 meters second is assumed in the calculation of echo position in the image In the natural or original position liquid crystal display Identified by the letter L linear and a number 38 The number corresponds to the radius of width of the array expressed in millimeters The transducer elements are electrically configured to control the characteristics and direction of the acoustic beam For example L38
7. C Test ICTx SLAx TEEx Still air 92 9 5 93 simulated 55 48 5 8 Use Acoustic output measurement Since the initial use of diagnostic ultrasound the possible human biological effects bioeffects from ultrasound exposure have been studied by various scientific and medical institutions In October 1987 the American Institute of Ultrasound in Medicine AIUM ratified a report from its Bioeffects Committee Bioeffects Considerations for the Safety of Diagnostic Ultrasound J Ultrasound Med Sept 1988 Vol 7 No 9 Supplement The report sometimes referred to as the Stowe Report reviewed available data on possible effects of ultrasound exposure Another report Bioeffects and Safety of Diagnostic Ultrasound dated January 28 1993 provides more current information The acoustic output for this ultrasound system has been measured and calculated in accordance with Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment NEMA UD2 2004 and Standard for Real Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment NEMA UDe3 2004 In Situ derated and water value intensities All intensity parameters are measured in water Since water does not absorb acoustic energy these water measurements represent a worst case value Biological tissue does absorb acoustic energy The true value of the intensity at any point depends on the amount type of tissue a
8. immersion method 1 Disconnect the transducer from the system 2 Remove any transducer sheath 3 Clean the surface using a soft cloth lightly dampened in a mild soap or compatible cleaning solution to remove any particulate matter or body fluids Apply the solution to the cloth rather than the surface 4 Rinse with water or wipe with water dampened cloth and then wipe with a dry cloth 5 Mixthe disinfectant solution compatible with the transducer following disinfectant label instructions for solution strengths and disinfectant contact duration 6 Immerse the transducer into the disinfection solution not more than 12 18 inches 31 46 cm from the point where the cable enters the connector Follow the instructions on the disinfectant label for the duration of the transducer immersion 7 Using the instructions on the disinfectant label rinse to the point of the previous immersion and then air dry or towel dry with a clean cloth 8 Examine the transducer and cable for damage such as cracks splitting or fluid leaks If damage is evident discontinue use of the transducer and contact SonoSite or your local representative Cleaning and disinfecting the battery Caution To avoid damaging the battery do not allow cleaning solution or disinfectant to come in contact with the battery terminals To clean and disinfect a battery wipe method 1 Remove the battery from the system 2 Clean the surface using a
9. 1 Press the PATIENT key 2 Select amp New End 3 Fillin the form fields See Patient information form fields on page 34 4 Select Done See also To append images and clips to a patient exam on page 37 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 36 1 Press the PATIENT key 2 Make changes as desired 3 Select one of the following e 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 35 2 Press the PATIENT key 3 Select amp 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 10 Patient e Last First Middle Patient name 34 Patient information form e ID Patient identification number Accession Enter number if applicable e Date of birth Gender Indications Enter desired text e User User initials Procedure button Available if the DICOM Worklist feature is licensed and configured See the DICOM user guide Selec
10. Abbreviation Definition CxL Cervix Length D Diameter D Apical Distance Apical DCCA Distal Common Carotid Artery DECA Distal External Carotid Artery DICA Distal Internal Carotid Artery Dist Distal dP dT Delta Pressure Delta Time E E Wave Peak Velocity EPG E Wave Peak Pressure Gradient E A E A Ratio E e E velocity Mitral Valve E velocity divided by the annular e velocity ECA External Carotid Artery ECG Electrocardiogram ECICA Extracranial Internal Carotid Artery ECVA Extracranial Vertebral Artery EDD Estimated Date of Delivery EDD by AUA Estimated Date of Delivery by Average Ultrasound Age The estimated date of delivery calculated from the measurements performed during the exam EDD by LMP Estimated Date of Delivery by Last Menstrual Period The due date calculated from the user entered LMP EDV End Diastolic Velocity EF Ejection Fraction EF SLOPE E F Slope Glossary 161 Aiessoj5 162 Abbreviations in User Interface Continued Abbreviation Definition EFW Endo Epi EPSS Estab DD ET FH FHR FL FM Right and Left FTA GA GA by LMP GA by LMPd Gate GS Gyn HC HR Estimated Fetal Weight Calculated from the measurements performed during the exam The measurements used to determine EFW are defined by the currently selected EFW calculation author Endocardial Epicardial E Point Septal Separation Established Due Date A user entered due date based on
11. 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 Chapter 7 References 149 so uaJoJay 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 Bres
12. 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 bl Left Atrium Aorta LA Ao Feigenbaum H Echocardiography Philadelphia Lea and Febiger 1994 206 Figure 4 49 Left Ventricular End Volumes Teichholz 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 LVESV Left Ventricular End Systolic Volume where LVDS Left Ventricular Dimension at Systole LVEDV 7 0 LVDD 2 4 LVDD LVEDV Left Ventricular End Diastolic Volume LVDD Left Ventricular Dimension at Diastole where Left Ventricular Mass in gm Oh J K J B Seward A J Tajik The Echo Manual 2nd Edition Boston Little Brown and Company
13. 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 On a frozen 2D image press the CALCS key b From the calculations menu locate PISA and then select Ann D c Position the calipers See Working with calipers on page 41 d Save the calculation See To save a calculation on page 45 2 Measure from Radius Color a Ona frozen Color image press the CALCS key b From the calculations menu select Radius c Position the calipers d Save the calculation 3 Ona 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 Using the touchpad trace the waveform Chapter 4 Measurements and Calculations 55 sjueulaJnseeiw To make a correction select Undo on screen backtrack with the touchpad or press the BACKSPACE key d Press the SET key to complete the trace e Save the calculation For information on the automatic trace tool see To trace automatically Doppler on page 44 To calculate Isovolumic Relaxation T
14. To configure the system for a printer 1 Setup the printer hardware See instructions included with the printer or docking system 2 Inthe Printer list on the Connectivity setup page select the printer To configure the system for a DVD recorder PC or serial bar code scanner 1 Onthe Connectivity setup page do the following DVD recorder In the Video Mode list select the video standard NTSC or PAL Inthe Serial Port list select the peripheral Computer PC allows patient report data to be sent 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 SonoSite Technical Support See also To send a patient report to a PC on page 69 Note Because these peripherals use the same RS 232 connector on the mini dock you can connect only one of them at a time 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 Chapter 2 System Setup 19 dnjas To receive storage alerts iei Onthe 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 Date and Time setup WARNING To obtain accurate obstetrics calculations an accurate date and time
15. and J Hobbins A Longitudinal Study of Fetal Weight Growth Journal of Ultrasound in Medicine 3 July 1984 321 328 Table 1 Also published in Hansmann Hackeloer Staudach and Wittman Ultrasound Diagnosis in 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 H
16. 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 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 on the left hand screen shows which touchpad function is active 4 Set options as desired See CPD and Color options CPD and Color options In CPD or Color imaging you can set the following on screen options Color CPD Toggle between CPD and Color The current selection appears in the fm upper left hand screen Color Shows or hides color information Suppress You can select Show or Hide while in live or frozen imaging The A setting shown on screen is the current selection Flow The current setting appears Sensitivity on screen Pe Low optimizes the system for low cT flow states Med optimizes the system for medium flow states High optimizes the system for high flow states Chapter 3 Imaging 27 PRF Scale Select the desired pulse repetition frequency PRF setting by pressing PRF the control keys There is a
17. compensation TGC controls on other ultrasound systems Freezing viewing frames 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 Turn the b knob e Use the touchpad Right moves forward and left moves backward e Press the LEFT ARROW and RIGHT ARROW keys 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 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 Imaging modes and exams available by transducer WARNING The transducer you use determines which exam 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 t
18. full scales a 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 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 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 d
19. power delay 19 power key 5 precision acoustic measurement 133 preferences 22 presets 22 pressure half time PHT 55 pressure limits 154 PRF 28 29 print 37 printer problem 71 setup 19 probe See transducer proximal isovelocity surface area PISA 51 pulsed wave PW Doppler imaging 28 PW Doppler See pulsed wave PW Doppler imaging R recording problem 71 references cardiac 141 general 149 gestational age tables 146 growth analysis tables 148 obstetrical 145 ratio calculations 149 report patient 68 resistive index RI measurement 44 right ventricular systolic pressure RVSP 55 S safety battery 90 biological 92 electrical 88 electromagnetic compatibility 93 equipment 90 save calculations 45 image 6 measurements 41 SAVE key 22 scale 29 scanhead See transducer screen layout 7 security 15 16 serial port 19 setup pages 15 shipping specifications 154 shortcut keys 15 Simpson s Rule 53 skin line definition 158 sleep delay 19 small parts calculations 64 software license 71 SonoHD 158 SonoMB 26 158 specifications 153 spectral trace 28 standards airborne equipment 155 DICOM 155 electromechanical 154 EMC classification 155 HIPAA 155 steering CPD 28 Doppler 29 storage specifications equipment 154 images 153 stroke volume SV 57 superficial intended uses 12 sweep speed Doppler 29 ECG 39 M Mode 27 symbols labeling 134 system clean and disinfect 73 controls 5 software 1 status 7 20
20. 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 e Inthe patient list review the patient s images Select Print when the image appears With the image displayed press the A shortcut key By default the A shortcut key prints To reprogram the A and B shortcut keys see Presets setup on page 22 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 e Print all images for multiple patients Select one or more patients in the patient list Then select Print e Print all images for one patient Highlight the patient in the patient list and then select Print Chapter 3 Imaging 37 Each image appears briefly on screen while printing To export patient exams to a USB storage device 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 23 1 Insert the USB storage device 2 Inthe 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 patie
21. that you export to a USB storage device See To export patient exams to a USB storage device on page 38 To specify a file format for exported images 1 Onthe USB Devices setup page select Export 2 Under USB Export select an export type e SiteLink organizes files in a SiteLink style folder structure Clips export in H 264 video saved as MP4 files To view them SonoSite recommends QuickTime 7 0 or later e 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 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 u
22. 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 34 To avoid incorrect calculations verify that the patient information date and time settings are accurate Exam Type C11x HFL38x L25x L38x SLAx Vascular Vascular Vascular Vascular 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 157 Chapter 4 Measurements and Calculations 67 sjueulaJnseeiw Vascular Calculations Menu Vascular Calculation Heading Measurement 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 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 Ona frozen Doppler spe
23. usec 5 PRF H2 z pr Pll max MPa S deq Pllmax cm 0 45 FocalLength FL cm 13 84 1 55 9 A en 5 FL cm 5 5 5 5 lIpa 3 Mlmax W cm o Z2 Control 1 Exam Type Card Card Card co 5 x Control 2 Zone og Zone 4 Zone1 Zone0 OUS O o a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 128 Table 29 Transducer Model SLAx 13 6 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 2 b Pr3 MPa Wo mW 8 75 min of W 3 Z ta 3 Z1 mW 3 5 Z cm v 2 Zbp cm E 5 7sp cm 0 65 o deg Zsp cm 0 13 lt f MHz 6 00 Dim of Aaprt X cm 0 24 Y cm 0 3 PD usec S PRF Hz E Pr PIl max MPa S deq P Imax cm 0 13 Focal Length FL cm 2 9 pem 5 FL cm lpa 3 Mlmax W cm Control 1 Exam Type Vas Nrv D_ Ven p 2 92 Control 2 Sample Volume 5 mm 969 GY Control 3 PRF 208
24. vertical caliper at the peak of the next heartbeat Save the calculation See To save a calculation on page 45 OB Doppler Calculations Menu OE Results Heading Calculation MCA Middle S D RI SD Cerebral RI Artery S D RI PI SD RI PI Umb A S D RI SD Umbilical RI Artery S D RI PI SD RI PI Calculation requires a trace measurement To calculate MCA or Umba Doppler Note The system does not provide an MCA UmbA ratio from the PI Pulsatility Index 1 64 Select OB exam type and select LMP or Estab DD in the patient information form On a frozen Doppler spectral trace press the CALCS key Do the following for each measurement you need to take a From the calculations menu select the measurement name under MCA Middle Exam based calculations Cerebral Artery or UmbA Umbilical Artery Position the calipers e 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 Save the calculation See To save a calculation on page 45 Only one calculation S D RI or S D RI PI can be saved Small P
25. 2 10 Wo mW 40 08 29 71 2 min of W 3 z l r4 3 z4 mW E 3 5 Z ai o iz cm g S cm 3 645 4 9 Sg P S KENT cm 0 343 i R MHz 193 i 1 93 1 94 Dim of Aaprt X cm 1 835 1 9 Y cm 1 3 1 3 PD usec 0 904 S PRF Hz 800 E Pr Pllmax MPa 2 679 S deq Pllmax cm 0 341 Focal Length FL cm 18 46 amp FL cm 5 5 IpA 3 MI max W cm 237 4 Control 1 Exam Type Abd Abd OB OB ApAIOE Card 2s Control 2 Optimization Any Gen Res Pen S z Control 3 Depth 7 5 cm 10 13cm 27 cm au S Control 4 THI On On Off Control 5 MB On or Multibeam en QNO t a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 125 Ayayes Table 26 Transducer Model P21x 5 1 Operating Mode CPD Color TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 5 1 3 24 Pr3 MPa 2 19 Wo mW 136 91 137 5 min of W 3 z lta 3 Z1 mW c E Z cm E Zp
26. 2D image press the CALCS key 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 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 Press the SET key to complete the trace line d If necessary adjust or edit the measurement See IMT tool options on page 60 e Save the calculation See To save a calculation on page 45 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 62 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 adjus
27. 76 footswitch 75 LCD screen 73 system 73 transducers 74 clip acquisition delay 39 clips See also images and clips options 26 35 color Doppler Color imaging 27 color power Doppler CPD imaging 27 color scheme background 23 color suppress 27 Color See color Doppler Color imaging connectivity setup wireless certificates 19 continuous wave CW Doppler imaging 28 29 controls direct 98 indirect 99 receiver 99 CPD See color power Doppler CPD imaging customer assistance vii CW Doppler See continuous wave CW Doppler imaging D date 20 default settings 15 delta pressure delta time dP dT 56 Index depth adjust 30 definition 157 keys 5 marker 7 DICOM standard 155 disinfect battery 75 ECG cable 76 system 73 transducers 74 disinfectants compatibility 77 display setup 20 distance measurements 2D 42 M mode 43 D line 28 Doppler Doppler gate depth 29 measurements 43 scale setup 22 dual images 25 duplex 22 DVD recorder 19 71 Dynamic Range 22 E ECG Monitoring 26 38 elapsed time ET measurement 44 electrical safety 88 specifications 154 electromagnetic compatibility 93 electromechanical safety standards 154 EMC classification standards 155 EMED worksheets 70 equipment safety 90 error message 89 errors acquisition 140 algorithmic 140 measurement 140 estimated date of delivery EDD 145 estimated fetal weight EFW 146 Event log 17 exam change type 31 end 34 type and transducer 3
28. 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 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 Yearboo
29. 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 Doany of the following e Adda 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 e 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 10 To specify text retention when unfreezing You can specify which text to keep when you unfreeze an image or change the imaging layout Inthe 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 33 To export predefined label groups 1 Insert a USB storage device 2 Onthe 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
30. Custom Tables setup on Tokyo U page 22 CXL 62 Exam based calculations Calculation Gestational OB Table Result Measurements Authors Estimated Fetal HC AC FL Hadlock 1 Weight EFW 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 Ratios HC AC Campbell FL AC Hadlock FL BPD Hohler FL HC Hadlock Amniotic Fluid Q Q2 Q3 Q Jeng Index Growth Analysis BPD Chitty Tables Hadlock Jeanty HC Chitty Hadlock Jeanty AC Chitty Hadlock Jeanty FL Chitty Hadlock Jeanty EFW Hadlock Jeanty HC AC Campbell a The Gestational Age is automatically calculated and displayed next to the OB measurement you selected The average of the results is the AUA For Tokyo U APTD and TTD are used only to calculate EFW No age or growth tables are associated with these measurements 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 tab
31. Do not put the battery into a microwave oven or pressurized container If the battery emits an odor or heat is deformed or discolored or in any way appears abnormal during use recharging or storage immediately remove it and stop using it If you have any questions about the battery consult SonoSite or your local representative Store the battery between 20 C 4 F and 60 C 140 F Use only SonoSite batteries Do not use or charge the battery with non SonoSite equipment Only charge the battery with the system Chapter 6 Safety 91 Ayayes Clinical safety 92 WARNING Non medical commercial grade peripheral monitors have not been verified or validated by SonoSite as being suitable for diagnosis To avoid the risk of a burn hazard do not use the transducer with high frequency surgical equipment Such a hazard may occur in the event of a defect in the high frequency surgical neutral electrode connection Do not use the system if it exhibits erratic or inconsistent behavior Discontinuities in the scanning sequence are indicative of a hardware failure that must be corrected before use 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 Perform ultrasound procedures prudently Use the ALARA as low as reasonably achievable principle and follow the prudent use informa
32. Figure 4 Connect the Transducer Chapter 1 Getting Started pa1xiejs buia To connect a transducer 1 Remove the system from the mini dock if present and turn it upside down 2 Pullthe 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 remove a transducer 1 Pull the transducer latch up and rotate it clockwise 2 Pullthe transducer connector away from the system Inserting and removing USB storage devices 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 USB storage devices Make sure that the USB storage device you use does not have password protection enabled 4 Preparing the system WARNING To avoid damaging the USB storage device and losing patient data f
33. 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 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 Chapter 7 References 145 so uaJoJay 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 MJ 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 V
34. Imaging modes 2D 256 gray shades e Color power Doppler CPD 256 colors Color Doppler Color 256 colors MMode e Pulsed wave PW Doppler Continuous wave CW Doppler Tissue Doppler Imaging TDI Tissue Harmonic Imaging THI Image and clip storage Internal storage The number of images and clips you can save depends on imaging mode and file format Accessories The following items are either included with or available for use on the ultrasound system Battery Biopsy Guide Carry case e ECG cable 6 ft 1 8 m Education keys External display e Footswitch Mini Dock Mobile Docking System M Series MDSm Mobile Docking System Lite II MDS Lite II Needle Guide Chapter 8 Specifications 153 suone yioedg Power supply SiteLink Image Manager SonoCalc IMT System AC power cord 10 ft 3 1 m Triple Transducer Connect Peripherals See the manufacturer s specifications for the following peripherals Medical grade Barcode scanner serial Bar code scanner USB e Black and white printer Recommended sources for printer paper Contact Sony at 800 686 7669 or www sony com professional to order supplies or to find the local distributor Color printer DVD recorder Non medical grade Kensington security cable e USB storage device Temperature and humidity limits Note The temperature pressure and humidity limits apply only to the ult
35. NY R MH2 4 91 4 91 Dim of Aaprt X cm 0 54 Y cm 0 4 PD usec 0 529 S PRF Hz 9547 E Pr Pllmax MPa 3 48 S deq Pllmax cm z Focal Length FL cm 1 5 8 FL cm 2 5 Ipa 3 MI max W cm 4393 Control 1 Mode Color CPD o 2 Control 2 Exam Type Any Bre s E S Control 3 PRF 331 2137 9 g Control 4 Optimization Depth Any 3 1 Med 3 1 O Control 5 Color Box Position Size Ky Def Def Def a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 118 Table 19 Transducer Model L38x 10 5 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 04 2 0 2 6 b Pr3 MPa 2 345 Wo mW 84 94 84 94 E min of W 5 z4 lra 3 z1 mW 3 5 Z cm X v z cm 9 S 0 8 1 3 Sg P 5 dizi cm 0 4685 i R MHZ 5 01 zm 5 05 5 05 Dim of Aaprt X cm 1 80 1 80 Y cm 0 4 0 4 PD usec 1 29 S PRF Hz2 1008 8 P Pllmax MPa 2 693 S deq Pll
36. Serial number type of control number Storage temperature conditions Submersible Protected against the effects of temporary immersion Water Tight Equipment Protected against the effects of extended immersion Table 34 Labeling Symbols Continued Symbol Definition W wil vi WARNING Connect Only Accessories and Peripherals Recommended by SonoSite Handle transducer with care Follow manufacturer s instructions for disinfecting time Disinfect transducer Type BF patient applied part B body F floating applied part Defibrillator proof type CF patient applied part Underwriter s Laboratories labeling Pollution Control Logo Applies to all parts products listed in the China RoHS disclosure table May not appear on the exterior of some parts products because of space limitations China Compulsory Certificate mark CCC Mark A compulsory safety mark for compliance to Chinese national standards for many products sold in the People s Republic of China Contains mercury Applies to the LCD and may apply to other components in the ultrasound system WARNING Connect Only Accessories and Peripherals Recommended by SonoSite Chapter 6 Safety 137 Ayayes 138 Chapter 7 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 dist
