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TITAN Ultrasound System User Guide

1. TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt 1 Global Maximum Index Value a a a 1 2 Pr3 MPa Wo mW 95 48 v min of mW E W 3 z1 lTa 3 z1 9 g Zi cm lt u Ki E Zbp cm 3 amp Zsp cm 3 deg Zsp cm fe MHz 2 27 Dim of Aaprt X cm 1 7616 Y cm 1 3 PD usec S PRF Hz 8 P Pll max MPa S deg Pllmax cm Focal Length FL cm 6 2 c9 S FLy cm 7 0 O lIpa 3 Mlmax W cm Control 1 Exam Type Cardiac a Control 2 Optimization Low 25 6 Control 3 Harmonics TH on Control 4 Depth 13 ag s 9 Control 5 PRF 1000 Hz Control 6 Color Box Size Wide amp 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 reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Datais not applicable for this transducer mode TITAN Chapter 6 Safety Table 11 Transducer Model C60 5 2 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 a
2. Ethernet Connectivity Ethernet Setup Reset Chapter 2 Getting Started BRWN 5 6 Press the Setup key Select Connectivity In the Transfer Mode list select SiteLink After changing connectivity a dialog box is displayed to restart the system Press the Setup key Select Connectivity Select Ethernet Setup Enter information in the following fields see DICOM chapter for definition of terms Host Name IP Address Subnet Mask Default Gateway Alternate Gateway In the Network Speed list select from the list Select Save To return settings for this setup page to factory default select Reset from the on screen menu BSonoSite To set Date and Time Pages Date and Time Date 2004 09 13 YYY MM 0D Time 20 hr 02 min Reset Done Figure 13 Setup Screen Date and Time Warning An accurate date and time are critical for accurate obstetrics calculations Verify that the date and time are accurate before each use of the system The system does not automatically adjust for daylight savings time changes Date 1 Press the Setup key 2 Select Date and Time 3 In the Date field enter the current date year month and day Time 1 Press the Setup key 2 Select Date and Time 3 Inthe Time field enter the current time in 24 hour format hours and minutes Reset To return settings for this setup page to factory default select Reset from the on screen menu TITAN Chapter 2 Getting Started
3. PATIENT 3 323 45 6789 2003Jun16 01 39 3 Pending PATIENT 4 423 45 6789 2003Jun16 02 06 1 archive Status gt Images archiving icon and message Figure 14 Patient List To automatically archive or print images Images are automatically transferred to the selected devices Pending exams are archived or printed starting at the top of the list The network connection icon in the system status area is animated during DICOM network activity 1 Ensure the current location is selected in the DICOM main screen 2 Ensure connection to LAN See Ethernet Connection on page 105 With the system on check the LAN link light green LED next to the mini dock connector to verify physical connection to LAN 3 Verify patient exam is closed See Patient Information on page 41 Note Images saved on the TITAN ultrasound system are stored on a CF See Image Storage on page 60 Images transferred to DICOM devices are automatically sent from the CF after you end the exam All images in the patient exams are sent at once to the DICOM devices rather than the individual images The DICOM formatted files are not saved to the CF card File transfer of pending patient exams occurs only when you end the exam or create a new patient To verify images are sent Press the Review key The Patient List indicates the status of image transfer See Figure 14 on page 125 Patient exams that are checked are archived Patient exams that ar
4. BunooysajqnolL Troubleshooting 188 Chapter 7 Troubleshooting and Maintenance BaSonoSite Chapter 8 References This section includes information about clinical measurements that can be made with the system the accuracy of each measurement and factors affecting measurement accuracy Display Size The precision with which a caliper can be placed in an image can be improved by making sure the area of interest fills as much of the screen as possible In 2D imaging the distance measurement is improved by minimizing the display depth Caliper Placement When making a measurement accurate placement of the caliper is essential To improve caliper placement precision adjust the display for maximum sharpness use leading edges closest to the transducer or borders for start and stop points and maintain a consistent transducer orientation for each type of measurement When the calipers are positioned farther apart they get larger When the calipers are moved closer together they get smaller The caliper line disappears as the calipers get closer together 2D Measurements The measurements provided by the system do not define a specific physiological or anatomical parameter Rather what is provided is a measurement of a physical property such as distance for evaluation by the clinician The accuracy values require that you can place the calipers over one pixel The values do not include acoustic anomalies of the bod
5. Figure 8 Setup Screen User List Information Add New User Modify User Information Delete User Chapter 2 Getting Started BRWDN e Select New In User Information enter information in Name Password and Confirm fields To ensure passwords are secure it is recommended that passwords contain characters from the following categories Upper case characters A Z Lower case characters a z Numters 0 9 Note The name and password are case sensitive In Sonographer enter the user s initials to display the information in the patient header and the sonographer field in the Patient Information form Optional In Administration Access click the check box to allow users access to all administration privileges or leave unchecked to restrict access Optional Select Save In the User List select desired user name Enter the new name Enter the new password and confirm Select Save Any change to the user name replaces the old name In the User List select the desired user name Select Delete A dialog is displayed Select Yes to delete or No to cancel BSonoSite Change User Password 1 Inthe User List select the desired user name 2 Enter the new password and confirm 3 Select Save Done To return to live imaging To export or import user accounts Note Export and import are used to configure multiple systems and to back up user account information Export User Account 1 Insert the CompactFlash card
6. wn v o Table 9 System Defined OB Calculations and Table Authors Continued Calculation Result Gestational OB Table Authors Measurements Estimated Fetal Weight HC AC FL Hadlock 1 EFW See note 2 and 3 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 Index Q Q2 Q3 Q4 Jeng Growth Analysis Tables BPD Chitty See note 4 Hadlock Jeanty HC Chitty Hadlock Jeanty AC Chitty Hadlock Jeanty FL Chitty Hadlock Jeanty EFW Hadlock Jeanty HC AC Campbell Chapter 4 Measurements and Calculations BSonoSite Note 1 The Gestational Age is automatically calculated and displayed next to the OB measurement you selected The average of the results is the AUA Note 2 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 in system setup determines the measurements you must perform to obtain an EFW calculation See To set up OB calculations authors on page 34 if necessary Note 3 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 report with priority given to the order listed above Note 4 The
7. N te c B u v Figure 20 Setup Screen System Information System Information 1 Press the Setup key 2 Select System Information from the on screen menu Note To install a license key see Installing a License Key on page 170 To change system setups to the default settings 1 Turn the system off 2 Connect the system to AC power See To operate the system using AC power directly to system on page 12 3 Simultaneously press and release 1 and the Power key The system beeps several times and then the image display appears with all default settings Note Default settings can not be changed by the user Default settings are set at the factory Chapter 2 Getting Started SonoSite Chapter 3 Imaging Patient Information The patient information form allows information to be entered into the system for the patient exam Information which can be entered includes patient demographics exam information and clinical information This information is automatically placed on the last page of the patient report Once a patient is entered all saved images will be linked to that patient To end the exam a New Patient can be created or End Exam can be selected Note Patient information can be edited during the exam by pressing the Patient key However if the patient name ID or Accession changes a new patient is created 2004Mar25 13 17 Patient ne ci AE iaeaea rf rti s SCC GLMP C Estab D
8. O M faa e gt Ce N fad w a M a To set up Delta Key and F Keys Setup Pages x U 6 N te c Ez u v Figure 14 Setup Screen Delta Key F Keys Delta Key 1 Press the Setup key 2 Select Delta Key F Keys 3 Select desired functionality for the Delta key The Delta key will now control this function F Keys 1 Press the Setup key 2 Select Delta Key F Keys 3 Type desired text Use the Backspace key or Delete key to correct mistakes Reset To return settings for this setup page to factory default select Reset from the on screen menu Chapter 2 Getting Started BASonoSite To set up Display Information Pages Institution Date and Time A M faa e gt Ce n oo w a M a Figure 15 Setup Screen Display Information Patient Header 1 Press the Setup key 2 Select Display Information 3 Select the desired check boxes to display desired information in the patient header Mode Data 1 Press the Setup key 2 Select Display Information 3 Select the desired check boxes to display imaging information on the screen System Status 1 Press the Setup key 2 Select Display Information 3 Select the desired check boxes to display the system status on the screen Reset To return settings for this setup page to factory default select Reset from the on screen menu TITAN Chapter 2 Getting Started To set up OB calculations authors Setup Pages Gestati
9. Specifications Chapter 9 Specifications BASonoSite Chapter 10 Glossary This glossary includes an alphanumeric listing of terms The American Institute of Ultrasound in Medicine AIUM has published Recommended Ultrasound Terminology Second Edition 1997 Refer to it for ultrasound terms not contained in this glossary Terms 2D two dimensional image as low as reasonably achievable ALARA Color Power Doppler CPD image Color Doppler Color image continuous wave CW Doppler mode curved array transducer depth Directional Color Power Doppler DCPD image in situ linear array transducer TITAN A way to display echoes in two dimensions on a video display Video pixels are assigned a brightness level based on echo signal amplitude See also CPD image Color Doppler Color image and DCPD image The guiding principle of ultrasound use which states that you should keep patient exposure to ultrasound energy as low as reasonably achievable for diagnostic results A Doppler imaging mode used to visualize the presence of detectable blood flow See also 2D image Color image and DCPD image A Doppler imaging mode used to visualize the presence velocity and direction of blood flow in a wide range of flow states See 2D image CPD image and DCPD image A Doppler recording of blood flow velocities along the length of the beam Identified by the letter C curved or curvilinear and a n
10. TITAN Chapter 6 Safety Warning Chapter 6 Safety 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 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 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 7 Troubleshooting and Maintenance To avoid the risk of electrical shock and fire hazard inspect the power supply AC power cord and plug on a regular basis Ensure they are not damaged To avoid the risk of electrical shock 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 electric
11. wn Go v o The following terms describe the measurements and calculations performed by the system References for measurements and calculations are in Chapter 8 References Table 8 OB Calculation Terms Acronym Definition AUA EDD by AUA EDD by LMP EFW Estab DD GA by LMP GA by LMPd LMP LMPd UA The AUA Average Ultrasound Age is 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 The EDD by AUA Estimated Date of Delivery by Average Ultrasound Age is the estimated date of delivery calculated from the measurements performed during the exam The EDD by LMP Estimated Date of Delivery by Last Menstrual Period is the due date calculated from the user entered LMP The EFW Estimated Fetal Weight is calculated from the measurements performed during the exam The measurements used to determine EFW are defined by the currently selected EFW calculation author The Estab DD Established Due Date is a user entered due date based on 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 The GA Gestational Age by Last Menstrual Period is the fetal age calculated using the date of the Last Menstrual Period LMP The GA
12. 1 26 3 23 b Pr3 MPa Wo mW 88 606 71 984 s min of mW W 3 Zy Ha 3 21 1 g 5 Zi cm g E Zbp cm amp Ss Zsp cm 1 0 a deg Zsp cm 0 4717 E fe MHz 2 99 2 99 Dim of Aaprt X cm 0 625 0 5 Y cm 1 3 1 3 PD usec 5 PRF Hz t P Pllmax MPa 5 deqg Pllmax cm 0 4378 Focal Length FL cm 1 825 FLy cm 5 0 Ip 3 M max W cm m2 Control 1 Exam Type Any Any z Control 2 Sample Volume 5mm 5mm ass Control 3 PRF gt 6250 Any O U J Control 4 Sample Vol Position zone 1 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 is not applicable for this transducer mode Chapter 6 Safety BASo nosite Table 12 Transducer Model ICT 8 5 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 a a 1 0 a Pr3 Wo 12 693 min of W 3 z lta 3 Z1 n 3 Z Z gE He gs Z 1 4 ui 8 degl Zsp 0 2119 lt f 4 39 Dim of Aaprt 0 40 0 50
13. Calculations Percent Reduction Calculations Percent reduction calculations may be performed and saved to the patient report The following table shows the transducers and exam types that provide vascular percent reduction calculations Table 2 Transducer and Exam Types for Percent Reduction Transducer Exam Types C11 Vascular C15 Abdominal C60 Abdominal HST Muscle Vascular L25 Vascular L38 Small Parts Vascular 3i A 0 67cm Area Red 29 5 X Delete Figure 5 Percent Area Reduction Measurement Chapter 4 Measurements and Calculations Bl Sonosite Percent Area 1 Ona frozen 2D image press the Calcs key Reduction 2 Highlight the desired measurement from the calculation menu and Measurement press the Select key 3 To perform the first trace move the caliper to the desired starting point and press the Select key to start the tracing function 4 Use the touchpad to trace the desired area Note Ifan error is made select Undo from the on screen menu to delete the previous position 5 Complete the trace and select Set from the on screen menu or press the Select key The measurement is displayed in the measurement and calculation data area and is updated as the caliper moves 6 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement
14. on page 105 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu Select New Enter network information in the fields pages 1 and 2 Each host name must have a unique name contain only alphanumeric characters and start with an alpha character The host name cannot contain symbols special characters or spaces underscore symbol The Alias and AE Title may contain special characters The IP address must be entered before the information is saved Note To use special characters select Symbols See To enter a symbol special character on page 20 Note Use the space bar on the keyboard to enter the underscore symbol Select Cancel to undo last change If using Dynamic Host Configuration Protocol DHCP select the DHCP check box When DHCP is selected the IP Address Subnet Mask Default Gateway and Alternate Gateway are inactive Note The IP Address Default Gateway and Alternate Gateway cannot have values from 127 0 0 0 to 127 0 0 8 An invalid value reverts back to the original value after information is saved Select Save Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system To delete a location 1 2 w Select the name of the location from the list of locations Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration info
15. specifications 205 calcs menu 17 calculations authors 83 cardiac 92 gyn 78 OB 81 OB Doppler 88 percent reduction 72 vascular 89 volume 75 volume flow 76 caliper calcs 15 cardiac calculations 2D and M Mode 92 AVA 99 CO 100 Doppler 96 dP dT 98 E A and VMax 97 HR 100 LV volume Simpsor s Rule 95 PHT 98 SV 100 VTI 97 cardiac output CO 100 cardiac references 192 cardiac intended uses 142 Index Index cautions definition 129 cine buffer 49 cleaning battery 176 LCD screen 173 system 172 transducer cables 175 transducers 173 Color Doppler imaging 52 color power Doppler imaging See Color Doppler imaging CompactFlash install 11 remove 11 context menu 17 18 continuous wave Doppler sample line 54 spectral trace 55 controls direct 138 indirect 138 receiver 138 remappable 19 CW Doppler imaging definition 209 D date 31 default settings change to 40 delta key 32 delta pressure delta time dP dT 98 depth adjust 48 definition 209 description 14 depth marker 17 deselect patient list 61 DICOM archive image 125 backup 105 connect to LAN 105 connectivity 29 manual archive image 126 patient information 126 patient query 127 print image 125 select archiver 123 select location 123 select printer 123 select worklist server 123 sort worklist 128 standard 207 system setup 105 verify archiver status 123 verify image transfer 125 verify printer status 123 verify worklis
16. tables for a custom OB measurement See To view and set up OB custom tables Chapter 2 Getting Started SonoSite To view and set up OB custom tables 2004Apr19 1457 Table f Gestational Age Measurement ASC 111 Table C Gestational Age Measurement BPO Ww f Growth Analysis Author a G Growth Analysia Author XYZED Diem Age Range Diem Age Dies weeks 5 95 weeks 5 50 96 Y a Onoa woa if wod voa Aof e e sa O N o 4 af owed Owed gal f oa vd E E i Bo wod aaf Owed Owed s Ff Ff Ff oo f EI a rtd owas gl oad on oe A a S oea ea dd E O a fe eaf wod f If modif Ooa g fF U E i i fO o ered ones ovo on a A A S _ oal wod aof Owed Owed E fF 7 5 fe f g fol al ered ones gl ov ona er sof Orb Gwe nd Od SS CLI Figure 18 Setup Screen OB Custom Table Age Table Measurements The system provides gestational age measurements by selected authors for the age table measurements listed in Table 6 Growth Analysis Table Measurements The system provides growth graphs or curves for the growth table measurements listed in Table 6 Table 6 OB Custom Table Measurements Age Table Measurements GS CRL BPD OFD HC TTD AC FTA FL 5 additional custom measurement labels Growth Analysis Table Measurements BPD HC AC FL EFW Warning Prior to use verify custom table data entries are correct The system does not confirm the accuracy of the custom table data entered by the user Press t
17. 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 0 06 9 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 focal zones Tissue Models and Equipment Survey 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 measur
18. 76 Chapter 4 Measurements and Calculations So nosite TITAN Volume Flow Calculation Volume Flow Calculation 2D measurement 1 2 3 Doppler measurement 1 w Ona frozen full screen 2D image or duplex image press the Calcs key Select Volume Flow and highlight D distance Perform the measurement The selected measurement is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement Note The A key or Save Key can be assigned in system setup to save calculations to the report See Delta Key on page 32 or Save Key on page 39 If desired press the Save key to save the image with the measurements displayed S212 9 sea On a frozen Doppler spectral trace or duplex image press the Calcs key Use the touchpad to highlight Volume Flow and then highlight TAM Press the Select key to display the first vertical caliper Use the touchpad to position the first vertical caliper at the beginning of the wave form Press the Select key to display the second vertical caliper Note If calipers are not placed in the correct position the calculation will not be performed accurately U
19. 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 SadIUZIZjJOY Estimated Fetal Weight EFW Hadlock F et al In Utero Analysis of Fetal Growth A Sonographic Weight Standard Radiology 181 1991 129 133 TITAN Chapter 8 References References Jeanty Philippe F Cantraine R Romero E Cousaert and J Hobbins A Longitudinal Study of Fetal Weight Growth Journal of Ultrasound in Medicine 3 July 1984 321 328 Table 1 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
20. Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 431 University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 885 Warning The gestational age calculated by your 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 TITAN Chapter 8 References SadIUZIZjJOY LEJA 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 50
21. Highlight the next measurement and press the Select key Perform the next trace 9 Complete the trace and select Set from the on screen menu or press the Select key 10 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The percent area reduction result is displayed in the measurement and calculation data area and in the patient report N oe S212 9 sea Percent Diameter 1 Ona frozen 2D image press the Calcs key Reduction 2 Highlight the desired measurement from the calculation menu and Measurement press the Select key 3 Perform the measurement The measurement is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement Highlight the next measurement and press the Select key Perform the next measurement 7 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The percent diameter reduction result is displayed in the measurement and calculation data area and in the patient report nun TITAN Chapter 4 Measurements and Calculations Volume Calculation Warning Verify the patient informat
22. ITE BSonoSite Caution 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 e 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 7 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 or emitting fumes and causing equipment damage observe the following precautions Warning The battery has a safety device Do not disassemble or alter the battery Charge the batteries only when the ambient temperature is between 0
23. PD 5 PRF E Pr PIl max 5 deq Pllmax 0 1989 Focal Length O lpa 3 Mlmax Control 1 Exam Type Any n 25 6 Control 2 Sample Volume 1mm 5 Control 3 PRF 15625 or Oc 6 U6 20833 iv 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 is not applicable for this transducer mode TITAN Chapter 6 Safety Table 13 Transducer Model L38 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 a a 1 73 b Pr3 MPa Wo m 34 73 3 min of m T W 3 z1 lTa 3 z1 D gt go z c lt LO 5 c pi Z Bis Zp c 1 1 3 deg Zsp c 0 287 fe M 5 33 Dim of Aaprt X c 1 02 Y cm 0 4 PD usec 5 PRF H pr Pll max M amp deq Pll max c 0 2 Focal Length FL cm e9 M n 5 FLy cm Ip 3 MI max W cm a Control 1 Exam Type Vascular ee c 2 Control 2 Sample Volume 10mm g 5 Control 3 PRF Any YT Con
24. 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 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 TITAN Chapter 6 Safety Warning Caution 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 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 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 Do not put the battery into a microwave oven or pressurized container If the battery leaks or emits an odor remove it from all possible flammable sources 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
25. cm Ipa 3 Ml max W cm a Control 1 Exam Type Any E 5 S Control 2 Sample Volume 3mm oe g 6 2 Control 3 PRF 3125 0 S Control 4 Sample Vol Position zone 6 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 is not applicable for this transducer mode TITAN Chapter 6 Safety Table 7 Transducer Model C8 8 5 Operating Mode Color Power Doppler TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a a b Pr3 Wo min of W 3 Zy ta 3 21 gg z L U Be e E amp Zsp deg Zsp fe M Dim of Aaprt X Y PD use 5 PRF z Pr Pll max amp deq Pllmax Focal Length FL cm 3 Pi m 5 FLy cm lIpa 3 Mlmax W cm Control 1 Exam Type OB amp Pro a_ Epo Control 2 Optimization Low S E Control 3 Depth 2 5 E amp 9 Control 4 Color Box Position and Bottom Size wide amp short a This index is not required for this op
26. e e gt a Figure 8 Upgrade Transducer Software 5 Select Yes to accept or No to cancel the upgrade When you accept the transducer software upgrade the system loads the new software and displays the following message TITAN Chapter 7 Troubleshooting and Maintenance Please wait transducer upgrade in progress Figure 9 Transducer Software Loading When the upgrade is completed the system displays the following message Figure 10 Transducer Software Installation Troubleshooting Chapter 7 Troubleshooting and Maintenance Bso noSsite 6 Select Restart When the transducer software has been replaced the system presents you with the license update screen so that you may license the software for your transducer Upgrade all transducers before obtaining license keys Repeat all steps in To upgrade transducer software 2003Jan05 01 57 49 hours 69 minutes of operating time Transducer remaining before license key needed To obtain a license key 1 Contact SonoSite at 1 877 657 8118 www sonosite com service sonosite com 2 Supply the following a Your name b Transducer name L e Transducer version 20 80 201 002 d Transducer serial 01GX00 3 Enter license key lt Figure 11 Transducer License Screen At this point the software upgrade process is complete but the software is not yet licensed The following section Obtaining a License Key explains how to license yo
27. output Chapter 6 Safety BASo noSite Output Display The system meets the AIUM output display standard for MI and TI see last reference listed in Related Guidance Documents below Table 3 indicates for each transducer and operating mode whether either the TI or MI is greater than a value of 1 0 thus requiring display Table 3 Cases Where Either a Thermal or Mechanical Index is gt 1 0 Transducer Model Index zD EPD DCPD P W M Mode Color Doppler Doppler C8 8 5 MHz MI No No No TIC TIB TIS No Yes Yes C11 8 5 MI No No No No TIC TIB or TIS No No Yes No C15 4 2 MI No No No No TIC TIB or TIS No Yes Yes No C60 5 2 MI No No No TIC TIB or TIS No No Yes HST 10 5 MI No No No TIC TIB or TIS No No No ICT 8 5 MI No No No TIC TIB or TIS No No Yes L25 10 5 MI No No TIC TIB or TIS No No L38 10 5 MI No No No TIC TIB or TIS No No Yes Regardless that an MI of greater than 1 0 never occurs the system provides a continuous real time display of MI whenever a transducer is operated in a 2D imaging mode The index is displayed in increments of 0 1 The system meets the output display standard for TI A continuous real time display of TI is provided for the operator whenever a transducer is operated in a CPD DCPD Color M Mode or PW Doppler imaging mode The index is displayed in increments of 0 1 TITAN Chapter 6 Safety The thermal index consists of three user selectable indic
28. Abbreviation Exam Type Sup Superficial Vas Vascular The following table describes the transducer s exam type imaging mode and optimization that may be available with your system The optimization settings for 2D are Res Gen and Pen The optimization settings for color power Doppler CPD directional color power Doppler DCPD and color Doppler Color are low medium and high flow sensitivity with a range of PRF settings for Color depending on the application Table 2 Transducer Exam Type and Imaging Mode Imaging Mode Transducer ExamType 2D THI CPD DCPD Color MMode PW CW C8 Prostate Gyn OB X XxX X X C11 Vascular Cardiac Neonatal Abdomen C15 Abdomen lt x XxX XxX XxX OB Cardiac c60 OB Gyn X X XJI X X X X XxX XxX X X X XJI X XxX X Abdomen HST Superficial Muscle X XJ X X X X X X X X X X X X X X XJ X X X X X X X X X X X X X X X XJ X XxX X Vascular Chapter 3 Imaging B Sonosite Table 2 Transducer Exam Type and Imaging Mode Continued Imaging Mode Transducer ExamType 2D THI CPD DCPD Color MMode PW CW ICT Gyn X X X X X OB X X X X X L25 Nerve X X Superficial X X Vascular X X L38 Breast X X X X X Small Parts X X X X X Vascular X X X X X Transducer Preparation Warning Some transducer sheaths contain natural rubber latex and talc which can cause allergic reactions in some individuals
29. About the User Guide This user guide is a reference for using the ultrasound system It is designed 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 The user guide covers the preparation use and maintenance of the ultrasound system transducers and accessories Refer to the manufacturers instructions for specific information about peripherals The user guide includes a table of contents and an index to help you find the information that you need The user guide is divided into the following chapters Chapter 1 Introduction Contains general information about the user guide and the system Customer assistance information is also included Chapter 2 Getting Started Contains information on healthy scanning practices basic operation and changing system settings Chapter 3 Imaging Contains detailed information about preparing for the exam entering patient information adjusting imaging modes annotating images saving images and reviewing patient images Chapter 4 Measurements Contains information on performing measurements and and Calculations calculations in the different imaging modes Chapter 5 DICOM Contains instructions for configuring and using DICOM Connectivity Chapter 6 Safety Contains information required by various regulatory agencies including information abou
30. 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 TITAN Chapter 8 References SadIUZIZjJOY References 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 Kurtz A B W D Middleton Ultrasound the Requisites Mosby Year Book Inc 1996 467 RI abs Velocity A Velocity B Velocity A in measurements where A velocity cursor B velocity cursor x Time Averaged Mean TAM in cm s TAM mean mean Trace 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 8 References BSonoSite
31. Chapter 7 Troubleshooting and Maintenance 173 Caution 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 To clean and disinfect a transducer using the wipe method 1 2 3 Disconnect the transducer from the system Remove any transducer sheath 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 Rinse with water or wipe with water dampened cloth then wipe with a dry cloth Mix the disinfectant solution compatible with the transducer following disinfectant label instructions for solution strengths and disinfectant contact duration Wipe surfaces with the disinfectant solution Air dry or towel dry with a clean cloth 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 using the immersion method 1 2 3 Troubleshooting Disconnect the transducer from the system Remove any transducer sheath Clean the surface using a soft cloth lightly dampened in a mild soap or compatible c
32. Chapter 9 Specifications This chapter contains system and accessory specifications and agency approvals The specifications for recommended peripherals can be found in the manufacturers instructions System Dimensions Length 11 8 in 29 97 cm Width 10 9 in 27 69 cm Depth 3 0 in 7 62 cm Weight 8 3 Ibs 3 76 kg with the C60 transducer and battery installed Display Dimensions Length 5 1875 in 13 18 cm Width 6 75 in 17 15 cm Diagonal 8 5 in 21 59 cm Transducers C8 8 5 MHz 8 mm curved array 5 ft 1 5 m C11 8 5 MHz 11 mm microcurved array 5 ft 1 5 m C15 4 2 MHz 15 mm microcurved array 5 5 ft 1 7 m C60 5 2 MHz 60 mm curved array 5 ft 1 5 m HST 10 5 MHz 25 mm linear array 8 ft 2 1 m ICT 8 5 MHz 11 mm intracavitary array 5 ft 1 5 m L25 10 5 MHz 25mm linear array 5 5 ft 1 7 m L38 10 5 MHz 38 mm linear array 5 5 ft 1 7 m Imaging Modes 2D 256 gray shades Color power Doppler CPD 256 colors Color Doppler Color 256 colors Directional color power Doppler DCPD 256 colors M Mode Pulsed wave PW Doppler 7 o A v f 5 v Continuous Wave CW Doppler Tissue Harmonic Imaging TITAN Chapter 9 Specifications Specifications Applications Abdominal Imaging Cardiac Imaging Gynecology and Infertility Imaging Interventional and Intraoperative Imaging Applications Obstetrical Imaging Pediatric and Neonatal Imaging Prostat
33. External Carotid Artery DICA Distal Internal Carotid Artery dP dT Delta Pressure Delta Time E E Wave Peak Velocity E PG E Wave Peak Pressure Gradient E A E A Ratio ECA External Carotid Artery ECG Electrocardiogram EDD Estimated Date of Delivery EDD by AUA Estimated Date of Delivery by Average Ultrasound Age EDD by LMP Estimated Date of Delivery by Last Menstrual Period EF Ejection Fraction EF SLOPE E F Slope EFW Estimated Fetal Weight EPSS E Point Septal Separation Estab DD Established Due Date Chapter 10 Glossary Bl Sonosite Table 1 Acronyms Continued Acronym Description ET Elapsed Time FHR Fetal Heart Rate FL Femur Length FTA Fetal Trunk Area GA Gestational Age GS Gestational Sac HC Head Circumference HR Heart Rate ICA Internal Carotid Artery IVS Interventricular Septum IVSd Interventricular Septum Diastolic IVSs Interventricular Septum Systolic IVSFT Interventricular Septum Fractional Shortening LA Left Atrium LA Ao Left Atrium Aorta Ratio LMP Last Menstrual Period LMPd derived Last Menstrual Period LV Volume Left Ventricular Volume LV Area Left Ventricular Area LVD Left Ventricular Dimension LVDd Left Ventricular Dimension Diastolic LVDs Left Ventricular Dimension Systolic LVDFS Left Ventricular Dimension Fractional Shortening LVEDV Left Ventricular End Diastolic Volume LVESV Left Ventricular End Systolic Volume TITAN Chapter 10 Glossary Aiesso 5 21
34. Gestational Age by derived Last Menstrual Period is the fetal age calculated using the Last Menstrual Period LMPd derived from the Established Due Date The LMP Last Menstrual Period is the first day of the Last Menstrual Period and is used to calculate gestational age and EDD The LMPd derived Last Menstrual Period is calculated from the user entered Established Due Date Estab DD The UA Ultrasound Age is calculated on the mean measurements taken for a particular fetal biometry Chapter 4 Measurements and Calculations S0 nosite If you change the calculation author during the exam the common measurements are retained The following table shows the system defined measurements available for OB calculations by author For descriptions of the acronyms see Acronyms on page 211 Table 9 System Defined OB Calculations and Table Authors Calculation Result Gestational OB Table Authors Measurements Gestational Age GS Hansmann See note 1 Nyberg Tokyo U CRL Hadlock Hansmann Osaka Tokyo U BPD Chitty Hadlock Hansmann Osaka Tokyo U S212 9 sea OFD Hansmann HC Chitty Hadlock Hansmann TTD Hansmann Tokyo U APTD Tokyo U AC Hadlock Hansmann Tokyo U FTA Osaka FL Chitty Hadlock Hansmann Osaka Tokyo U For Toyko U APTD and TTD are only used to calculate EFW No age or growth tables are associated with these measurements TITAN Chapter 4 Measurements and Calculations
35. Head Circumference HC Chitty Lyn S et al Charts of Fetal Size 2 Head Measurements British Journal of Obstetrics and Gynaecology 101 January 1994 43 Appendix HC Derived Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine A longitudinal study of Fetal Head Biometry American J of Perinatology 1 January 1984 118 128 Table 3 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 176 Table 7 8 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 Ha
36. Healthy Scanning Guidelines found in Chapter 2 of this user guide Electrical Safety 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 safety standards See Chapter 9 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
37. Insert a blank CompactFlash card in the back slot See Installing and Removing the CompactFlash Card on page 11 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu Select Export from the on screen menu Remove the CompactFlash card when complete UAWN TITAN Chapter 5 DICOM Connectivity DICOM Configuration The TITAN system provides configuration pages for setting up DICOM devices for network connectivity The DICOM configuration pages are typically configured by network administrators or PACS managers Locations List of locations for the TITAN system Archivers Devices for storing patient images Printers Film printers for printing patient exam images Worklist List of scheduled patient procedures used to enter patient data in the Patient Information form Procedure List of system and user defined procedures Configuring Locations 2004Sep29 16 11 Configure l Locations Alias DHCP IP Address Subnet Mask Default Gateway List of locations Location Host Name TITAN DHCP Alias Alias _01 IP Address 120 20 20 12 Location sp cific AE Title 000000 _SCU Subnet Mask 255 255 255 i To network information Derauit Gateway 120 20 20 120 Alternate Gateway B i f 142 Nex New Delete Symbols Cancel L Save Log Import Export Done Figure 1 Locations Configuration Page 1 gt
38. J 7 w 7a te c B P v Table 3 Context Menus Icon Description Values Types Gen Controls 2D image optimization Res Gen Pen Cycle OA LR Flips the image left or right Action A gt uD Flips the image up or down Action Brightness Controls display brightness 1 10 Up Down xN Biopsy Turns biopsy guidelines on or off On Off AA Dual Displays side by side images On Off Chapter 2 Getting Started SonoSite Remappable Controls The remappable controls consists of six sets of 2 button groups at the top of the control panel They adjust the values of each control displayed in the context menu The buttons function in one of four ways depending on context Table 4 Remappable Control Options a a Control Description Ft N Cycle Moves through a list of values then begins again when the bottom or Rj top of the list is reached D 2 Up Down Stops at the top and bottom of a value list not allowing user to go from the first to last or last to first value in one button press On Off Turns available features on or off depending on their current state Action Performs some action related to an object on the screen Annotation and Text Keyboard Controls 6 7 8 9 10 Figure 5 Keyboard Controls Table 5 Keyboard Controls Number Key Description 1 f Function key used with numbered key to display predefined text 2 Tab Moves cursor among fields in the forms and
39. Measurements and Calculations So nosite Table 14 Cardiac Calculations in 2D and M Mode Continued Imaging Anatomy Cardiac Measurement Calculation Result Mode LV Vol A4Cd LV Vol A4Cs LV Area A2Cd EF A2Cs cCoO Biplane SV LVOT D LVOT D LVOT D LVOT area M Mode ACS ACS LVET LVET w EF SLOPE EF SLOPE a EPSS EPSS o A wv TITAN Chapter 4 Measurements and Calculations gt A2Cd 35 5cm 3 122 4mi X Delete Figure 12 Cardiac M Mode and LV Volume Note As you advance through the LV measurements the top caliper will automatically reposition to help you proceed with the next selected measurement wn v S Cardiac 1 Ona frozen 2D image or M Mode trace press the Calcs key Calculation 2 Highlight the desired calculation package and press the Select key 4 2D and M Mode 3 Select the measurement and press the Select key o 4 Perform the measurement 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Note The A key or Save Key can be assigned in system setup to save calculations to the report See Delta Key on page 32 or Save Key on page 39 6 Highlight the next measurement and press the Select key 7 Repeat these st
40. N TC T C A R Foam Insurance USA Spray n Alkyl U U U N U U U Gercid 90 France Liquid Quat Ammonia U U U N U U U Gigasept AF 3 Germany Liquid Quat Ammonia TC T C N N TC TC N Gigasept FF Germany Liquid Bersteinsaure N N N N N N N Gluteraldehyde SDS USA Liquid Gluteraldehyde U U U U T T A Helipur H N 3 Germany Liquid Gluteraldehyde U U U N U U U Propanol Hexanios France Liquid Polyhexanide Quat T C T C N N TC TC A Ammonia Hi Tor Plus USA Liquid Chloride TC TC N N T C N N Hibiclens USA Cleaner Chlorhexidine TC TC N N TC TC A Hydrogen Peroxide USA Liquid Hydrogen Peroxide T C T C T C U T C TC N Incides Germany Wipe Alcohol U U U N U U U Incidine Germany Spray Aldehydes U U U N U U U B Incidur Germany Liquid Gluteraldehyde U U U N U U U D y Table 3 Disinfectants Compatibility with System and Transducers Continued meton Gah Wee Atveingresint A G icr Hst ce us Sem Incidur Spray Germany Spray Ethanol U U U N U U U Instruzyme France Liquid Quat Ammonia U U U T U U U Kawason Australia U U U N U U U Kleen aseptic b 4 USA Spray Isopropanol U U U N U U U Klenzyme USA Cleaner Proteolytic Enzymes U U U T U U U Kodan Germany Spray Propanol Alcohol U U U N U U U Kohrsolin ff Germany Liquid Gluteraldehyde N N N T N N A Kohrsolin iD Germany Liquid Gluteraldehyde U U U T U U U Korsolex 3 Germany Liquid Gluteraldehyde U U U TC U U U Korsolex basic 3 Germany Liquid Gluteraldehyde N N N T C N N A Korsolex Consentrate 3 Germany Liquid Glu
41. N U U isopropanol Cidex 2 4 5 USA Liquid Gluteraldehyde TC TC TC TC TC TC A Cidex OPA 2 3 4 5 USA Liquid ortho phthaldehyde T C TC TC TC TC TC A Cidex Plus 2 4 5 USA Liquid Gluteraldehyde TC TC TC T U TC U Cidezyme USA Cleaner Ethylene Glycol U U U N U U U Coldspor Spray USA Spray Gluteraldehyde U U N N U U U Control Ill 4 USA Liquid Quat Ammonia TC T C N N T C N A Coverage Spray 4 USA Spray Quat Ammonia TC TC N N T C N A Cutasept F Germany Spray 2 Propanol U U N N U U U F Dentured Alcohol USA Liquid Ethanol N N N N N N N 3 Dismonzon pur Germany Liquid Hexahydrate TC TC N N TC TC A 3 Dispatch 4 USA Spray NaCl Hypochlorite TC TC N N TC TC N A End Bac II USA Liquid Quat Ammonia T C N N N T C TC A z Endo FC France Liquid Gluteraldehyde U U U T C U U U 3 Endozime AW Plus France Liquid Propanol TC TC N N TC TC A Envirocide 4 USA Liquid Isopropyl TC T C N N T C N A 3 Enzol USA Cleaner Ethylene Glycol TC T C N N TC T C A 5 8 Bunooysajqnoll Troubleshooting p Table 3 Disinfectants Compatibility with System and Transducers Continued gel y Cleaning Solutions of Origin DPE Activelngredient 3g cy ICT HST C8 L25 cure 4 a Enzy Clean USA Cleaner Amylase Protease U U U TC U U U 2 Complex 5 z Epizyme Rapid Australia Cleaner Citric Acid U U U T C U U U 3 Esculase 388 France Liquid Quat Ammonia U U U N U U U Ethylene Oxide EtO 4 System Ethylene Oxide N N N N N N N z Expose USA Liquid Isopropyl T C T C N
42. Refer to 21 CFR 801 437 User labeling for devices that contain natural rubber Caution Using gels not recommended for your transducer can damage it and void the warranty If you have questions about gel compatibility contact SonoSite or your local representative SonoSite recommends you clean transducers after each use Refer to Cleaning and Disinfecting Transducers on page 173 for cleaning and disinfecting procedures Acoustic coupling gel must be used during exams Although most gels provide suitable acoustic coupling some gels are incompatible with some transducer materials SonoSite recommends Aquasonic gel and a sample is provided with the system General Use Apply Gel Apply a liberal amount of gel between the transducer and the body TITAN Chapter 3 Imaging Invasive Use Figure 2 Install Transducer Sheath Install Transducer Sheath Chapter 3 Imaging Note SonoSite recommends the use of market cleared transducer sheaths for clinical applications of an invasive nature such as transvaginal 1 2 Place gel inside the sheath Insert the transducer into the sheath Note To lessen the risk of contamination install the sheath only when you are ready to perform the procedure Pull the sheath over the transducer and cable until the sheath is fully extended Secure the sheath using the bands supplied with the sheath Check for and eliminate bubbles between the footprint of the transducer a
43. 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 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 PA Peak Pressure Gradient PGmax PGmax 4 PV Mean Pressure Gradient PGmean PGmean 4 Vmax 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 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 CSA Cross Sectional Area of the LVOT VTI Velocity Time Integral of the aortic valve SadIUZIZjJOY TITAN Chapter 8 References References Stroke Volume SV 2D and M Mode in ml Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Boston Littl
44. TC T C N T TC TC A Chloride Mikrozid Tissues 3 Germany Wipe Ethanol Propanol T C N N N TC TC A Milton Australia Liquid Sodium U U U N U U U Hypochlorite New Ger 3 Spain Liquid n Duopropenide U U U N U U U Nuclean France Spray Alcohol Biguanide TC TC N N TC TC N Omega 4 USA Liquid Isopropyl U U U N U U U Peract 20 1 2 3 5 USA Liquid Hydrogen Peroxide U U U N U U U Phagocide D 3 France Liquid Gluteraldehyde U U U T C U U U Table 3 Disinfectants Compatibility with System and Transducers Continued NELIL Disinfection and Country A c60 C15 System Cleaning Solutions of Origin Type Active Ingredient L38 C11 el s cas Surfaces Phagolase ND NFLE 3 France Cleaner Quaternary U U U TC U U U Ammonium Alkylamine Enzyme proteolytique Phagolase pH Basique France Liquid Gluteraldehyde U U U T C U U U Phagolingette D 120 3 France Towelette Alcohol Biguanide U U U N U U U Quaternary Ammonium Phagosept Spray 3 France Spray Alcohol Biguanide U U U N U U U Quaternary Ammonium Phagozyme ND 3 France Liquid Quaternary U U U T C U U Ammonium Enzymes PowerQuat Canada Liquid Quat Ammonia U U U N U U U S Precise 4 USA Spray O phenylphenol N N N N N N N ge g Presept USA Liquid NaCl Dichlorite U U U N U U U x 5 Prontocid N 3 Germany Liquid Formaldahyde U U U N U U U Gluteraldehyde D Pyobactene France Liquid Aldehydes U U U N U U U O 2 Rivascop France Liquid Quat Ammonia U U U N U U U fe a Ruthless USA Spra
45. The results are displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Note This will save the new measurement to the patient report and overwrite the previously saved measurement Note Only one calculation S D RI or S D RI PI can be saved 6 Repeat these steps until all measurements have been performed wn v o 88 Chapter 4 Measurements and Calculations SonoSite View or Repeat 1 Highlight the desired measurement from the calculations menu Saved The saved measurement is shown at the bottom of the calculation Measurement menu 2 Press Select key or the Caliper key to select the measurement 3 Repeat the measurement The new results are displayed in the measurement and calculation data area You can compare the active measurement to the saved measurements 4 To save anew measurement select Save from the on screen menu or press the Enter key Note This will save the new measurement to the patient report and overwrite the previously saved measurement Delete 1 Highlight the measurement Measurement Select Delete from the on screen menu This will remove the last saved measurement from the patient report N Vascular Calculations S212 9 sea Warning Verify the patient information date and time settings are accurate Before starting a new calculation st
46. This is a single caliper from the baseline The results are displayed in the measurement and calculation data area They are updated as the caliper moves and are completed when you finish moving the calipers 3 If desired press the Save key to save the image with the measurements displayed Note The measurements cannot be saved to the patient report Chapter 4 Measurements and Calculations So nosite Velocities Elapsed Time x Ratio Resistive Index RI Acceleration On a frozen Doppler spectral trace press the Caliper key A single caliper is displayed on screen with the following menu options First caliper gt lt Second caliper af Manual X Delete Use the touchpad to position the first caliper to a peak systolic wave form Press the Caliper key or select the second caliper from the on screen menu A second caliper is displayed on the screen Use the touchpad to position the second caliper at the end diastole on the wave form The results are displayed in the measurement and calculation data area They are updated as the caliper moves and are completed when you finish moving the calipers Note A measurement taken with the second caliper provides a second velocity elapsed time x ratio RI and acceleration S212 9 sea If desired press the Save key to save the image with the measurements displayed Note The measurements cannot be saved to the patient report The following table shows the tra