37. a b Pr3 MPa 1 62 Wo mW 9 min of W 5 z4 lza 3 z4 mW 3 5 Z a o iz cm E S a cm 47 So P i o deg Zsp cm 4 2 R MHZ 285 i Dim of Aaprt X cm Y cm PD usec 0 577 S PRF Hz 800 E pr Pll max MPa 2 576 S deq Pllmax cm Focal Length FL cm m amp FL cm IpA 3 M max W cm 184 3 o Z2 Control 1 Exam Type Any z g Control 2 Optimization Pen as 8 Control 3 Depth 7 8 cm Control 4 MB Multi Beam Off or On a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 111 Ayayes Table 12 Transducer Model C60x 5 2 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 3 1 b Pra MPa Wo mW E 85 64 3 Z cm 9s lt E Zpp cm O p Zsp cm 1 255 9 fdeaZsp cm 0 51 i R MH2 2 233 Dim of Aaprt X cm 0 6552 Y cm 1 3 PD usec S PRF Hz p PII a MPa S Feg Pl
38. accounts and view the event log Chapter 2 System Setup 15 dnjas 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 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 SonoSite See SonoSite Technical Support on page vii 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 Login as Administrator 16 Administration setup 2 Inthe User Login list select On Onrequires a us
39. calculations The IMT measurement names are specified on the IMT setup page See IMT Calculations setup on page 20 Chapter 4 Measurements and Calculations 59 sjueulaJnseeiw IMT Calculations 2D Menu Heading Available Measurements Right IMT Ant N Anterior Near Wall Left IMT 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 2 On a frozen 2D image press the CALCS key From the calculations menu select the measurement Using the touchpad or arrow keys position the IMT tool over the area of interest until the measurement results appear Adjust the tool and edit as needed See IMT tool options on page 60 Save the calculation See To save a calculation on page 45 60 Exam based calculations IMT tool options When using the IMT tool you can select the following options on screen Option Description Hide Use to check results Hides the measurement results and trace e 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 4 width and the lower key decreases the width Edit Display
40. csescsesecssecsecssccsnscsssecssecesscesscessccesccesscessccssccesseessecsseeeseeess 153 Dust qq 153 Peripherals m E aria eaa aa E E EEA e Riads EEEn iia 154 Temperature and humidity limits eerte 154 Operating teniente tees C Ded 154 Shipping and storage sesscsssssseccseecssecsscssseecsecssecsneceseesssessscceseceseeesseesaeeeseees 154 Electrical ss 154 tie 154 Electromechanical safety standards 154 EMC standards classification sscsssssscccssssscessseeccessseececssecsesneeessnneeecesneeeseeneeeees 155 Airborne equipment standards ou sessssssssescsssssnseecssescsnsessssesesssescsnseesssesssnees 155 BEONE tTa o EIo BENEAT E A E A EE 155 HIPAA standard sssini niia 155 Glossary TEN pep 157 PATO VIEL ONS isisisi hnair aiiai e eiar 159 Lil RN 169 Introduction This M Turbo Ultrasound System User Guide provides information on preparing and using the M Turbo 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 for a reader familiar with ultrasound techniques It does not provide training in sonography or clinical practices Before using the system you must have ultrasound training See the applicable SonoSite accessory user guide for informat
41. duplex and dual screens and arrow position and orientation Saves calculations and their measurements to the patient report Toggles between dual and duplex screens and imaging modes in M Mode and Doppler for example between D line and Doppler spectral trace Turns M Mode on toggles between M line and M Mode trace Turns Doppler on toggles between D line and Doppler trace Turns CPD Color on and off Turns 2D on Screen layout PATIENT 1 er mmn Figure 1 Screen Layout 1 Mode Data Area 2 Orientation Marker 3 Text 4 Pictograph 5 Calculations Menu 6 Image 7 Measurement and Calculations Data Area 8 On screen Options 9 Patient Header 10 System Status 11 Depth Marker 123456 2010Sep18 22 45 4 9 Abd C60 4 10 Symbols Current imaging mode information for example Gen Res THI and PW Provides indication for image orientation In dual and duplex images the orientation marker is green on the active screen Text entered using keyboard Pictograph to indicate anatomy and transducer position You can select anatomy and screen location Contains available measurements Ultrasound image Current data on measurements and calculations Options available in the current context Includes current patient name ID number institution user and date time Information on system status for example exam type transducer AC connected battery charging and USB Ma
42. for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 6 b Pr3 MPa Wo mW m 14 02 e min of W 3 Z4 lra 374 mW E 3 5 Z cm v 5 3 E Zpp cm E Zsp cm 0 6 o deg Zsp cm 0 155 lt fe MH2 s 6 00 Dim of Aaprt X cm 0 16 Y cm 0 3 PD usec S PRF H2 2 pr Pll max MPa S deq Pllmax cm 0 1549 Focal Length FL cm FN fo 5 FLy cm IpA 3 MI max W cm Control 1 Exam Type Vas Nrv D_ Ven eu Control 2 Sample Volume 12mm 579 GY Control 3 PRF 20833 v Control 4 Sample Volume Position Zone 0 Chapter 6 Safety 117 Ayayes Table 18 Transducer Model L38x 10 5 Operating Mode CPD Color TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 3 1 0 b Pr3 MPa 2 89 Wo mW 64 88 Y min of W 3 z4 lz 3 z4 mW 5 Z o Z cm E S cm 1 1 Som P i 9 deqlZsp cm
43. form 1 Ona 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 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 45 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 Chapter 4 Measurements and Calculations 57 sjueulaJnseeiw 1 CI Only Fill in the Height and Weight fields on me pakeni form gu TORT erus WARNING To avoid incorrect calculations calculated automatically See To create a e new patient information form on page 34 Ye CE Ha cabin raion i date and time settings are 2 Calculate SV See To calculate Stroke Volume accurate Per ene TRU Ox pagea To avoid misdiagnosis or harming 3 Calculate HR See To calculate Heart Rate the patient outcome start a new HR on page 57 patient information form before starting a new patient exam and To measure a Tissue Doppler Imaging TDI performing calculations Starting a waveform new p
44. 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 exported or archived 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 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 1x 1 2x 1 4x 5 Select 3 x xto 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 Printing exporting and deleting images and clips 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
45. image press the CALCS key From the calculations menu select LVOT D c Position the calipers See Working with calipers on page 41 d Save the calculation See To save a calculation on page 45 2 Measure from LVOT and then measure from AV Doppler e For Vmax see To measure peak velocity on page 54 From the calculations menu select AV select sample site and then select Vmax For VTI see To calculate Velocity Time Integral VTI on page 54 From the calculations menu select AV select sample site and then select VTI To calculate Qp Qs The Op Os calculation requires two measurements in 2D and two measurements in Doppler After the measurements are saved the result appears in the patient report 1 Ona frozen 2D image press the CALCS key 2 Dothe 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 41 c Save the calculation See To save a calculation on page 45 3 Ona frozen Doppler spectral trace press the CALCS key 4 Dothe 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 w
46. key In forms you can instead select the option by using the touchpad and the SELECT key Action Performs an action You can press either control key Or you can instead select the option by using the touchpad and the SELECT key Figure 5 On screen options 2D imaging shown Annotation and text Alphanumeric keyboard 1 TAB 2 CAPS LOCK 3 SHIFT 4 TEXT 5 PICTO 6 ARROW 7 SPACEBAR Moves cursor among fields in the forms and tabs between text position in dual screens Sets the keyboard to capital letters Allows entry of capitalized characters and international characters Turns the keyboard on and off for text entry Turns pictographs on and off Displays an arrow graphic that can be moved and rotated within the image area Turns the keyboard on for text entry In text entry adds a space 8 9 10 11 DELETE Arrow Keys BACKSPACE ENTER Removes all text from the screen during text entry and when not measuring 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 Removes the character left of the cursor in text entry mode Moves cursor among fields in forms and saves calculations to report Chapter 1 Getting Started 9 peers bunya Symbols You can enter symbols and special charact
47. measurement labels Growth Analysis Table Measurements The system provides growth graphs or curves for BPD HC AC FL EFW and HC AC WARNING Priorto 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 To view OB tables 1 Onthe 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 Onthe OB Calculations or OB Custom Measurements setup page select Tables on screen 2 Select the desired table Gestational Age or Growth Analysis 3 Inthe Measurement list select the measurement for the custom table 22 OB Custom Tables setup Select New on screen 4 5 In the Author box type a unique name 6 Enter the data 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 21 To edit or delete an OB custom table 1 Onthe 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 prefer
48. neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 121 Ayayes Table 22 Transducer Model P10x 8 4 Operating Mode PW Doppler 122 TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 1 2 2 0 1 8 Pr3 MPa 2 03 Wo mW 36 25 34 4 31 5 Y min of W 5 z4 lza 3 z4 mW E 5 Z sis oz cm E S a cm 2 1 0 8 So SP i 9 dez cm 0 32 i R MHZ 387 6 86 3 84 3 86 Dim of Ago X cm 0 992 0 416 224 Y cm 0 7 0 7 0 7 PD usec 1 28 S PRF Hz 1563 E pr Pll max MPa 2 70 S deq Pllmax cm 0 25 Focal Length FL cm 6 74 0 92 amp FLy cm 5 0 5 0 lpa 3 MImax W cm 233 Control 1 Exam Type Crd Crd Neo Crd 2s Control 2 Sample Volume 1mm 7 mm 12 mm 1mm S Z 5 Control 3 PRF TDI 1563 Any 15625 5208 S JO amp off On Off Off Control 4 Sample Volume Position Zone 3 Zone 6 Zone 2 Zone 1 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the g
49. or emitting fumes and causing personal injury or equipment damage observe the following precautions WARNING 90 The battery has a safety device Do not disassemble or alter the battery Charge the batteries only when the ambient temperature is between 0 and 40 C 32 and 104 F Do not short circuit the battery by directly connecting the positive and negative terminals with metal objects Do not touch battery contacts Do not heat the battery or discard it in a fire Do not expose the battery to temperatures over 60 C 140 F Keep it away from fire and other heat sources Do not charge the battery near a heat source such as a fire or heater Do not leave the battery in direct sunlight Do not pierce the battery with a sharp object hit it or step on it Do not use a damaged battery Do not solder a battery The polarity of the battery terminals are fixed and cannot be switched or reversed Do not force the battery into the system WARNING Caution Do not connect the battery to an electrical power outlet Do not continue recharging the battery if it does not recharge after two successive six hour charging cycles If the battery leaks or emits an odor remove it from all possible flammable sources To avoid the battery bursting igniting or emitting fumes from the battery and causing equipment damage observe the following precautions Do not immerse the battery in water or allow it to get wet
50. reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 114 Table 15 Transducer Model HFL38x 13 6 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 1 2 2 2 b pra MPa 2 37 Wo mW 46 55 46 55 E min of W 5 z1 l4 3 z1 mW d 5 Z cm X v z cm rm 9 S 0 9 1 1 Sg P 3 dz cm 0 33 4 R MHz 5 32 z 5 33 5 33 Dim of Aaprt X cm 1 04 1 04 Y cm 0 4 0 4 PD usec 1 29 S PRF Hz 1008 Pr Pll max MPa 2 404 S deqGPllia cm 0 46 Focal Length FL cm Mw 32 FL cm 2 5 Ipa 3 MI max W cm 323 35 Control 1 Exam Type Bre Vas Vas Ven Vas Ven 2 SmP IMT IMT IMT S 2 E Control 2 Sample Volume 1mm 12mm 12mm amp S S Control 3 PRF 1008 10417 10417 Control 4 Sample Volume Position Zone 2 Zone 7 Zone 7 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Da
51. safety standards See Chapter 8 Specifications For maximum safety observe the following warnings and cautions WARNING To avoid discomfort or minor risk of patient injury keep hot surfaces away from the patient Under certain circumstances the transducer connector and back of the display enclosure can reach temperatures that exceed EN60601 1 limits for patient contact therefore only the operator shall handle the system This does not include the transducer face To avoid discomfort or minor risk of operator injury when handling the transducer connector the system should not be operated for more than 60 minutes continuously in a live scan mode as opposed to freeze or sleep modes To avoid the risk of electrical shock or injury do not open the system enclosures All internal adjustments and replacements except battery replacement must be made by a qualified technician To avoid the risk of injury do not operate the system in the presence of flammable gasses or anesthetics Explosion can result To avoid the risk of electrical shock use only properly grounded equipment Shock hazards exist if the power supply is not properly grounded Grounding reliability can only be achieved when equipment is connected to a receptacle marked Hospital Only or Hospital Grade or the equivalent The grounding wire must not be removed or defeated To avoid the risk of electrical shock when using the system in an environmen
52. 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 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 50 To specify cardiac measurement names Under TDI Walls on the Cardiac Calculations setup page select a name for each wall 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 and DICOM which are optional features Refer to the SiteLink and DICOM documentation
53. soft cloth lightly dampened in a mild soap or detergent cleaning solution Apply the solution to the cloth rather than the surface 3 Wipe the surfaces with the disinfection solution Sani Cloth HB Sani Cloth Wipes or 7076 isopropyl alcohol is recommended 4 Airdr Cleaning the footswitch Caution To avoid damaging the footswitch do not sterilize It is not intended for use in a sterile environment To clean the footswitch 1 Dampen a non abrasive cloth with one of the following products Isopropyl alcohol Soap and water e Cidex Sodium Hypochlorite 5 25 Bleach diluted 10 1 2 Wring out cloth until slightly wet and then gently rub soiled area until clean Chapter 5 Troubleshooting and Maintenance 75 Bunoouse qnoJ Cleaning and disinfecting ECG cables Caution To avoid damaging the ECG cable do not sterilize To clean and disinfect the ECG cable wipe method 1 Remove the cable from the system 2 Clean the surface using a soft cloth lightly dampened in a mild soap or detergent cleaning solution Apply the solution to the cloth rather than the surface 3 Wipe the surfaces with any of the following products Bleach sodium hypochlorite e Cidex disinfectants Green soap 4 Air dry or towel dry with a clean cloth 76 Maintenance e ueuajureyy pue 6unoouse gqnoJ 4a3deyD Recommended disinfectants Table 1 does not have the following regulatory information for disinf
54. the calculations menu select Follicle 3 Do the following for each follicle you want to measure a From the calculations menu select the measurement name under Right Fol or Left Fol b Position the calipers See Working with calipers on page 41 c Save the calculation See To save a calculation on page 45 IMT calculations WARNING 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 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 34 Transducer Exam Type L38x IMT HFL38x IMT The following table shows available measurements for IMT
55. trace manually See To trace manually Doppler on page 44 1 Ona 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 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 41 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 Cardiac Output CO Peak Systolic Velocity PSV Time Average Mean TAM e x or Systolic Diastolic S D e Pulsatility Index PI End Diastolic Velocity EDV Acceleration Time AT e Resistive Index RI Time Average Peak TAP Gate Depth 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 68 Calculation packages d
56. user selects an appropriate TI based on the specific exam being performed SonoSite provides a copy of AIUM Medical Ultrasound Safety which contains guidance on determining which TI is appropriate See Related guidance documents on page 104 MI and TI output display accuracy The accuracy result for the MI is stated statistically With 95 confidence 95 of the measured MI values will be within 18 to 25 of the displayed MI value or 0 2 of the displayed value whichever value is larger The accuracy result for the TI is stated statistically With 95 confidence 9576 of the measured TI values will be within 21 to 40 of the displayed TI value or 0 2 of the displayed value whichever value is larger The values equate to 1dB to 3dB A displayed value of 0 0 for MI or TI means that the calculated estimate for the index is less than 0 05 Factors that contribute to display uncertainty The net uncertainty of the displayed indices is derived by combining the quantified uncertainty from three sources measurement uncertainty system and transducer variability and engineering assumptions and approximations made when calculating the display values Measurement errors of the acoustic parameters when taking the reference data are the major source of error that contributes to the display uncertainty The measurement error is described in Acoustic measurement precision and uncertainty on page 133 The displayed MI and TI values ar
57. wake up 3 T Technical Support vii temperature limits 154 text 32 text description 7 thermal index TI 22 103 158 THI 26 time setup 20 tissue Doppler imaging TDI 29 58 tissue models 106 touchpad 6 8 transcranial intended uses 13 transducer clean and disinfect 74 curved array 157 definition 158 disinfect 74 exam type 31 general use 10 imaging modes 31 invasive or surgical use 10 linear array 157 preparation 10 problems 71 specifications 153 troubleshoot 71 Index 173 x pul 174 U ultrasound terminology 157 unfreeze text 18 USB storage device export to 38 user account 17 user guide conventions used vii user setup 16 uses intended 11 13 V variance 28 vascular calculations 67 intended uses 13 velocity measurement 44 velocity time integral VTI 54 volume calculation 48 Doppler adjust 29 volume flow 48 WwW wall filter 28 29 warnings definition vii worksheets EMED 70 Z zoom 30 Index BSonoSite P07662 02 HARI
58. 0 kHz to 80 MHz field strengths should be less than 3 V m ALARA principle ALARA is the guiding principle for the use of diagnostic ultrasound Sonographers and other qualified ultrasound users using good judgment and insight determine the exposure that is as low as reasonably achievable There are no set rules to determine the correct exposure for every situation The qualified ultrasound user determines the most appropriate way to keep exposure low and bioeffects to a minimum while obtaining a diagnostic examination A thorough knowledge of the imaging modes transducer capability system setup and scanning technique is necessary The imaging mode determines the nature of the ultrasound beam A stationary beam results in a more concentrated exposure than a scanned beam which spreads that exposure over that area The transducer capability depends upon the frequency Chapter 6 Safety 97 Ayayes penetration resolution and field of view The default system presets are reset at the start of each new patient It is the scanning technique of the qualified ultrasound user along with patient variability that determines the system settings throughout the exam The variables which affect the way the qualified ultrasound user implements the ALARA principle include patient body size location of the bone relative to the focal point attenuation in the body and ultrasound exposure time Exposure time is an especially useful variable because th
59. 1 export and import OB calculation tables 21 predefined label groups 18 user accounts 17 E far 5 fetal heart rate FHR 63 flow sensitivity 27 focal zones optimize 25 footswitch setup 15 forms 6 freeze 30 G gain adjust 30 ECG 39 knob 5 gate size 29 gestational age setup 21 tables references 146 gestational growth measure 63 grace period 71 grayscale 25 growth analysis setup 21 tables references 148 guidance documents related 104 guideline 26 gynecology intended uses 12 H heart rate 34 heart rate HR 43 57 63 HIPAA standard 155 home position 33 humidity limits 154 image quality poor 71 images and clips archive 38 delete 38 export to USB 38 review 37 imaging modes list of 153 transducer 31 import See export and import IMT See Intima Media Thickness IMT in situ definition 157 infertility intended uses 12 intended uses 11 13 intensity derated 105 in situ 105 water value 105 interventional intended uses 12 Intima Media Thickness IMT calculations 20 59 sketch 61 trace 61 intraoperative intended uses 12 invert Color 28 spectral trace 29 iso volumic relaxation time IVRT 52 K keys 5 knobs 5 L labeling symbols 134 language 23 layout 22 LCD screen clean 73 output 103 left atrium LA 53 left ventricular diastolic LVd 53 left ventricular outflow tract diameter LVOT D 53 left ventricular systolic LVs 53 left ventricular volume LV volum
60. 33 Control 4 Sample Vol Position Zone 2 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 129 Ayayes Table 30 Transducer Model TEEx 8 3 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 7 b Pr3 MPa Wo mW 29 29 B min of W 3 z4 lzA 374 mW 5 Zz cm 8g 1 cm E Zpp cm RS esp m 0 6 g Bug cm 0 34 i R HZ2 5 3 84 Dim of Aaprt X cm zs 0 261 Y cm 0 9 PD usec S PRF Hz 2 pr PIl max MPa deq Pllmax cm 0 34 Focal Length FL cm fo E FL cm IpA 3 MI max W cm o Control 1 Exam Type Crd 5 2 2 Control 2 Sample Volume 1mm 2 9 Control 3 PRF gt 2604 S Control 4 Sample Volume Position Zone 1 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this oper
61. 4 2 Electrical fast Transient burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and voltage variations on power supply input lines IEC 61000 4 11 2 0KV 4 0KV 6 0KV contact 2 0KV 4 0KV 8 0KV air 2KV on the mains 1KV on signal lines 0 5KV 1 0KV 2 0KV on AC power lines to ground 0 5KV 1 0KV on AC power lines to lines gt 5 Ur gt 95 dip in Ur for 0 5 cycle 4096 Ur 60 dip in Ur for 5 cycles 7096 Ur 30 dip in U7 for 25 cycles 2596 Ur 29596 dip in U7 for 5s 2 0KV 4 0KV 6 0KV contact 2 0KV 4 0KV 8 0KV air 2KV on the mains 1KV on signal lines 0 5KV 1 0KV 2 0KV on AC power lines to ground 0 5KV 1 0KV on AC power lines to lines gt 5 Ur gt 95 dip in Ur for 0 5 cycle 40 U7 60 dip in Ur for 5 cycles 7096 Ur 30 dip in Ur for 25 cycles 2596 Ur gt 95 dip in Ur for 5s Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment If the user of the SonoSite ultrasound system requires continued operation during power mains interruptions it is recommended that the SonoSi
62. 44 Measurement publications and terminology 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 2nzr 2n 6 28 r aliasing radius where Qp Qs Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 400 Qp Qs SV Op site SV Os site SV sites will vary depending upon the location of the shunt 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 RAP where RAP Right Atrial Pressure S D Reynolds Terry The Echocardiographer s Pocket Reference 2nd e
63. A PCoA PECA PGmax PGmean PGr Mitral Valve Area Mitral Valve Regurgitant Fraction Mitral Valve Regurgitant Volume Mitral Valve Velocity Time Integral Mitral Valve Area Mitral Valve Effective Regurgitant Orifice Mitral Valve Proximal Iso Velocity Surface Area Mitral Valve Rate Neonatal Nerve Non stress test National Television Standards Committee Ophthalmic Artery Obstetrical Occipital Frontal Diameter Ophthalmic Orbital Phase Alternating Line Posterior Cerebral Artery Peak Proximal Common Carotid Artery Posterior Communicating Artery Proximal External Carotid Artery Maximum Pressure Gradient Mean Pressure Gradient Pressure Gradient Glossary 165 Kaesso 5 166 Abbreviations in User Interface Continued Abbreviation Definition PHT PI PICA PISA Plaq POSTF POSTN PRF Prox PSV PV P Vein PW Qp Qs RA RI RVD RVDd RVDs RVOTD RVOT VTI RVSP RVW RVWd RVWs Pressure Half Time Pulsatility Index Proximal Internal Carotid Artery Proximal Isovelocity Surface Area Plaque Posterior Far Posterior Near Pulse Repetition Frequency Proximal Peak Systolic Velocity Pulmonic Valve Pulmonary Vein Pulsed Wave Doppler Pulmonary blood flow divided by systemic blood flow Right Atrial pressure Resistive Index Right Ventricular Dimension Right Ventricular Dimension Diastolic Right Ventricular Dimension Systolic Right Ventricular Outflow Tract Diameter Right Ventricul