47. Z 4a3deyD auISouos tg Troubleshooting Table 3 Disinfectants Compatibility with System and Transducers Continued Cleaning Solutions of Origin DPE Activelngredient 3g cy ICT HST C8 L25 Srfaces Asepti Steryl USA Spray Ethanol T C N N TC TC TC A Asepti Wipes USA Wipe Propanol Isopropyl T C T C N U TC TC A Alcohol Aseptosol Germany Liquid Gluteraldehyde U U U N U U U Autoclave Steam System Steam Heat N N N N N N N Bacillocid rasant Germany Liquid Glut Quat TC T C N N TC TC Ammonia Bacillol 25 Germany Liquid Ethanol Propanol U U U N U U U Bacillol Plus Germany Spray Propanol Glut T C N N N T C N A Bactilysine France Liquid Quat Ammonia U U U N U U U Baktobod Germany Liquid Glut Quat U U U N U U U Ammonia Banicide 4 USA Liquid Gluteraldehyde TC TC lt TC U TC TC N Betadine USA Liquid Providone lodine N N N N N N N Biotensid Germany Spray 2 Propanol U U U N U U U Biospray France Spray Ethanol Aldehyde U U U N U U U Bioxal M 3 France Liquid Hydrogen Peroxide U U U N U U U Acetic Acid Bleach 4 USA Liquid NaCl Hypochlorite TC TC N N TC TC N Bodedex France Liquid Quat Ammonia U U N N U U U Cavicide 4 USA Liquid Isopropyl T C N N N T C TC A y Table 3 Disinfectants Compatibility with System and Transducers Continued Cetera Gh Wee Atveingresint Sa Q icr st ce us Sem Cetavlon France Liquid Cetrimide U U N N U U U Chlorispray France Spray Gluteraldehyde U U N N U U Cidalkan 3 France Liquid Alkylamine U U U
48. a factor of two from the center of the image Note You can change the depth while the image is zoomed 2 Press the Zoom key again to exit zoom Freeze 1 Press the Freeze key The cine icon and frame number are displayed in the system status area of the screen 2 Press the Freeze key again to return to live imaging The cine icon is removed from the system status area of the screen and live imaging begins Cine Buffer 4il On a frozen image press the Cine keys to view individual frames in the cine buffer The frame number will change dynamically as the cine key is pressed Note The total number of frames in the buffer is displayed in the system status under the freeze icon TITAN Chapter 3 Imaging M Mode Imaging The following instructions cover Motion mode M Mode imaging Refer to 2D Imaging on page 47 for instructions about depth and optimization M Mode Sample Line Figure 4 M Mode Sample Line Sample 1 Press the M Mode key for the M Mode sample line Line Note If M Mode does not come on make sure the system is in live imaging 2 Use the touchpad to position the M Mode sample line over the area of interest on the image Note Depth changes are not available in M Mode trace Adjust the depth prior to activating the M Mode trace Chapter 3 Imaging BSonoSite M Mode Trace Figure 5 M Mode Trace Image M Mode Trace Sweep gt Speed Gain Freeze Cine Buffer jj I gt 45 2D Imag
49. accessories Chapter 1 Introduction BASonoSite System peripherals include medical grade conforming to the requirements of EN60601 1 and non medical commercial grade products System medical grade peripherals include a printer VCR and DVD System non medical grade peripherals include a CompactFlash card and a Kensington Security Cable System setup instructions for the use of peripherals are covered in Chapter 2 System Setup on page 21 5 ot g Q A 5 Manufacturer s instructions accompany each peripheral Instructions for the use of peripherals with the system are covered in the TITAN Accessory User Guide About the System Software The ultrasound system contains software that controls its operation A software upgrade may be required SonoSite will provide you with a CompactFlash card containing the software Typically new software provides new capabilities A single CompactFlash card can be used to update one or more systems Software upgrades use the back CompactFlash slot on the right hand side of the system CompactFlash cards installed in the front CompactFlash slot do not upgrade the system TITAN Chapter 1 Introduction S 2 v ao Le Chapter 1 Introduction BSonoSite Chapter 2 Getting Started This chapter contains information on healthy scanning practices basic operation and changing system settings O a Healthy Scanning Guidelines a u These gu
50. and Terms Used in This User Guide 0 0 0 cceceseeseeneeees 2 Upgrades and User Guide Updates oo eeeeeeeeseseseeeeeeeeseeeseeeees 2 Customer GOmuments sisii eii ni a EE ER EEE 2 AbOtit the System 2 5 306i ac dcisssscassss odes tdsinseeansatisas disdeastacetadasatessteiessstiarscvies 3 About the System Software esenenidmsssonenanonodnsnnnaias 5 Chapter 2 Getting Started Healthy Scanning Guidelines iiisssessieiisssiisssssessiesississsnseisisiasessssssnseses 7 System Preparation ccccccscsesessesesseesseeseesesseesssesseesesseessesessseseesaes 10 Installing or Removing Battery oo cee seseeseee cesses ceeeeseeenees 10 Installing and Removing the CompactFlash Card ou 11 Using AC Power Charging Battery cccecceseseeeeeeeeneeeeeeees 12 Turning System On Off sieisen 12 Connecting and Removing the Transducer n s 13 System Controls senesi Kisssiststessetecassssteistascstasasatassbnadiadcanssdaietiantacaeacsies 14 SVEN LAVOUL T E E T 16 General Interaction snnsoninuunnu paranana 18 TOUCHPaAd ostaisi aiee an E aE 18 C ntext MENUS ccisiscsscesesscsessics sadseaseessssssaseaturdeasas i 18 Remappable Controls cceceeecseseseseseeeeeeeeseseeeeeeneneeaeaeeaneneees 19 Anmotation and Text eesccscnonacsnanonti drii akn nn 19 1o o aa E EEE 21 Oyster SCUUP iis csistscialacacats dacs desstaidiste dei rE EESE aS EEEE R ESERE 21 Chapter 3 Imaging Patient orna cucun a 41 Transducer Exam Type and Imaging Mode s sssssssissssissssi
51. be moved and rotated within the image area 4 THI Turns Tissue Harmonic Imaging on and off 5 Depth Depth Adjusts the imaging depth for 2D Chapter 2 Getting Started Depth Up Decreases imaging depth Depth Down Increases imaging depth Bl Sonosite TITAN Table 1 System Controls Continued System er Number Control Description 6 Zoom Magnifies image 2x a 7 Gain R Near Adjusts the gain applied to the near field of the g image S A Far Adjusts the gain applied to the far field of the S image A A Gain Adjusts the overall gain applied to the entire image Note Some keyboards may have the words instead of the symbols 8 AC power A steady green light indicates AC power is connected A flashing indicator green light indicates the system is in sleep mode 9 Caliper Calcs Caliper activates a measurement caliper on the screen Calcs turns the calculation menu on and off 10 Touchpad Use to select adjust and move objects on the screen 11 Select Use to switch between frozen images in duplex and dual screens color and Doppler menus calipers for measurement calipers pictograph marker position angle picto arrow position orientation arrow 12 Print Prints the active image to the printer 13 Save Saves an image to the CompactFlash card Saves an image to the CompactFlash card and saves measurements calculation to the report when configured in system setup 14 Remappable Controls features on the context menu which ar
52. disinfectant you are using indicates it can be used with an immersion method 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 if a pre mixed disinfection solution is used observe the solution expiration date and ensure that the date has not passed To avoid infection the level of disinfection required for a transducer is dictated by the type of tissue it contacts during use Ensure the solution strength and duration of contact 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 FDA e c z o a S e e gt a Caution Transducers must be cleaned after every use Cleaning transducers is necessary TITAN prior to effective disinfection Ensure 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 Using a non recommended cleaning or disinfection solution incorrect solution strength or immersing a transducer deeper or for a longer period of time than recommended can damage or discolor the transducer and void the transducer watranty
53. dry or towel dry with a clean cloth w Troubleshooting 176 Chapter 7 Troubleshooting and Maintenance BSonoSsite Table 3 Disinfectants Compatibility with System and Transducers NELIL Disinfection and Country A c60 C15 System Cleaning Solutions of Origin Type Active Ingredient L38 C11 ICT HSI Surfaces 105 Spray USA Spray Quat Ammonia EC TE N N T C T C A AbcoCide 4 USA Liquid Gluteraldehyde T T T U U U U AbcoCide 28 4 USA Liquid Gluteraldehyde T U T U U U U Aidal Plus Australia Liquid Gluteraldehyde TC TC TC N TC TC N Alkacide France Liquid Gluteraldehyde TC TC TC U TC TC A Alkalingettes 3 France Liquid Alkylamine U U N T C U U U Isopropanol Alkaspray GSA 3 France Spray Isopropyl Alcohol U U U N U U U Alkazyme France Liquid Quat Ammonia TC T C N T TC TC A Ampholysine Basique 3 France Liquid Biguanide Quat U U N T U U U Ammonia Ampholysine plus France Liquid Quat Ammonia U U N N U U U Q EJ Amphospray 41 3 France Spray Ethanol U U N N U U U T Ri Amphyl 4 USA Liquid O phenylphenol U U N N U U U o S Aniosyme P L A France Liquid Quat Ammonia U U U N U U U t Anioxyde 1000 France Liquid Hydrogen Peroxide U U U N U U U 8 Peracetic Acid S S Ascend 4 USA Liquid Quat Ammonia TC TC N U T C TC A Asepti HB USA Liquid Quat Ammonia TC TC N U TC TC N D z Asepti Steryl 14 or 28 4 USA Liquid Gluteraldehyde U U U T C U U U 8 8 BunooysajqnolL N e e adueuajuley pue Bunooysajqnoi
54. functions are accessed on any DICOM configuration page To export configurations data 1 Complete all pages of the configuration for one TITAN system 2 Insert a blank CompactFlash card in the back slot See Installing and Removing the CompactFlash Card on page 11 3 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu 5 Select Export from the on screen menu All configuration data for the locations archivers printers and worklists except TITAN location IP addresses are copied to the CompactFlash card 6 Remove the CompactFlash card A To import configurations data 1 Insert the CompactFlash card in the back slot of the TITAN system See Installing and Removing the CompactFlash Card on page 11 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu Select Import from the on screen menu After all files are imported the system restarts UAWN Note All configurations currently on the system will be replaced with imported data Manually enter the IP addresses and AE titles for locations on the receiving TITAN system 6 Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 DICOM Connectivity Bso noSsite Reviewing the Network Log The Network Log function is accessible on any DICOM configuration page The log col
55. in one row across the bottom of each section of the screen Annotation is available in both live imaging and on a frozen image You cannot annotate on a saved image Enter Text Arrow Chapter 3 Imaging 1 Press the Text key or the Spacebar key In a single image a green data entry cursor is displayed in the upper left corner Use the keyboard to enter delete or modify text Press the Backspace key to delete characters to the left of the cursor Press the Space key to add spaces between words or replace characters with blank spaces to the right of the cursor Press the Arrow keys to move the cursor to the left or right Press the Enter key to return the cursor to the beginning of the line of text Press the Delete key to delete characters to the right of the cursor Select Delete Line from the on screen menu to remove the entire line of text Select Symbols from the on screen menu to enter special characters See Symbols on page 20 Press the Text key to turn off text entry Press the Arrow key Use the arrow as a pointer to bring attention to a specific part of the image Use the touchpad to move the arrow over the image Press the Select key to switch the arrow s orientation and then use the touchpad to adjust the arrow s orientation Press the Select key again to set the arrow s orientation and then use the touchpad to move the arrow over the image Press the Arrow key to set the arrow The arrow changes from g
56. key has been entered correctly The license key should be exactly 12 digits for example 123348990552 with no other characters or punctuation Note If after confirming correct entry of the license key you are still unable to license your system call SonoSite technical support USA Canada customers call 1 877 657 8118 International customers call your local representative or 1 425 951 1330 Maintenance This section is intended to assist in effective cleaning and disinfection It is also intended to protect the system and transducers against damage during cleaning or disinfection Use the recommendations in this section when cleaning or disinfecting your ultrasound system transducer and accessories Use the cleaning recommendations in the peripheral manufacturer s instructions when cleaning or disinfecting your peripherals For more information about cleaning or disinfection solutions or ultrasound gels used with the transducer contact SonoSite or your local representative For information about a specific product contact the product manufacturer There is no recommended periodic or preventive maintenance required for the system transducer or accessories There are no internal adjustments or alignments that require periodic testing or calibration All maintenance requirements are described in the TITAN Ultrasound System User Guide and TITAN Ultrasound System Service Manual Performing maintenance activities not described in the User Guide
57. not work No CPD image No DCPD image No Color image TITAN Check all power connections Perform the following sequence remove DC input connector and battery wait 10 seconds connect DC input or install battery press the power key Ensure the battery is charged Adjust the LCD screen to improve viewing angle Adjust the brightness as necessary to improve image quality Adjust the gain Press Freeze key Zoom does not work when the image is frozen Adjust the gain Adjust the gain Adjust the gain Chapter 7 Troubleshooting and Maintenance e c z o 2 gt e a gt a Troubleshooting Symptom Table 1 Troubleshooting Continued Solution No OB measurement selections Print does not work VCR does not record External monitor does not work Unexpected labels using the function keys Inaccurate fetal age calculation System does not recognize the transducer Text cursor does not move when touchpad or arrows are selected A maintenance icon displays on the system screen Chapter 7 Troubleshooting and Maintenance Select the OB exam type Set the correct printer in system setup Check the printer connections Check the printer to ensure that it is turned on and set up properly See the printer manufacturer s instructions if necessary Check the VCR connections Check the VCR to ensure that it is turned on and set up properly See
58. on screen menu Previous to view image Image Patient List aL Select List from the on screen menu to display the patient list Print Image B 1 Verify a printer is selected See Printer on page 29 2 Select Print from the on screen menu to print the displayed image Delete x Select Delete from the on screen menu to delete the displayed image A confirmation screen is displayed Done Select Done from the on screen menu to exit patient images and return to the previous imaging state Chapter 3 Imaging B Sonosite Chapter 4 Measurements and Calculations Measurements Measurements and calculations are performed on frozen images The following sections explain how to perform basic measurements in each imaging mode Based on the measurements performed the SonoSite system automatically calculates specific information and displays the results Some of the options described in the user guide may not apply to your system System features are dependent on your configuration transducer and exam type 2D Measurements The basic measurements that can be performed in 2D are Distance in cm Area in cm Circumference in cm S212 9 sea gt 6 98em Area 35 8cm Cire 21 2cm 4 78cem Cai2 O Elipse X Delete Figure 1 2D Measurement with One Linear and Ellipse TITAN Chapter 4 Measurements and Calculations Distance 1 Ona frozen 2D image press the Caliper key Measurement A set of calipers is displayed on the screen a
59. or Service Manual may void the product warranty Contact SonoSite Technical Support for any maintenance questions Recommended Disinfectant See the Table 3 Disinfectants Compatibility with System and Transducers on page 177 Safety Please observe the following warnings and cautions when using cleaners disinfectants and gels More specific warnings and cautions are included in the product literature and in the procedures later in this chapter c kem M Pa a gt Q Warning Disinfectants 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 TITAN Chapter 7 Troubleshooting and Maintenance Troubleshooting Warning Caution The level of disinfection required for a device is dictated by the type of tissue it will contact during use To avoid infection ensure the disinfectant type is 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 FDA To prevent contamination the use of sterile transducer sheaths and sterile coupling gel is recommended for clinical applications of an invasive nature Do not apply the transducer sheath and gel until you are rea
60. 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 TITAN system Biological Safety Observe the following precautions related to biological safety Warning Chapter 6 Safety Non medical commercial grade peripheral monitors have not been verified or validated by SonoSite as being suitable for diagnosis 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 Do not use the system if it exhibits artifacts on the LCD screen either within the clinical image or in the area outside of the clinical image Artifacts are indicative of hardware and or software errors 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 BSonoSite Warning Perform ultrasound procedures prudently Use the ALARA as low as reasonably achievable principle SonoSite does not currently recommend a specific brand of acoustic standoff Electromagnetic Compatibility EMC The TITAN ultrasound system has been tested and found to comply with
61. remaining available memory are displayed on the screen Note It may take a few seconds for the image memory counter to display the available memory Note If the CompactFlash card is inserted into the back slot the save icon and number are not displayed 3 Press the Save key to save an image to the CompactFlash card After the audible beep is heard the next image may be saved It may take a few seconds for the image memory counter to display the available memory The image memory indicator decreases by one Note Ensure that there is sufficient memory available on the CompactFlash card before saving additional images Print to Local Printer Ensure the printer is properly set up for operation with the system See Printer on page 29 for system setting and the TITAN Accessory User Guide for hardware setup Print Image Press the Print key Chapter 3 Imaging BSonoSite Image Review The patient list displays all the patients who have images saved on the CompactFlash card Image review is comprised of two parts the patient list and the patient images The patient images display images for the current patient or the patient selected from the patient list Patient List 503Jun 6 p 223 45 6789 2003Jul12 01 37 1 PATIENT 3 32345 6789 2003Jun16 01 39 3 Figure 9 Patient List Patient List Press the Review key If there is a current patient select List from the on screen menu Select All Select All from the on screen me
62. s or greater on the negative side of the baseline S 1 Ona frozen Doppler spectral trace press the Calcs key amp 2 Highlight MV or TV and press the Select key 4 3 Select dP dT and press the Select key A horizontal dotted line with an active caliper is displayed at 100 cm s 4 Position the first caliper along the beginning of the wave form at 100 cm s 5 Press the Select key A second horizontal dotted line with an active caliper is displayed at 300 cm s 6 Position the second caliper along the beginning of the wave form at 300 cm s 7 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations Bo noSsite TITAN Aortic Valve Area AVA Note This calculation requires a measurement taken in 2D and two measurements taken in Doppler After the three measurements are completed and saved the result is displayed in the patient report 2D measurement from LVOT 1 Ona frozen 2D image press the Calcs key 2 Highlight LVOT D and press the Select key 3 Perform the measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bot
63. save y Log Import Export Done Figure 8 Worklist Configuration Page 1 Name Network hostname for a worklist server Alias Personalized name for a worklist server AE Title Application Entity Title IP Address Unique identifier for the worklist server Port Device port number IP port 104 is normally assigned for DICOM Chapter 5 DICOM Connectivity SonoSite 2 2004May18 10 51 Configure Worklist Servers Alias Model IP Address Port AE Title Worklist Today Automatic Query I This TITAN Only Laan ee Occurs Every 2 hours Start Time 8 00 212 Next New Delete Cancel Save Log Import Export Done Figure 9 Worklist Configuration Page 2 Date Range Defines the date range for manual or automatic queries This TITAN Only Restricts the query to patient procedures that are scheduled for the TITAN based on its AE Title Automatic Query Turns automatic query on off Occurs Every An option for an automatic query to select the length of time between automatic updates Start Time An option for an automatic query to select the start time for the automatic update displayed in 24 hour time TITAN Chapter 5 DICOM Connectivity 117 The following table identifies the parameters used for worklist queries Table 1 Manual and Automatic Query Parameters Manual item ME a Update from Kirie ae Worklist Patient data X Date Range X X X This TITAN Only X X Automatic Query On Off X Occurs Eve
64. tabs between text position in dual screens 3 Caps Locks keyboard in caps mode 4 Shift Allows entry of capitalized characters and international characters 5 Text Turns the keyboard on and off for text entry TITAN Chapter 2 Getting Started a U 6 wn ke2 lt B u v Table 5 Keyboard Controls Continued Number Key Description 6 Picto Turns pictographs on and off 7 Arrow Displays an arrow that can be moved and rotated within the image area 8 Spacebar Turns the keyboard on for text entry or adds a space 9 Delete Removes one character to the right of the cursor during text entry 10 Arrow keys Moves highlighted selection in calculations menus moves cursor one space when entering text moves caliper position and moves among pages in image review and reports 11 Backspace Removes one character to the left of the cursor in text entry mode 12 Enter Moves cursor among fields in forms and saves calculations to report Symbols Symbols special characters can be entered in selected fields and forms Patient Information Last First Middle ID Accession Indications Procedure ID Sonographer Reading Dr Referring Dr and Institution Connectivity DICOM Configure Alias AE Title Delta Key F Keys f1 f0 Text mode Imaging Annotation field fJAafj j l la la l fj fef fle s lalilolifi E a a A a A A A A A A macra Figure 6 Symbols Special Characters To
65. the VCR manufacturers instructions if necessary 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 Ensure labels have been assigned to the function keys Ensure that the patient information date and time are set accurately Disconnect and reconnect the transducer Text cursor is constrained to one line This icon indicates that system maintenance may be required Record the number in parentheses on the C line and contact SonoSite or your SonoSite representative BSonoSite Software Licensing SonoSite software is controlled by a license key which is obtained from SonoSite or from its authorized representatives You must obtain one key for each system or transducer that will use the new software See Obtaining a License Key on page 169 The software may be installed and will operate for a short period of time without requiring a valid license key We refer to this period of time as the grace period The grace period is variable When you first install your software your SonoSite system prompts you for a license key If you have not yet obtained a valid license key you can elect to use the software as long as the grace period time has not been fully consumed When a system is running in the grace period all system functions are available As you use the system the grace period is slowly consumed When t