64. A 601 1 Supplement 1 1994 and CSA 601 1 Amendment 2 1998 CEI TEC 61157 1992 International Electrotechnical Commission Requirements for the Declaration of the Acoustic Output of Medical Diagnostic Ultrasonic Equipment UL 60601 1 1st Edition Underwriters Laboratories Medical Electrical Equipment Part 1 General Requirements for Safety EMC standards classification EN 60601 1 2 2007 European Norm Medical Electrical Equipment General Requirements for Safety Collateral Standard Electromagnetic Compatibility Requirements and Tests CISPR11 2004 International Electrotechnical Commission International Special Committee on Radio Interference Industrial Scientific and Medical ISM Radio Frequency Equipment Electromagnetic Disturbance Characteristics Limits and Methods of Measurement The Classification for the ultrasound system docking system accessories and peripherals when configured together is Group 1 Class A Airborne equipment standards RTCA DO 160E 2004 Radio Technical Commission for Aeronautics Environmental Conditions and Test Procedures for Airborne Equipment Section 21 0 Emission of Radio Frequency Energy Category B DICOM standard NEMA PS 3 15 2000 Digital Imaging and Communications in Medicine DICOM Part 15 Security Profiles HIPAA standard The Health Insurance and Portability and Accountability Act Pub L No 104 191 1996 45 CFR 160 General Administrative Requirements
65. Adjusts the gain applied to the near field of the image Adjusts the gain applied to the far field of the image In live imaging adjusts the overall gain applied to the entire image On a frozen image moves the cine buffer Chapter 1 Getting Started peueis 6Bunyo5 20 AC power indicator CALIPER CALCS Touchpad FREEZE SAVE CLIP Control keys Forms SETUP REPORT REVIEW PATIENT EXAM A amp B shortcut keys SET SELECT SAVE CALC UPDATE Imaging Modes M MODE DOPPLER COLOR 2D System controls A steady light indicates that AC power is connected A flashing light indicates that the system is asleep Displays calipers on screen for measuring Turns the calculations menu on and off Selects adjusts and moves items on screen Stops live imaging and displays a frozen image Saves an image to internal storage If configured also saves calculations to the report See Presets setup on page 22 Saves a clip to internal storage Control on screen options Displays the system settings Accesses the patient report and EMED worksheets Accesses the patient list saved images and archiving functions Accesses patient information Opens exam menu Keys that you can program to perform common tasks Sets a trace measurement Used with the touchpad to select items on screen Also switches between Color and Doppler options calipers for measurement pictograph marker position and angle frozen images in
66. B Custom Measurements setup e esecsecseessscsescseececneessccssessscssecseeseecseesseeneerseess 21 OB Custom Tables setup cesssssecssscsssessessseccssccsscsssscescessccsssccsecsuecesseesscesseeesseessees 22 dicii 22 System Information setup sssssssscccssssccsssssecsssseeceessseeceesneeccsssseeceesueecseeneeessnseeessane 23 USB Deyic s I qUomee e M 23 Limitations of JPEG format sscssssssssccsssssescsesecccsssseceesseecsesssecessnneseessnsesessees 23 Chapter 3 Imaging IMAGING MORES t PIDATO e Iae e M Medle TMA GING sicsssssesissssassccestzosseoscsasussasssiesstasasosertaasetsicessctesssnsensesatasiiesecosssees CPD and color Doppler imaging PW and CW Doppler imaging Adjusting depth and gain Freezing viewing frames and ZOOMING Imaging modes and exams available by transducer 31 Annotating iIMageS sccaiscscsvssssscsstescenicsdeesanesatesszeieoicconcesegessosstenctdacosissentessesstiscas suionaes 32 Patient information form sssssccsssssscecsssscccssseccssseceeesseecessnseccessueesessseeecssseeessaneeess 33 Imag sand CLIPS cicsruienininensnunennnnian an a aea 35 Saving images and clips s sssssssssssssssssssssssssesseeeessseessssssssssssssssessseeseerrreserreseesse 35 Reviewing patient exams o eeecsescseeseecsecstecseesccseececcnsersceseessecseecseesterseessets 36
67. B0815793 GB1180970 GB1180971 GB1175713 IT0881492 IT0815793 IT1175713 KR532359 KR528102 NZ542968 RCD000897368 0001 SP0881492 SP0815793 Patents pending P07662 02 10 2008 Copyright 2008 by SonoSite Inc All rights reserved Contents Introduction Conventions symbols and terms sesssscsseccsescssecsssscssecseecssccsstecssccssecsuccessceseeesees vii Customer COmlmTielts u oen icta eco etos eet oret eoo raren ebbe AE S ataa vii Chapter 1 Getting Started About the sVStelri cts tester A iaa 1 Preparing the SyStelm siisii iias ii iaeiei iiss 1 Installing or removing the battery sseccssscsseccseecssecseecsseecseessessseceseecseeess Using AC power and charging the battery Turning the system on or off sss i3 Connecting transducers see 3 Inserting and removing USB storage devices 4 iere 5 Sereen rd M 7 er cllc d 8 Touchpad and cursor sescssesssesssesssescssccssccssccenseesscessccsssccsscessccsnscesscesscsseseesseeseees 8 Side de 8 Annotation and text sscssscassessccacecinessessvennsessssssccinessssassgreesssbauschendssbavsesevussossisonoeee 9 Preparing transducers 10 Training Vides e 11 Intended USES e 11 Chapter 2 System Setup Displaying the setup pages seescssssscssesecssescssssecssescsssccsssesesssesessecssseecsseeessseessseees 15 Restorin
68. Cd 2D LV Vol Doppler A4Cs 2D LV Area Wall e anda A2Cd 2D EF Doppler A2Cs 2D CO SV CI SI Biplane Epi 2D LV Mass Endo 2D Epi Area Apical 2D Endo Area D Apical Chapter 4 Measurements and Calculations 51 sjueulaJnseeiw Cardiac Cardiac Menu Calculation Menu Calculation Headin Measurements Results Headin Measurements Results ing Imaging Mode S g Imaging Mode P Vein A Doppler VMax AV Vmax Doppler Vmax Adur Doppler time Pamax S Doppler VMax VTI Doppler VTI S D ratio Vimax D Doppler PGmax MV E Doppler E Vmean A Doppler EPG PGmean A VTI or Vmax from AVA APG LVOT Doppler EA VTI or Vmax from AV Doppler Adur Doppler time PP Ao LA LVOT D 2D PHT Doppler PHT MVA AV VTI Doppler SV Decel time Ao LA LVOT D 2D VTI Doppler vr AV VTI Doppler CO Vmax PGmax Ao LA LVOT D 2D Vmean HR HRa PGmean LVOT Vmax Doppler Vmax IVRT Doppler time PGmax MV MR dP dT gt CW dP dT VTI Doppler VTI Doppler Vmax PGmax Vmean PGmean AV Al PHT slope Al PHT Doppler Al slope 52 Exam based calculations Menu Cardiac Calculation Heading Measurements Results Imaging Mode TV TRmax Doppler Vmax PGmax E Doppler E A Doppler EPG 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 VTI AT Doppler Vmax PGmax Vmean PGmean AT a You can
69. Done 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 for a DVD recorder PC or serial bar code scanner on page 19 Make sure to use the connection cable supplied by 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 Onthe 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 TCD patient report The maximum values for the TAP calculation appear on the summary page To delete a row of TCD measurements 1 OntheDetails 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 Del
70. HB USA Liquid Quat Ammonia A U A A U Asepti Steryl USA Spray Ethanol A U A A U Asepti Wipes USA Wipe Propanol Isopropyl A U A A A Alcohol Bacillocid rasant DEU Liquid Glut Quat Ammonia A U A A U Bacoban DEU Liquid Ethanol Isopropanol A A U U U Bacoban WB DEU Liquid Benzalkoniumchloride A A U U U Diethylenglycol Banicide USA Liquid Gluteraldehyde A U U A U Betadine USA Liquid Providone lodine N U N A U Bleach USA Liquid NaCl Hypochlorite A U A A U Cavicide USA Liquid Isopropyl A U A A U Caviwipes USA Wipes Isopropanol A U A N A Chlor Clean GBR Liquid Sodium A U N A U Dichloroisocyanurate e ueuajurey pue 6unoouse qnoJ 4a3deyD Table 1 Disinfectant Compatibility with System and Transducers continued C60x ICTx oaoa ona me Active Ingredient mao ba m ud onem P21x SLAx Cidalkan FRA Liquid Alkylamine isopropanol U N U U U Cidalkan Lingettes FRA Wipes Ethyl Alcohol U N U U U Cidex USA Liquid Gluteraldehyde A U A A A Cidex OPA USA Liquid Ortho phthaldehyde A A A A U Cidex Plus USA Liquid Gluteraldehyde A U A A A Cleanisept DEU Wipes Quat Ammonia A A A A A Clorox Wipes USA Wipes Isopropanol A U A A U Control Ill USA Liquid Quat Ammonia A U A N U Coverage Spray USA Spray Quat Ammonia A U A N N Denatured Alcohol USA Liquid Ethanol N U N N U DentaSept FRA Liquid Quat Ammonia N U N N U DisCide Ultra USA Wipes Isopropyl Alcohol U U U U N Disinfecting Towelettes DisCide Wipes USA Wipes Isopropyl Alcohol A U A A N DisOPA JPN Li
71. M Turbo Ultrasound System User Guide CE E SonoSite M Turbo Ultrasound System User Guide 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 SonoSite Ltd Alexander House 40A Wilbury Way Hitchin Herts SG4 0AP UK T 44 1462 444800 F 44 1462 444801 Caution Federal United States law restricts this device to sale by or on the order of a physician M Turbo SiteLink SonoCalc SonoHD SonoSite and the SonoSite logo are registered trademarks or trademarks of SonoSite Inc DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information Non SonoSite product names may be trademarks or registered trademarks of their respective owners The SonoSite product s referenced in this document may be covered by one or more of the following US patents 5722412 5817024 5893363 6135961 6203498 6364839 6371918 6383139 6416475 6447451 6471651 6569101 6648826 6575908 6604630 6817982 6835177 6962566 7169108 D456509 D461895 D509900 D538432 D544962 D558351 D559390 and by the following counterpart foreign patents AU727381 AU730822 CA2373065 CN98106133 8 CN98108973 9 DE60021552 0 DE60029777 2 DE60034670 6 DE69730563 5 DE6980539 6 DE69831698 3 FR0875203 FR0881492 FR0815793 FR1180970 FR1175713 GB0875203 GB0881492 G
72. 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 61 Nyberg None Hadlock M Hadlock Hadiock M None None M Hadlock Hadiock M Hadlock None Hadlock M N Hadliock Hadiock Campbell Hadiock Hadlock Figure 1 OB Calculations Setup Page 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 To export OB calculation tables 1 Insert a USB storage device 2 Onthe 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 To import OB calculation tables Tables that you import are added to those already on the system 1 Insertthe USB storage device that contains the tables 2 Onthe OB Calcul
73. Printing exporting and deleting images and clips 37 ECG entier 38 Chapter 4 Measurements and Calculations ME ASUFEIMENIS ecsscosssecosssesssovssososscosossensossesevsssnsossensensensessonsonssoseeensonssoscnscbesessbecessescses 41 Working With Calipers sesssssscsssessssescssesscsseesssesssssesesussssssesessesssnseeenneessnseeens 41 2D measurements csssssssccsssscsscsscsecsecsscsucsecsucsscsscsecsucsssecsessecaseaseasencenseneensens 42 M Mode measurements ecssssssessecssessecssessesssessecssessscssessnccsscsscesccsscesessscenseess 43 Doppler measurements 43 General calculations 45 Calculations MENU eene tentent tonto n tonto tento att stone 45 Performing and saving measurements in CALCULATIONS csccsusscssdssedsoosssassvesucessausestedssosdevnsecessovssosose sussevvnncesesnsueatecoa sassesnosss 45 Displaying repeating and deleting saved measurements in calculations c escssescessessessessessessessesstsseeseeseseeees 46 EMED calculations eese ttt tette tentent nte tentatio tte tun 46 Percent reduction calculations eee ttes 46 Volume calculations 48 Volume flow calculations 48 Exam based calculations 50 Cardiac calculations Gynecology Gyn calculations IMT calculations sisusse anaa a 59 OB calcul
74. 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 See To change the exam type on page 31 2 Ona 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 From the calculations menu select the measurement You may need to select Next or Prev to locate the measurement 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 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 Press the SET key Save the calculation See To save a calculation on page 45 Vascular calculations WARNING Transducer To avoid misdiagnosis or harming
75. This chapter provides guidelines that may help you work more comfortably and may reduce your risk of MSDs f a Magnavita N L Bevilacqua P Mirk A Fileni and N Castellino Work related Musculoskeletal Complaints in Sonologists Occupational Environmental Medicine 41 11 1999 981 988 b Craig M Sonography An Occupational Hazard Journal of Diagnostic Medical Sonography 3 1985 121 125 c Smith C S G W Wolf G Y Xie and M D Smith Musculoskeletal Pain in Cardiac Ultrasonographers Results of a Random Survey Journal of American Society of Echocardiography May1997 357 362 d Wihlidal L M and S Kumar An Injury Profile of Practicing Diagnostic Medical Sonographers in Alberta International Journal of Industrial Ergonomics 19 1997 205 216 Chapter 6 Safety 85 Ayayes e Habes D J and S Baron Health Hazard Report 99 0093 2749 University of Medicine and Dentistry of New Jersey 1999 fVanderpool H E E A Friis B S Smith and K L Harms Prevalence of Carpal Tunnel Syndrome and Other Work related Musculoskeletal Problems in Cardiac Sonographers Journal of Medicine 35 6 1993 605 610 Position the system Promote comfortable shoulder arm and hand postures Use a stand to support the weight of the ultrasound system Minimize eye and neck strain If possible position the system within reach Adjust the angle of the system and display to minimize glare If using a stan
76. U Transeptic USA Cleaner Alcohol N U N N U Tristel GBR Liquid Chlorine Dioxide A A A A U Tristel Duo GBR U U U U U Tristel Solo GBR Foam Hexamethylenebiguanide U A U U U Tristel Wipes GBR Wipe Chlorine Dioxide N A N N A e ueuajurey pue 6unoousa gqnoJ 4a3deyD 8 Table 1 Disinfectant Compatibility with System and Transducers continued C60x ICTx Disinfection and Country L38x C11x System Cleaning Solutions of Origin Type Active Ingredient P10x D2 HFL38x L25x Surfaces P21x SLAx Vesphene II USA Liquid Sodium A U A A U o Phenylphenate Virex Il 256 USA Liquid Ammonium Chloride A U A A U Virex TB USA Liquid Quat Ammonia A U A N N Virox 5 CAN Wipe Hydrogen Peroxide A A A A A Virufen FRA Liquid Alkyl Ammonium Chloride U A U U U Wavicide 01 USA Liquid Gluteraldehyde N U N N U Wavicide 06 USA Liquid Gluteraldehyde A U A A U Wet Wipe DNK Wipe Guanidinium chloride U A U U U Disinfection Wex Cide USA Liquid O phenylphenol A U A A U A Acceptable N No Do not use U Untested Do not use Bunoouse qnoJ 84 Chapter 6 Safety This chapter contains information required by regulatory agencies including information about the ALARA as low as reasonably achievable principle the output display standard acoustic power and intensity tables and other safety information The information applies to the ultrasound system transducer accessories and peripherals Ergonomic safety These healthy scanning g
77. USB port on the system 2 Press the REVIEW Key 3 Ifthere is an active exam select List on screen 4 Select the Videos tab 5 If the list does not appear select the correct USB device a Select Select USB b Inthe 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 Od 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 e List to return to the video list Doneto return to 2D imaging Intended uses This system transmits ultrasound energy into various parts of the patient s body to obtain ultrasound images as follows For the intended transducer and imaging modes for each exam type see Imaging modes and exams available by transducer on page 31 Chapter 1 Getting Started 11 pares bunje5 Abdominal Imaging Applications You can assess the liver kidneys pancreas spleen gallbladder bile ducts transplanted organs abdominal vessels and surrounding anatomical structures for t
78. ackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 176 Table 7 8 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 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 General references x or S D Ratio x abs Velocity A Velocity B where A velocity cursor
79. acy is defined as the greater of the lateral or axial accuracy and by the following equation 96 tolerance 2 maximum of 2 errors 100 0 5 Chapter 7 References 139 so uaJoJay Table 2 M Mode Measurement and Calculation Accuracy and Range fov vo v Ec y o 8 S gt Uo o S ea o ac S gt 9 ctc o 3 7 o v E ld s c gt E 3 u S 2 i 9 os v lt Lr J 2 z E e z Distance lt Acquisition Phantom 0 26 cm 2 plus 1 of full scale Time lt Acquisition Phantom 0 01 10 2 sec plus 1 of full scales Heart Rate lt Acquisition Phantom 5 923 2 bpm plus Full Scale Heart Rate 1 00 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 SonoSite special test equipment was used 140 Sources of measurement errors Table 3 PW Doppler Mode Measurement and Calculation Accuracy and Range v o SES gt o B E g a 5 o o z RE o G 29 o oss w on nm 9 lt c S g x ge GS an gt gt 5 U c e Sg ne g o 5 E P a U J lt x Velocity lt 2 Acquisition Phantom 0 01 cursor plus 1 of cm sec full scale 550 cm s ec Frequency lt 2 Acquisition Phantom 0 01kHz cursor plus 1 of 20 8 kHz full scale Time lt 2 Acquisition Phantom 0 01 10 plus 1 of sec
80. al sources within facility control such as paging systems Label devices susceptible to EMI Educate clinical staff to recognize potential EMI related problems Eliminate or reduce EMI with technical solutions such as shielding e Restrict use of personal communicators cell phones computers in areas with devices susceptible to EMI Share relevant EMI information with others particularly when evaluating new equipment purchases which may generate EMI Purchase medical devices that comply with IEC 60601 1 2 EMC Standards Chapter 6 Safety 93 Ayayes Caution To avoid the risk of increased electromagnetic emissions or decreased immunity use accessories user guide Manufacturer s declaration 94 only accessories and peripherals recommended by SonoSite Connection of accessories and peripherals not recommended by SonoSite could result in malfunctioning of your ultrasound system or other medical electrical devices in the area Contact SonoSite or your local representative for a list of accessories and peripherals available from or recommended by SonoSite See the SonoSite Electrostatic discharge ESD or static shock is a naturally occurring phenomenon ESD is common in conditions of low humidity which can be caused by heating or air conditioning Static shock is a discharge of the electrical energy from a charged body to a lesser or non charged body The degree of discharge can be significant enough to cause
81. aliper at the start of the waveform and press the SELECT key to start the trace 4 Using the touchpad trace the waveform 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 45 For information on the automatic trace tool see To trace automatically Doppler on page 44 To calculate Right Ventricular Systolic Pressure RVSP 1 Ona 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 41 4 Save the calculation See To save a calculation on page 45 5 To adjust the RA pressure see To delete a vascular or cardiac measurement on page 69 Changing the RA pressure from the default 5 affects the RVSP calculation in the patient report To calculate Pressure Half Time PHT in MV Al or TV 1 Ona 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 4 Position the second caliper e n 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 45
82. alues 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 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 146 Measurement publications and terminology 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 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 y
83. ance 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 m vo 7 Li mo m See cb p 6 c c S M Sic Ys D gt v o v5 ax 2 M Oo zcv me 9 z c o Q lt 6 3 cf e d Axial lt 2 plus Acquisition Phantom 0 26 cm Distance 1 of full scale Lateral lt 2 plus Acquisition Phantom 0 35 cm Distance 1 of full scale Diagonal lt 2 plus Acquisition Phantom 0 44 cm Distance 1 of full scale Area lt 4 plus Acquisition Phantom 0 01 720 296 of full cm scale smallest dimension 100 plus 0 596 Circumfer lt 3 plus Acquisition Phantom 0 01 96 ence 1 496 of full cm scale smallest dimension 100 plus 0 596 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 96 tolerance 1 lateral error 1 axial error 1 100 0 596 d The circumference accur
84. ansducer Model C60x 5 2 Operating Mode 2D TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 0 a b Pr3 MPa 1 69 Wo mW min of W 3 Z4 lrA 374 mW 3 E Z cm v au 3 E Zpp cm LI fs S Zsp cm 4 7 a o dea cm fe MHz 2 84 as Dim of Aaprt X cm Y cm PD usec 0 579 S PRF HzZ 5440 z pr Pll max MPa 2 679 S deq Pllmax cm Focal Length FL cm 9 m en 5 FL cm I Ip 3 MI max W cm 197 7 Control 1 Exam Type Abd OB 2s 5 Control 2 Optimization Any S i5 Control 3 Depth 11 29 13 cm O o Control 4 THI On Control 5 MB Multi Beam On a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 110 Table 11 Transducer Model C60x 5 2 Operating Mode M Mode TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 a
85. ar Outflow Tract Velocity Time Integral Right Ventricular Systolic Pressure Right Ventricular Free Wall Right Ventricular Free Wall Diastolic Right Ventricular Free Wall Systolic Abbreviations in User Interface Continued Abbreviation Definition S SonoHD S D Systolic Diastolic Ratio SI Stroke Index Siphon Siphon internal carotid artery SM Submandibular SmP Small Parts SO Suboccipital Sup Superficial SV Stroke Volume TAM Time Average Mean TAP Time Average Peak TCD Transcranial Doppler TDI Tissue Doppler Imaging THI Tissue Harmonic Imaging TI Thermal Index TICA Terminal Internal Carotid Artery TO Transorbital TRmax Tricuspid Regurgitation peak velocity TT Transtemporal TTD Transverse Trunk Diameter TV Tricuspid Valve TVA Tricuspid Valve Area UA Ultrasound Age Calculated on the mean measurements taken for a particular fetal biometry Umb A Umbilical Artery Glossary 167 K esso 5 168 Abbreviations in User Interface Continued Abbreviation Definition VA VArty Vas Ven VF Vmax Vmean Vol vil YS Vertebral Artery Vertebral Artery Vascular Venous Volume Flow Peak Velocity Mean Velocity Volume Velocity Time Integral Yolk Sac Index Symbols x measurement 44 Numerics 2D imaging 25 2D options 25 A A amp B shortcut keys 15 abbreviations 159 abdominal intended uses 12 AC power indicator 6 acceleration ACC index 44 accessories list 153 a
86. 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 To set the date and time Onthe Date and Time setup page do the following Inthe Date box type the current date Inthe 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 20 Date and Time setup 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 See also IMT calculations on page 59 To customize the IMT calculations menu Onthe IMT Calculations setup page do the following 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 The Network Status setup page displays information on system IP address Location Ethernet
87. arts calculations Small Parts calculations include volume hip angle and d D ratio For instructions to calculate volume see Volume calculations on page 48 Transducer Exam Type HFL38x Small Parts L38x Small Parts To calculate hip angle 1 Ona frozen 2D image press the CALCS key 2 From the calculations menu select Right or Left 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 41 Line A alpha line appears on screen and Line A is selected in the calculations menu 5 6 Position Line A and save the measurement See To save a calculation on page 45 Line B beta line appears on screen and Line B is selected in the calculations menu Position Line B and save the measurement To calculate d D ratio 1 2 On a frozen 2D image press the CALCS key From the calculations menu select Right or Left Under d D Ratio select Fem Hd femoral head Using the touchpad position and resize the circle The SELECT key toggles between position and size Press the SET key The baseline automatically appears with the left caliper active Position the caliper See Working with calipers on page 41 Save the measurement See To save a calculation on page 45 Transcranial Doppler and Orbital calculations WARNING To avoid injury to the patient use only a
88. assword 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 Loginas 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 To import user accounts 1 Insertthe USB storage device that contains the accounts 2 Loginas Administrator Select Import on screen 4 Select the USB storage device and select Import 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 Login 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
89. asure 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 7 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 35 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 45 Some options may not apply to your system Options 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 Only measurement names available for the imaging mode and exam type are selectable 3 Save the calculation See To save a calculation on page 45 To start a calculation before measuring see Performing and saving measurements in calculations on page 45 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 us
90. at axial distance z4 milliwatts per square centimeter Z Axial distance corresponding to the location of maximum min W 3 z lx4 3 z x 1 cm where z gt zbp in centimeters Zbp 1 69 Aapr in centimeters Zsp For MI the axial distance at which p 3 is measured For TIB the axial distance at which TIB is a global maximum for example z Zp 3 in centimeters Table 32 Acoustic Output Terms and Definitions Continued Term Definition deg z Equivalent beam diameter as a function of axial distance z and is equal to A 4 n Wo IrA z where lz z is the temporal average intensity as a function of z in centimeters fc Center frequency in MHz Dim of Aaprt Active aperture dimensions for the azimuthal x and elevational y planes in centimeters PD Pulse duration microseconds associated with the transmit pattern giving rise to the reported value of MI PRF Pulse repetition frequency associated with the transmit pattern giving rise to the reported value of MI in Hertz P Pll max Peak rarefactional pressure at the point where the free field spatial peak pulse intensity integral is a maximum in Megapascals deq Pllmax Equivalent beam diameter at the point where the free field spatial peak pulse intensity integral is a maximum in centimeters FL Focal length or azimuthal x and elevational y lengths if different measured in centimeters Acoustic measurement precision and uncertainty All tabl
91. atiOns sssccsssssessssesecsssscecsssdssesssescssicescvasconsodoveasscsscuteesconssvessustesccuisescessio s 61 Small Parts calculations u ccsccsssssessessessesssssessessessssssssssssssessesssssssssssessssseesees 64 Transcranial Doppler and Orbital calculations 65 Vascular calculations eese tesentenntttnnnnttnnntenen 67 udis 68 Vascular and cardiac patient reports ees 69 TED patient report 4 eeeecit cetera rere tae re inai i 69 OB patient report E 69 EMED worksheets oreritteiicien tester epe ette ette tees veros tertie 70 Chapter 5 Troubleshooting and Maintenance Troubleshooting sensns nenacia 71 Software icerisilgi eceii rte cities ceo aeeai iaa 71 D iEDM d 72 Cleaning and disinfecting the ultrasound system 73 Cleaning and disinfecting transducers Cleaning and disinfecting the battery Cleaning the footswitch sss Cleaning and disinfecting ECG cables Recommended disinfectants eese teennttnenn tenentes Chapter 6 Safety Ergonomic safety cssscssssecssscssssscsssecssssecsssccssssccsssccssueccsssccsssccessecesssccssuccesssecessccesseeses 85 Position the system ccscssscssssssecssccssccssscesscessccsssecssccsccsscesacessesssccsscceneeesseesess 86 Position yourself aneirin isinna 86 Take breaks exe
92. atient information form 1 Ensure that TDI is on See PW Doppler clears the previous patient s data options on page 29 The previous patient s data will be combined with the current patient 2 Onafrozen Doppler spectral trace press the if the form is not first cleared See CALCS key To create a new patient 3 From the calculations menu select TDI and information form on page 34 then do the following for each measurement you want to take a From the calculations menu select the Transducer Exam Type measurement name b Position the calipers See Working with C60x Gyn calipers on page 41 ICTx Gia c Save the calculation See To save a calculation on page 45 To measure uterus or ovary 1 Ona frozen 2D image press the CALCS key Gynecology Gyn calculations Gynecology Gyn calculations include Uterus Ovary Follicle and Volume For instructions to calculate volume see Volume calculations on 2 From the calculations menu select Gyn 3 Do the following for each measurement you want to take page 48 a Select the measurement name from the calculations menu b Position the calipers See Working with calipers on page 41 c Save the calculation See To save a calculation on page 45 58 Exam based calculations To measure follicles You can save up to six follicular measurements one distance measurement for each of up to six follicles 1 Ona frozen 2D image press the CALCS key 2 From
93. ating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 130 Table 31 Transducer Model TEEx 8 3 Operating Mode CW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 2 b Pr3 MPa Wo mW 27 23 p min of W 3 Z4 lra 374 mW 3 E Z cm amp t z cm gE S Zsp cm 1 1 a o deg Zsp cm 0 39 i H2 4 00 Dim of Aaprt X cm 0 435 Y cm 0 9 PD usec E PRF Hz E P Pll max MPa S deqGPllia cm 0 34 Focal Length FL cm e L 9 A a FL cm IpA 3 MI max W cm o g Control 1 Exam Type Crd r E 2 Control 2 Depth Any a3 g Control 3 Zone Zone 3 O Uo a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 131 Ayayes Terms used in the acoustic output tables 132 Table 32 Acoustic Output Terms and Definiti
94. ations 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 61 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 OntheOB Custom Measurements setup page select New 2 Inthe Name box type a unique name 3 Inthe 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 1 OntheOB Custom Measurements setup page highlight the measurement in the Custom Measurements list 2 Select Delete Last Chapter 2 System Setup 21 dnjas 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 CRL GS BPD OFD HC AC FL APTD TTD FTA and 5 additional custom
95. aximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 2 1 3 4 0 2 7 Pr3 MPa 1 844 Wo mW 95 55 95 55 B min of W 3 Z4 lza 374 mW 120 13 a n cm 3 1 oY Zpp cm 2 66 RS p cm 3 718 0 6 2 BUNC cm 0 49 lt fe MHz 2 16 2 22 2 23 2 23 Dim of Ago X cm 1 9 0 459 0 459 Y cm 1 3 1 3 1 3 PD usec 1 21 S PRF Hz 1562 5 2 Pr PIl max MPa 2 432 S deq Pllmax cm 0 49 FocalLength FL cm m 13 84 1 55 fo amp FLy cm 5 5 5 5 lpa 3 Mlmax W cm 187 5 o 2 Control 1 Exam Type Card Card TCD TCD s B 2 Control 2 Sample Volume 1mm 3mm 14mm 14mm gS Control 3 PRF 1563 3906 12500 12500 O Control 4 Sample Volume Position Zone 1 Zone 4 Zone 0 Zone 0 127 Ayayes Table 28 Transducer Model P21x 5 1 Operating Mode CW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a 1 0 3 4 2 9 Pr3 MPa Wo mW 88 30 101 73 9 min of W 3 z1 lra 3 z1 mW 102 54 2 iz cm 1 386 9 3 E Zpp cm 1 71 R S Zsp cm 1 255 a o deg Zsp cm 0 49 lt fe MHz s nn 2 00 2 00 2 00 Dim of Aaprt X cm 0 786 0 655 0 459 Y cm 1 3 1 3 1 3 PD
96. ay Note The D2x transducer has a static continuous wave CW output This output is fixed Therefore TI and MI values cannot be changed by any system controls available to the user Table 5 Tl or MI gt 1 0 102 Transducer Model Index M M id Boonie Te C11x 8 5 MI No No No TIC TIB or TIS No Yes Yes C60x 5 2 MI Yes No No TIC TIB or TIS No No Yes D2x 2 MI No TIC TIB or TIS Yes HFL38x 13 6 MI No Yes Yes TIC TIB or TIS No Yes Yes ICTx 8 5 MI No No No TIC TIB or TIS No No Yes L25x 13 6 MI No Yes No TIC TIB or TIS No No Yes L38x 10 5 MI No Yes Yes TIC TIB or TIS No Yes Yes P10x 8 4 MI No Yes Yes No TIC TIB or TIS Yes Yes Yes Yes P21x 5 1 MI Yes Yes Yes No TIC TIB or TIS Yes Yes Yes Yes SLAx 13 6 MI No No No TIC TIB or TIS No No Yes Table 5 TI or MI gt 1 0 Continued 2D CPD PW Cw Transducer Model Index M Mode Color Doppler Doppler TEEx 8 3 MI No No No No TIC TIB or TIS No No Yes Yes Even when MI is less than 1 0 the system provides a continuous real time display of MI in all imaging modes in increments of 0 1 The system meets the output display standard for TI and provides a continuous real time display of TI in all imaging modes in increments of 0 1 The TI consists of three user selectable indices and only one of these is displayed at any one time In order to display TI properly and meet the ALARA principle the
97. bout the system The M Turbo ultrasound system is a portable lt lt Se software controlled device using all digital architecture The system has multiple configurations and feature sets used to acquire Lal le 1 and display high resolution real time a LL ultrasound images Features available on your system depend on system configuration 1 2 3 4 transducer and exam type Figure 2 System Back Connectors 1 DC input connector 2 I O connector 3 Battery and 4 ECG connector A license key is required to activate the software See Software licensing on page 71 On occasion a software upgrade may be required SonoSite provides a USB device containing the software One USB device can be used to upgrade multiple systems 1 Attach a transducer To use the ultrasound system 2 Turn the system on For power switch location see System controls on page 5 3 Press the PATIENT key and complete the patient information form 4 Press an imaging mode key 2D M MODE COLOR or DOPPLER 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 Figure 1 System Front Features 1 Control panel 2 Handle 3 Display 4 USB ports for storage updates importing and exporting To avoid data loss and to conduct a safe system shutdown always keep a batte
98. bundle version number After you obtain a license key you must enter it into the system To enter a license key 1 Turn on the system The license update screen appears 2 Enter the license key in the Enter license number field 3 Select Done on screen If you entered a valid license key but the license update screen appears verify that you entered the license key correctly If the license update screen still appears contact SonoSite Technical Support See SonoSite Technical Support on page vii Maintenance Use the recommendations in this section when cleaning or disinfecting your ultrasound system transducer and accessories Use the cleaning 72 Maintenance recommendations in the peripheral manufacturer s instructions when cleaning or disinfecting your peripherals No periodic or preventive maintenance is required for the system transducer or accessories other than cleaning and disinfecting the transducer after every use See Cleaning and disinfecting transducers on page 74 There are no internal components that require periodic testing or calibration All maintenance requirements are described in this chapter and in the ultrasound system service manual Performing maintenance procedures not described in the user guide or service manual may void the product warranty Contact SonoSite Technical Support for any maintenance questions See SonoSite Technical Support on page vii WARNING Disinfe
99. by connecting an accessory not recommended by 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 2 Select ECG on screen ECG may be on another page It appears only if the ECG cable is connected 3 Select options as desired ECG Monitoring options Show Hide A Gain lt Position Turns on and off ECG trace Increases or decreases ECG gain Settings are 0 20 Sets the position of the ECG trace Sweep Speed Settings are Slow Med and Fast D a Delay Line p Save Displays Line and Save for clip acquisition delay For instructions to capture clips see To capture and save a clip on page 35 The position of the delay line on the ECG trace The delay line indicates where the clip acquisition is triggered 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 options Chapter 3 Imaging 39 40 ECG Monitoring Chapter 4 Measurements and Calculations You can me
100. c power to the acoustic power required to raise tissue temperature by 1 C under defined assumptions See Chapter 6 Safety for a more complete description of TI A thermal index for applications in which the ultrasound beam passes through soft tissue and a focal region is in the immediate vicinity of bone A thermal index for applications in which the ultrasound beam passes through bone near the beam entrance into the body A thermal index related to soft tissues Transmits at one frequency and receives at a higher harmonic frequency to reduce noise and clutter and improve resolution A device that transforms one form of energy into another form of energy Ultrasound transducers contain piezoelectric elements which when excited electrically emit acoustic energy When the acoustic energy is transmitted into the body it travels until it encounters an interface or change in tissue properties At the interface an echo is formed that returns to the transducer where this acoustic energy is transformed into electrical energy processed and displayed as anatomical information Displays a variation in Color Doppler flow imaging within a given sample Variance is mapped to the color green and is used to detect turbulence Abbreviations Abbreviations in User Interface Abbreviation Definition x A APG A2Cd A2Cs A4Cd A4Cs AAA AAo Abd abs AC ACA ACC ACoA ACS Adur AFI Al Al PHT AL Ann D ANT F ANTN
101. cal zones Tissue models and equipment survey 106 Tissue models are necessary to estimate attenuation and acoustic exposure levels In Situ from measurements of acoustic output made in water Currently available models may be limited in their accuracy because of varying tissue paths during diagnostic ultrasound exposures and uncertainties in the acoustic properties of soft tissues No single tissue model is adequate for predicting exposures in all situations from measurements made in water and continued improvement and verification of these models is necessary for making exposure assessments for specific exam types A homogeneous tissue model with attenuation coefficient of 0 3 dB cm MHz throughout the beam path is commonly used when estimating exposure levels The model is conservative in that it overestimates the In Situ acoustic exposure when the path between the transducer and site of interest is composed entirely of soft tissue When the path contains significant amounts of fluid as in many first and second trimester pregnancies scanned transabdominally this model may underestimate the In Situ acoustic exposure The amount of underestimation depends upon each specific situation Fixed path tissue models in which soft tissue thickness is held constant sometimes are used to estimate In Situ acoustic exposures when the beam path is longer than 3 cm and consists largely of fluid When this model is used to estimate maximum exposure to the fe
102. can open ina 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 Chapter 2 System Setup 17 dnjas 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 Inthe 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 Inthe 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 For instructions to annotate images see Annotating images on page 32 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 32 18 Annotations setup 1 In the Exam list on the
103. 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 e Use the touchpad or arrow keys Select Home to move the cursor to the home position The default home position depends on the imaging screen layout You can reset the home position See To reset the home position on page 33 3 Using the keyboard type text e The arrow keys move the cursor left right up and down The DELETE key deletes all text The X Word option removes a word Select Symbols to enter special characters See Symbols on page 10 4 Optional To add a predefined label select Label and then select the desired label group E Ep or Ec 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 To reset the home position 1 Press the TEXT Key 2 Using the touchpad or arrow keys position the 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 KE 2 Ifyou need to adjust the arrow s orientation press the SELECT key and then use the touchpad When th
104. connected to a center tapped single phase supply circuit when users in the United States connect the equipment to a 240V supply system Caution Verify that the hospital supply voltage corresponds to the power supply voltage range See Electrical on page 154 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 2 Connect the AC power cord to the power supply and to a hospital grade electrical outlet 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 SonoSite or your local representative To turn the system on or off Press the power switch See System controls on page 5 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 Connecting transducers WARNING Caution 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
105. coustic measurement precision 133 acoustic output measurement 105 tables 107 132 acquisition error 140 add new user 16 Administrator 16 age gestational 62 airborne equipment standards 155 ALARA principle 97 98 157 alphanumeric keys 5 angle correction 28 29 annotations keys 5 place 32 predefine label groups 18 setup 18 aorta Ao 53 aortic valve area AVA 56 arrow graphic 33 ascending aorta AAo 53 audio 19 bar code scanner 19 baseline 29 battery clean 75 safety 90 setup 19 specifications 154 beeps 19 biological safety 92 biopsy 26 bodymarker See pictographs brightness 26 C cables clean and disinfect ECG 76 connect power 3 calculations cardiac See cardiac calculations delete measurement 46 general 45 gynecology Gyn 58 IMT 59 menu 7 45 OB 61 percent area 47 percent diameter 47 percent reduction 46 perform measurement 45 performing 45 repeat measurement 46 save 45 small parts 64 specialized 50 vascular 67 view measurement 46 volume 48 volume flow 48 49 calipers 41 cardiac calculations AAo 53 Ao 53 AVA 56 CI 57 CO 57 dP dT 56 HR 57 IVRT 52 LA 53 LV volume Simpson s Rule 53 Index 169 xepu 170 LVd 53 LVOT D 53 LVs 53 MV AV area 54 overview 50 PHT 55 PISA 51 RVSP 55 setup 19 SV 57 TDI 58 VTI 54 cardiac index Cl 57 cardiac output CO 57 cardiac references 141 cardiac intended uses 12 cautions definition vii cine buffer 5 30 clean battery 75 ECG cable
106. ct the system from the power supply or remove from the mini dock or docking system To avoid infection always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection ensure that the solution expiration date has not passed Caution Do not spray cleaners or disinfectant directly on the system surfaces Doing so may cause solution to leak into the system damaging the system and voiding the warranty Do not use strong solvents such as thinner or benzene or abrasive cleansers since these will damage the exterior surfaces Use only recommended cleaners or disinfectants on system surfaces Immersion type disinfectants are not approved for use on system surfaces When you clean the system ensure that the solution does not get inside the system controls or the battery compartment Do not scratch the LCD screen To clean the LCD screen Dampen a clean non abrasive cotton cloth with an ethanolic based cleaner and wipe the screen clean Apply the cleaner to the cloth rather than the surface of the screen To clean and disinfect system surfaces 1 Turn off the system 2 Disconnectthe system from the power supply or remove it from the mini dock or docking system 3 Clean the exterior surfaces using a soft cloth lightly dampened in a mild soap or detergent cleaning solution to remove any particulate matter or body fluids Apply the solution to the cloth rath
107. ctants and cleaning methods listed are recommended by SonoSite for compatibility with product materials not for biological effectiveness Refer to the disinfectant label instructions for guidance on disinfection efficacy and appropriate clinical uses The level of disinfection required for a device is dictated by the type of tissue it contacts during use To avoid infection ensure that the disinfectant type and the solution strength and duration are appropriate for the equipment For information see the disinfectant label instructions and the recommendations of the Association for Professionals in Infection Control and Epidemiology APIC and the FDA WARNING Caution 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 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 Cleaning and disinfecting the ultrasound system The exterior surface of the ultrasound system and the accessories can be cleaned and disinfected using a recommended cleaner or disinfectant See Recommended disinfectants on page 77 WARNING To avoid electrical shock before cleaning disconne
108. ctral trace press the CALCS key 2 From the calculations menu select Left or Right 68 Patient report 3 Do the following for each measurement you want to take a From the calculations menu select the measurement name b Usingthe touchpad position the caliper at the peak systolic waveform Press the SELECT key 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 45 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 toolarge 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 Doany ofthe following e 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 3 Optional Press the SAVE key to save the current page of the patient report To exit the patient report and return to imaging select
109. d 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 amp Allied Health Dictionary 4th ed 1994 1492 SI SV BSA SV Stroke Volume BSA Body Surface Area where 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 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 SV Stroke Volume LVEDV End Diastolic Volume LVEDSV End Systolic Volume where Velocity Time Integral VTI incm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 383 VTI sum of abs velocities n Auto Trace distance cm blood travels with each ejection period Velocities are absolute values where Obstetrical references Amniotic
110. d adjust its height so that the display is at or slightly below eye level Position yourself 86 Support your back during an exam Use a chair that supports your lower back that adjusts to your work surface height that promotes a natural body posture and that allows quick height adjustments Always sit or stand upright Avoid bending or stooping Minimize reaching and twisting Use a bed that is height adjustable Position the patient as close to you as possible Face forward Avoid twisting your head or body Move your entire body front to back and position your scanning arm next to or slightly in front of you Stand for difficult exams to minimize reaching Position the ultrasound system or display directly in front of you Provide an auxiliary monitor for patient viewing Promote comfortable shoulder and arm postures Keep your elbow close to your side Relax your shoulders in a level position Support your arm using a support cushion or pillow or rest it on the bed Promote comfortable hand wrist and finger postures Hold the transducer lightly in your fingers Minimize the pressure applied on the patient Keep your wrist in a straight position Take breaks exercise and vary activities Minimizing scanning time and taking breaks can effectively allow your body to recover from physical activity and help you avoid MSDs Some ultrasound tasks may require longer or more frequent breaks However simp
111. d endocardial border This option depends on transducer and exam type Select from four image orientations U R Up Right U L Up Left D L Down Left D R Down Right 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 Turns biopsy guidelines on and off This feature depends on transducer type See the SonoSite Biopsy user guide Biopsy is not available when the ECG cable is connected Turns the guideline on and off This feature depends on transducer and exam type See the user guide for L25x transducer and needle guide Cardiac exam Specifies the sector width SonoMB On is available only for Sector Full 26 Imaging modes SonoMB MB On and MB Off turn SonoMB MB multi beam imaging technology on and off When SonoMB is on MB Ils appears in the upper left hand screen SonoMB depends on transducer and exam type ECG Displays the ECG trace See ECG Monitoring on page 38 This feature is optional and requires a SonoSite ECG cable Clips Displays the clips options See To capture and save a clip on page 35 This feature is optional THI Turns Tissue Harmonic Imaging on and off When on THI appears in the upper left hand screen This feature is optional and depends on transducer and exam type Page x x Indicates which page of options is displayed Select to display t
112. damage to a transducer or an ultrasound system The following precautions can help reduce ESD anti static spray on carpets anti static spray on linoleum and anti static mats Table 1 and Table 2 document the intended use environment and EMC compliance levels of the system For maximum performance ensure that the system is used in the environments described in this table The system is intended for use in the electromagnetic environment specified below Table 1 Manufacturer s Declaration Electromagnetic Emissions Emissions Test Compliance Electromagnetic Environment RF emissions Group 1 The SonoSite ultrasound system uses RF energy only CISPR 11 for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions Class A The SonoSite ultrasound system is suitable for use in CISPR 11 all establishments other than domestic and those directly connected to the public low voltage power supply network which supplies buildings used for domestic purposes Harmonic emissions Class A IEC 61000 3 2 Voltage fluctuations Complies flicker emissions IEC 61000 3 3 The system is intended for use in the electromagnetic environment specified below Table 2 Manufacturer s Declaration Electromagnetic Immunity Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Electrostatic Discharge ESD IEC 61000