66. the system software is upgraded To install a license key 1 Turn on the system If the software is not yet licensed the license update screen displays The license update screen displays the following information how to contact SonoSite the required information to obtain the license key and the grace period time remaining on your system a 49 hours 56 minutes of operating time System 49 hours 59 minutes of operating time Transducer e remaining before license key needed remaining before license key needed e To obtain a license key To obtain a cense key 1 Contact SonoSite at 1 877 857 8118 1 Contact SonoSite at 1 877 667 8118 v www sonosite com www sonosite com 2 service sonosite com service sonosite com s 2 Supply the following a Your name 2 Supply the following a Your name Q b System serial b Transducer name ke L e ARM version L e Transducer version 20 80 201 014 20 80 201 002 d PCBA seriali d Transducer serial 000000 01GX00 Previous license update 5627795754325 3 Enter license key EO oO j 3 Enter license key C a E a Figure 12 System and Transducer License Screens 2 Enter your license key in the license number field 3 Select Done from the on screen menu to install the license key and license your software 170 Chapter 7 Troubleshooting and Maintenance BSonoSite Note If you have entered a valid license key and you cannot complete the licensing procedure verify that the license
67. transducers please refer to the Biopsy User Guide Note The feature is dependent on transducer and exam type TITAN Chapter 3 Imaging Image Storage Save to CompactFlash Images are saved to the CompactFlash card The images in the patient list are organized alphabetically by the patient name and ID If a name is not entered in the patient name field a patient exam is created and identified as No_Name_ If an ID number is not entered in the ID field the ID number is identified as No_ID_ To review saved images see Image Review on page 61 The images saved on the CompactFlash card cannot be opened and viewed on a PC Images may be archived from the ultrasound system using DICOM Image Transfer or to a PC using SiteLink Image Manager 2 2 See DICOM Connectivity on page 105 or the SiteLink User Guide The number of images saved to the CompactFlash card varies depending on the storage capacity of the card Warning To prevent loss of data loss of images or damage to the CompactFlash card turn the ultrasound system off before removing the CompactFlash card When the CompactFlash card is removed before turning off the ultrasound system the system must be restarted Save Image 1 Verify the CompactFlash card is inserted into the front slot on the ultrasound system See Figure 1 on page 3 2 Turn system on m The CompactFlash card is ready to use when the save icon and the image memory counter showing the
68. wave PW Doppler to obtain ultrasound images The liver kidneys pancreas spleen gallbladder bile ducts transplanted organs abdominal vessels and surrounding anatomical structures can be assessed for the presence or absence of pathology transabdominally Cardiac Imaging Applications This system transmits ultrasound energy into the thorax of patients using 2D M Mode color Doppler Color Tissue Harmonic Imaging THI pulsed wave PW Doppler and continuous wave CW Doppler to obtain ultrasound images The heart cardiac valves great vessels surrounding anatomical structures overall cardiac performance and heart size can be assessed for the presence or absence of pathology The heart can be imaged transthoracic The patient s electrocardiogram ECG may be obtained and is used for accurate timing of diastolic and systolic function Warning The ECG is not used to diagnose cardiac arrhythmias and is not designed for long term cardiac rhythm monitoring Chapter 6 Safety BASo noSite Gynecology and Infertility Imaging Applications This system transmits ultrasound energy in the pelvis and lower abdomen using 2D M Mode color power Doppler CPD directional color power Doppler DCPD Tissue Harmonic Imaging THI and pulsed wave PW Doppler to obtain ultrasound images The uterus ovaries adnexa and surrounding anatomical structures can be assessed for the presence or absence of pathology transabdominally or transva
69. 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 Safety of Diagnostic Ultrasound AIUM 1993 Intended Uses The intended uses for each exam type are contained here See the intended transducer for exam type in Table 2 Transducer Exam Type and Imaging Mode on page 44 Abdominal Imaging Applications This system transmits ultrasound energy into the abdomen of patients using 2D M Mode color Doppler Color color power Doppler CPD Tissue Harmonic Imaging THI and pulsed
70. 0 40 C 50 104 F 15 95 R H 7 o A e f 5 v Shipping Storage Limits Battery 20 60 C 4 140 F 0 95 R H 500 to 1060hPa 0 5 to 1 05 ATM For storage longer than 30 days store at or below room temperature TITAN Chapter 9 Specifications Operating Limits Transducer 10 40 C 50 104 F 15 95 R H Shipping Storage Limits Transducer 35 65 C 31 149 F 15 95 R H Electrical Power Supply Input 100 240 VAC 50 60 Hz 1 2 A Max 100 VAC Power Supply Output system on 1 15 VDC 2 7A Max system 2 12 6 VDC 0 8A Max battery charging Power Supply Output system off 1 15 VDC 2 0A Max system 2 12 6 VDC 1 8A Max battery charging Combined output not exceeding 52W Battery 6 cell 11 25 VDC 4 4 amp hours rechargeable lithium ion battery pack Run time is 2 hours or more 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 C22 2 No 601 1 1990 Canadian Standards Association Medical Electrical Equipment Part 1 General Requirements for Safety CEI IEC 61157 1992 International Electrotechnical Commission Requirements for the Declaration of
71. 04May11 11 10 OB CAD C60 S212 8 sea Figure 10 OB Doppler Calculation TITAN Chapter 4 Measurements and Calculations 87 OB Doppler Note The system does not provide an MCA UmbA ratio from the PI Calculations Pulsatility Index 1 Select OB exam type and enter either the LMP or Estab DD into the MCA patient information form Middle Cerebral 2 Ona frozen Doppler spectral trace press the Calcs key Artery 3 Highlight the desired measurement from the calculation menu and press the Select key UmbA 4 Perform the measurement Umbilical Artery Caliper Function If S D RI is selected the caliper function is activated Position the first caliper at the peak systolic waveform Press the Select key and position the second caliper at end diastole on the waveform OR Manual Trace If S D RI Pl is selected the manual trace function is activated Position the caliper at the beginning of the desired waveform and press the Select key Use the touchpad to move the caliper to the next desired point on the wave form Continue marking points by pressing the Select key The last point must be placed at the end of the waveform Select Set from the on screen menu to complete the trace and display the results Note If calipers are not placed in the correct position the calculation will not be performed accurately 5 Select Save from the on screen menu or press the Enter key to save the measurements to the patient report
72. 1 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 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 Univer
73. 1 x from the on screen menu to view additional pages of the patient report The last page of the patient report contains patient information In the OB report pages a signature space is available for signing printed reports Press the Save key to save the current page of the patient report 4 Select Done from the on screen menu to exit patient report and return to the previous imaging state w Vascular Report 1 At the end of a vascular exam press the Report key 2 Inthe Ratio list select the desired measurements for the ICA CCA ratio for both the right and left sides OB Twins Report 1 At the end of an OB exam press the Report key Individual 2 Select Twin A B from the on screen menu to view individual twin reports OB Twins Report 1 At the end of an OB exam press the Report key Combined 2 Select Compare from the on screen menu to view both twins in a single report TITAN Chapter 4 Measurements and Calculations wn Go v o Delete 1 At the end of an OB exam press the Report key Measurement Use the cursor to point to the desired OB measurement and press the OB Report only Select key The selected measurement is highlighted green 3 Select Delete from the on screen menu To delete all measurements select the measurement label and press the Select key then select Delete from the on screen menu N Send Report 1 Ensure the printer is configured for serial port data export See
74. 2D key to return to 2D imaging ECG Monitoring Note This option requires a SonoSite ECG cable Warning Caution ECG Show Hide Gain Position Sweep Speed TITAN To prevent misdiagnosis do not use the ECG trace to diagnosis cardiac rhythms The SonoSite ECG option is a non diagnostic feature To prevent misdiagnosis do not use the SonoSite ECG option for long term cardiac rhythm monitoring Use only accessories recommended by SonoSite with the system Your system can be damaged by connecting an accessory not recommended by SonoSite Note This menu option is displayed only when the ECG cable is connected 1 Connect the ECG cable to the ECG connector on the docking system mini dock TITAN system See the TITAN Accessories User Guide Note When the ECG cable is connected ECG monitoring turns on automatically Note Biopsy guidelines are not available when ECG is connected 2 Select ECG from the on screen menu Ny Select show hide from the on screen menu to turn on off ECG trace a Select the desired gain from the on screen menu to increase or decrease ECG gain 1 20 Select the desired position of the ECG trace from the on screen menu Select the desired sweep speed from the on screen menu slow med fast Chapter 3 Imaging Annotation Note In a single image you can only enter annotation in one row across the top of a frozen or live image In Dual image you can only enter text
75. 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 Elapsed Time ET in msec ET time between velocity cursors in milliseconds Heart Rate HR in bpm HR 3 digit value input by user or measured on M Mode and Doppler image in one heart cycle Interventricular Septum IVS Fractional Thickening percent Laurenceau J L M C Malergue The Essentials of Echocardiography Le Hague Martinus Nijhoff 1981 71 IVSFT IVSS IVSD IVSD 100 where IVSS Interventricular Septal Thickness at Systole IVSD Interventricular Septal Thickness at Diastole 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 where LVESV Left Ventricular End Systolic Volume LVDS Left Ventricular Dimension at Systole LVEDV 7 0 LVDD 2 4 LVDD where LVEDV Left Ventricular End Diastolic Volume LVDD Left Ventricular Dimension at Diastole SadIUZIZjJOY TITAN Chapter 8 References Left Ventricular Volume Biplane Method in ml Schiller N B P M Shah M Crawford et al Rec
76. 3 Table 1 Acronyms Continued Acronym Description LVET LVOT LVOT area LVOT D LVPW LVPWd LVPWFT LVPWs MCA MCCA MECA MI MICA MV MVA NTSC OFD PAL PCCA PECA PGr PGmax PGmean PHT Pl A bl v 7 2 214 Chapter 10 Glossary Left Ventricular Ejection Time Left Ventricular Outflow Tract Left Ventricular Outflow Tract Area Left Ventricular Outflow Tract Diameter Left Ventricular Posterior Wall Left Ventricular Posterior Wall Diastolic Left Ventricular Posterior Wall Fractional Thickening Left Ventricular Posterior Wall Systolic Middle Cerebral Artery Mid Common Carotid Artery Mid External Carotid Artery Mechanical Index Mid Internal Carotid Artery Mitral Valve Mitral Valve Area National Television Standards Committee Occipital Frontal Diameter Phase Alternating Line Proximal Common Carotid Artery Proximal External Carotid Artery Pressure Gradient Maximum Pressure Gradient Mean Pressure Gradient Pressure Half Time Pulsatility Index Bl Sonosite Table 1 Acronyms Continued Acronym Description PICA Proximal Internal Carotid Artery PV Pulmonic Valve PW Pulsed Wave Doppler RI Resistive Index RVD Right Ventricular Dimension RVDd Right Ventricular Dimension Diastolic RVDs Right Ventricular Dimension Systolic RVW Right Ventricular Free Wall RVWd Right Ventricular Free Wall Diastolic RVWs Right Ventricular Free Wall Systolic S D Systolic Diastolic Ratio SV S
77. 40 gynecological calculations 79 gynecology intended uses 143 H heart rate HR 67 100 horizontal flip 47 humidity limits 205 l image description 17 problem 161 review 61 save to CompactFlash 60 image mode transducer 44 image storage specifications 204 imaging CW Doppler 209 import user account 25 in situ definition 209 infertility intended uses 143 intended uses 142 144 intensity derated 141 in situ 141 water value 141 interventional intended uses 143 intraoperative intended uses 143 invert CPD DCPD 53 Doppler 56 L labeling symbols 158 LCD screen clean 173 output 139 specifications 203 license key 169 170 live trace 39 56 login 22 27 Index Index M M mode sample line 50 trace 51 maintenance 171 manual trace 71 measurement area circumference 65 delete 65 distance 64 66 follicle 80 heart rate 67 second distance 64 terminology publications 191 vascular 89 measurement accuracy 2D measurements 189 caliper placement 189 display size 189 measurement and calcs data 17 measurements and calculations cardiac Doppler calculations 96 mechanical index MI 139 210 mode data 17 modes 16 neonatal intended uses 143 new patient 41 NTSC definition 210 O OB calculations 81 86 Doppler calculations 88 table set up 37 obstetrical references 196 obstetrical intended uses 143 optimize 47 orientation marker 17 output display 139 P PAL definition 210 passwo
78. 9 hours 66 minutes of operating time System remaining before license key needed To obtain a license key 1 Contact SonoSite at 1 877 657 8118 wrew sonosite com service sonosite com 2 Supply the following a Your name b System serial c ARM version y 20 80 201 014 d PCBA serial 8 000000 Ei Previous license update o 627796754325 2 3 Enter license key ey 2 Figure 6 System Software License Key At this point the software upgrade process is complete but the software is not yet licensed See Obtaining a License Key on page 169 Note If you are upgrading a system and one or more transducers it is recommended to upgrade all items before calling SonoSite Technical Support for your license keys To postpone obtaining a license key press Cancel from the on screen menu Chapter 7 Troubleshooting and Maintenance Sonosite To upgrade transducer software 1 Turn the system off and remove the CompactFlash card from the back slot 2 Connect the transducer for the upgrade 3 Turn the system on 4 Wait approximately 10 seconds and then insert the upgrade CompactFlash card Note XXX identifies the current software version 2003Jan05 01 35 incompatible transducer To use the active transducer please insert the upgrade CF card lt 20 80 201 Xxx gt into the back slot Figure 7 Incompatible Transducer Update This screen is not displayed for compatible transducers e c z o a S e
79. ACC abs delta velocity delta time Acceleration Time AT in msec Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 219 See Figure 4 on page 70 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 383 442 Ag A1 V1 V2 where A gt Ao valve area Ay LVOT area V LVOT velocity V Ao valve velocity LVOT Left Ventricular Outflow Tract AVA PV vor PVao CSALvor AVA VTILvor VTIao CSALVor Cardiac Output CO in l min Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 59 CO SV HR 1000 where CO Cardiac Output SV Stroke Volume HR Heart Rate References 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 of the anatomy of interest Chapter 8 References BSonoSite 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 Ejection Fraction EF percent Oh J K J B Seward A J Tajik The Echo Manual
80. Acoustic Output Tables Table 5 indicates the acoustic output for all system and transducer combinations for those imaging modes with a thermal index and mechanical index less than one Table 5 Acoustic Output Transducer TI TI i l l Mima Model Imaging Modes SPTA 3 Type Value MI pa 3 xX C8 8 5 MHz 2D M Mode 78 TIC 0 2 0 8 130 4 C11 8 5 MHz 2D CPD Color 73 TIC 0 4 0 5 16 47 M Mode CW Doppler C15 4 2 MHz 2D M Mode 289 TIC 0 7 0 7 45 03 CW Doppler C60 5 2 MHz 2D CPD Color 60 TIC 0 7 0 6 37 66 M Mode HST 10 5 MHz All 182 TIB 0 4 0 3 8 89 ICT 8 5 MHz 2D CPD DCPD 67 TIC 0 4 0 5 21 51 M Mode L25 10 5 MHz 2D CPD Color 108 TIC 0 7 0 7 40 42 L38 10 5 MHz 2D CPD Color 256 TIC 0 9 0 7 109 9 M Mode Table 6 through Table 13 indicate the acoustic output for the system and transducer combinations with a thermal index equal to or greater than one Chapter 6 Safety BSonoSite Table 6 Transducer Model C8 8 5 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 a a 1 5 b Pr3 Wo 24 67 y min of z W 3 z1 lTa 3 z1 gt go z lt LO g TE Zp 2 3 3 deg Zsp 0 23 fe 5 33 Dim of Aaprt X 0 768 Y 0 4 PD usec PRF k Pr PIl max E deq Pllmax 0 179 Focal Length FL cm _ ep g FLy
81. CT HST C8 L25 Sarfaces 4 a Transeptic USA Cleaner Alcohol T N N N T N A b Tristel UK Liquid Chlorine Dioxide T C N T C U T C TC N 7 Ultra Swipes USA Wipe Ethanol U U U N U U U 3 Vaposeptol Germany Spray Biguanide U U U T U U U 3 Vesphene II 4 USA Liquid Sodium TC TC N N TC TC A 5 o Phenylphenate 2 Virex 4 USA Liquid Quat Ammonia T C T C N N T C N N Virkon Australia Liquid Potassium U U U N U U U Monopersulfate VP 483 Germany Liquid Unknown U U U N U U U VP 483 2H Germany Liquid Unknown U U U N U U U Wavicide 01 2 4 5 USA Liquid Gluteraldehyde N N N N N N A Wavicide 06 4 USA Liquid Gluteraldehyde T C N T C N T C TC N Wavicide 06 Plus 4 USA Liquid Gluteraldehyde U U U U U U U Wex Cide 4 USA Liquid O phenylphenol TC FE N N TC TC A Ytdesinfektion Plus Sweden Liquid Isopropanol U U U N U U U 1 Compatible but no EPA Registration 2 Has FDA 510 k 3 Has CE Mark 4 EPA Registered 5 FDA 510 k cleared liquid sterilant or high level disinfectant auISouos ea Table 3 Disinfectants Compatibility with System and Transducers Continued Disinfection and Country A c60 C15 System Cleaning Solutions of Origin Type Active Ingredient L38 C11 ol al ne 2S Surfaces N ELIL A Acceptable for use N No do not use T Transducer only T C Transducer and Cable U Untested do not use Q a D ge D z y e Z jen D n gt O e aA 5 Q 5 a 2 5 D 5 D 5 a
82. Change 1 In User Login select Password Password 2 Enter your old password new password confirm the new password and then click OK To ensure passwords are secure it is recommended that passwords contain characters from the following categories Upper case characters A Z Lower case characters a z Numbers 0 9 Note The password is case sensitive TITAN Chapter 2 Getting Started U 6 N te c Ez u v To set up Audio and Battery 2004Sep11 20 01 Key click On Beep alert On Battery and Power Steep detay min 70 Power delay min 30 Figure 11 Setup Screen Audio Battery Key click Beep alert Sleep delay Power delay Reset Chapter 2 Getting Started 1 Press the Setup key 2 Select Audio Battery 3 Inthe Key click list select On or Off 1 Press the Setup key 2 Select Audio Battery 3 Inthe Beep alert list select On or Off 1 Press the Setup key 2 Select Audio Battery 3 Inthe Sleep delay list select Off 5 or 10 minutes 1 Press the Setup key 2 Select Audio Battery 3 Inthe Power delay list select Off 15 or 30 minutes To return settings for this setup page to factory default select Reset from the on screen menu BASonoSite To set up Connectivity 2004Sep11 20 02 d 2004Sep16 18 66 Connectivity TITAN Ethernet Location Printer Sony E amp W Host Name Y Subnet Mask f oo ouaa Gateway off Transfer Mode SteL
83. Doppler and CW Doppler are optional features and are dependent on transducer and exam type The following instructions cover PW and CW Doppler imaging Doppler Sample Line 2004May1f 11 18 Figure 7 Doppler with Sample Line Image and ROI Box Sample 1 Press the Doppler key for the Doppler sample line Line 2 Use the touchpad to position the Doppler sample line over the area of interest on the image 3 Press the Select key to set sample line and to toggle between Doppler sample line and Angle Correction An indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling Note If PW or CW Doppler mode does not come on make sure the system is in live imaging Note The color ROI box is tied to the PW or CW sample line PW CW 1 Press the Doppler key Doppler 2 Select PW from the on screen menu to toggle between PW Doppler and CW Doppler CW Doppler only in cardiac exams Chapter 3 Imaging BSonoSite Angle 4 There are two ways to adjust the angle correction in PW Doppler Correction imaging PW only Select Angle Correction from the on screen menu to adjust the angle correction to 0 60 or 60 degrees OR 1 Press the Select key to highlight the angle correction icon displayed on the left side of the screen The indicator is highlighted green to show which function the touchpad is controlling 2 Use the touchpad to adjust the angle in two degree increments from 74 to 74 de
84. Growth Analysis tables are used by the Report Graphs feature Three growth curves are drawn using the table data for the selected growth parameter and published author Growth tables are only available with a user entered LMP or Estab DD 2003Juni6 14 59 S212 9 sea AC 33 9cm ST w6d Figure 9 OB Measurement TITAN Chapter 4 Measurements and Calculations OB Calculation 1 Select OB exam type and enter either the LMP or Estab DD in the patient information form 2 Ona frozen 2D image press the Calcs key 3 Highlight the desired measurement from the calculations menu and press the Select key For twin calculations select Twin A or Twin B and then highlight the desired measurement from the calculations menu and press the Select key As you navigate through the measurements on the calculation menu the caliper tool may change However the caliper position remains 4 Perform the measurement 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report For each 2D OB measurement except AFI the system stores up to three individual measurements and their average If more than three measurements are made the oldest measurement is deleted The average measurement and ultrasound age are shown at the bottom of the calculation menu and a check mark is put in front of the measurement wn Go v o Note The A key or Save Key can be assigned in system set
85. Host Name Unique network host name for the TITAN system The default host name is TITAN Alias Personalized name for the TITAN system AE Title TITAN system DICOM Application Entity Title DHCP Dynamic Host Configuration Protocol A protocol for automating and managing the network configuration of the TITAN system Chapter 5 DICOM Connectivity SonoSite IP Address Unique identifier of the TITAN system location Subnet Mask Identifies a network subdivision The default value is 255 255 0 0 Default Gateway IP address where the network connects to another network Alternate Gateway Alternate location where the network connects to another network Configure Locations X Alias DHCP IP Address Subnet Mask Default Gateway Location Network Speed Auto Negotiate Device Read Timeout sec fas Device Write Timeout sec fas 2 2 Next New Delete Cancel Save N Log Import Export Done Figure 2 Locations Configuration Page 2 Network Speed Speed at which the network is transferring data Device Read Timeout Length of time the TITAN system will keep the network line open when receiving information Device Write Timeout Length of time the TITAN system will keep the network line open when sending information TITAN Chapter 5 DICOM Connectivity 107 To configure a new location 1 UAWN Ensure the TITAN system is set up for DICOM connectivity See To set up the TITAN system for DICOM connectivity
86. N system is set up for DICOM connectivity See To set up the TITAN system for DICOM connectivity on page 105 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu In the Configure list select Printers Select New Enter information in the fields pages 1 2 and 3 The Name cannot contain special characters The Alias and AE Title may contain special characters The IP address and port must be entered before the information is saved Note To use special characters select Symbols See To enter a symbol special character on page 20 Note Use the space bar on the keyboard to enter the underscore symbol Select Cancel to undo last change Select Save Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Select the name of the device from the list of printers Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 DICOM Connectivity Configuring Worklist Servers 2 2004Sep29 16 20 Configure Worklist Servers z Alias Model IP Address Port AE Title Worklist Name New_Name IP Address 120 20 20 120 Alias Alias_04 Port 104 AE Title New_AE_Title Ping 1 2 Next New Delete Symbols Cancel L