113. e 53 license key 71 live trace 22 30 login Administrator 16 user 16 LVO Left Ventricular Opacification 26 Index 171 xepu 172 M M Mode imaging 26 maintenance 72 measurements x Ratio Doppler 44 See also calculations 2D 42 about 41 Acceleration Doppler 44 accuracy 41 139 area 2D 42 automatic trace Doppler 44 circumference 2D 42 delete 41 distance 2D 42 distance M Mode 43 Doppler 43 edit 41 Elapsed Time Doppler 44 errors 140 fetal heart rate 63 heart rate 43 63 M Mode 43 manual trace 42 44 Pressure Gradient Doppler 43 publications 141 Resistive Index Doppler 44 save to calculation and report 41 terminology 141 vascular 67 Velocities Doppler 44 mechanical index MI 103 157 mitral valve aortic valve MV AV 54 M line 26 mode data 7 20 modes keys 6 N near 5 network 20 NTSC definition 157 option 19 O OB calculations 20 61 custom measurements setup 21 Index custom tables setup 22 graphs 70 intended uses 12 references 145 tables setup 22 on screen controls 6 optimize 25 orientation marker 7 option 26 output display 103 P PAL definition 157 option 19 password 16 17 18 patient header 7 20 patient information form 33 36 37 patient list 36 patient report about 68 cardiac 69 general 68 OB 69 save measurement to 41 vascular 69 PC 19 pediatric intended uses 12 percent reduction calculation 46 peripherals 154 pictographs PICTO key 7 placing 33
114. e modes changing these parameters does not affect MI or TI Changes to other parameters may also result in MI and TI reductions Please note the MI and TI values on the right side of the screen Chapter 6 Safety 99 Ayayes Table 3 MI Transducer Depth C11x C60x HFL38x ICTx L25x L38x P10x P21x gt gt gt gt gt gt gt gt gt SLAx TEEx T V Decrease or lower setting of parameter to reduce MI TIncrease or raise setting of parameter to reduce MI Table 4 TI TIS TIC TIB Color Power Doppler Settings Transducer PW Settings Box Box Box Width Height Depth Pepth Optimize C11x T i V Depth C60x 4 t 4 V PRF HFL38x T T f Y Depth ICTx ii T i Exam Gyn V PRF L25x i T PRF L38x l V Depth P10x T 4 PRF P21x Y 3 T Y PRF Table 4 TI TIS TIC TIB Color Power Doppler Settings EET Box Box Box PW Settings Width Height Depth PRF Depth Optimize SLAx T Y jj Y PRF TEEx Y T Y PRF V Decrease or lower setting of parameter to reduce MI Increase or raise setting of parameter to reduce MI Chapter 6 Safety 101 Ayayes Output display The system meets the AIUM output display standard for MI and TI see last reference in Related guidance documents below Table 5 indicates for each transducer and operating mode when either the TI or MI is greater than or equal to a value of 1 0 thus requiring displ
115. e based on calculations that use a set of acoustic output measurements that were made using a single reference ultrasound system with a single reference transducer that is representative of the population of transducers of that type The reference system and transducer are chosen from a sample population of systems and transducers taken from early production units and they are selected based on having an acoustic output that is representative of the nominal expected acoustic output for all transducer system combinations that might occur Of course every transducer system Chapter 6 Safety 103 Ayayes combination has its own unique characteristic acoustic output and will not match the nominal output on which the display estimates are based This variability between systems and transducers introduces an error into displayed value By doing acoustic output sampling testing during production the amount of error introduced by the variability is bounded The sampling testing ensures that the acoustic output of transducers and systems being manufactured stays within a specified range of the nominal acoustic output Another source of error arises from the assumptions and approximations that are made when deriving the estimates for the display indices Chief among these assumptions is that the acoustic output and thus the derived display indices are linearly correlated with the transmit drive voltage of the transducer Generally this assumption is very g
116. e entries have been obtained at the same operating conditions that give rise to the maximum index value in the first column of the table Measurement precision and uncertainty for power pressure intensity and other quantities that are used to derive the values in the acoustic output table are shown in the table below In accordance with Section 6 4 of the Output Display Standard the following measurement precision and uncertainty values are determined by making repeat measurements and stating the standard deviation as a percentage Chapter 6 Safety 133 Ayayes Table 33 Acoustic Measurement Precision and Uncertainty Quantity Precision u Uncertainty 96 of standard deviation 9596 confidence Pr 1 996 11 2 Pr 1 9 12 2 Wo 3 4 10 fc 0 1 4 7 PII 3 2 12 5 to 16 8 PII 3 3 2 13 47 to 17 5 Labeling symbols The following symbols are used on the products packaging and containers Table 34 Labeling Symbols Symbol Definition Alternating Current AC PNZ g Class 1 device indicating manufacturer s declaration of conformance with C Annex VII of 93 42 EEC Class 1 device requiring verification by the Notified Body of sterilization or C measurement features or to a Class lla Ilb or III device requiring verification or opa auditing by the Notified Body to applicable Annex es of 93 42 EEC i Attention see the user guide Device complies with relevant Australian regulations for electronic devices
117. e is PW Doppler In cardiac exams you can select the CW Doppler on screen option 1 Press the DOPPLER key Note If the D line does not appear make sure that the system is in live imaging 2 Doany ofthe following as needed Setoptions See PW Doppler options on page 29 e Using the touchpad position the D line where desired PW Doppler To correct the angle manually press the SELECT key and then use the touchpad to adjust the angle in 2 increments from 74 to 74 Press the SELECT key again to set the desired angle The SELECT key toggles between the D line and angle correction To display the spectral trace 1 Display the D line 2 Press the DOPPLER key The time scale above the trace has small marks at 200 ms intervals and large marks at one second intervals 3 Doany ofthe following as needed e Set options See Spectral trace options on page 29 e Press the UPDATE key to toggle between the D line and spectral trace e If using a duplex layout press the 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 PW Doppler options In PW Doppler imaging you can set the following on screen options PW CW amp Angle Correction Gate Size di T TDI On TDI Off Steering Cardiac exam only Toggle between PW Doppler and CW Doppler The current selection appears in the upp
118. e orientation is correct press the SELECT key again 3 Using the touchpad position the arrow where desired 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 PICTO key 2 Select E x x to display the desired pictograph and then press the SELECT key 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 SELECT key and then use the touchpad 5 Selecta screen location for the pictograph U L Up Left D L Down Left D R Down Right U R Up Right Ina duplex layout the pictograph is restricted to upper left In Dual all four positions are available To remove the pictograph select Hide 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 exam are linked to that patient See Patient report on page 68 Chapter 3 Imaging 33 To create a new patient information form
119. e qualified ultrasound user can control it The ability to limit the exposure over time supports the ALARA principle Applying ALARA The system imaging mode selected by the qualified ultrasound user is determined by the diagnostic information required 2D imaging provides anatomical information CPD imaging provides information about the energy or amplitude strength of the Doppler signal over time at a given anatomical location and is used for detecting the presence of blood flow Color imaging provides information about the energy or amplitude strength of the Doppler signal over time at a given anatomical location and is used for detecting the presence velocity and direction of blood flow Tissue Harmonic Imaging uses higher received frequencies to reduce clutter artifact and improve resolution on the 2D image Understanding the nature of the imaging mode used allows the qualified ultrasound user to apply the ALARA principle Prudent use of ultrasound requires that patient exposure to ultrasound be limited to the lowest ultrasound output for the shortest time necessary to achieve acceptable diagnostic results Decisions that support prudent use are based on the type of patient exam type patient history ease or difficulty of obtaining diagnostically useful information and potential localized heating of the patient due to transducer surface temperature The system has been designed to ensure that temperature at the face of the transducer will n
120. ectants EPA Registration FDA 510 k clearance liquid sterilant high level disinfectant CE approval Before using a disinfectant confirm that its regulatory status is appropriate for your jurisdiction and use Verify expiration dates on chemicals When disposing of chemicals follow manufacturer recommendations and EPA regulations See www sonosite com for updated cleaning and disinfectant information Table 1 Disinfectant Compatibility with System and Transducers C60x ICTx Cleaning Solutions of Origin TPE Active Ingredient Pox Dax HFLB8x S Surfaces P21x SLAx AbcoCide 14 USA Liquid Gluteraldehyde A A A U Accel Plus CAN Wipe Hydrogen Peroxide N N N U Accel TB CAN Wipe Hydrogen Peroxide N N N U Accel Wipes CAN Wipe Hydrogen Peroxide A A A U Aidal Plus AUS Liquid Gluteraldehyde A A A U Alkacide FRA Liquid Gluteraldehyde A A A U Alkazyme FRA Liquid Quat Ammonia A A A U Anioxyde 1000 FRA Liquid Peracetic Acid N N N U Aquatabs 1000 IRL Tablet Sodium A N A U Dichloroisocyanurate Buljooysajqnoly 8Z Table 1 Disinfectant Compatibility with System and Transducers continued C60x ICTx Disinfection and Country 3 n L38x C11x System Cleaning Solutions of Origin Type Active Ingredient P10x D2x HFL38 L25x Surfaces P21x SLAx Aquatabs 2000 IRL Tablet Sodium A U N A U Dichloroisocyanurate Aquatabs 5000 IRL Tablet Sodium N U N N U Dichloroisocyanurate Ascend USA Liquid Quat Ammonia A U A A U Asepti
121. electing from the calculations menu not by pressing the CALIPER 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 35 e Save both the image and calculation Press the SAVE key if the SAVE key functionality Chapter 4 Measurements and Calculations 45 sjueulaJnseeiw is set to Image Calcs See Presets setup on page 22 The calculation saves to the patient report and the image saves to internal storage with the measurements displayed 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 68 To repeat a saved measurement 1 Highlight the measurement name in the calculations menu 2 Press the SELECT key or the CALIPER key 3 Perform the measurement again The new results appear on screen in the measurement and calculations data area See Screen layout on page 7 You can compare them to the saved results below the menu 4 Tosavethe new measurement press the SAVE CALC key The new measurement saves to the
122. elta 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 A Ay V4 V5 where A gt Ao valve area A4 LVOT area V4 LVOT velocity V5 Ao valve velocity LVOT Left Ventricular Outflow Tract AVA PViyojr PVAo CSAryor AVA The VITAG CBArwor Body Surface Area BSA in m Grossman W Cardiac Catheterization and Angiography Philadelphia Lea and Febiger 1980 90 BSA 0 007184 Weight Height Weight kilograms Height centimeters Cardiac Index CI in I min m2 Oh J K J B Seward A J Tajik The Echo Manual 2nd Edition Boston Little Brown and Company 1999 59 CI CO BSA CO Cardiac Output BSA Body Surface Area where 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 CO Cardiac Output SV Stroke Volume HR Heart Rate where Cross Sectional Area CSA in cm2 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
123. ences 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 Save Key Behavior of the SAVE key Image Only 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 Units Units for patient height and weight in cardiac exams in ft Ibs or cm m kg Language The system language Changing the language requires restarting the system 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 and license information See also To enter a license key on page 72 USB Devices setup On the USB Devices setup page you can view information about connected USB devices including space availability You can also specify afile format for images and clips in patient exams
124. enter the HR measurement three ways Patient information form Doppler measurement See To calculate Heart Rate HR on page 57 or M Mode measurement See To measure heart rate M Mode on page 43 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 69 To measure LVd and LVs 1 On a frozen 2D image or M Mode trace press the CALCS key From the calculations menu select the measurement name Position the active green caliper at the starting point See Working with calipers on page 41 Press the SELECT key and position the second caliper Press the SELECT key Another caliper appears and the calculations menu highlights the next measurement name 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 Save the calculation See To save a calculation on page 45 To measure Ao LA AAo or LVOT D 1 On a frozen 2D image or M Mode trace press the CALCS key From the calculations menu select the measurement name Position the calipers See Working with calipers on page 41 Save the calculation See To save a calculation on page 45 To calculate LV Volume Simpson s Rule 1 2 On a fro
125. epend 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 68 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 Menu items followed by ellipses have subentries To select from the calculations menu 1 Ona 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 SELECT key Only measurement names available for the imaging mode are selectable 3 Press the SELECT key 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 s
126. er left hand screen Corrects the angle to 0 60 or 60 Settings depend on transducer and 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 Select the desired steering angle setting The PW Doppler angle correction automatically changes to the optimum setting 15 has an angle correction of 60 Page x x Ohasan angle correction of 0 15 has 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 Indicates which page of options is displayed Select to display the next page Spectral trace options In spectral trace imaging you can set the following on screen options Scale Invert Mey Volume J Wall Filter 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 Sets the baseline position On a frozen trace the baseline can be adjusted if Live Trace is off Vertically flips the spectral trace On a frozen trace Invert is avai
127. er name and password at startup e 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 Letusers 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 3 Under User Information make changes as desired 4 Select Save Any change to the user name replaces the previous name To delete a user 1 Login as Administrator 2 Under User List select the user 3 Select Delete 4 Select Yes To change a user password 1 Login as Administrator 2 Inthe User List select the user 3 Type the new p
128. er than the surface 4 Mixthe disinfectant solution compatible with the system following disinfectant label Chapter 5 Troubleshooting and Maintenance 73 Bunoouse qnoJ 5 6 instructions for solution strengths and disinfectant contact duration Wipe surfaces with the disinfectant solution Air dry or towel dry with a clean cloth Cleaning and disinfecting transducers To disinfect the transducer and its cable use the immersion method or the wipe method Immersible transducers can be disinfected only if the product labeling indicates they can be used with an immersion method See Table 1 Disinfectant Compatibility with System and Transducers on page 77 WARNING To avoid electrical shock before cleaning disconnect the transducer from the system To avoid injury always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection ensure that the solution expiration date has not passed Caution Transducers must be cleaned after 74 every use Cleaning transducers is necessary prior to effective disinfection Ensure that you follow the manufacturer s instructions when using disinfectants Do not use a surgeon s brush when cleaning transducers Even the use of soft brushes can damage a transducer Use a soft cloth Maintenance Using a non recommended cleaning or disinfection solution incorrect solution strength or immersing a transduce
129. erating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 113 Ayayes Table 14 Transducer Model HFL38x 13 6 Operating Mode CPD Color TIS TIB Index Label M Non scan Non TIC Scan AaprtS1 Aaprt gt 1 Can Global Maximum Index Value 1 1 1 0 b Pr3 MPa 2 556 Wo mW 53 49 2 min of W 3 zi lrA 3 z4 Jl mW 2 D Z1 cm J 3 y Zpp cm SS 5 cm 12 a o dea 2 3 cm lt fe MHz 5 328 5 324 Dim of Aaprt X cm 0 44 Y cm 0 4 PD usec 0 525 S PRF Hz 2597 s p GPll MPa 3 187 deqGPllia cm Focal Length FL cm 1 32 fo on amp FL cm 2 5 lpa 3 MImax W cm 325 5 Control 1 Mode Color Color Control 2 Exam Type Any Any o 5 I 9 Control 3 Optimization Depth PRF Low 3 3 cm Med ev 5 1938 Control 4 Color Box Position Size Top Any Short a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are
130. ers 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 amp 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 You can also press the keys on the keyboard 3 Select OK 10 Preparing transducers Preparing transducers WARNING 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 Caution To avoid damage to the transducer use only gels recommended by SonoSite Using gels other than the one recommended by SonoSite can damage the transducer and void the warranty If you have questions about gel compatibility contact SonoSite or your local representative SonoSite recommends that you clean transducers after each use See Cleaning and disinfecting transducers on page 74 Acoustic coupling gel must be used during exams Although most gels provide sui
131. eted 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 Onthe 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 delete an OB measurement 1 Onthe 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 Chapter 4 Measurements and Calculations 69 sjueulaJnseeiw 2009Aug29 16 46 3 4 Anatomy Checklist Fetal Lie a Plac Location mu Gender Face O Nose Lips Profile M Lateral Vent Ei Cisterna Magna Ej Nuchal 34 Ch Heart m Aortic Arch EjRVOT ELvorT Diaphragm m Cord Insert Fetal E Cord Insert Plac m3 V Cord Stomach Bladder D Kidneys B Spine O Upper Extrem Lower Extrem Maternal DAdnexa O Cervix Fibroids 3 4 raph Figure 3 OB Anatomy Checklist Page To fill out the OB anatomy checklist You can document reviewed anatomy lt On the Anatomy Checklist page in the OB patient report select the check boxes Press the TAB key to move between fields and the SPACEBAR to select and deselect items in the checklist To comp
132. f 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 13 148 Measurement publications and terminology 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 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
133. 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 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 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
134. fety of Diagnostic Ultrasound AIUM 1993 Acoustic output tables Table 8 through Table 31 indicate the acoustic output for the system and transducer combinations with a TI or MI equal to or greater than one These tables are organized by transducer model and imaging mode For a definition of terms used in the tables see Terms used in the acoustic output tables on page 132 Chapter 6 Safety 107 Ayayes Table 8 Transducer Model C11x 8 5 Operating Mode CPD Color TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 2 Pr3 MPa Wo mW 40 50 I min of W 3 z l r4 3 z4 mW E 5 Z sis oz cm E S 2 cm So SP 8 dez cm i f MH2 4 38 Dim of Aaprt X cm E 0 36 Y cm 0 5 PD usec S PRF Hg E Pr Pll max MPa S deq Pllmax cm Focal Length FL cm 1 56 E FLy cm 2 5 Ip 3 MI ax W cm o 2 Control 1 Mode CPD E 9 Control 2 Exam Type Vas PK E Control 3 PRF 2841 O O Control 4 Optimization Depth Med 2 0 Control 5 Color Box Top Position Size Short 108 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condit
135. g e Turn on the system Press the 2D key 2 Set options as desired See 2D options 2D options In 2D imaging you can select the following on screen options Optimize Settings are as follows E 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 Adjusts the grayscale range 3 2 Range 1 0 1 2 3 DIO The positive range increases the number of grays displayed and the negative range decreases the number of grays displayed Dual Displays side by side 2D images OD 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 UPDATE key to toggle between the images To return to full screen 2D imaging select Dual or press the 2D key Chapter 3 Imaging 25 LVO On LVO Off Orientation O Brightness ote Jer es Biopsy e Guide Sector amp LVO On turns on Left Ventricular Opacification LVO Off turns off this option Use LVO for cardiac exams in 2D imaging mode when using an imaging contrast agent LVO lowers the mechanical index MI of the system to enhance visualization of the contrast agent an
136. g 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 The factors identified in the literature that affect the accuracy are as follows e Using the diameter method for 2D area Difficulty ensuring uniform insonation of the vessel The system is limited to the following sample volume sizes e Cllxtransducer 1 2 3 Gate Size mm e C60x and P10x transducers 2 3 5 7 10 12 Gate Size mm e HFL38x L25x L38x and SLAx transducers 1 3 5 7 10 12 Gate Size mm e P21x transducer 2 3 5 7 11 5 14 Gate Size mm Precision in placing the caliper e Accuracy in angle correction The considerations and degree of accuracy for volume flow measurements and calculations are discussed in the following reference Allan PaulL et al Clinical Doppler Ultrasound 4th Ed Harcourt Publishers Limited 2000 36 38 To calculate volume flow 1 Perform the 2D measurement a Onafrozen full screen 2D image or duplex image press the CALCS key b From the calculations menu select D distance under Vol Flow c Position the calipers See Working with calipers on page 41 d Save the calculation See To save a calculation on page 45 2 Perform the Doppler measurement a Ona frozen Doppler spectral trace press the CALCS key b From the calculations menu selec
137. g default settings csssccsssssssseccssesssseccsssccsssecsssesssssecsssscssssccssuecsssnecesseesss 15 A amp B Key Footswitch setup we 15 Administration setup 15 Security Settings sccsscssdecvseccssvanssesscsonsseuvoetascontvtadcssaseovssensgenstdodasedssenbvcenesehostbecersite 16 Eie E OT o EE 16 Exporting or importing user accounts sssesssessssessssssssssssseserrreeesesssssssssssseee 17 Exporting and clearing the Event log sees 17 Logging in as user ou eeeesseessesssecssecsecseecsceseccssccsecsccssecsecseesssessccuceseesecsecsseeseeseense 18 Choosing a secure password essere teen ttent testen ttnnttnntttnns 18 Annotations Setup RR 18 Audio Battery setup ccsssssssscsssssssecsccssscsssccsscsssccsuccesscesscessccssccessccsscesusecnecsscssscesnees 19 Cardiac Calculations setup cssssssscsssesssecssesssesssecesscssssesssecssecsuscsssecssesssccenscesseesees 19 Mugen M 19 Date and Timie setup inciter tibicen eee Heer tiep Neo atia 20 Display Information setup sssesscccssssecccssescccsssecesssseececsnsccessnsecesssnseeessnuesesssneeeessaes 20 IMT Calculations setup sssssscsssesssecsecsssccseccsscssssecssecssccssscsssecsuccsseecsscesscecseecssesssees 20 Network Stats SCCUP M 20 OB Calculations setup 0 eessseessssssscssesesssescsscsesssecssecessscsessecesnseeesseesusesessesesseeeenseeess 20 O