87. O YYYY MM DO BPD HC AC FL HC AC EFW g miade SS aa jal se sol Md MT id Rs S g q YY MM DD M eee ee COo ee EEn _ _ _ _s Date ofbith sf i i E og m i f di di ee ww mM oD Et i i Ii I E Gender z k Measurement units cm Figure 1 Patient Information Form New L 1 Press the Patient key Patient 2 Select New from the on screen menu This clears the existing patient information Note New patient will erase any previously entered information including any calculations and report pages To save this information save the screen for each item e g report pages patient information calculations and graphs 3 Enter information into appropriate fields The patient information fields vary based on the selected exam type Patient Patient Enter Last First Middle and ID Accession Enter number if applicable Date of birth Enter YYYY MM DD Gender Select Female Male other or leave blank Indications Enter desired text TITAN Chapter 3 Imaging New Patient continued End Exam Chapter 3 Imaging Exam Type Select desired exam type LMP or Estab DD Enter either last menstrual period or established due date YYYY MM DD Estab DD only in OB exam Note The date for LMP must precede the current system date Twins Select the Twins check box to display Twin A and Twin B measurements on the calculation menu only in OB exam and report Previous Exams Enter data from previous exams only in OB exa
88. OM Connectivity A So nosite To delete a worklist server 1 2 Select the name of the device from the worklist Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Configuring Procedures Procedures are automatically added to the procedure list when new exam types from the patient procedures are selected from the worklist 2 2004May18 10 51 Configure Procedure List C Add Delete Log Import Export Done Figure 10 Procedure Configuration To add a new procedure 1 NAN BW ND TITAN Ensure the TITAN system is set up for DICOM connectivity See To set up the TITAN system for DICOM connectivity on page 105 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu In the Configure list select Procedure List Type desired text Select Add Select Done from the on screen menu Chapter 5 DICOM Connectivity To delete a procedure 1 Select the name of the procedure from the list of procedures 2 Select Delete Importing and Exporting Configurations All configuration data for the locations except IP addresses and AE titles archivers printers and worklists can be imported and exported This allows you to share configuration data between TITAN systems The import and export
89. TITAN Ultrasound System User Guide CE A Sonosite TITAN Ultrasound System User Guide Manufactured by 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 OAP UK T 44 1462 444800 F 44 1462 444801 Caution United States federal law restricts this device to sale by or on the order of a physician SonoSite SonoSite TITAN and TITAN are trademarks of SonoSite Inc Kensington is a registered trademark of Kensington Technology Group CompactFlash is a registered trademark of Symbol Technologies 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 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 Patents pending Other international patents may also apply P03322 08 08 2008 Copyright 2008 by SonoSite Inc All rights reserved Printed in the USA BSonoSite Contents Chapter 1 Introduction About the User Guide o ccccccceseseeceeseseeeeeeeseesseessnesseessetasatavsneeseeeaas 1 Conventions Used in This User Guide oo eeneneneeeeeeeees 2 Symbols
90. TITAN Accessory User Guide ao J 7 w 7a te c B P v To operate the system using AC power directly to system Warning The equipment shall be connected to a center tapped single phase supply circuit when users in the United States connect the equipment to a 240V supply system Caution Verify the hospital supply voltage corresponds to the power supply voltage range See Electrical on page 206 1 Connect the DC power cable from the power supply to the connector on the system See Figure 2 on page 4 2 Connect the AC power cord to the power supply and connect to a hospital grade electrical outlet Turning System On Off To turn the system on 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 1 Locate the Power key on the top left side of the system See Figure 3 on page 14 2 Press the Power key once to turn on and once to turn off To wake up the system To conserve battery life the system is configured to go into sleep mode The system goes into sleep mode when the lid is closed or if the system has not been touched for a preset amount of time Press any key touch the touchpad or open the lid to wake up the system To adjust the time for sleep delay see To set up Audio and Battery on page 28 Chapter 2 Getting Started BASonoSite Connecting and Removing the Tran
91. The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement Note The A key or Save Key can be assigned in system setup to save calculations to the report See Delta Key on page 32 or Save Key on page 39 If desired press the Save key to save the image with the measurements displayed Repeat these steps until all measurements have been performed S212 9 sea Use the touchpad to highlight the desired measurement from the calculations menu The saved measurement is shown at the bottom of the calculation menu Press the Select key or the Caliper key to select the measurement Repeat the measurement The new results appear in the measurement and calculation data area You can compare the active measurement to the saved measurement To save the new measurement select Save from the on screen menu or press the Enter key Note This will save the new measurement to the patient report and overwrite the previously saved measurement Use the touchpad to highlight the measurement Select Delete from the on screen menu This will remove the last saved measurement from the patient report Chapter 4 Measurements and Calculations Volume Flow Calculation Warning Verify the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 41 T
92. To set up Connectivity on page 29 2 Select Send Rep from the on screen menu Data is sent to the computer as a text file Note This function can be used for all reports an oF gla nt a a a BRY mLV ac gaco ac a r Send Rep Done Figure 14 Anatomy Demonstrated Anatomy 1 At the end of an OB exam press the Report key Demonstrated 2 On the page for Anatomy Demonstrated select the check boxes to document reviewed anatomy Note Use the Tab key to move between fields and the Space Bar to check and uncheck items from the checklist Biophysical Profile 1 At the end of an OB exam press the Report key 2 On page 2 of the report select a value for the biophysical profile 0 1 2 The total score is calculated when values are entered NST non stress test is optional Chapter 4 Measurements and Calculations So nosite 2004Mar11 14 27 6 15 20 25 30 35 40 45 Gestational Age by LMP weeks Report Figure 15 OB Graphs OB Graphs Note OB Graphs may only be viewed when LMP or Estab DD is entered in the patient information screen 1 At the end of an OB exam press the Report key 2 Select Graphs from the on screen menu 3 Inthe Graphs list select the desired measurement author The graph for the selected measurement is displayed If desired select another measurement author or select Next Page from the on screen menu If desired press the Save key to save the current graph page 4 Sel
93. Transducer Model Imaging Mode Derated l pra MI C60 5 2 MHz 2D 2 0 6 CPD Color 60 0 6 M Mode 20 0 6 PW Doppler 496 0 6 Table 18 HST 10 5 Transducer Transducer Model Imaging Mode Derated Icpta MI HST 10 5 MHz 2D 2 0 2 CPD DCPD 17 0 3 M Mode 5 0 2 PW Doppler 182 0 3 Table 19 ICT 8 5 Transducer Transducer Model Imaging Mode Derated lspTA MI ICT 8 5 MHz 2D 3 0 4 CPD DCPD 67 0 5 M Mode 20 0 4 PW Doppler 353 0 5 Table 20 L25 10 5 Transducer Transducer Model Imaging Mode Derated IsptA MI L25 10 5 MHz 2D 13 0 7 CPD Color 108 0 7 Chapter 6 Safety BSonoSite Table 21 L38 10 5 Transducer Transducer Model Imaging Mode Derated Icpta MI L38 10 5 MHz 2D 7 0 6 CPD Color 256 0 7 M Mode 121 0 7 PW Doppler 552 0 7 Acoustic Measurement Precision and Uncertainty All table 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 Table 22 Acoustic Measurement Precision and Uncertainty Quantity Precision aai Uncertainty of standard deviation 95 confiden
94. Ultrasound J Ultrasound Med Sept 1988 Vol 7 No 9 Supplement sometimes referred to as the Stowe Report which 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 the Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment NEMA UD 2 1998 and the Standard for Real Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment AIUM and NEMA 1998 Chapter 6 Safety BASo noSite 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 and 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 eA where In Situ In Situ intensity value Water Water intensity value e 2 7183 a attenuation factor dB cm MHz 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
95. Vmax from LVOT VTI or Vmax from aorta VTI LVOT D in 2D VTI HR LVOT D in 2D TRmax dP dT E E PG A A PG E A PHT MVA dP dT VTI Vmax PGmax Vmean PGmean Vmax PGmax VTI Vmax PGmax Vmean PGmean AVA SV CO TRmax PGmax dP dT Bl Sonosite Table 15 Cardiac Calculations in Doppler Continued Anatomy Cardiac Measurement Calculation Result TITAN PV Pulmonic Valve E A VMax and TRmax Velocity Time Integral VTI VTI VTI Vmax PGmax Vmean PGmean Vmax or VTI Vmax PGmax On a frozen Doppler spectral trace press the Calcs key Highlight the desired calculation package and press the Select key Select the desired measurement and press the Select key Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed OABWDN HS S212 9 sea Note The A key or Save Key can be assigned in system setup to save calculations to the report See Delta Key on page 32 or Save Key on page 39 6 Highlight the next measurement and press the Select key 7 Repeat these steps until all measurements have been performed Note In addition to VTI results this calculation will compute other resu
96. ad to adjust the position of the first caliper The active caliper is highlighted green 4 Press the Select key and use the touchpad to adjust the position of the second caliper 5 Press the Select key and use the touchpad to adjust the size of the ellipse The results are displayed in the measurement and calculation data area and are updated as the caliper moves The measurement is complete when you finish moving the calipers Note When an ellipse measurement is performed only one distance measurement is available 6 If desired press the Save key to save the image with the measurements displayed 7 Select Ellipse again from the on screen menu to turn off the ellipse H Ro Delete 1 Select first or second caliper set or Ellipse from the on screen menu Q Measurement 2 Select Delete from the on screen menu a This will remove the active set of calipers from the screen M Mode Measurements The basic measurements and calculations that can be performed in M Mode are Distance in cm Time in seconds Heart Rate HR in beats per minute bpm Note The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals xX Delete Figure 2 M Mode Trace Image with Heart Rate TITAN Chapter 4 Measurements and Calculations Distance 1 Ona frozen M Mode trace press the Caliper key Measurement A single caliper is displayed on the screen and the following on screen menu option
97. al error 1 100 0 5 e The circumference accuracy is defined as the greater of the lateral or axial accuracy and by the following equation ano tolerance 2 maximum of 2 errors 100 0 5 Table 2 M Mode Measurement and Calculation Accuracy and Range M Mode Measurement System Accuracy Test Rind Accuracy and Range Tolerance By Method g Distance lt 2 plus 1 Acquisition Phantom 0 26 cm of full scale Time lt 2 plus 1 Acquisition Phantom 0 01 10 sec of full scales Heart Rate lt 2 plus Full Acquisition Phantom 5 923 bpm Scale Heart Rate 100 Full scale for distance implies the maximum depth of the image An RMI 413a model phantom with 0 7 dB cm MHz attenuation was used Full scale for time implies the total time displayed on the scrolling graphic image SonoSite special test equipment was used an ow Chapter 8 References BSonoSite Table 3 PW Doppler Mode Measurement and Calculation Accuracy and Range Doppler Mode System Accuracy Test Measurement Accuracy Range Tolerance By Method and Range Velocity cursor lt 2 plus 1 Acquisition Phantom 0 01 cm sec of full scale 550 cm sec Frequency cursor lt 2 plus 1 Acquisition Phantom 0 01kHz 20 8 kHz of full scale Time lt 2 plus 1 Acquisition Phantom 0 01 10 sec of full scales a SonoSite special test equipment was used b Full scale for frequency or velocity implies the total frequency
98. al 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 inspect cables and power cords used within the system on a regular basis for damage 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 standards 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
99. art a new patient exam to delete the previous measurements See New Patient on page 41 Vascular Measurements The following table shows the transducers and exam types that provide vascular measurements Table 11 Transducer and Exam Types for Vascular Transducer Exam Types C11 Vascular HST Vascular L25 Vascular L38 Vascular Carotid vascular measurements may be performed and saved to the patient report The specific measurements that can be stored to the patient report are provided in the following table For definitions of acronyms see Acronyms on page 211 TITAN Chapter 4 Measurements and Calculations Table 12 Carotid Vascular Measurements Vascular Measurement Systolic Diastolic PCCA X X MCCA X X DCCA X X Bulb X X PICA X X MICA X X v DICA X X PECA X X S v s MECA X X DECA X X VArty X X Note After vascular measurements are performed values used in the ICA CCA ratio are selectable on the vascular report page PCCA s 104 6cm s 2 PCCA 26 7cm s X Delete v Save Figure 11 Vascular Measurement Chapter 4 Measurements and Calculations So nosite TITAN Label Vascular Measurement View or Repeat Saved Measurement Delete Measurement On a frozen Doppler spectral trace press the Calcs key Use the touchpad to highlight Left or Right from the calculation menu Press the Select key Use the touchpad to highlight the desired measurement from the ca
100. as an angle correction of 0 degrees Steering angle of 15 degrees has an angle correction of 60 degrees Note If two modes are active CPD DCPD Color and PW Doppler press the Select key to toggle between the on screen menus Variance je Select variance from the on screen menu to turn on Cardiac only Invert yt Select Invert from the on screen menu to switch the displayed direction of flow Note Invert is only displayed when DCPD Color is selected ROI Box Ji 1 Use the touchpad to position or change the size of the region of 7 interest ROT box While you are moving or changing the size of the ROI box you will see a green outline of the new position or the new size as it moves on the display 2 Press the Select key to toggle between the position and size of the ROI box The ROI box indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling Gain Turn the Gain knob on the lower left side of the control panel to increase or decrease the amount of color gain applied to the CPD DCPD or Color ROI box Note While in CPD DCPD or Color imaging Near and Far knobs affect only the 2D image 2D Press the 2D or Color key to return to 2D imaging Imaging Note If two modes are active CPD DCPD Color and PW Doppler press the Select key to toggle between context menus TITAN Chapter 3 Imaging Pulsed Wave PW and Continuous Wave CW Doppler Imaging Note PW
101. asound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 154 Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 103 105 Chapter 8 References BSonoSsite Shepard M J V A Richards R L Berkowitz et al An Evaluation of Two Equations for Predicting Fetal Weight by Ultrasound American Journal of Obstetrics and Gynecology 142 1 January 1 1982 47 54 University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 880 Equation 1 Gestational Age GA by Last Menstrual Period LMP The gestational age derived from the LMP date entered on the patient information form Results are displayed in weeks and days and is calculated as follows GA LMP System date LMP date Gestational Age GA by Last Menstrual Period LMPd Derived from Established Due Date Estab DD Same as GA by Estab DD The gestational age derived from the system derived LMP using the Established Due Date entered on the patient information form Results are displayed in weeks and days and is calculated as follows GA LMPd System Date LMPd Last Menstrual Period Derived LMPd by Established Due Date Estab DD Results are displayed as month day year LMPd Estab DD Estab DD 280 days Gestational Age Tables Abdominal Circumference AC Hadlock F et al Estimating Fetal Age
102. average intensity at axial distance z milliwatts per square centimeter Z1 Axial distance corresponding to the location of maximum min W 3 2 lta 3 Z x 1 cm where z gt zbp in centimeters Zbp 1 69 Aaprr in centimeters Zsp For MI it is the axial distance at which p 3 is measured For TIB it is the axial distance at which TIB is a global maximum i Z Zp 3 in centimeters deq z Equivalent beam diameter as a function of axial distance z and is equal to J 4 Wo 1TA 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 TITAN the reported value of MI in Hertz Chapter 6 Safety Table 4 Acoustic Output Terms and Definitions Continued Term Definition 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
103. ay the ECG trace See ECG Monitoring on page 57 1 Select Dual from the on screen menu to display side by side 2D images 2 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 except if calipers calcs arrow or picto are displayed Select Dual from the on screen menu or press the 2D key to return to full screen 2D imaging Turn the Near Far or Gain knobs on the lower left side of the control panel to increase or decrease the amount of gain applied to the near field far field or the overall image near and far correspond to the time gain compensation TGC controls found on other ultrasound systems Press the Depth key up to decrease or down to increase the displayed depth As you adjust the depth the maximum depth number changes in the lower right corner of the screen Note The vertical depth scale is marked in 5 cm 1 cm and 5 cm increments depending on the depth Note This is an optional feature and is dependent on transducer and exam type 1 Press the THI key to turn on THI THI is displayed in the top left portion of the screen next to the optimization setting 2 Press the THI key again to turn off THI The THI icon is removed from the screen BSonoSite Zoom Note Zoom is only available during real time imaging You cannot zoom on a frozen or saved image 1 Press the Zoom key The image is magnified by
104. ce Pr 1 9 11 2 Pr3 1 9 12 2 Wo 3 4 10 fc 0 1 4 7 PII 3 2 12 5 to 16 8 Pll 3 2 13 47 to 17 5 TITAN Chapter 6 Safety iy Labeling Symbols The following symbols are found on the products packaging and containers Table 23 Labeling Symbols Symbol Definition Alternating Current AC fy g Affixed to a Class 1 device indicating manufacturer s declaration of C conformance with Annex VII of 93 42 EEC Affixed to a Class 1 device requiring verification by the Notified Body of C sterilization or measurement features or to a Class Ila llb or III device requiring 0086 verification or auditing by the Notified Body to applicable Annex es of 93 42 EEC Attention see the User Guide Batch code date code or lot code type of control number LOT m Canadian Standards Association Cc US REF Catalog number Collect separately from other household waste see European Commission De Directive 93 86 EEC Refer to local regulations for disposal S Corrugated recycle Corrugated Recycles J Date of manufacture Direct Current DC alse Do not get wet T Chapter 6 Safety BASo nosite Table 23 Labeling Symbols Continued Definition Do not stack over 2 high Do not stack over 5 high Do not stack over 10 high Electrostatic sensitive devices e 00 00 00 Fragile Indoor use only Non ionizing radiation Paper recycle E D Serial number t
105. ce results displayed by exam type Table 1 Trace Calculations by Exam Type Cardiac Vascular OB Gyn panne Velocity Time Integral VTI X Peak Velocity Vmax X X X X Mean Pressure Gradient PGmean X Mean Velocity on Peak Trace Vmean X Pressure Gradient PGmax X Time Average Mean TAM X X x or Systolic Diastolic S D X X X Pulsatility Index PI X X X End Diastolic Velocity EDV X TITAN Chapter 4 Measurements and Calculations Table 1 Trace Calculations by Exam Type Continued i Abdominal Cardiac Vascular OB Gyn and Other Acceleration Time AT X X X X X Resistive Index RI Note The automatic trace tool must be used to calculate the TAM Velocity Peak Velocity Vmax l End Diastolic Velocity EDV wn Go v o Time Acceleration lt _ Time AT i 4 Velocity Time Integral gt VTI Figure 4 Trace Calculations of the Doppler Wave Form 70 Chapter 4 Measurements and Calculations So nosite TITAN Manual Trace Automatic Trace AI 1 Ona frozen Doppler spectral trace press the Caliper key 2 Select Manual from the on screen menu A single caliper is displayed on the screen This caliper is used to mark points on the trace 3 Position the caliper at the beginning of the desired wave form and press the Select key Note If calipers are not placed in the correct position the calculation will not be
106. cleansers since these will damage the exterior surfaces Use only recommended cleaners or disinfectants on system surfaces Immersion type disinfectants are not tested for use on system surfaces When you clean the system ensure the solution does not get inside the system keys or the battery compartment Do not scratch the LCD screen Chapter 7 Troubleshooting and Maintenance So nosite To clean the LCD screen Dampen a clean non abrasive cotton cloth with an ammonia based window cleaner and wipe the screen clean It is recommended to apply the cleaning solution to the cloth rather than the surface of the screen To clean and disinfect the system surfaces 1 2 3 Turn off the system Disconnect the system from the power supply or remove from the docking system mini dock 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 rather than the surface Mix the disinfectant solution compatible with the system following disinfectant label 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 use the immersion method or the wipe method Immersible transducers can be disinfected only if the product labeling of the compatible
107. 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 cm2 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 Chapter 6 Safety BASo noSite Table 4 Acoustic Output Terms and Definitions Continued Term Definition 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 z1 Derated ultrasonic power at axial distance z4 in units of milliwatts Ispta 3 Z1 Derated spatial peak temporal
108. cscasscsesesetatsssssastcctagesceasetsetereneseistntatacheyeteseienasetite 205 Non Medical Grade ss sssssssssssssssssessesssstssresssstsssnrenresnresreennseneens 205 Temperature Pressure and Humidity Limits ccceeeeee 205 Operating Limits SySteM sssssisressrrirrsrisrrssorirrriinrisionisrrrsriseesees 205 Shipping Storage Limits System without Battery 0 205 Operating Limits Battery oo eee ceseneeneeeeeneeeteeeeenee 205 Shipping Storage Limits Battery sssini 205 Operating Limits Transducer ssscssscsrcnosssnrsniiass 206 Shipping Storage Limits Transducer ccccsssseeeeeeeeens 206 jE Perot au Core EAEE E T E E E A 206 Battery tisscscsttesiisdsiesesetitsessiedsdsnidessausiasassasedataeariinananbeateaiaslisiasecaseieanss 206 Electromechanical Safety Standards oes eeeseseseeeeeeneneeees 206 EMC Standards Classification cccceceeeseseseseeeeeeeereeeeneeneteneeneaes 206 Airborne Equipment Standards ccccseessssesseseeeeseseseeeseeeesenens 207 DICOM Standard cies itiaieshisdacaaendeuiuaandneiaaantin 207 HIPAA Standard serresipeninniegen nianie 207 Chapter 10 Glossary DNE n o a AE E EA 209 AGONY S aonair asitin ai a irin 211 AQE nonssnnonsnmsaninnnnnnns a nro 217 Bl Sonosite Chapter 1 Introduction Please read the information in this user guide before using the TITAN high resolution ultrasound system It applies to the ultrasound system and transducers 5 ot g Q A E
109. ct Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Highlight the next measurement and press the Select key 8 Repeat these steps until all measurements have been performed BRWN nn N View or Repeat 1 Highlight the desired measurement from the calculations menu Saved The saved measurement is shown at the bottom of the calculation Measurement menu 2 Press the Select key or the Caliper key to select the measurement 3 Repeat the measurement The new results are displayed in the measurement and calculation data area You can compare the active measurement to the saved measurement 4 To save the new measurement select Save from the on screen menu or press the Enter key S212 9 sea Note This will save the new measurement to the patient report and overwrite the previously saved measurement Delete 1 Highlight the measurement Measurement 2 Select Delete from the on screen menu This will remove the last saved measurement from the patient report TITAN Chapter 4 Measurements and Calculations 79 wn Go v o gt E063cm v A 0 50 B050 C 0 55 v D 0 68 v E053 cm K Delete v Figure 8 Follicle Measurement Follicle Note You
110. ctivity Configuring Printers Be 2004Sep29 16 13 Configure Printers Mg Alias Model IP Address Port AE Title Agfa_DS2000 120 20 20 20 104 New_AE_Titl List of printers m Printer Name New_Name IP Address 120 20 20 20 os Alias Alias_03 Port 104 Printer specific information Model Agfa_DS2000 AE Title New_AE_Title i Ping 113 Next New Delete Symbols Cancel Save IN Log Import Export Done Figure 5 Printers Configuration Page 1 Name Network hostname for a printer Alias Personalized name for a printer Model List of Agfa Codonics and Kodak printer models If a specific model is not listed choose one of the generic models at the end of the list IP Address Unique identifier for the printer Port Device port number IP port 104 is normally assigned for DICOM AE Title Printer DICOM Application Entity Title Ping Utility to determine whether a specific IP address is accessible Chapter 5 DICOM Connectivity SonoSite 2003Jan05 02 07 Configure Printers Alias Model IP Address Port AE Title 4 Printer Film Size 8inXx10in Attempts fs E Film Type Clear Fim Interval sec 15 Destination Processor Copies j1 Format 2X3 Priority Medium Orientation Portrait 213 Next New Delete Cancel Save Log Import Export Done Figure 6 Printers Configuration Page 2 Film Size Film sizes supported by the prin
111. d Reference Global Maximum Index Value line Data is not applicable for this transducer mode TITAN Chapter 6 Safety Table 9 Transducer Model C15 4 2 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt 1 Global Maximum Index Value a a 3 2 b Pr3 MPa Wo m 88 846 T min of m W 3 2 ta 3 21 J 9 z lt L U BE 2 l Se ila 0 8 3 deqlZsp 0 5487 fe M 2 17 Dim of Aaprt X c 0 5138 Y cm 1 3 PD usec 5 PRF 8 pr Pll max M 5 deq Pllmax c 0 5221 Focal Length FL cm fo E FLy cm _ lIpa 3 Mlmax W cm a Control 1 Exam Type Any ae 2 Control 2 Sample Volume 5 mm gS 2 Control 3 PRF gt 3125 O YY Control 4 Sample Vol Position 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 is not applicable for this transducer mode Chapter 6 Safety BASo nosite Table 10 Transducer Model C15 4 2 Operating Mode Color
112. d is ready to use when the save icon and the image memory counter showing the remaining available memory are displayed on the screen A D er e gt Co N faa w e M a To remove the CompactFlash card Warning To prevent loss of data loss of images or damage to the CompactFlash card turn the ultrasound system off before removing the CompactFlash card When the CompactFlash card is removed before turning off the ultrasound system the system must be restarted 1 Turn off the ultrasound system before removing the card 2 Press the ejector pin in the front card slot to position it to the outside of the system See Figure 1 on page 3 3 Press in the ejector pin to eject the CompactFlash card Note If the CompactFlash card does not eject properly try a new card 4 Remove the card 5 Push in the ejector pin to avoid damaging the ejector pin TITAN Chapter 2 Getting Started Using AC Power Charging Battery The battery charges when the system is connected to the AC power supply If the system is off and connected to AC power a completely discharged battery will fully charge in 2 5 to 3 5 hours If the system is on and connected to AC power a completely discharged battery will fully charge in 5 to 6 hours The system can run on AC power and charge the battery in three ways Connected directly to the system Connected to the mini dock See the TITAN Accessory User Guide Connected to the docking system See the
113. device or devices Select Done from the on screen menu A dialog box is displayed to restart the system The system restarts Press the Setup key and select Connectivity and then DICOM Setup Select Verify to confirm that a printer archiver or worklist server is connected Chapter 5 DICOM Connectivity The connection status of the device is identified in the Device list If the verify button is disabled restart the system a 2004May18 10 53 DICOM Location ABC m AE Title 000000_SCU Type Device Status M Printer XYZ Worklist OLDENBURG fal Verify Must reboot to enable verify Log Config Done Figure 13 DICOM Main Screen Post Verify Failed DICOM communication with the selected device was unsuccessful Success DICOM communication with the selected device was accomplished Unknown DICOM device does not support the C ECHO i e verify query command DICOM Image Archive and Print Images are sent from the TITAN ultrasound system to a PACS server or printer using an Ethernet connection The images are automatically sent when the TITAN system detects an Ethernet connection a5 This icon is present and animated when the ultrasound system is connected and images are archiving 124 Chapter 5 DICOM Connectivity BASonoSite PATIENT 4 423 45 6789 HOSPI ABC 2003Jun16 02 07 Archived PATIENT 1 123 45 6789 2003Jun16 01 41 2 v PATIENT 2 223 45 6789 2003Jul12 01 37 1 Suspended
114. dure allows position the system within reach Adjust the angle of the system display to minimize glare from overhead or outside lighting To minimize neck strain consider the following If using a stand adjust the stand height such that the display is at or slightly below eye level Position Yourself To support your back consider the following Use a chair that has support for your lower back Use a chair that adjusts to your work surface height and promotes a natural body posture Use a chair that allows for quick height adjustments Always sit or stand in an upright manner Avoid bending or stooping To minimize reaching and twisting consider the following Use a bed which 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 To promote comfortable shoulder and arm postures for your scanning arm consider the following 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 To minimize neck bending and twisting consider the following Position the ultrasound system display directly in front of you Provide an auxiliary monitor for patient viewing Chapter 2 Getting Started SonoSite Go Lightly To promote comf
115. dy 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 Warning Caution To avoid electrical shock before cleaning disconnect the system from the power supply or remove from the docking system mini dock To avoid infection always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection if a pre mixed disinfection solution is used observe the solution expiration date and ensure that the date has not passed To avoid infection the level of disinfection required for a product is dictated by the type of tissue it contacts during use Ensure the solution strength and duration of contact 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 FDA 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 watranty Do not use strong solvents such as thinner or benzene or abrasive
116. e Brown and Company 1994 44 SV LVEDV LVESV where SV Stroke Volume LVEDV End Diastolic Volume LVEDSV End Systolic Volume Velocity Time Integral VTI in cm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 383 VTI sum of abs velocities n where Auto Trace distance cm blood travels with each ejection period Velocities are absolute values Obstetrical References Amniotic Fluid Index AFI Jeng C J et al Amniotic Fluid Index Measurement with the Four Quadrant Technique During Pregnancy The Journal of Reproductive Medicine 35 7 July 1990 674 677 Average Ultrasound Age AUA The system provides an AUA derived from the component measurements from the measurement tables 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 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 Ultr
117. e Archive and Print 0 eee eeeeeeeeeees 124 Patient Information s sssssssssssssssseessssssssresnternresntesntenresesrrenrereneens 126 DICOM W rklistS siise 127 Chapter 6 Safety Ergonomic Safety csessscssissnsssesssssssssssensteasiscassasasesavenssatotactareiareseussatets 129 Electrical Safety ciirciicssioisinsiintnsrn sanaa 129 EQuipMent Safety sisasoncniramen n ng a nana AR 131 Battery Saicy acisssscsdeseseucatarscacesehasesthsaessauatebthavsstacassusschasnsresorubocssevisates 131 Biological Safety sis cessvesssdeasscasesaressnsovvesnednseyetasaishishasetneatobanassehereseeasabote 132 Electromagnetic Compatibility EMC ccceesseseeeseseeeeeeeneeenees 133 Manufacturer s Declaration s ssssssssssssssssrssrirssrissssiesstesnneessnressne 134 BASonoSite The ALARA Principle arsana inn Ei 137 Applying ALARA win nictediiauisnidiningieahohiemuesane 137 Direct Controls aniei AEE 138 Tinditect Controls scussiun E 138 Receiyer COmtrol ss uneei i a 138 Output Dis play eeen N ENNE NNE 139 Related Guidance Documents ss sssssiesiesiesieerssrerresrresrsrernress 140 Acoustic Output Measurement ssccscssnunnerossuninraiss 140 In Situ Derated and Water Value Intensities 1 0 0 0 141 Tissue Models and Equipment Survey ccesesseeeseseeeeees 141 Tnitended Uses sunsnsnisnnen sectedtaterssessseseetttevsescornsucasncnsteciecrbensdsecnas 142 About the Acoustic Output Table ccecesseeseseeeeessesneeeeenesnens 144 Acoustic Out
118. e Imaging Superficial Imaging Vascular Imaging Image Storage The number images saved to the CompactFlash card vary depending on the card storage capacity Cine buffer Accessories Hardware Software and Documentation AIUM Ultrasound Medical Safety Guidance Document Battery Biopsy Guide Carry case External display MDS Lite Mobile Docking System MDS Mini Dock Power supply Quick Reference Guide SiteLink Image Manager 2 2 System User Guide Triple Transducer Connect MDS Triple Transducer Connect MDS Lite Ultrasound gel Chapter 9 Specifications BASonoSite Cables ECG cable 6 ft 1 8 m System AC power cord 10 ft 3 1 m Peripherals See the manufacturer s specifications for the following peripherals Medical Grade Black and white printer Recommended sources for printer paper Contact Sony at 1 800 686 7669 or www sony com professional to order supplies or to obtain the name and number of the local distributor Color printer Video cassette recorder Non Medical Grade Kensington Security Cable Temperature Pressure and Humidity Limits Note The temperature pressure and humidity limits apply only to the ultrasound system and transducers Operating Limits System 10 40 C 50 104 F 15 95 R H 700 to 1060hPa 0 7 to 1 05 ATM Shipping Storage Limits System without Battery 35 65 C 31 149 F 15 95 R H 500 to 1060hPa 0 5 to 1 05 ATM Operating Limits Battery 1
119. e adjusted based on controls the system state 15 Forms Setup Access to the system settings Report Access to the patient report Review Access to the patient list and saved patient images and archive functions Patient Access to patient information 16 A Use as a shortcut to existing functionality in the system Delta key 17 Video Record Turns VCR record on and off recording Save Clip Not available Chapter 2 Getting Started Table 1 System Controls Continued System er Number Control Description 18 Freeze Freeze Stops the live imaging and displays a frozen image g Cine Review images stored in the cine buffer S back forward back forward through last in first out sequence pel All mode images can be stored and reviewed in 5 the cine buffer o 19 Update Toggles between dual and duplex screens and image modes in M Mode and Doppler e g between 2D Doppler sample line and Doppler spectral trace 20 Modes M Mode Turns M Mode on and toggles between M Mode sample line and the M Mode trace Doppler Turns Doppler on and toggles between Doppler sample line and the Doppler trace Color Turns CPD DCPD Color on and off 2D Turns 2D on Screen Layout gt Patient Name 123 45 6789 Hospital ABC 2003Dec0812 45 Benam ___ O gt 37cm Vol 43 6cm 8 gt fee Figure 4 Screen Layout Chapter 2 Getting Started SonoSite Table 2 Screen Layout Number Key Description 1 Mode Data Displays cur
120. e at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals Note You can set up three screen layouts For duplex imaging see Duplex on page 39 Select the desired scale pulse repetition frequency PRF setting from the on screen menu Select the desired baseline position from the on screen menu Note Baseline can be adjusted on a frozen trace if Live Trace is not displayed Select Invert from the on screen menu to vertically flip the spectral trace Note Invert can be adjusted on a frozen trace if Live Trace is not displayed Select the desired Doppler volume setting from the on screen menu to increase or decrease Doppler speaker volume 0 10 Select the desired wall filter setting from the on screen menu low med high Select the desired sweep speed from the on screen menu slow med fast Select Trace from the on screen menu to display a live trace of the peak or mean See Live Trace on page 39 Turn the Gain knob to increase or decrease the amount of Doppler gain 1 Press the Freeze key In 2D mode the cine icon is displayed in the system status area of the screen 2 Press the Freeze key again to return to live imaging The cine icon is removed from the system status area of the screen and live imaging begins BSonoSite Cine Buffer 2D Imaging 4il ll On a frozen image press the Cine keys to view the trace at different 45 points in time Press the
121. e 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 and thermal index National Television Standards Committee A video format setting See also PAL Phase Alternating Line A video format setting See also NTSC A Doppler recording of blood flow velocities in a range specific area along the length of the beam A depth on the display that corresponds to the skin transducer interface The ratio of total acoustic 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
122. e not checked are pending archive Patient exams that are identified with an asterisk are suspended Transfer of images is suspended when the TITAN system executes the number of Attempts and Interval configured in the configuration setup These exams need to be manually archived TITAN Chapter 5 DICOM Connectivity To manually archive or print images 1 Verify the ultrasound system is turned on and the correct location is selected With the system on check the LAN link light green LED next to the mini dock connector to verify physical connection to LAN The network connection icon in the system status area is animated during DICOM network activity when images are transferred 2 Press the Review key on the ultrasound system or If there is a current patient select List from the on screen menu Select an individual patient exam or Select All from the on screen menu 4 Select Archive from the on screen menu Any check marks or asterisks will be removed Once archived a check mark reappears to the left of the selected patient s name w Patient Information The patient information form is used to enter patient data into the system See Patient Information on page 41 for information on completing fields on the form The options listed below are only available in DICOM Worklist New aL 1 Press the Patient key Patient 2 Select New from the on screen menu This ends the current patient procedure Note New patient will
123. ect Done to return to the previous menu DICOM Usage The TITAN system can be connected through a LAN to send images from single or multiple network locations to single or multiple devices printers archivers or worklists The system can be configured to recognize a maximum of 16 printers 16 archivers and 16 worklist servers From each location you may select a maximum of two printers four archivers and one worklist server Each device selected will receive the files that you transfer Based on your connectivity needs TITAN DICOM can be configured in the following ways Stationary TITAN system location transferring to a single device or to multiple devices Mobile TITAN system locations user selects between multiple locations within the facility transferring to a single device or to multiple devices 2 2004May18 10 53 DICOM Location ABC X AE Title 000000_SCU Type Device Status M Printer XYZ M Worklist OLDENBURG Z Verify Must reboot to enable verify Log Config Done Figure 12 DICOM Main Screen Location Geographical location which identifies the network where the TITAN is connected Network and DICOM device settings can be independently configured for each defined location Chapter 5 DICOM Connectivity SonoSite AE Title Type Device Status Verify Log Config Done Refers to the Application Entity the name by which the DICOM devices on the LAN knows the TITAN system Type of device arc
124. ect Report from the on screen menu to return to the previous report page or Done to return to live imaging S212 9 sea Note For twins both measurement sets are plotted on the same graph TITAN Chapter 4 Measurements and Calculations wn v o Chapter 4 Measurements and Calculations BSonoSite Chapter 5 DICOM Connectivity DICOM Digital Imaging and Communications in Medicine is an optional data transfer feature that allows the TITAN system to connect over a local area network LAN to PACS archivers to film printers and to worklist servers This chapter contains instructions for configuring and using DICOM TITAN System Setup for DICOM To set up the TITAN system for DICOM connectivity 1 Press the Setup key 2 Select Connectivity 3 Inthe Transfer Mode list select DICOM A dialog box is displayed to restart the system Ethernet Connection To connect to a LAN Connect the Ethernet cable to the Ethernet interface cable and then connect to the Ethernet connection on the docking system mini dock See TITAN Accessories User Guide With the system on check the LAN link light green LED next to the Ethernet connector to verify physical connection to LAN DICOM Setting Backup Before configuring the TITAN system SonoSite highly recommends saving the DICOM factory settings to a CompactFlash card and storing the card in a secure location To create DICOM settings backup 1
125. ed on image patient information mode data and system status data Select OB calculation authors Configure system for user defined measurements OB Custom Measurements are an optional feature Configure Preset functions Doppler Scale Duplex Live Trace Thermal Index and Save Key Displays system hardware and software versions Chapter 2 Getting Started To set up 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 SonoSite provides a comprehensive set of tools on the TITAN system that allows its customers to meet the applicable security requirements listed in the HIPAA standard SonoSite s customers are ultimately responsible for ensuring the security and protection of all electronic protected health information collected stored reviewed and transmitted on the TITAN system x U 6 N ten S Ez U v To access administrative settings enter your administrator user name and password and then click Login Name Administrator Login To reset y
126. ements 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 TITAN Chapter 6 Safety 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 fetus 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 A survey of 1990 equipment models
127. enter a symbol special character 1 Select the desired field and then select Symbols 2 Click the desired symbol character In the Symbols dialog box the keyboard controls may also be used 3 Click OK Chapter 2 Getting Started SonoSite Forms A floating cursor is available in the setup patient and report forms The floating cursor allows interaction to occur using the touchpad and the Select key For example in the patient form placing the floating cursor over the last name field and pressing the Select key will activate that field Additionally the floating cursor can be used to interact with the list and check boxes System Setup System setup is used to customize the system Press the Setup key to access and set up the following system functions Administration Audio Battery Connectivity Date and Time Delta Key F Keys Display Information OB Calculations OB Custom Measurements Presets System Information TITAN A M faa e gt a N fad w a M a Configure system to protect patient data by requiring users to log on and enter passwords Configure for type of Audio alert Sleep delay and Power delay Configure Printer Video mode Serial Port and Transfer Mode DICOM or SiteLink DICOM and SiteLink are optional features Configure Date and Time functions Configure existing system functionality as a shortcut and create predefined labels for images Configure information display
128. eps until all measurements have been performed Chapter 4 Measurements and Calculations So nosite TITAN LV Volume Simpson s Rule View or Repeat Saved Measurement Delete Measurement N On a frozen 2D image press the Calcs key Highlight the desired calculation package and press the Select key To perform the first measurement select A4Cd and press the Select key Position the caliper at the medial mitral annulus and press the Select key to start the tracing function Use the touchpad to trace the left ventricular LV cavity Note Ifan error is made select Undo from the on screen menu to delete the previous position Complete the trace and select Set from the on screen menu or press the Select key The measurement is displayed in the measurement and calculation data area and is updated as the caliper moves Adjust the caliper position if needed Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed S212 8 sea Note The key or Save Key can be assigned in system setup to save calculations to the report See Delta Key on page 32 or Save Key on page 39 Highlight the next measurement and press the Select key Repeat these steps unt
129. er spectral trace press the Calcs key 2 Perform the calculation for SV See Stroke Volume SV on page 100 3 Perform the calculation for HR See Heart Rate HR on page 67 Heart Rate HR Note The Heart Rate is not calculated using the ECG trace 1 Ona frozen Doppler spectral trace press the Calcs key 2 Select desired cardiac calculation package Heart Rate is available in all cardiac packages 3 Select HR and press the Select key See Heart Rate HR on page 67 Chapter 4 Measurements and Calculations BSo nosite Vascular Heart rate 65 bpm Cardiac 20 M Mode Right Diastolic cm Systolic em Prox cms Mid cmJs Dist cm s Vol Flow0 17lim s d s d s d D 0 58em CCA 80 2 207 838 198 96 6 189 TAM 10 6cm s KA 874 207 60 180 514 162 ECA 71 2 198 775 17 1 748 189 Bulb 78 4 er VArty 43 3 LV Volume SS Ratio 1 01 o Diastolic mi Systolic mi 4 AAC 114 9 40 5 A2C 122 4 37 1 Biplane 119 8 39 1 EF 67 CO 6 1m SV 80 7mi Figure 13 Example of Vascular Report Screen and Cardiac Report Patient Reports 1 Press the Report key The current patient report is shown with the following on screen menu options b Next Page 1 x Done M w H go Q L A v Note The pound symbol is displayed on the patient report when an entry is out of range e g too large or small Note The value for a calculation is displayed only when the calculation has been performed 2 Select Next Page
130. erase any previously entered information including any calculations and report pages To save this information save the screen for each item e g report pages patient information calculations and graphs 3 Enter information into appropriate fields Procedure Select the procedure type only available when DICOM Worklist feature Type is licensed and configured Procedure Enter desired identification information The field is editable when ID performing a manual patient query Query The Query on screen menu is displayed when the following is set up Data is entered in the following fields Patient Last First Middle Patient ID Accession Procedure ID TITAN is connected to a LAN Worklist server is active See To perform a manual patient query on page 127 Chapter 5 DICOM Connectivity So nosite Worklist 1 Press the Patient key 2 Select Worklist from the on screen menu to view all scheduled patient procedures that have been queried by the system DICOM Worklists DICOM worklist provides the ability to import patient data from the Hospital Information System or Radiology Information System The patient information form also provides the ability to enter specific patient data and query the worklist server for a matching patient procedure The system s worklist capability functions only when the following is set up The system is configured before using DICOM See DICOM Configuration on page 106 The system