138. he 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 To display the M line 1 Press the M MODE key Note If the M line does not appear make sure that the image isn t frozen 2 Usethetouchpad to position the M line where desired 3 Set options as desired Many optimization and depth options available in 2D imaging are also available in M Mode imaging See 2D options on page 25 To display the M Mode trace 1 2 Display the M line Adjust the depth if necessary See To adjust depth on page 30 Press the M MODE key The time scale above the trace has small marks at 200ms intervals and large marks at one second intervals 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 e Ifusing a duplex layout press the M MODE 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
139. he 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 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 12 Intended uses multiple pregnancy
140. id crystal display LCD contains mercury Dispose of the LCD properly in accordance with local regulations Electromagnetic compatibility The ultrasound system has been tested and found to comply with the electromagnetic compatibility EMC limits for medical devices to IEC 60601 1 2 2001 These limits are designed to provide reasonable protection against harmful interference in a typical medical installation Caution Medical electrical equipment requires special precautions regarding EMC and must be installed and operated according to these instructions It is possible that high levels of radiated or conducted radio frequency electromagnetic interference EMI from portable and mobile RF communications equipment or other strong or nearby radio frequency sources could result in performance disruption of the ultrasound system Evidence of disruption may include image degradation or distortion erratic readings equipment ceasing to operate or other incorrect functioning If this occurs survey the site to determine the source of disruption and take the following actions to eliminate the source s e Turn equipment in the vicinity off and on to isolate disruptive equipment e Relocate or re orient interfering equipment Increase distance between interfering equipment and your ultrasound system Manage use of frequencies close to ultrasound system frequencies Remove devices that are highly susceptible to EMI Lower power from intern
141. ime IVRT 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select MV and then select IVRT A vertical caliper appears 3 Usingthe 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 45 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 options on page 29 1 Ona 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 3 Position the first caliper along the waveform at 100 cm s 56 Exam based calculations 4 Press the SELECT key A second horizontal dotted line with an active caliper appears at 300 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 45 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 On a frozen 2D
142. ing the touchpad In trace measurements the results appear after you complete the trace Outside a calculation you can add calipers by pressing the CALIPER key You can have multiple sets 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 45 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 press the SELECT key To switch the active set when measuring outside a calculation select Switch on screen To delete or edit a measurement With the measurement active highlighted do one of the following e To delete select Delete on screen To edit use the touchpad to move the calipers Note Trace measurements cannot be edited once set Chapter 4 Measurements and Calculations 41 sjueulaJnseeiw To improve precision of caliper placement ie Do any of the following Adjust the display for maximum sharpness e Use leading edges closest to the transducer or borders for starting and stopping points Maintain a consistent transducer orientation f
143. ion 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 e Numbered steps in procedures must be performed in order tems in bulleted lists do not require a sequence Single step procedures begin with Symbols and terms used on the system and transducer are explained in Chapter 1 Chapter 5 Chapter 6 and Glossary Customer comments Questions and comments are encouraged SonoSite is interested in your feedback regarding the system and the user guide Please call SonoSite at 888 482 9449 in the US Outside the US call the nearest SonoSite representative You can also e mail SonoSite at comments sonosite com For technical support please contact SonoSite as follows SonoSite Technical Support Phone US or 877 657 8118 Canada Phone Outside 425 951 1330 US and Canada Or call your local representative Fax 425 951 6700 E mail service sonosite com Web site www sonosite com Click Support amp Service Europe 44 0 1462 444 800 Service uk service sonosite com Center vii uon npoanu viii Customer comments Chapter 1 Getting Started A
144. ion since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 9 Transducer Model C11x 8 5 Operating Mode PW Doppler a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 8 1 7 Pr3 MPa Wo mW 26 29 24 65 2 min of W 3 z l r4 3 z4 mW d n cm Em E g Zpp cm E c Zsp cm 1 1 S gt asta cm 0 236 21 R H2 s 4 36 4 36 Dim of Aaprt X cm 0 28 0 2 Y cm 0 5 0 5 PD usec S PRF H2 E p GPIll ax MPa S deq Pllmax cm 0 226 Focal Length FL cm Lx FN 0 77 amp FLy cm 2 5 Ipa 3 Mlmax W cm o 2 Control 1 Exam Type Any Any s z Control 2 Sample Volume 2 mm 3 mm y S E Control 3 PRF 3906 73906 O Control 4 Sample Volume Position Zone 1 Zone 0 No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 109 Ayayes Table 10 Tr
145. ip saves directly to internal storage If Prev On is selected the clip plays back in preview mode You can select any of the following on screen e A playback speed 1x 1 2x 1 4x e Pause to interrupt playback e 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 Saveto save the clip to internal storage Delete to delete the clip To set Clips options Setting Clips options ensures that clips are captured to your specifications 1 In2D imaging mode select Clips on screen 2 Setoptions as desired Chapter 3 Imaging 35 Clips options Time ECG Time and ECG share the same E e location on screen e With Time capturing is based on number of seconds Select the time duration e With ECG capturing is based on the number of heart beats Select the number of beats PrevOn and PrevOff turn the preview feature on and off m e With Prev On the captured Q clip automatically plays on screen The clip can be trimmed saved or deleted e With Prev Off the clip saves to internal storage and the trim and delete options are not available Preview On Preview Off Prospective Pro and Retro determine how Retrospective clips are captured b e With Pro a clip is captured prospectively after you press the cLip key e With Retro a clip is captured retrospectively from pre saved data before you press the CLIP key Re
146. ith the touchpad or press the BACKSPACE key d Press the SET key to complete the trace e Save the calculation See To save a calculation on page 45 For information on the automatic trace tool see To trace automatically Doppler on page 44 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 34 2 Measure from LVOT 2D a Onafrozen2D image press the CALCS key b From the calculations menu select LVOT D c Position the calipers See Working with calipers on page 41 d Save the calculation See To save a calculation on page 45 3 Measure from aorta Doppler See To calculate Velocity Time Integral VTI on page 54 From the calculations menu select AV and then select VTI For information on the automatic trace tool see To trace automatically Doppler on page 44 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
147. k 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 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 Chapter 7 References 147 so2uaJoJay 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 Occipito Frontal Diameter OFD Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 431 Transverse Trunk Diameter TTD 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 Growth analysis tables Abdominal Circumference AC Chitty Lyn S et al Charts of Fetal Size 3 Abdominal Measurements British Journal o
148. l 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 See To save a measurement to a calculation and patient report on page 41 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 63 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 Ona 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 41 Chapter 4 Measurements and Calculations 43 s UsWaiINseayy To measure Velocities Elapsed Time x Ratio Resistive Index RI and Acceleration Doppler 1 Ona frozen Doppler spectral trace press the CALIPER key A single caliper appears 2 Using the touchpad position
149. lable if Live Trace is off Increases or decreases Doppler speaker volume 0 10 Settings include Low Med High Sweep Speed Settings include Slow Med Fast M Chapter 3 Imaging 29 Live Trace Displays a live trace of the peak or mean See Presets setup on Es d page 22 to specify peak or mean Page x x Indicates which page of options is displayed Select to display the next page Adjusting depth and gain 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 Turn a gain knob NEAR amp adjusts the gain applied to the near field of the 2D image FAR AN adjusts the gain applied to the far field of the 2D image GAIN X adjusts the overall gain applied to the entire image In CPD or Color imaging the GAIN knob affects the color gain applied to the region of interest ROT 30 Adjusting depth and gain box In PW and CW Doppler imaging the the GAIN knob affects Doppler gain Near and far correspond to the time gain
150. lau Clinical Applications of Doppler Ultrasound Raven Press N Y 1988 130 136 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 cm 100 where A1 original area of the vessel in square cm A2 reduced area of the vessel in square cm 150 Measurement publications and terminology 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 E PG 4 PE Peak A Pressure Gradient A PG A PG 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 K
151. les 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 Inthe patient information form select OB exam type and select LMP or Estab DD Select Twins if appropriate 2 Ona 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 41 c Save the calculation See To save a calculation on page 45 To measure fetal heart rate M Mode 1 Ona frozen M Mode trace press the CALCS key 2 Select FHR from the calculations menu A vertical caliper appears Chapter 4 Measurements and Calculations 63 sjueulaJnseeiw Using the touchpad position the vertical caliper at the peak of the heartbeat Press the SELECT key A second vertical caliper appears Using the touchpad position the second
152. lete 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 fo 1 70 rm On the OB patient report select Graphs on screen In the Graphs list select the desired measurement author The graph for the selected measurement appears You can select another Patient report measurement author or select 1 x on screen For twins both measurement sets are plotted on the same graph 3 Optional Press the SAVE key to save the current graph page 4 Select one of the following on screen Report to return to the previous patient report page Done to return to live imaging EMED worksheets EMED worksheets contain results from EMED calculations and checklists that you can complete To display an EMED worksheet This feature is optional 1 After or during the exam press the REPORT key Select EMED on screen Select the worksheet from the Worksheet list or by selecting x x on screen Chapter 5 Troubleshooting and Maintenance This chapter contains information to help correct problems with system operation to enter a software license and to take proper care of the system transducer and accessories Troubleshooting If you encounter difficulty wi
153. lic Left Ventricular Dimension Left Ventricular Dimension Diastolic Left Ventricular Dimension Fractional Shortening Left Ventricular Dimension Systolic Glossary 163 Aiessoj5 164 Abbreviations in User Interface Continued Abbreviation Definition LVEDV LVESV LVET LVO LVOT LVOT Area LVOT D LVOT VTI LVPW LVPWd LVPWFT LVPWs LVs MB MCA MCCA MECA MI MICA Mid MM MR PISA MR VTI Msk MV Left Ventricular End Diastolic Volume Left Ventricular End Systolic Volume Left Ventricular Ejection Time Left Ventricular Opacification Left Ventricular Outflow Tract Left Ventricular Outflow Tract Area Left Ventricular Outflow Tract Diameter Left Ventricular Outflow Tract Velocity Time Integral Left Ventricular Posterior Wall Left Ventricular Posterior Wall Diastolic Left Ventricular Posterior Wall Fractional Thickening Left Ventricular Posterior Wall Systolic Left Ventricular systolic SonoMB Middle Cerebral Artery Mid Common Carotid Artery Mid External Carotid Artery Mechanical Index Mid Internal Carotid Artery Middle M Mode Mitral Regurgitation Proximal Iso Velocity Surface Area Mitral Regurgitation Velocity Time Integral Muscle Mitral Valve Abbreviations in User Interface Continued Abbreviation Definition MV Area MV Regurgitant Fraction MV Regurgitant Volume MV VTI MVA MV ERO MV PISA Area MV Rate Neo Nrv NST NTSC OA OB OFD Oph Orb PAL PCAp PCC
154. lnax cm 0 415 Focal Length FL cm 9 5 FL cm E re lpa 3 M max W cm o 2 Control 1 Exam Type Abd 5 S Control 2 PRF Any 6 9 Control 3 Sample Volume 12mm Qu 5 dO Control 4 Sample Volume Position Zone 1 112 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 13 Transducer Model D2x 2 Operating Mode CW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 2 6 b Pr3 MPa Wo mW m 90 52 9 min of W 5 z4 lza 3 z4 mW 3 5 Z ai o iz cm E S a cm 1 1 So P i B fdeaZsp cm 0 66 lt f MH2 2 00 Dim of Aaprt X cm 0 8 Y cm 0 4 PD usec S PRF H2 E p GPII max MPa S deq Pllmax cm 0 54 Focal Length FL cm Lx FN amp FLy cm Ex Ip 3 GMl max W cm o Z2 Control 1 Exam Type Crd z g Control 2 Depth Fixed as 8 Control 3 Zone Fixed a This index is not required for this op
155. lobal maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 23 Transducer Model P10x 8 4 Operating Mode CW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 2 1 2 0 Pr3 MPa Wo mW 40 72 30 00 9 min of W 5 z4 lza 3 z4 mW 3 5 Z ai o iz cm E S a cm 0 7 So P deglZsp cm 0 36 i R MHz i 4 00 4 00 Dim of Aaprt X cm 0 320 0 16 Y cm 0 7 0 7 PD usec S PRF H2 E p GPIll ax MPa S deq Pllmax cm 0 27 Focal Length FL cm 0 92 amp FLy cm 5 0 IpA 3 Mlmax W cm o Z2 Control 1 Exam Type Card Card z g Control 2 Depth Any Any as 8 Control 3 Zone Zone 3 Zone 0 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 123 Ayayes Table 24 Transducer Model P21x 5 1 Operating Mode 2D
156. ly changing tasks can help some muscle groups relax while others remain or become active Work efficiently by using the software and hardware features correctly and leg positions Keep moving Avoid sustaining the same posture by varying your head neck body arm Do targeted exercises Targeted exercises can strengthen muscle groups which may help you avoid MSDs Contact a qualified health professional to determine stretches and exercises that are right for you Electrical safety classification Class equipment Internally powered equipment Type BF applied parts Type CF applied parts IPX 7 watertight equipment IPX 8 watertight equipment Non AP APG Ultrasound system powered from power supply or part of the Mobile Docking System Ultrasound system not connected to the power supply battery only Ultrasound transducers ECG module ECG leads Ultrasound transducers Footswitch Ultrasound system power supply docking system and peripherals Equipment is not suitable for use in the presence of flammable anaesthetics Chapter 6 Safety 87 Ayayes Electrical safety 88 This system meets EN60601 1 Class I internally powered equipment requirements and Type BF isolated patient applied parts safety requirements This system complies with the applicable medical equipment requirements published in the Canadian Standards Association CSA European Norm Harmonized Standards and Underwriters Laboratories UL
157. m screen System maintenance may be required Record the number in parentheses on the C line and contact SonoSite or your SonoSite representative Software licensing SonoSite software is controlled by a license key After you install new software the system prompts you for a license key You must obtain one key for each system or transducer that uses the software The software will operate for a short time the grace period without a license key During the grace period all system functions are available After the grace period the system is not usable until you enter a valid license key Grace period time is not used while the system is off or asleep Grace period time remaining appears on the license update screen Caution After the grace period expires all system functions except licensing are unavailable until a valid license key is entered Chapter 5 Troubleshooting and Maintenance 71 Bunoouse qnoJ To obtain a license key for your software contact SonoSite Technical Support See SonoSite Technical Support on page vii You need to provide the following information See System Information setup on page 23 System Software Transducer Software Name of person installing the upgrade Name of person installing the upgrade Serial number on Transducer serial number bottom of system ARM version Transducer part number REF or model number for example C60x PCBA serial Transducer
158. max cm 0 2533 Focal Length FL cm 5 54 amp FLy cm 25 Ipa 3 Mlmax W cm 284 5 Control 1 Exam Type Any Vas Vas e Control 2 Sample Volume 1mm 12 mm 12 mm S Z E Control 3 PRF 1008 Any Any amp U S Control 4 Sample Volume Position Zone 0 Done Zone 7 top a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 119 Ayayes Table 20 Transducer Model P10x 8 4 Operating Mode 2D Mode TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 0 Pr3 MPa Wo mW 35 24 Y min of W 5 z4 lza 3 z4 mW 3 E Z cm lt iz cm ilz s Sg 9 dez cm lt fe MH2 4 84 Dim of Aaprt X cm E 0 416 Y cm 0 7 PD usec 5 PRF H2 E Pr Pll max MPa S deq Pllmax cm Focal Length FL cm 1 67 FLy cm 5 0 lpa 3 Mlmax W cm o 2 Control 1 Exam Type Neo s E g Control 2 Optimization Gen gS Con
159. 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 41 iii Save the measurement See To save a calculation on page 45 Volume flow 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 34 Transducer Exam Types C11x Abdomen C60x Abdomen HFL38x Vascular L25x Vascular L38x Vascular P10x Abdomen P21x Abdomen SLAx Vascular The following table shows the measurements required to complete the volume flow calculation For definitions of acronyms see Glossary on page 157 Volume Flow Calculations Measurement Menu Imaging Calculation Heading Mode Result Vol Flow D 2D VF Volume TAM Doppler Flow l min Both a 2D and a Doppler measurement are required for the volume flow calculation The Doppler sample volume should completely insonate the vessel Consider the following factors when performin
160. n Orbital Orb exam type when performing imaging through the eye Verify that the patient information date and time settings are accurate To avoid carrying over measurements from the previous patient start a new patient information form for each new patient before you perform calculations on the new patient See To create a new patient information form on page 34 Transducer Exam Types P21x Transcranial TCD Orbital Orb The following table shows the measurements required to complete Transcranial Doppler TCD and Orbital Orb calculations For definitions of acronyms see Glossary on page 157 Chapter 4 Measurements and Calculations 65 sjueulaJnseeiw Transcranial and Orbital Calculations Menu Heading TeDand or Results Measurements TT TAP MCA Dist PSV Mid EDV Prox PI RI Bifur S D ACA Gate Size ACoA TICA TT PCAp1 PCAp2 PCoA TO OA TAP Siphon PSV EDV PI RI S D Gate Size SM ECICA TAP PSV EDV PI RI S D Gate Size 66 Exam based calculations Transcranial and Orbital Calculations Menu Heading IeDahd Orb Results Measurements FM VA TAP FM PSV BA Prox EB Mid n Dist Rl S D Gate Size AL ECVA TAP PSV EDV PI RI S D Gate Size Available but not required WARNING 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 opthalmic use
161. n form on page 34 Transducer Exam Types C11x Abdomen C60x Abdomen HFL38x IMT Small Parts Vascular L25x Vascular Muscle L38x IMT Small Parts Vascular P10x Abdomen P21x Abdomen SLAx Muscle Vascular A 0 67cm 2010Sep18 22 43 Vas A 0 23cm Area Red 59 696 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 Ona frozen 2D image press the CALCS key 2 Do the following for A and then for A a From the calculations menu select the measurement name under Area Red Using the touchpad move the caliper to the trace starting point and press the SELECT Key Using the touchpad trace the desired area To make a correction select Undo on screen or press the BACKSPACE Key Complete the trace and press the SET key Save the calculation See To save a calculation on page 45 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 Ona frozen 2D image press the CALCS key 2 Do the following for D and then for D a From the calculations menu select the measurement name under Dia Red Position the calipers See Working with calipers on page 41 Save the calculation See To save a calculation on page 45 The percen
162. nd the frequency of the ultrasound passing through the tissue The intensity value in the tissue In Situ has been estimated by using the following formula In Situ Water e0249 where In Situ In Situ intensity value Water Water intensity value e 2 7183 a attenuation factor dB cm MHz Chapter 6 Safety 105 Ayayes Attenuation factor a for various tissue types are given below brain 0 53 heart 0 66 kidney 0 79 liver 0 43 muscle 0 55 1 skinline to measurement depth in cm f center frequency of the transducer system mode combination in MHz Since the ultrasonic path during the exam is likely to pass through varying lengths and types of tissue it is difficult to estimate the true In Situ intensity An attenuation factor of 0 3 is used for general reporting purposes therefore the In Situ value commonly reported uses the formula In Situ derated Water e 00695 Since this value is not the true In Situ intensity the term derated is used to qualify it The maximum derated and the maximum water values do not always occur at the same operating conditions therefore the reported maximum water and derated values may not be related by the In Situ derated formula For example a multi zone array transducer that has maximum water value intensities in its deepest zone but also has the smallest derating factor in that zone The same transducer may have its largest derated intensity in one of its shallowest fo
163. nity Test IEC 60601 Test Level Compliance Level Environment Radiated RF Field strengths from fixed RF IEC 61000 4 3 transmitters as determined by an electromagnetic Site survey should be less than the compliance level in each frequency range continued Interference may occur in the vicinity of equipment marked with the following symbol IEC 60417 No 417 IEC 5140 Source of non ionizing radiation Note Uris the AC mains voltage prior to application of the test level At 80 MHz and 800 MHz the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the SonoSite ultrasound system is used exceeds the applicable RF compliance level above the SonoSite ultrasound system should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the SonoSite ultrasound system b Over the frequency range 15
164. nt 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 To delete images and clips 1 Select one or more patients in the patient list 2 Select Delete to delete the selected patients 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 DICOM and SiteLink are optional features For more information about archiving see the SiteLink and DICOM documentation 1 Select one or more patients in the patient list 2 Select Archive 38 ECG Monitoring To display information about a patient exam 1 Onthe patient list select the exam 2 Select Info ECG Monitoring ECG Monitoring is an optional feature and requires a SonoSite ECG cable WARNING To prevent misdiagnosis do not use the ECG trace to diagnose cardiac rhythms The SonoSite ECG option is anon diagnostic feature To avoid electrical interference with aircraft systems do not use the ECG cable on aircraft Such interference may have safety consequences Caution Use only accessories recommended by SonoSite with the system Your system can be damaged
165. ntials of Echocardiography Le Hague Martinus Nijhoff 1981 71 LVPWFT LVPWS LVPWD LVPWD 100 LVPWS Left Ventricular Posterior Wall Thickness at Systole LVPWD Left Ventricular Posterior Wall Thickness at Diastole where Mean Velocity Vmean in cm s Vmean mean velocity Chapter 7 References 143 so2uaJoJay 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 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 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 E PG 4 PE Peak A Pressure Gradient A PG A PG 4 PA Peak Pressure Gradient PGmax PGmax 4 PV Mean Pressure Gradient PGmean PGmean Average of pressure gradients Duration of flow 1
166. o operate the system using AC power on page 3 3 Simultaneously press 1 and the power key The system beeps several times A amp B Key Footswitch setup On the A amp 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 Record The shortcut keys are below the alphanumeric keypad Footswitch L Footswitch R The function of the left and right footswitches Save Clip Record Freeze Save Image or Print See also To connect the footswitch To connect the footswitch The SonoSite footswitch allows hands free operation with a customizable two pedal footswitch The footswitch is an optional feature WARNING To avoid contamination do not use the footswitch in a sterile environment The footswitch is not sterilized 1 Connect the cables Y adapter cable to the ECG connector on the mini dock or docking system e Footswitch cable to Y adapter cable 2 Onthe A amp B Key Footswitch setup page select a function for the left and right footswitches 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
167. ock use only accessories and peripherals recommended by SonoSite including the power supply Connection of accessories and peripherals not recommended by SonoSite could result in electrical shock Contact SonoSite or your local representative for a list of accessories and peripherals available from or recommend by SonoSite To avoid the risk of electrical shock use commercial grade peripherals recommended by SonoSite on battery power only Do not connect these products to AC mains power when using the system to scan or diagnose a patient subject Contact SonoSite or your local representative for a list of the commercial grade peripherals available from or recommended by SonoSite To avoid the risk of electrical shock to the patient subject do not touch the system battery contacts while simultaneously touching a patient subject To prevent injury to the operator bystander the transducer must be removed from patient contact before the application of a high voltage defibrillation pulse To avoid possible electrical shock or electromagnetic interference verify proper operation and compliance with relevant safety standards for all equipment before clinical use Connecting additional equipment to the ultrasound system constitutes configuring a medical system SonoSite recommends verifying that the system all combinations of equipment and accessories connected to the ultrasound system comply with JACHO installation requirements and or safety standa
168. of the anatomy of interest Deceleration Time in msec Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 453 time a time bl Chapter 7 References 141 so uaJoJay 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 mm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 455 ERO 628 r Va MR Vel where r radius Va aliasing velocity Ejection Fraction EF percent Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 40 EF LVEDV LVESV LVEDV 100 where EF Ejection Fraction LVEDV Left Ventricular End Diastolic Volume LVESV Left Ventricular End Systolic Volume 142 Measurement publications and terminology Elapsed Time ET in msec ET time between velocity cursors in milliseconds
169. ol IC USA Liquid O phenylphenol A U N A U Madacide 1 USA Liquid Isopropanol A N A N N Matar USA Liquid O phenylphenol A U U A U MetriCide 14 USA Liquid Gluteraldehyde A U A A U MetriCide 28 USA Liquid Gluteraldehyde A U A A U MetriZyme USA Cleaner Propylene Glycol A U A A U Mikrobak forte DEU Liquid Ammonium Chloride A U A A U Mikrozid Wipes DEU Wipe Ethanol Propanol A U A A N Nuclean FRA Spray Alcohol Biguanide A U A A U Precise USA Spray O phenylphenol N U N N U Ruthless USA Spray Quat Ammonia A U A N U Sagrosept Wipe DEU Wipe Propanol A U A A U Salvanios pH 7 FRA Liquid Quat Ammonia A U A A U Sani Cloth HB USA Wipe Quat Ammonia A U A N A Sani Cloth Plus USA Wipe Quat Ammonia A U A A A Sekusept DEU Liquid Gluteraldehyde U A U U U Bunoouse qnoJ c8 Table 1 Disinfectant Compatibility with System and Transducers continued C60x ICTx Cleaning Solutions of Origin TYPE Active Ingredient prox Dax MEGA asx surfaces P21x SLAx Sklar USA Liquid Isopropanol A U A N U Sporicidin USA Liquid Phenol A N A A U Sporicidin Wipes USA Wipe Phenol A U A A N Staphene USA Spray Ethanol A U N A N Steranios FRA Liquid Gluteraldehyde A U A A U Super Sani Cloth USA Wipe Isopropyl Alcohol N U N N N T Spray USA Spray Quat Ammonia A U A N N T Spray II USA Spray Alkyl Chloride A U A A U TASK 105 USA Spray Quat Ammonia A U A A U TBO USA Liquid Alkyl A U A A U Theracide Plus USA Wipe Quat Ammonia A U A A A Wipes Tor USA Liquid Quat Ammonia A U A N
170. ons Term Definition Ispra 3 Derated spatial peak temporal average intensity in units of milliwatts cm Tl type Applicable thermal index for the transducer imaging mode and exam type TI value Thermal index value for the transducer imaging mode and exam type MI Mechanical index Ipa 3 MImax Derated pulse average intensity at the maximum MI in units of W cm TIS Soft tissue thermal index is a thermal index related to soft tissues TIS scan is the soft tissue thermal index in an auto scanning mode TIS non scan is the soft tissue thermal index in the non autoscanning mode TIB Bone thermal index is a thermal index for applications in which the ultrasound beam passes through soft tissue and a focal region is in the immediate vicinity of bone TIB non scan is the bone thermal index in the non autoscanning mode TIC Cranial bone thermal index is the thermal index for applications in which the ultrasound beam passes through bone near the beam entrance into the body Aaprt Area of the active aperture measured in cm Pr3 Derated peak rarefactional pressure associated with the transmit pattern giving rise to the value reported under MI Megapascals Wo Ultrasonic power except for TIS can in which case it is the ultrasonic power passing through a one centimeter window in units of milliwatts W 3 2 Derated ultrasonic power at axial distance z in units of milliwatts Ispta 3 Z1 Derated spatial peak temporal average intensity
171. ood but it is not exact and thus some error in the display can be attributed to the assumption of voltage linearity Related guidance documents Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers FDA 1997 Medical Ultrasound Safety American Institute of Ultrasound in Medicine AIUM 1994 A copy is included with each system Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment NEMA UD2 2004 Acoustic Output Measurement and Labeling Standard for Diagnostic Ultrasound Equipment American Institute of Ultrasound in Medicine 1993 Standard for Real Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment NEMA UD3 2004 Guidance on the interpretation of TI and MI to be used to inform the operator Annex HH BS EN 60601 2 37 reprinted at P05699 Transducer surface temperature rise 104 Table 6 and Table 7 list the measured surface temperature rise from ambient 23 C 3 C of transducers used on the ultrasound system The temperatures were measured in accordance with EN 60601 2 37 section 42 with controls and settings positioned to give maximum temperatures Table 6 Transducer Surface Temperature Rise External Use C Test C11x C60x D2 HFL38x L25x L38x P10x P21x Still air 17 6 162 8 3 15 5 16 1 163 156 168 S Eoo 9 1 8 8 1 9 79 8 5 9 6 9 8 9 0 Table 7 Transducer Surface Temperature Rise Internal Use
172. or 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 e Area in cm e Circumference in cm You can also measure area or circumference by tracing manually 2010Sep19 21 03 A 0 73cm A 0 42cm C 2 31cm B 0 96cm Figure 1 2D image with two distance and one circumference measurement 42 Measurements 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 Onafrozen 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 Usingthe 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 41 To measure area or circumference 2D 1 Ona 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
173. ot exceed the limits established in Section 42 of EN 60601 2 37 Particular requirement for the safety of ultrasound medical diagnostic and monitoring equipment See Transducer surface temperature rise on page 104 In the event of a device malfunction there are redundant controls that limit transducer power This is accomplished by an electrical design that limits both power supply current and voltage to the transducer The sonographer uses the system controls to adjust image quality and limit ultrasound output The system controls are divided into three categories relative to output controls that directly affect output controls that indirectly affect output and receiver controls Direct controls 98 The system does not exceed a spatial peak temporal average intensity ISPTA of 720 mW cm for all imaging modes For either the Ophthalmic or Orbital exam the acoustic output is limited to the following values ISPTA does not exceed 50 mW cm TI does not exceed 1 0 and MI does not exceed 0 23 The mechanical index MI and thermal index TI may exceed values greater than 1 0 on some transducers in some imaging modes One may monitor the MI and TI values and adjust the controls to reduce these values See Guidelines for reducing MI and TI on page 99 Additionally one means for meeting the ALARA principle is to set the MI or TT values to a low index value and then modifying this level until a satisfactory image or Doppler mode i
174. our 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 Anteroposterior Trunk Diameter APTD University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 885 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 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 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 Crown Rump Length CRL Hadlock F et al Fetal Crown Rump Length Re evaluation of Relation to Menstrual
175. p cm S S cm 4 5 a o deg Zsp cm lt fe MHz 2 15 2 16 I ES 2 16 Dim of Aaprt X cm 0 918 0 918 Y cm 1 3 1 3 PD usec 1 20 S PRF Hz 1063 pr Pll max MPa 2 574 S deg Pllmax cm Focal Length FL cm 3 68 3 68 0 on 8 FLy cm 5 5 5 5 IpA 36 Ml max W cm 330 4 Control 1 Mode Color CPD Color Control 2 Exam Type Abd OB Abd o 2 OB S Control 3 PRF Depth 300 10 850 7 5 751 7 5 gS Y Control 4 Color Optimization Any Med Med O Control 5 THI On Off Off Control 6 Color Box Size Short and Short and Any Narrow Narrow a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 126 Table 27 Transducer Model P21x 5 1 Operating Mode PW Doppler a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global M
176. 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 46 General calculations Some measurements can be deleted directly from the patient report pages See Patient report on page 68 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 Savethe 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 informatio
177. 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 41 To trace manually 2D 1 Ona 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 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 41 M Mode measurements The basic measurements that you can perform in M Mode imaging are as follows 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 Ona 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 41 To measure heart rate M Mode 1 Ona frozen M Mode trace press the CALIPER key 2 Select HR on screen A vertical caliper appears 3 Using the touchpad position the vertica
178. pounds or kilos To change the units see Presets setup on page 22 e BSA Cardiac exam Body Surface Area Automatically calculated after you enter height and weight Ethnicity IMT exam Ethnic origin e Reading Dr Referring Dr e Institution 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 To access saved images and clips open the patient list See Reviewing patient exams on page 36 The percentage icon in the system status area shows the percentage of space used in internal storage To receive alerts when storage is near capacity see To receive storage alerts on page 20 To access saved images and clips open the patient list See Reviewing patient exams on page 36 To save an image Press the SAVE key The image saves to internal storage By default the SAVE key saves only the image As a shortcut during calculations the SAVE key can save both the image to internal storage and the calculation to the patient report See Presets setup on page 22 To capture and save a clip Clips an optional feature lets you capture preview and save clips 1 Set Clips options See To set Clips options on page 35 2 Press the CLIP key One of the following occurs If Prev Off is selected the cl
179. previous exam data or other available information The LMP is derived from the Established Due Date and is listed in the patient report as LMPd Elapsed Time Femoral Head Fetal Heart Rate Femur Length Foramen Magnum same as SO Fetal Trunk Area Gestational Age Gestational Age by Last Menstrual Period The fetal age calculated using the date of the Last Menstrual Period LMP Gestational Age by derived Last Menstrual Period The fetal age calculated using the Last Menstrual Period LMPd derived from the Estab DD Depth of Doppler Gate Gestational Sac Gynecology Head Circumference Heart Rate Abbreviations in User Interface Continued Abbreviation Definition ICA IMT IVRT IVS IVSd IVSFT IVSs LA LA Ao LAT F LAT N LMP LMP LMPd LV LV Area LV mass LV Volume LVd LVD LVDd LVDFS LVDs Internal Carotid Artery Intima Media Thickness Iso Volumic Relaxation Time Interventricular Septum Interventricular Septum Diastolic Interventricular Septum Fractional Thickening Interventricular Septum Systolic Left Atrium Left Atrium Aorta Ratio Lateral Far Lateral Near Last Menstrual Period Last Menstrual Period The first day of the last menstrual period Used to calculate gestational age and EDD derived Last Menstrual Period Calculated from the user entered Estab DD Left Ventricular Left Ventricular Area Left Ventricular mass Left Ventricular Volume Left Ventricular diasto
180. quid Ortho phthaldehyde A A A A A Dispatch USA Spray NaCl Hypochlorite A A A A U Dynacide PA FRA Liquid Peracetic Acid U A U U U Buljooysajqnoly 08 Table 1 Disinfectant Compatibility with System and Transducers continued C60x ICTx Cleaning Solutions of Origin Pe Active Ingredient Pox Dax HFL38K asx Surfaces P21x SLAx End Bac II USA Liquid Quat Ammonia A U A A A Endozime AW Plus FRA Liquid Propanol A U A A U Envirocide USA Liquid Isopropyl A U U N U Enzol USA Cleaner Ethylene Glycol A U A A U Expose USA Liquid Isopropyl A U A A U Gigasept AF DEU Liquid Quat Ammonia A U A A U Gigasept FF DEU Liquid Bersteinsaure N U N N U Gluteraldehyde SDS USA Liquid Gluteraldehyde A U U A U Hexanios FRA Liquid Polyhexanide Quat A U A A U Ammonia Hi Tor Plus USA Liquid Chloride A U A N U Hibiclens USA Cleaner Chlorhexidine A U A A U Hydrogen Peroxide USA Liquid Hydrogen Peroxide A A A A A Isopropanol Alcohol ALL Liquid Alcohol N U N N U Kodan T cher DEU Liquid Propanol A U A A N Kohrsolin ff DEU Liquid Gluteraldehyde A U U A U Korsolex basic DEU Liquid Gluteraldehyde N U N N U Lem O Quat USA Liquid Alkyl Chloride U A U U U e ueuajurey pue 6unoousa gnoJ 193deu5 i8 Table 1 Disinfectant Compatibility with System and Transducers continued C60x ICTx Cleaning Solutions of Origin Pe Active Ingredient P1ox Dax HFL38K asx surfaces P21x SLAx LpHse USA Liquid O phenylphenol A U A A U Lysol USA Spray Ethanol N U N N U Lys
181. r deeper or for a longer period of time than recommended can damage or discolor the transducer and void the transducer warranty Do not allow cleaning solution or disinfectant into the transducer connector Do not allow disinfectant to contact metal surfaces Use a soft cloth lightly dampened in a mild soap or compatible cleaning solution to remove any disinfectant that remains on metal surfaces Attempting to disinfect a transducer or transducer cable using a method other than the one included here can damage the transducer and void the warranty To clean and disinfect a transducer wipe method 1 Disconnect the transducer from the system 2 Remove any transducer sheath 3 Clean the surface using a soft cloth lightly dampened in a mild soap or detergent cleaning solution to remove any particulate matter or body fluids Apply the solution to the cloth rather than the surface 4 Rinse with water or wipe with water dampened cloth then wipe with a dry cloth 5 Mix the disinfectant solution compatible with the transducer following disinfectant label instructions for solution strengths and disinfectant contact duration 6 Wipe surfaces with the disinfectant solution 7 Air dry 8 Examine the transducer and cable for damage such as cracks splitting or fluid leaks If damage is evident discontinue use of the transducer and contact SonoSite or your local representative To clean and disinfect a transducer
182. ransducers 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 types are available In addition the exam type you select determines which imaging modes are available To change the exam type Do one of the following Press the EXAM key and select from the menu On the patient information form select from the Type list under Exam See Patient information form on page 33 Imaging modes and exams available by transducer Imaging Mode X x g amp So t 2 E C ALO 9 P p 3 g SES 8 5 i E Cc11x Abd X X X X Neo X X X X Nrv X X X X Vas X X X X C60x OB X X X X Gyn X X X X Abd X X X X Nrv X X X X D2x Crd X HFL38x Bre X X X X SmP X X X X Vas X X X X Msk X X X X IMT X X X X Nrv X X X X Ven X X X X ICTx Gyn X X X X OB X X X X Chapter 3 Imaging 31 Imaging Mode i x 5 0 x amp amp 3 Res B 8 6 s E U L25x Msk X X X X Vas X X X X Nrv X X X X Oph X X X X Sup X X X X Ven X X X X L38
183. rasound system transducers and battery Operating System battery and transducer 10 40 C 50 104 F 15 95 R H 700 to 1060hPa 0 7 to 1 05 ATM 154 Temperature and humidity limits Shipping and storage System and transducer 35 65 C 31 149 F 15 95 R H 500 to 1060hPa 0 5 to 1 05 ATM Battery 20 60 C 4 140 F 15 95 R H For storage longer than 30 days store at or below room temperature 500 to 1060hPa 0 5 to 1 05 ATM Electrical Power Supply Input 100 240 VAC 50 60 Hz 2 0 A Max 100 VAC Power Supply Output 1 15 VDC 5 0 A Max Power Supply Output 2 12 VDC 2 3 A Max Battery The battery comprises six lithium ion cells plus electronics a temperature sensor and battery contacts Run time is up to two hours depending on imaging mode and display brightness Electromechanical safety standards EN 60601 1 1997 European Norm Medical Electrical Equipment Part 1 General Requirements for Safety EN 60601 1 1 2001 European Norm Medical Electrical Equipment Part 1 General Requirements for Safety Section 1 1 Collateral Standard Safety Requirements for Medical Electrical Systems EN 60601 2 37 2001 Amendment A1 2005 European Norm Particular requirements for the safety of ultrasonic medical diagnostic and monitoring equipment CAN CSA C222 No 601 1 M90 Canadian Standards Association Medical Electrical Equipment Part 1 General Requirements for Safety including CS
184. rcise and vary activities sss 87 Electrical safety classification ssssscssssssscssessescsssssccsssscessnsesesssneecessssesesssneesssees 87 Electrical Tiii 88 Equipment Safety ssssscssssssscscsssecsesssecccsnsscssssseccsssneecssnseecessnsessssnseecessueessssneeessesee 90 Battery safety e 90 Clinical safety itat om Decet e a a exse duda 92 Hazardous materials sesssssssssssscssssccssesesssescssecesssescssecessscsessesessseecsseeesnssessseeesneeees 93 Electromagnetic compatibility eese tenentes 93 Manufacturer s declaration eser teennntennnttnnnn 94 ALARA PritiGh eMe 97 APPIyINGALARA 98 DiEGt COMEPOIS c 98 alo IEO Tni o ENTE EE 99 Receiver controls 99 Acoustic artifacts ooeeeseeesccssssesccesseccsessseccessssecccensecessnssecsssnsecessuseesssussecessuecesesnseessenseeeees 99 Guidelines for reducing MI and TI uu sesesssssssesssescssccssccssceessecssccssccsssccsscsssccsseeesess 99 Output display ee 102 MI and TI output display accuracy 103 Factors that contribute to display uncertainty 103 Related guidance documents sss 104 Transducer surface temperature rise ssssecssssccsssecssescsssecssesesssecssescsssneessneessss 104 Acoustic output measurement eese eeseeeneentenntenttnnt
185. rds such as AAMI ES1 NFPA 99 OR IEC Standard 60601 1 1 and electromagnetic compatibility standard IEC 60601 1 2 Electromagnetic compatibility and are certified according to IEC Standard 60950 Information Technology Equipment ITE Do not use the system if an error message appears on the image display note the error code call SonoSite or your local representative turn off the system by pressing and holding the power key until the system powers down To avoid increasing the system and transducer connector temperature do not block the airflow to the ventilation holes on the side of the system Chapter 6 Safety 89 Ayayes Equipment safety To protect your ultrasound system transducer and accessories follow these precautions Caution Excessive bending or twisting of cables can cause a failure or intermittent operation Improper cleaning or disinfecting of any part of the system can cause permanent damage For cleaning and disinfecting instructions see Chapter 5 Troubleshooting and Maintenance Do not submerge the transducer connector in solution The cable is not liquid tight beyond the transducer connector cable interface Do not use solvents such as thinner or benzene or abrasive cleaners on any part of the system Remove the battery from the system if the system is not likely to be used for some time Do not spill liquid on the system Battery safety To prevent the battery from bursting igniting
186. rks in 5 cm 1 cm and 5 cm increments depending on depth Chapter 1 Getting Started peus bunya General interaction Touchpad and cursor 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 SELECT key to activate that field Additionally you can use the cursor to select check boxes and items in lists On screen options The on screen options let you make adjustments and select settings The options available depend on context Each option is controlled by the pair of keys below it Depending on the option the control keys function in one of four ways 8 General interaction Cycle Moves through a list of settings continuously The upper control key cycles upward The lower control key cycles downward Up Down Moves through a list of settings stopping at the top or bottom The upper control key moves upward The lower control key moves downward By default a beep sounds when you reach either end of the range See Audio Battery setup on page 19 On Off Turns a feature on or off You can press either control
187. rom 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 Caution 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 23 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 System controls Power switch Alphanumeric keys Annotation keys ZOOM DEPTH UP DEPTH DOWN AUTO GAIN Gain ei gt Near A Far Y Gain Cine Buffer o 9 10 11 12 13 Turns system on and off Use to enter text and numbers See Alphanumeric keyboard on page 9 Magnifies the image 100 Decreases and increases imaging depth Adjusts gain automatically
188. ry in the system Chapter 1 Getting Started 1 peueis 6Bunyo5 J Locking levers m J S d lt n e Gr uj a Figure 3 Install the Battery 2 Preparing the system To install 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 Pushdownonthetwo locking levers to secure the battery 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 Pullup the two locking levers 4 Slide the battery back 5 Liftthe battery from the compartment Using AC power and charging the battery 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 WARNING The equipment shall be
189. s Smooth Adven and Lumen Smooth Adjusts the IMT line smoothing Select Edit to display this option Adven Adjusts the adventitia media d line The upper key moves the uw line upward The lower key moves the line downward Select Edit to display this option Lumen Adjusts the lumen intima line a The upper key moves the line uw upward The lower key moves the line downward Each of the two IMT lines can be adjusted independently Select Edit to display this option To trace IMT manually In manually tracing IMT the user defines the location 1 Ona 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 Iumen 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 45 To sketch IMT The IMT sketch measurement involves two user defined sketch lines that you can adjust manually 1 Ona frozen