131. erating 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 is not applicable for this transducer mode Chapter 6 Safety BASo nosite Table 8 Transducer Model C11 8 5 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 a a 1 0 a Pr3 MPa Wo m 12 693 v min of m E W3 z1 lTa 3 z1 go Z1 lt L BS Zp 1 4 a deg Zsp 0 2119 lt x fe M 4 39 Dim of Aaprt X c 0 40 Y c 0 50 PD usec 5 PRF z pr Pll max M 5 deq Pllmax c 0 1989 Focal Length FL cm ep pl ext 5 FL cm Ipa 3 MI max W cm Control 1 Exam Type Any 2s 6 Control 2 Sample Volume 1mm S Control 3 PRF 15625 or Oc Bo 5 20833 cw 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 liste
132. es and only one of these is displayed at any one time In order to display properly and meet the ALARA principle the user selects an appropriate TI based on the specific exam being performed SonoSite provides the AIUM Medical Ultrasound Safety reference which contains guidance on how to determine which TI is appropriate see second reference listed in Related Guidance Documents below 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 1998 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 American Institute of Ultrasound in Medicine 1998 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 prepared by its Bioeffects Committee Bioeffects Considerations for the Safety of Diagnostic
133. eseseseseseseseseeeseseees 68 Calculations nouae E EEA tin ed 72 Percent Reduction Calculations 0 ccccccccccccsscesecssesecesesecsssesseseees 72 Volume Calculation wo cccccccccccecscccscssesssscssssesccssscesssssesessessesssseseass 74 Volume Flow Calculation wi ccccccccccccccccscssssessssssccsssssessessssesensesease 76 Gya Calculations sa R 78 OB Call culations a ana Er AAE TEE EEI ERIEN EEE EA 81 Vascular Calculations w cccccccccccccssscscscsscssssessssescessssssecsesssseseseeese 89 Cardiac Calculations c cccccccccessccssscssccssscssesescessesessssssesscsasecsssenes 92 Patient Report cssssiicanicacinaacismancisariinsnnsicnsitas 101 Chapter 5 DICOM Connectivity TITAN System Setup for DICOM uu ccccssssssesseseeseeseseseeeeeeeseesens 105 Ethernet Connect i icscecctecacicavssscteesusieisareredhconssveastssarsnsestsinvsastesess 105 DICOM Setting Backup anemensrnrononuninoniininianei 105 DICOM Gonfi puration einenesnnrononienienononan iaia s 106 Config ring Locations serenrinrsreiiiiarannanin ns 106 Configuring Archivers encnsrenannnnnaniin ann 109 Configuring Printers ninsa nE RN 112 Configuring Worklist Servers ss ssssssssisssissssissrirssriessnresreessnne 116 Configuring Procedures sernoroneniiiienini i nis 119 Importing and Exporting Configurations ccccceeeeee 120 Reviewing the Network Log s ssssessssisssissssiesriessrinssnresriessnienress 121 DICOM USDE naa satiated pair aitaiaiais dareaaanapees 122 DICOM Imag
134. ginally Interventional and Intraoperative Imaging Applications This system transmits ultrasound energy into the various parts of the body using 2D color Doppler Color color power Doppler CPD directional color power Doppler DCPD Tissue Harmonic Imaging THI and pulsed wave PW Doppler to obtain ultrasound images that provide guidance during interventional and intraoperative procedures This system can be used to provide ultrasound guidance for biopsy and drainage procedures vascular line placement peripheral nerve blocks ova harvesting amniocentesis and other obstetrical procedures and provide assistance during abdominal and vascular intraoperative procedures Warning This system is not intended for use in providing guidance for central nerve blocks i e the brain and spinal cord or for ophthalmic applications Obstetrical Imaging Applications This system transmits ultrasound energy into the pelvis of pregnant women using 2D M Mode color Doppler Color color power Doppler CPD directional color power Doppler DCPD Tissue Harmonic Imaging THI and pulsed wave PW Doppler to obtain ultrasound images The fetal anatomy viability estimated fetal weight gestational age amniotic fluid and surrounding anatomical structures can be assessed for the presence or absence of pathology transabdominally or transvaginally CPD color Doppler Color and DCPD imaging is intended for high risk pregnant women High risk pregnanc
135. grees 3 Press the Select key again to set the desired angle Gate Size L Select the desired gate size setting from the on screen menu PW only Note Gate size options vary with transducer and exam type Steering Select the desired steering angle setting from the on screen menu L38 and gt This automatically changes PW angle correction to the optimum setting HST only Steering angle of 15 degrees has an angle correction of 60 degrees Steering angle of 0 degrees has an angle correction of 0 degrees Steering angle of 15 degrees has an angle correction of 60 degrees Note The angle correction can be adjusted manually after steering has been selected See Angle Correction PW only Note If two modes are active CPD DCPD Color and PW CW Doppler press the Select key to toggle between on screen menus Doppler Spectral Trace Scale Line gt invert i Figure 8 Doppler Trace Image TITAN Chapter 3 Imaging Spectral Trace Scale Line Invert Volume Wall Filter Sweep Speed Live Trace Gain Freeze Chapter 3 Imaging 1 Press the Doppler key again to acquire the Doppler trace 2 Press the Update key to toggle between the 2D sample line and trace 3 In duplex press the Doppler key to return to the full screen Doppler sample line The on screen menu options for Doppler spectral trace are Scale Baseline Invert Volume Wall Filter Sweep Speed Live Trace peak or mean Note The time scal
136. gt ao Le i e Figure 2 TITAN System Back View Table 2 System Back Connectors Number Feature 1 DC input connector 2 I O connector 3 Battery 4 ECG connector The TITAN system is a portable software controlled ultrasound system using all digital architecture The system is used to acquire and display high resolution real time ultrasound images 2D color power Doppler CPD directional color power Doppler DCPD Color Doppler Color Tissue Harmonic Imaging THI M Mode pulsed wave PW Doppler and continuous wave CW Doppler The system has cine buffer image zoom labeling biopsy measurements calculations a USB connection for image transfer image storage image review printing recording and the ability to archive Doppler with audio output to a videotape Currently the system supports the following broadband transducers C8 8 5 MHz 8 mm microcurved array C11 8 5 MHz 11 mm microcurved array C15 4 2 MHz 15 mm microcurved array C60 5 2 MHz 60 mm curved array HST 10 5 MHz 25 mm linear array ICT 8 5 MHz 11 mm intracavitary array L25 10 5 MHz 25mm linear array L38 10 5 MHz 38 mm linear array System accessories include the following TITAN mobile docking system TITAN MDS Lite TITAN mini dock Triple Transducer Connect a power supply a battery ECG cable video and printer cables SiteLink Image Manager 2 2 software and DICOM connectivity See the TITAN Accessory User Guide for information on the
137. h as shielding 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 3V meter EMI immunity limit interference level to 0 0014 V meter TITAN Chapter 6 Safety Caution To avoid the risk of increased electromagnetic emissions or decreased immunity use 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 TITAN Accessories User Guide 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 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 Manufacturer s Declarati
138. he Setup key Select OB Custom Meas or OB Calculations Select Tables from the on screen menu Select the desired table Age or Growth and measurement author View OB Tables BRWN TITAN Chapter 2 Getting Started Create New OB Custom Tables 1 Press the Setup key 2 Select OB Custom Meas or OB Calculations 3 Select Tables from the on screen menu 4 Select the desired table Age or Growth 5 Inthe measurement list select the desired measurement for the custom table 6 Select New from the on screen menu 7 Inthe Author field enter a unique name 8 Enter the data 9 Select Save from the on screen menu Two custom tables may be created for each OB measurement ao J 7 w 7a te c B P v Note To display the measurement for the custom table in the calculation menu see To set up OB calculations authors on page 34 and select More Note Growth analysis tables cannot be created for custom OB measurements Edit OB Custom Tables 1 Press the Setup key 2 Select OB Custom Meas or OB Calculations 3 Select Tables from the on screen menu 4 Select the desired custom OB table 5 Select Edit and enter data and then select Save from the on screen menu Delete OB Custom Tables Press the Setup key Select OB Custom Meas or OB Calculations Select Tables from the on screen menu Select the desired custom OB table Select Delete from the on screen menu to rem
139. he following table shows the transducers and exam types that provide a volume flow calculation Table 4 Transducers and Exam Types for Volume Flow Transducer Exam Types Gate Sizes mm C60 Abdomen 2 3 5 8 10 12 L38 HST Vascular 1 3 5 7 10 12 ke The following table shows the measurements required to complete the volume flow calculation gt Table 5 Volume Flow Calculation Measurement Calculation Result D 2D distance VF Volume Flow TAM Doppler auto trace Volume flow measurements are done in 2D and Doppler Both measurements are required for the volume flow calculation The Doppler sample volume should completely insonate the vessel Note The following factors should be considered when acquiring volume flow measurements Users should follow current medical practice for volume flow calculation applications The accuracy of the volume flow calculation is largely dependent on the user The factors identified in the literature that affect the accuracy are Using the diameter method for 2D area Difficulty ensuring uniform insonation of the vessel The TITAN system is limited to the sample volume sizes listed in Table 4 Precision in placing the caliper Accuracy in angle correction The considerations and degree of accuracy for volume flow measurements and calculations are discussed in the following reference Allan Paul L et al Clinical Doppler Ultrasound 4th Edition Harcourt Publishers Limited 2000 pp 36 38
140. he grace period has expired the system will not be usable until a valid license key has been entered Grace period time is not consumed while the system is powered off or when it is in sleep mode Whenever a system is running in the grace period the grace period time remaining is available on the license update screen Caution When the grace period expires all system functions except for licensing are unavailable until a valid license key is entered into the system Upgrading the System and Transducer Software As described in Chapter 1 About the System Software on page 5 software upgrades are provided on CompactFlash cards which are installed in the back CompactFlash slot on the right hand side of the system Upgrades provided may be required or optional Whenever you install a CompactFlash card containing a newer version of software into the system the system will determine the level of software prepare the system for the upgrade and then install the new software onto the system When a CompactFlash card contains new transducer software and the transducer that requires a software upgrade is connected the system prompts the user that the transducer requires the upgrade e c z o a S e e gt a TITAN Chapter 7 Troubleshooting and Maintenance To upgrade the system software 1 Remove any transducer or Triple Transducer Connect from the TITAN system 2 Connect the TITAN system directly to t
141. he power supply or through the docking system mini dock See the TITAN Accessories User Guide 3 Insert the CompactFlash card into the back slot The system displays the following message Figure 1 Upgrade System Software 4 Select Yes to accept or No to cancel the upgrade When you accept the system software upgrade the system begins to load the new software and prepare for the upgrade and displays the following message 2 2003Juni7 23 04 Troubleshooting Figure 2 System Software Loading Chapter 7 Troubleshooting and Maintenance BSo nosite When the software upgrade has prepared the system for upgrade the system displays the following message 2003Jun17 23 04 Figure 3 System Software Step 1 Restart 5 Select Restart After restart there is a short delay before the system goes into the upgrade process Do not turn the system off The system displays the following message 2 2003Juni7 23 04 f c z o a S e e gt Co Figure 4 System Software Installation TITAN Chapter 7 Troubleshooting and Maintenance When the upgrade is completed the system displays the following message Figure 5 System Software Step 2 Restart 6 Select Restart When the operating software has been replaced the system presents you with the license update screen so that you may license the software If upgrading a transducer press Cancel from the on screen menu gt 2003Jan05 01 30 4
142. his system transmits ultrasound energy into various parts of the body using 2D M Mode color Doppler Color color power Doppler CPD directional color power Doppler DCPD and pulsed wave PW Doppler to obtain ultrasound images The breast thyroid testicle lymph nodes hernias musculoskeletal structures soft tissue structures and surrounding anatomical structures can be assessed for the presence or absence of pathology This system can be used to provide ultrasound guidance for biopsy and drainage procedures vascular line placement and peripheral nerve blocks Warning This system is not intended for use in providing guidance for central nerve blocks i e the brain and spinal cord or for ophthalmic applications Vascular Imaging Applications This system transmits ultrasound energy into the various parts of the body using 2D M Mode color Doppler Color color power Doppler CPD directional color power Doppler DCPD and pulsed wave PW Doppler to obtain ultrasound images The carotid arteries deep veins in the arms and legs superficial veins in the arms and legs great vessels in the abdomen and various small vessels feeding organs can be assessed for the presence or absence of pathology About the Acoustic Output Table Transducer Model is the SonoSite transducer model Table 4 Acoustic Output Terms and Definitions Term Definition Ispra 3 Derated spatial peak temporal average intensity in units of milliwatts
143. hiver printer or worklist server Name by which TITAN knows the printer archiver or worklist server Indication of whether the device is available for use Test to ensure that the selected devices can communicate to the devices and servers Log file for troubleshooting DICOM problems See Reviewing the Network Log on page 121 Access to a series of pages for configuring network devices See DICOM Configuration on page 106 Returns to the previous page if no changes are made or restarts the To select a location archiver printer or worklist server Note The system must be configured before using DICOM See DICOM Configuration on page 106 1 2 3 system if changes are made Press the Setup key and select Connectivity and then DICOM Setup In the Location list select the current location of the TITAN system In the Device list select one or more archivers printers or worklist servers A check mark is displayed next to each device selected A maximum of two printers four archivers and one worklist server may be selected for each location Select the device again to deselect Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system To verify status of an archiver printer or worklist server 1 2 3 TITAN Press the Setup key and select Connectivity and then DICOM Setup From the Device list select the desired
144. icense 163 upgrade 164 special characters 20 specifications 203 TITAN spectral trace 56 standards airborne equipment 207 DICOM 207 electromechanical 206 EMC classification 206 steering CPD DCPD 53 Doppler 55 sterilizable transducers 174 storage specifications equipment 205 stroke volume SV 100 superficial intended uses 144 symbols 20 symbols labeling 158 system clean and disinfect 172 software 5 specifications 205 turn on off 12 upgrade software 163 wake up 12 system control AC power indicator 15 alphanumeric 14 annotation 14 caliper calcs 15 depth 14 forms 15 freeze 16 gain 15 modes 16 power 14 print 15 remappable controls 15 save 15 select 15 THI 14 touchpad 15 update 16 video recording 15 zoom 15 system dimensions 203 system setup beep alert 28 date 31 delta key 32 Index Index description 21 DICOM 105 Doppler scale 39 duplex images 39 export OB tables 34 F keys 32 gestational age 34 growth analysis 34 import OB tables 35 key click 28 live trace 39 mode data 33 OB custom measurement 36 patient header 33 power delay 28 printer 29 save key 39 security 22 serial port 29 sleep delay 28 system information 40 system status 33 thermal index 39 time 31 transfer mode 29 video mode 29 system status 17 T temperature limits 205 text description 17 enter 58 entry problems 162 thermal index TI 139 210 THI description 14 turn on off 48 time 31 tissue models 141 to
145. id Phenol T C TC N N T C TC N NELIL Q a D ge D z y e Z jen D n gt O e aA 5 Q 5 a 2 5 D 5 D 5 a Table 3 Disinfectants Compatibility with System and Transducers Continued Cetera Gh Wee Atveingresint SY CIS scr st ce us Sem Sporicidin 2 4 USA Wipe Phenol TC TC N N T C TC N Sporicidin Sterilant 2 4 USA Liquid Phenol Sodium U U U T C U U U 5 Phenate Glute Sporox II 4 USA Liquid Hydrogen Peroxide U U U T C U U U Staphene 4 USA Spray Ethanol T C N N N TC TC A Steam sterilization USA Gas Water N N N N N N N Steranios France Liquid Gluteraldehyde TC TC TC U TC TC A STERIS 4 USA Liquid Peracetic Acid U U U N U U U Surfaces Hautes 3 France Spray Quat Ammonia U U U N U U U Surg L Kleen USA Liquid U U U N U U U T Spray USA Spray Quat Ammonia T C T C N N T C N A T Spray Il USA Spray Alkyl Chloride TC TC N N TC TC A TBQ 4 USA Liquid Alkyl TC TC N N TC TC N Theracide USA Liquid Quat Ammonia TC TC N N U U U Theracide USA Wipe Quat Ammonia TC TC N N U U U Thericide Plus USA Liquid Quat Ammonia T C TC N N TC T C A Thericide Plus USA Wipe Quat Ammonia TC TC N N T C T C A Tor 4 USA Liquid Quat Ammonia T C T C N N T C N N Tor Spray USA Spray Butoxyethanol N N N U N N N Alkane Bunooysajqnoll Troubleshooting p Table 3 Disinfectants Compatibility with System and Transducers Continued gel y Cleaning Solutions oforigm DPE Activelngredient 3g cy I
146. idelines are intended to assist you in the comfort and effective use of your ultrasound Rj system T a Warning Use of an ultrasound system may be linked to musculoskeletal disorders Use of an ultrasound system is defined as the physical interaction between the operator the ultrasound system and 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 musculoskeletal disorders 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 This chapter provides guidelines that may help you work m
147. il all measurements have been performed Use the touchpad to highlight the desired measurement from the calculations menu The saved measurement is shown at the bottom of the calculation menu Press the Select key or the Caliper key to select the measurement Repeat the measurement The new results appear in the measurement and calculation data area You can compare the active measurement to the saved measurement To save anew measurement select Save from the on screen menu or press the Enter key Note This will save the new measurement to the patient report and overwrite the previously saved measurement Use the touchpad to highlight the measurement Select Delete from the on screen menu This will remove the last saved measurement from the patient report Chapter 4 Measurements and Calculations wn Go v o Doppler Cardiac Calculations The following table shows the measurements required to complete the desired cardiac calculation The cardiac measurements are done in PW Doppler and CW Doppler mode For definitions of acronyms see Acronyms on page 211 Table 15 Cardiac Calculations in Doppler Anatomy Cardiac Measurement Calculation Result MV Mitral Valve LVOT Left Ventricular Outflow Tract AV Aortic Valve TV Tricuspid Valve Chapter 4 Measurements and Calculations E A PHT deceleration time dP dT VTI Vmax or VTI VTI LVOT D in 2D VTI or
148. in the back slot of the TITAN system See Installing and Removing the CompactFlash Card on page 11 2 Press the Setup key Select Administration 4 Select Export from the on screen menu All user names and passwords are copied to the CompactFlash card 5 Remove the CompactFlash card Ww Import User Account 1 Insert the CompactFlash card in the back slot of the TITAN system See Installing and Removing the CompactFlash Card on page 11 2 Press the Setup key 3 Select Administration 4 Select Import from the on screen menu A dialog box is displayed 5 After all user names and passwords are imported the system restarts Note All user names and passwords currently on the system are replaced with the imported date Reset To return settings for this setup page to factory default select Reset from the on screen menu TITAN Chapter 2 Getting Started A M faa e gt a N Pa w a M a To view export and clear event log The Event Log collects errors and events and can be exported to a CompactFlash card and read by a CompactFlash card reader 20040ct01 12 68 U 6 N te c B u v 2004 10 01 11 51 User Administrator logged in 2004 10 01 12 49 User Administrator logged in Figure 9 Event Log Event Log 1 Press the Setup key 2 Select Administration 3 Select Log from the on screen menu The Event Log is displayed 4 Select Back to return to the previous menu E
149. ing TITAN 1 Press the M Mode key again to acquire the M Mode trace Note The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals 2 Press the Update key to toggle between the sample line and trace 3 Induplex press the M Mode key to return to the full screen M Mode sample line Note You can set up three screen layouts For duplex imaging see Duplex on page 39 Select the desired sweep speed from the on screen menu slow med fast Turn the Near Far or Gain knobs on the lower left side of the control panel to increase or decrease the amount of gain applied to the near field far field or the overall image near and far correspond to the time gain compensation TGC controls found on other ultrasound systems 1 Press the Freeze key 2 Press the Freeze key again to return to live imaging The cine icon is removed from the system status area of the screen and live imaging begins Note Press the M Mode or Update key to display the associated frozen 2D image with the M Mode sample line On a frozen image press the Cine keys to view the trace at different points in time Press the 2D key to return to 2D imaging Chapter 3 Imaging Color Doppler Imaging Note Color power Doppler CPD directional color power Doppler DCPD and color Doppler Color are optional features and are dependent on transducer and exam type The following instructions cove
150. ink Alternate Gateway S _Ethernet Setup Network Speed Auto Negotiate r PS a Esej cence Figure 12 Setup Screens Connectivity and Ethernet Printer 1 Press the Setup key 2 Select Connectivity 3 In the Printer list select the desired printer from the list of recommended printers Video mode 1 Press the Setup key 2 Select Connectivity 3 Inthe Video mode list select NTSC or PAL for the desired mini dock video output Serial Port 1 Press the Setup key 2 Select Connectivity 3 In the Serial Port list select VCR DVD or Computer PC 4 Restart the system to activate VCR or DVD connectivity 5 Attach a serial cable RS 232 to the serial port from the TITAN mini dock TITAN docking system to the VCR DVD or PC Note If PC is selected the system allows report data to be sent as ASCII text from the TITAN system to a PC Special third party software must be on the PC to acquire view or format the data into a report Check the compatibility of your software with SonoSite technical support Transfer Mode 1 Press the Setup key 2 Select Connectivity 3 Inthe Transfer Mode list select DICOM or SiteLink After changing connectivity a dialog box is displayed to restart the system Note The settings for SiteLink Image Manager and TITAN configurations must correspond See the SiteLink Image Manger 2 2 User Guide TITAN Chapter 2 Getting Started ao J p 7a te c B bag 7