190. s obtained For more information on MI and TI see BS EN 60601 2 37 2001 Annex HH Indirect controls The controls that indirectly affect output are controls affecting imaging mode freeze and depth The imaging mode determines the nature of the ultrasound beam Tissue attenuation is directly related to transducer frequency The higher the PRF pulse repetition frequency the more output pulses occur over a period of time Receiver controls The receiver controls are the gain controls Receiver controls do not affect output They should be used if possible to improve image quality before using controls that directly or indirectly affect output Acoustic artifacts An acoustic artifact is information present or absent in an image that does not properly indicate the structure or flow being imaged There are helpful artifacts that aid in diagnosis and those that hinder proper interpretation Examples of artifacts include Shadowing Through transmission Aliasing Reverberations Comet tails For more information on detecting and interpreting acoustic artifacts see the following reference Kremkau Frederick W Diagnostic Ultrasound Principles and Instruments 7th ed W B Saunders Company Oct 17 2005 Guidelines for reducing MI and TI The following are general guidelines for reducing MI or TI If multiple parameters are given the best results may be achieved by minimizing these parameters simultaneously In som
191. ses 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 Chapter 2 System Setup 23 dnjas 24 USB Devices setup Chapter 3 Imaging Imaging modes The system has a high performance display and advanced image optimization technology that significantly simplifies user controls Imaging modes available depend on the transducer and exam type See Imaging modes and exams available by transducer on page 31 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 followin
192. t Back to save entries and return to the previous screen Exam TypeExam types available depend on transducer See Imaging modes and exams available by transducer on page 31 LMPEstab 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 e 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 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 option does not appear select Back and make sure that the Twins check box is selected 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
193. t TAM under Vol Flow A vertical caliper appears Chapter 4 Measurements and Calculations 49 sjueulaJnseeiw 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 45 To display the volume flow calculation see Patient report on page 68 Transducer Exam Type D2x Cardiac 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 157 Cardiac Calculations Cardiac Menu Measurements Calculation Exam based calculations Heading imaging Mode Results In addition to the general calculations there are eva RVW 2D CO calculations specific to the Cardiac Gynecology d Gyn IMT OB Orbital Small Parts Transcranial RVD 2D EF Doppler TCD and Vascular exam types IVS 2D SV LVD 2D LVESV Cardiac calculations LVPW 2D LVEDV IVSFT WARNING To avoid incorrect calculations LVs RVW 2D LVPWET verify that the patient information RVD 2D date and time settings are acc
194. t diameter reduction result appears in the measurement and calculation data area and in the patient report Chapter 4 Measurements and Calculations 47 sjueaulaJnseeiw Volume calculations WARNING Transducer 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 34 Exam Types C11x C60x HFL38x ICTx L25x L38x P10x P21x SLAx Abdomen Nerve Abdomen Gyn Nerve Breast Nerve Small Parts Vascular Gyn Muscle Nerve Vascular Superficial Breast Nerve Small Parts Vascular Abdomen Neonatal Abdomen Muscle Nerve Superficial Vascular 48 General calculations To calculate volume The volume calculation involves three 2D distance measurements D D2 and D After all measurements are saved the result appears on screen and in the patient report Do the following for each image you need to measure a Onthe frozen 2D image press the CALCS key b Do the following for each measurement you need to take i From the calculations
195. t for daylight savings time changes Chapter 4 Measurements and Calculations 61 sjueulaJnseeiw To avoid misdiagnosis or harming Results from System Defined OB Measurements the patient outcome start a new and Table Authors patient information form before starting a new patient exam and Calculation Gestational OB Table performing calculations Starting a Result Measurements Authors new patient information form Ep ve clears the previous patient s data P RM The previous patient s data will be GS Hansmann combined with the current patient Nyberg if the form is not first cleared See Tokyo U To create a new patient CRL Hadlock information form on page 34 Hansmann Osaka Prior to use verify that OB custom Tokyo U table data entries are correct The system does not confirm the BRD eat accuracy of the custom table data MARE entered by the user Osaka Tokyo U Transducer Exam Type OFD Fiansmnn HC Chitty C60x OB Hadlock ICT OB Hansmann x TTD Hansmann P21x OB Tokyo U If you change the calculation author during the aid Tokyo U exam the common measurements are retained AC Hadlock The following table shows the system defined E a measurements available for OB calculations by l author For definition of the acronyms see FTA Osaka Glossary on page 157 To select authors see E Chitty OB Calculations setup on page 20 Hadlock See also OB Custom Measurements setup on Poi page 21 and OB
196. t where the integrity of the protective earth conductor arrangement is in doubt operate the system on battery power only without using the power supply To avoid the risk of electrical shock do not connect the system s power supply or a docking system to an MPSO or extension cord To avoid the risk of electrical shock before using the transducer inspect the transducer face housing and cable Do not use the transducer if the transducer or cable is damaged To avoid the risk of electrical shock always disconnect the power supply from the system before cleaning the system WARNING Caution To avoid the risk of electrical shock do not use any transducer that has been immersed beyond the specified cleaning or disinfection level See Chapter 5 Troubleshooting and Maintenance To avoid the risk of electrical shock to the patient do not simultaneously touch the patient and the ungrounded signal input output connectors on the back of the ultrasound system To avoid the risk of electrical shock and fire hazard inspect the power supply AC power cords cables and plugs on a regular basis Ensure that they are not damaged To avoid the risk of electrical shock and fire hazard the power cord set that connects the power supply of the ultrasound system or MDS to mains power must only be used with the power supply or docking system and cannot be used to connect other devices to mains power To avoid the risk of electrical sh
197. ta are not applicable for this transducer mode Chapter 6 Safety 115 Ayayes Table 16 Transducer Model ICTx 8 5 Operating Mode PW Doppler a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 116 TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 2 a Pr3 MPa Wo mW 16 348 2 min of W3 z1 lTa 3 Zz1 mW gt 5 Zz cm _ 8g 1 cm E Zpp cm E E Zsp cm 1 6 o deg Zsp cm 0 192 lt R MHz m e 4 36 Dim of Aaprt X cm E 0 6 Y cm 0 5 PD usec 5 PRF H2 p PII MPa S deq Pllmax cm 0 187 Focal Length FL cm Qq amp FLy cm IpA 3 MI max W cm D Control 1 Exam Type Any E Control 2 Sample Volume 3mm gS Control 3 PRF Any S Control 4 Sample Volume Position Zone 1 Table 17 Transducer Model L25x 13 6 Operating Mode PW Doppler a This index is not required
198. table acoustic coupling some gels are incompatible with some transducer materials SonoSite recommends Aquasonic gel and provides a sample 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 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 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 Pullthe 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 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
199. te ultrasound system be powered from an uninterruptible power supply or a battery Chapter 6 Safety 95 Ayayes Table 2 Manufacturer s Declaration Electromagnetic Immunity Continued Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Power Frequency Magnetic Field IEC 61000 4 8 Conducted RF IEC 61000 4 6 Radiated RF IEC 61000 4 3 96 3 A m 3 Vrms 150 kHz to 80 MHz 3 Vim 80 MHz to 2 5 GHz 3 A m 3 Vrms 3 V m If image distortion occurs it may be necessary to position the SonoSite ultrasound system further from sources of power frequency magnetic fields or to install magnetic shielding The power frequency magnetic field should be measured in the Intended installation location to assure that it is sufficiently low Portable and mobile RF communications equipment should be used no closer to any part of the SonoSite ultrasound system including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended Separation Distance d 1 2 P d 1 2 P 80 MHz to 800 MHz d 2 3 JP 800 MHz to 2 5 GHz Where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and dis the recommended separation distance in meters m Table 2 Manufacturer s Declaration Electromagnetic Immunity Continued Electromagnetic Immu
200. th the system use the following list to help troubleshoot the problem If the problem persists contact SonoSite Technical Support See SonoSite Technical Support on page vii System does not turn on Check all power connections Remove the DC input connector and battery wait 10 seconds and then reinstall them Ensure that the battery is charged System image quality is poor Adjust the display to improve viewing angle Adjust the brightness Adjust the gain No CPD image Adjust the gain No Color image Adjust the gain or the PRF scale No OB measurement selections Select the OB exam type Print does not work Select the printer on the Connectivity setup page See To configure the system for a printer on page 19 Check the printer connections Ensure that the printer is turned on and set up properly See the printer manufacturer s instructions if necessary DVD recorder does not record Check the DVD recorder connections Ensure that the DVD recorder is turned on and set up properly See the applicable SonoSite accessory user guide and the manufacturers instructions External monitor does not work Check the monitor connections Check the monitor to ensure that it is turned on and set up properly See the monitor manufacturers instructions if necessary System does not recognize the transducer Disconnect and reconnect the transducer A maintenance icon N appears on the syste
201. 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 41 To measure time duration Doppler 1 OnaDoppler spectral trace press the CALIPER key 2 Press Time on screen A vertical caliper appears 4 Using the touchpad position the caliper where desired and press the SELECT key A second caliper appears 6 Using the touchpad position the second caliper where desired and press the SELECT key To trace manually Doppler 1 Ona 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 44 Measurements 4 Using the touchpad trace the waveform To make a correction select Undo on screen backtrack with the touchpad or press the BACKSPACE key 5 Press the SET key The measurement results appear See To save a measurement to a calculation and patient report on page 41 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
202. the trace and press the SET key e Save the calculation See To save a calculation on page 45 4 Select Apical from the calculations menu 54 Exam based calculations 5 Positioning the calipers measure the ventricular length See Working with calipers on page 41 6 Save the calculation 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 Onafrozen Doppler spectral trace press the CALCS key 2 From the calculations menu select MV TV or 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 41 c Save the calculation See To save a calculation on page 45 To calculate Velocity Time Integral VTI Note This calculation computes other results in addition to VIT See the table Cardiac Calculations on page 50 1 Ona 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 c
203. tion concerning MI and TI SonoSite does not currently recommend a specific brand of acoustic standoff If an acoustic standoff is used it must have a minimum attentuation of 3dB cm MHz Some SonoSite transducers are approved for intraoperative applications if a market cleared sheath is used To avoid injury or reduce the risk of infection to the patient observe the following Follow Universal Precautions when inserting and maintaining a medical device for interventional and intraoperative procedures e Appropriate training in interventional and intraoperative procedures as dictated by current relevant medical practices as well as in proper operation of the ultrasound system and transducer is required During vascular access the potential exists for serious complications including without limitation the following pneumothorax arterial puncture guidewire misplacement and risks normally associated with local or general anesthesia surgery and post operative recovery To avoid device damage or patient injury do not use the P10x P17x or P21x needle guide bracket on patients with pacemakers or medical electronic implants The needle guide bracket for the P10x P17x and P21x transducers contains a magnet that is used to ensure the bracket is correctly oriented on the transducer The magnetic field in direct proximity to the pacemaker or medical electronic implant may have an adverse effect Hazardous materials WARNING The liqu
204. tnttnnentttntin 105 vi In Situ derated and water value intensities ses 105 Tissue models and equipment survey ee 106 Acoustic output tables o eeeessesssseccseccsseesssesstecssccsseccseccssccssecssecesecesseesseesseesssecssses 107 Terms used in the acoustic output tables sss 132 Acoustic measurement precision and uncertainty 133 Labeling symb ols aeter tret ani i 134 Chapter 7 References Measurement accuracy eeeseeseeeeeennten tentent tnnnttnnnttnnttentnntttnntenntsnnttnntnnn 139 Sources of measurement errors cecssecssecsssssssesssessssessseccssesssesssecssscesscessecssseesseeese 140 Measurement publications and terminology sees 141 Cardiac refererices sss inn nonn aaa 141 Obstetrical references 145 Gestational age tables cssccssccsssesssecsecssccsssecssessseccseecssccsacessserseessseesseeess 146 Growth analysis tables 148 Ratio calculations 1149 General teferences sssrinin iiie 149 Chapter 8 Specifications DIMENSIONS s csisssssesssccassessasaassennsscansssnsscshoezva qnvsnensanszessavbiseadeeantantdseaoctoaseousbeaseensvesanien 153 System 44153 Display 153 Supported transducers cecsescssecssecsseccnsecssccsscsssscesscessccsscsssssssecescessceeasesseeeseeeess 153 Manite lale Mantol A RERO 153 Image and clip storage
205. trol 3 Depth 2 0 O O Control 4 MB SonoHD Off Off a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 120 Table 21 Transducer Model P10x 8 4 Operating Mode Color TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 a 1 3 Pr3 MPa 2 02 Wo mW 41 38 E min of W 5 z1 l4 3 z1 mW d 5 Z cm X v z cm EC Som o i deq Zsp cm 4i R MHZ 3 90 3 91 Dim of Aaprt X cm S 0 608 Y cm 0 7 PD usec 0 70 S PRF H2 2772 Pr PIl max MPa 2 80 S deq Pllmax cm Focal Length FL cm 248 s FL cm 5 0 Ipa 3 M max W cm 252 Control 1 Mode Color Color 4 Control 2 Exam Type Neo Abd 5 5 Control 3 Optimization Depth PRF Low Med S g 5 3 7 2 0 amp OQ amp 772 2315 Control 4 Color Box Pos Size Any Short Tall Narrow a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or
206. tus during transabdominal scans a value of 1 dB cm MHz may be used during all trimesters Existing tissue models that are based on linear propagation may underestimate acoustic exposures when significant saturation due to non linear distortion of beams in water is present during the output measurement The maximum acoustic output levels of diagnostic ultrasound devices extend over a broad range of values Asurvey of 1990 equipment models yielded MI values between 0 1 and 1 0 at their highest output settings Maximum MI values of approximately 2 0 are known to occur for currently available equipment Maximum MI values are similar for real time 2D and M Mode imaging Computed estimates of upper limits to temperature elevations during transabdominal scans were obtained in a survey of 1988 and 1990 pulsed Doppler equipment The vast majority of models yielded upper limits less than 1 and 4 C 1 8 and 7 2 F for exposures of first trimester fetal tissue and second trimester fetal bone respectively The largest values obtained were approximately 1 5 C 2 7 F for first trimester fetal tissue and 7 C 12 6 F for second trimester fetal bone Estimated maximum temperature elevations given here are for a fixed path tissue model and are for devices having Ispra values greater than 500 mW cm The temperature elevations for fetal bone and tissue were computed based on calculation procedures given in Sections 4 3 2 1 4 3 2 6 in Bioeffects and Sa
207. uidelines are intended to assist you in the comfort and effective use of your ultrasound system WARNING To prevent musculoskeletal disorders follow the guidelines in this section Use of an ultrasound system may be linked to musculoskeletal disorders MSDs Use of an ultrasound system is defined as the physical interaction between the operator the ultrasound system and the transducer When using an ultrasound system as with many similar physical activities you may experience occasional discomfort in your hands fingers arms shoulders eyes back or other parts of your body However if you experience symptoms such as constant or recurring discomfort pain throbbing aching tingling numbness burning sensation or stiffness do not ignore these warning signs Promptly see a qualified health professional Symptoms such as these can be linked with MSDs MSDs can be painful and may result in potentially disabling injuries to the nerves muscles tendons or other parts of the body Examples of MSDs include carpal tunnel syndrome and tendonitis While researchers are not able to definitively answer many questions about MSDs there is a general agreement that certain factors are associated with their occurrence including preexisting medical and physical conditions overall health equipment and body position while doing work frequency of work duration of work and other physical activities that may facilitate the onset of MSDs
208. urate IVS 2D re To avoid misdiagnosis or harming LVD 2D si the patient outcome start a new LVPW 2D patient information form before HR needed for starting a new patient exam and CO amp CI performing calculations Starting a new patient information form clears Ao LA Ao 2D or Ao the previous patient s data The M Mode LA Ao previous patient s data will be combined with the current patient AAo QD ARO if the form is not first cleared See LA 2D or LA To create a new patient M Mode LA Ao information form on page 34 LVOT D 2D LVOT D LVOT area 50 Exam based calculations Menu Heading MV LV LVd 1Vs HR Area LV Vol EF LV mass Cardia Calculation Menu Cardiac Calculation Measurements Results Heading Measurement Results Imaging Mode Imaging Mode ACS M Mode ACS PISA Ann D 2D PISA Area LVET M Mode LVET Radius Color ERO MR VTI Doppler MV Rate EF Slope EF SLOPE MV VTI Doppler Regurgitant M Mode Volume EPSS M Mode EPSS Regurgitant Fraction RVW M Mode CO RVD M Mode EF Spas OTD 20 B IVS M Mode SV RVOT DZD v LVD M Mode LVESV ds VM Doppler PGmax LVPW M Mode LVEDV RVOT VTI Vmean RVW M Mode IVS Doppler PGmean RVD M Mode DVPWET SV IVS M Mode e Qp Qs LVD M Mode LVPW M Mode SI TDI Wall e and a E MV e ratio LV Mass Doppler HRa Wall e and a Doppler AV 2D AV Area Wall e and a MV 2D MV Area Doppler Wall e and a A4
209. urtz 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 Volume Vol Beyer W H Standard Mathematical Tables 28th ed CRC Press Boca Raton FL 1987 131 Volume Flow VF in l m Allan Paul L et al Clinical Doppler Ultrasound 4th ed Harcourt Publishers Limited 2000 36 38 VF CSA TAM 06 Chapter 7 References 151 so2uaJoJay 152 Measurement publications and terminology Chapter 8 Specifications This chapter contains system and accessory specifications and standards The specifications for recommended peripherals are in the manufacturers instructions Dimensions System Length 11 8 in 29 97 cm Width 10 8 in 27 43 cm Height 3 1 in 7 87 cm Weight 8 5 Ibs 3 9 kg with the C60x transducer and battery installed Display Length 8 4 in 21 34 cm Height 6 3 in 16 cm Diagonal 10 4 in 26 4 cm Supported transducers e Cl1x 8 5 MHz 6 ft 1 8 m e C60x 5 2 MHz 5 5 ft 1 7 m e D2x 2 MHz 5 5 ft 1 7 m e HFL38x 13 6 MHz 5 6 ft 1 7 m ICTx 8 5 MHz 5 5 ft 1 7 m e L25x 13 6 MHz 7 5 ft 2 3 m e L38x 10 5 MHz 5 5 ft 1 7 m e P10x 8 4 MHz 6 ft 1 8 m e P21x 5 1 MHz 6 ft 1 8 m e SLAx 13 6 MHz 7 5 ft 2 3 m e TEEx 8 3 MHz 7 2 ft 2 2 m
210. 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 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 Orb or Oph exam type is selected 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 Chapter 1 Getting Started pares bunya 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 Onthe setup page select Reset on screen To restore all default settings 1 Turn the system off 2 Connect the system to AC power See T
211. viewing patient exams Caution If the internal storage icon does not appear in the system status area internal storage may be defective Contact SonoSite Technical Support See SonoSite Technical Support on page vii 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 36 Images and clips Videos Image Gallery Name lio Date Time B PATENTS 345676 2010Sepi6 20 46 Figure 1 Patient List To display the patient list 1 Press the REVIEW key 2 Ifthere 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 yv column heading is selectable 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 has not been exported or archived 1 In the patient list select the patient 2 Select Edit 3 Fill in the
212. wide range of PRF settings for each Flow Sensitivity setting Low Med and High Available on select transducers Wall Filter Settings include Low Med and High Available on select transducers Steering Select the steering angle setting of the color ROI box 15 0 or 15 If T adding PW Doppler see PW Doppler options on page 29 Available on select transducers Variance Turns variance on and off D Available only for cardiac exam Invert Switches the displayed direction of X flow gt Available in Color imaging Sector Cardiac exam Specifies the sector B width Page x x Indicates which page of options 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 28 Imaging modes 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 SELECT key cycles among color ROI box position color ROI box size the D line 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 mod
213. x Bre X X X X SmP X X X X Vas X X X X IMT X X X X Nrv X X X X Ven X X X X P10x Abd X X X X Crd X xX X X Neo X X X X P21x Abd X X X X OB X X X X Crd X X X X TCD X X X X Orb X X X X SLAx Msk X X X X Nrv X X X X Sup X X X X 32 Annotating images Imaging Mode X z x w v 9 g LEM 2 2 2 3 2 A Oo A o Q 2 D E a ZA o o N N U o a a c E s W S z 3 E ui a UJ Vas X X X X Ven X X X X TEEx Crd X X X X 1 Exam type abbreviations are as follows Abd Abdomen Bre Breast Crd Cardiac Gyn Gynecology IMT Intima Media Thickness Msk Muscle Neo Neonatal Nrv Nerve OB Obstetrical Oph Ophthalmic Orb Orbital 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 options on page 29 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
214. zen 2D image press the CALCS key 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 SELECT key to start the trace Chapter 4 Measurements and Calculations 53 sjueulaJnseeiw c Using the touchpad trace the left ventricular LV cavity To make a correction select Undo on screen or press the BACKSPACE key d Complete the trace and press the SET key e Save the calculation See To save a calculation on page 45 To calculate MV or AV area 1 Ona frozen 2D image press the CALCS key 2 Inthe 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 BACKSPACE key 5 Complete the trace and press the SET key 6 Save the calculation See To save a calculation on page 45 To calculate LV Mass 1 Ona frozen 2D image press the CALCS key 2 Inthe calculations menu locate LV Mass 3 Dothe 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 Using the touchpad trace the desired area To make a correction select Undo on screen or press the BACKSPACE key d Complete

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