151. ion date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 41 The following table shows the transducers and exam types that provide a volume calculation Table 3 Transducers and Exam Types for Volume Transducer Exam Types C8 Gyn Prostate C11 Vascular Neonatal Abdomen C15 Abdomen 2 C60 Gyn Abdomen E HST Vascular Superficial Muscle L25 Superficial Vascular Small Parts ICT Gyn L38 Breast Small Parts Vascular The following measurements D D D 2D distance are required to complete the volume calculation Volume measurements are performed in 2D mode 11 Sd X Delete v Save Figure 6 2D Image with Volume Calculation Chapter 4 Measurements and Calculations S0 noSsite TITAN Volume Calculation View or Repeat Saved Measurement Delete Measurement Note D1 D and D are required to complete a volume calculation 1 2 On a frozen 2D image press the Calcs key Use the touchpad to highlight the desired measurement from the calculations menu and press the Select key Perform the measurement The selected measurement is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Select Save from the on screen menu or press the Enter key to save the measurement to the patient report
152. ired Secondary Capture Attempts Number of times the TITAN system tries to resend a failed file transfer Interval Amount of time between attempts Chapter 5 DICOM Connectivity Sonosite To configure a new archiver 1 NOB WNDN N To delete an archiver 1 2 TITAN Ensure the TITAN system is set up for DICOM connectivity See To set up the TITAN system for DICOM connectivity on page 105 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu In the Configure list select Archivers Select New Enter information in the fields pages 1 and 2 The Name cannot contain special characters The Alias and AE Title may contain special characters The IP address and port must be entered before the information is saved Note To use special characters select Symbols See To enter a symbol special character on page 20 Note Use the space bar on the keyboard to enter the underscore symbol Select Cancel to undo last change Select Save Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Select the name of the device from the list of archivers Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 DICOM Conne
153. is User Guide Symbols and terms used on the system are explained in Screen Layout on page 16 Chapter 5 DICOM Connectivity and or Chapter 10 Glossary Upgrades and User Guide Updates SonoSite may offer software upgrades new features and improvements to the system performance User guide updates accompany the upgrade software and provide detailed information on the enhancements Customer Comments Questions and comments are encouraged SonoSite is interested in your feedback regarding the system and the user guide Please call SonoSite at 1 888 482 9449 If you are outside the USA call the nearest SonoSite representative You can also send electronic mail e mail to SonoSite at the following address comments sonosite com Chapter 1 Introduction BSonoSite About the System The ultrasound system has multiple configurations and feature sets All are described in this user guide but not every option may apply to your system System features are dependent on your system configuration transducer and exam type 5 ot g Q A E Figure 1 TITAN System Front View Table 1 System Front Features Number Feature 1 Control panel 2 Transducer connection 3 Handle 4 Display 5 CompactFlash slots front for image storage back for system and transducers updates import export OB tables user names passwords and DICOM configurations TITAN Chapter 1 Introduction S 2 v
154. is connected to a LAN See To connect to a LAN on page 105 A worklist server has been configured for the active location To perform a manual patient query 1 o0 Ensure that a worklist server is configured and is communicating with the TITAN by selecting Verify on the main DICOM configuration screen Press the Patient key Select New from the on screen menu This ends the current patient procedure Note New patient will end the existing exam and will erase any previously entered information including any calculations and report pages To save this information save the screen for each item e g report pages patient information calculations and graphs Enter data in any of the following six fields Patient Last First Middle Accession Number Patient ID or Procedure ID A query is made on the character or characters e g searching for Smith will return Smith Smithson Smithy Select Query from the on screen menu After the query has completed the total number of patient procedures matching the query is displayed in the lower right corner of the screen Use the touchpad to highlight the desired patient procedure and then Select from the on screen menu The information is displayed on the Patient Information form In the Type list edit the desired procedure type if required Select More to enter information on page 2 Select Done from the on screen to return to previous page To perform a manual work
155. lculation menu Press the Select key Use the touchpad to position the caliper at the peak systolic wave form Press the Select key A second caliper is displayed on the screen The active caliper is highlighted green Use the touchpad to position the second caliper at end diastole on the waveform The results are displayed in the measurement and calculation data area and are updated as the caliper moves Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed S212 9 sea Note The A key or Save Key can be assigned in system setup to save calculations to the report See Delta Key on page 32 or Save Key on page 39 Repeat these steps until all measurements have been performed Use the touchpad to highlight the desired measurement from the calculations menu The saved measurement is shown at the bottom of the calculation menu Press the Select key or the Caliper key to select the measurement Repeat the measurement The new results appear in the measurement and calculation data area You can compare the active measurement to the saved measurement To save anew measurement select Save from the on screen menu or press the Enter key Note This will save
156. leaning solution to remove any particulate matter or body fluids Apply the solution to the cloth rather than the surface Rinse with water or a wipe with water dampened cloth then wipe with a dry cloth Mix the disinfectant solution compatible with the transducer following disinfectant label instructions for solution strengths and disinfectant contact duration Immerse the transducer into the disinfection solution not more than 12 18 inches 31 46 cm from the point where the cable enters the transducer Follow the instructions on the disinfectant label for the duration of the transducer immersion 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 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 Sterilizable Transducers The only method of sterilizing SonoSite transducers is liquid sterilants See Table 3 Disinfectants Compatibility with System and Transducers on page 177 174 Chapter 7 Troubleshooting and Maintenance BSonoSsite Cleaning and Disinfecting Transducer Cables The transducer cable can be disinfected using a recommended wipe or immersion disinfectant Before disinfecting orient the cable to ensure that the transducer and system do not get immersed expiration date and ensure
157. lects network errors and events typically to support diagnostics and can be exported to a CompactFlash card and read by a CompactFlash card reader The log contents are saved when the TITAN system is turned off The log has a finite amount of space and writes over existing information when it is full gt 2003Jan05 02 09 Network Log Export Clear l Done Figure 11 Network Log Clear Deletes all entries from the log Export Copies the contents of the log to the CompactFlash card back slot The log file is named log txt on the CompactFlash card Done Returns to the previous page To export log Note The Event log and the DICOM network log have the same filename log txt When you export either one to the same CF card it will overwrite the existing log txt file 1 Insert the CompactFlash card in the back slot of the TITAN system 2 Press the Setup key and select Connectivity and then DICOM Setup 3 Select Log and then Export from the on screen menu 4 View the files on a CompactFlash card reader The log is a text file that can be opened by a text file application e g Microsoft Word or Notepad The log file is named log txt TITAN Chapter 5 DICOM Connectivity To clear log 1 Press the Setup key and select Connectivity and then DICOM Setup 2 Select Log from the on screen menu 3 Select Clear from the on screen menu to delete all text A dialog box is displayed 4 Select Yes to delete or No to cancel 5 Sel
158. list update 1 2 TITAN Press the Patient key Select Worklist from the on screen menu and then select Update from the on screen menu Chapter 5 DICOM Connectivity 127 To perform an automatic worklist update 1 Ensure TITAN system is turned on and connected to the LAN See To connect to a LAN on page 105 2 Ensure TITAN system is set up for an automatic worklist query See To set up an automatic query update on page 118 The worklist is automatically updated 3 Verify the current system date and time To sort a worklist 1 Press the Patient key 2 Select Worklist from the on screen menu 3 Select the desired column heading Name ID Accession Procedure or Date The worklist is sorted in ascending order Chapter 5 DICOM Connectivity Bso noSsite Chapter 6 Safety Read this information before using the ultrasound system The information in this guide applies to the ultrasound system transducer accessories and peripherals This chapter contains information required by various 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 A Warning describes precautions necessary to prevent injury or loss of life A Caution describes precautions necessary to protect the products Ergonomic Safety Warning To prevent musculoskeletal disorders follow the
159. lts See Table 15 1 Ona frozen Doppler spectral trace press the Calcs key 2 Highlight the LVOT AV or PV and press the Select key 3 Select VTI and press the Select key 4 Perform manual or automatic trace See Manual Trace on page 71 and Automatic Trace on page 71 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations 97 Pressure Half Time Note PHT is calculated by measuring deceleration time from peak to baseline PHT 1 Ona frozen Doppler spectral trace press the Calcs key 2 Highlight MV and press the Select key 3 Select PHT 4 Position the first caliper at the peak and press the Select key A second caliper is displayed Position the second caliper along the EF slope 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Delta Pressure Note To perform the dP dT measurements the Doppler scale must include v Delta Time dP dT velocities of 300 cm
160. m HR Enter the Heart Rate only in vascular exam If the heart rate is obtained and saved using M Mode the values will override the number entered on the patient information screen BP Enter blood pressure only in vascular exam Symbols See Symbols on page 20 More Sonographer Enter initials Reading Dr and Referring Dr Enter names Institution Enter name Note All patient information can be edited up until the first image is saved After the first image is saved the Patient Name ID and Accession number cannot be modified Modifying these fields closes the current patient exam and starts a new exam Select Done from the on screen menu to save information and return to previous menu Previous Exams only in OB exam Enter data from previous exams Data from five previous exams may be entered For twins select Twin A B from the on screen menu to enter data for each twin Note The date for a previous exam must precede the current system date Select Done from the on screen menu to save information and return to previous menu Press the Patient key Select End Exam from the on screen menu to close the current patient exam Note Selecting End Exam selecting New Patient or modifying patient name or ID erases any previously entered information including any calculations and report page To save this information save the screen for each item e g report pages patient information calculations Bl So
161. may save up to six follicular measurements One distance Measurement measurement is provided for each follicle 1 2 3 4 N Select Gyn exam type On a frozen 2D image press the Calcs key Select Follicle Highlight the desired measurement from the calculations menu and press the Select key Perform the measurement on the first follicle The measurement is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Highlight the next measurement and press the Select key Repeat these steps until all measurements have been performed Chapter 4 Measurements and Calculations Sonosite View or Repeat 1 Highlight the desired measurement from the calculations menu Saved The saved measurement is shown at the bottom of the calculation Measurement menu 2 Press the Select key or the Caliper key to select the measurement 3 Repeat the measurement The new results are displayed in the measurement and calculation data area You can compare the active measurement to the saved measurement 4 To save the new measurement select Save fr
162. n Pen provides the best possible penetration Note Some of the parameters that are optimized to provide the best image include focal zones aperture size frequency center and bandwidth dynamic range and waveform They cannot be adjusted by the user Select left or right flip from the on screen menu to change image orientation Select up or down flip from the on screen menu to change image orientation Chapter 3 Imaging Brightness Biopsy x Guide L25 only ECG Dual k Images Gain Depth Tissue Harmonic Imaging Chapter 3 Imaging Select the desired brightness setting from the on screen menu to adjust display brightness 1 10 Note The display brightness affects battery life To conserve battery life adjust brightness to a lower setting Select Biopsy from the on screen menu to display biopsy guidelines Select again to turn off See Biopsy on page 59 and Biopsy User Guide for more information Note The feature is dependent on transducer and exam type Note Biopsy is not available when ECG cable is connected Select Guide from the on screen menu to display guide Select again to turn off See the L25 Bracket and Needle Guide User Guide for more information Note The feature is dependent on transducer and exam type Note This option requires a SonoSite ECG cable 1 Connect the ECG cable See the TITAN Accessories User Guide 2 Select ECG from the on screen menu to displ
163. natomical 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 DCPD 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 and direction 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 TITAN Chapter 6 Safety The system has been designed to ensure that temperature at the face of the transducer will not exceed 41 C 106 F In the event of a de
164. nd the following on screen menu options are available First caliper set gt lt Second caliper set Ellipse circumference area X Delete Note The two calipers are connected by a dotted line When the calipers get close together they decrease in size and the caliper line is removed Note No additional calipers are available on Dual screens 2 Use the touchpad to position the first caliper The active caliper is highlighted green 3 Press the Select key to activate the second caliper 4 Use the touchpad to position the second caliper The result is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers 5 If desired press the Save key to save the image with the measurements displayed wn U v o Second Distance 1 Press the Caliper key or select the second set of calipers from the Measurement on screen menu A second set of calipers is displayed The active caliper is highlighted green 2 Use the touchpad and the Select key as described in the preceding steps to complete the second measurement 3 If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations S0 nosite Area 1 Ona frozen 2D image press the Caliper key Circumference 2 Select Ellipse from the on screen menu Measurement 3 Press the Select key and use the touchp
165. nd the sheath Note If any bubbles are present between the footprint of the transducer and the sheath the ultrasound image may be affected Inspect the sheath to ensure there are no holes or tears BASonoSite Modes 2D Imaging The system has advanced image optimization technology that greatly simplifies user controls To achieve the best possible image quality it is important to properly adjust the display brightness gain depth settings and exam type It is also important to select an optimization setting that best matches your needs The system has a high performance liquid crystal display LCD To optimize image quality adjust the display for viewing angle and brightness Each time you turn the system on the 2D image is displayed It displays echoes in two dimensions on the display by assigning a brightness level based on the echo signal amplitude This is the system s default imaging mode When imaging in another mode you may return to 2D imaging by pressing the 2D key If the system does not return to 2D imaging after pressing the 2D key ensure the system is in live imaging Figure 3 2D Image Optimize Horizontal Flip Vertical Flip TITAN voi Patent Name 123 45 6789 Hospital ABC O3Juni6 14 58 Gen sn ae on e Biopsy AA Dusi Select the desired optimization setting from the on screen menu Res provides the best possible resolution Gen provides a balance between resolution and penetratio
166. nger 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 of Obstetrics and Gynaecology 101 February 1994 131 Appendix AC Derived Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine Normal Growth of the Abdominal Perimeter American Journal of Perinatology 1 January 1984 129 135 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 179 Table 7 13 Biparietal Diameter BPD Chitty Lyn S et al Charts of Fetal Size 2 Head Measurements British Journal of Obstetrics and Gynaecology 101 January 1994 43 Appendix BPD Outer Inner Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine A Longitudinal Study of Fetal Limb Growth
167. ninterruptible power supply or a battery If image distortion occurs it may be necessary to position the SonoSite TITAN 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 Chapter 6 Safety Table 2 Manufacturer s Declaration Electromagnetic Immunity Continued Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Conducted RF 3 Vrms 3 Vrms Portable and mobile RF IEC 61000 4 6 150 kHz to 80 MHz communications equipment should be used no closer to any part of the SonoSite TITAN 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 Radiated RF 3 Vim 3 V m d 1 2 P IEC 61000 4 3 80 MHz to 2 5 GHz 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 Radiated RF Field strengths from fixed RF IEC 61000 4 3 transmitters as determined by an continued electromagnetic Site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of e
168. nosite Cancel x Select Cancel from the on screen menu to undo any changes to the patient information form and return to the previous imaging state Pressing Cancel will not close the current patient exam Done Select Done from the on screen menu to save information and return to the previous imaging state Information is saved when exiting the patient information form unless Cancel is selected from the on screen menu Note If any changes are made to the current patient s name ID or accession number that patient exam will be closed and a new one will be started Transducer Exam Type and Imaging Mode The system has various configurations and options All are described in this user guide and may not apply to your system System features are dependent on your configuration transducer and exam type Warning The diagnostic capability differs for each transducer exam type and imaging mode Verify your system s capabilities prior to diagnosis Transducers have been developed to specific criteria depending on their application This criteria includes biocompatability requirements The following table describes the abbreviations for exam types Table 1 Exam Type Abbreviations Abbreviation Exam Type Abd Abdomen Bre Breast Crd Cardiac Gyn Gynecology Msk Muscle Neo Neonatal Nrv Nerve OB Obstetrical Pro Prostate SmP Small Parts TITAN Chapter 3 Imaging Table 1 Exam Type Abbreviations Continued
169. nu to highlight all the entries Deselect within the patient list Deselect removes the highlight from all the entries and highlights the previously selected patient Note Review is disabled when all entries in the list are selected Review Select Review from the on screen menu to review the images for Images the currently selected patient Archive oF Select Archive from the on screen menu to send the selected patient exams to a PC using SiteLink or to a DICOM printer or archiver See Transfer Mode on page 29 Note SiteLink and DICOM are optional features Print All Images A Verify a printer is selected See Printer on page 29 Press the Review key Select List from the on screen menu Highlight the desired patient Note An individual patient or all patients may be selected 5 Select Print from the on screen menu to print all images Each image will display briefly on the screen before printing starts BRWN TITAN Chapter 3 Imaging Delete x Select Delete from the on screen menu to delete the selected patient exam A confirmation screen is displayed Done Select Done from the on screen menu to exit the patient list and return to the previous imaging state Patient Images Figure 10 Patient Images Patient Press the Review key Images If there is not a current patient highlight the desired patient and select Review from the on screen menu Next or h Select the Next or Previous Image 1 x from the
170. oltage variations on power supply input lines IEC 61000 4 11 Power Frequency Magnetic Field IEC 61000 4 8 TITAN 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 U for 0 5 cycle 40 Uy 60 dip In U for 5 cycles 70 Uy 30 dip in U7 for 25 cycles gt 5 Ur gt 95 dip In U7 for 5s 3 A m 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 Uy for 0 5 cycle 40 Ur 60 dip In Uz for 5 cycles 70 Ur 30 dip in U7 for 25 cycles gt 5 Ur gt 95 dip In U for 5s 3 A m 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 TITAN ultrasound system requires continued operation during power mains interruptions it is recommended that the SonoSite TITAN ultrasound system be powered from an u
171. om the on screen menu or press the Enter key Note This will save the new measurement to the patient report and overwrite the previously saved measurement Delete 1 Highlight the measurement Measurement 2 Select Delete from the on screen menu OB Calculations Warning This will remove the last saved measurement from the patient report S212 9 sea Make sure you have selected the OB exam type and the OB calcs author for the OB table you intend to use See Table 9 System Defined OB Calculations and Table Authors on page 83 In OB exams an accurate date and time are critical for accurate obstetrics calculations Verify that the date and time are accurate before each use of the system The system does not automatically adjust for daylight savings time changes Verify the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 41 Prior to use verify OB custom table data entries are correct The system does not confirm the accuracy of the custom table data entered by the user References for measurements and calculations are in Chapter 8 References The following table shows the transducers and exam types that provide OB calculations Table 7 Transducers and Exam Type Transducer Exam Type C8 OB C15 OB C60 OB ICT OB TITAN Chapter 4 Measurements and Calculations
172. ommendations for Quantitation of the Left Ventricle by Two Dimensional Echocardiography Journal of American Society of Echocardiography September October 1989 2 362 n v Jr ae i l where V Volume a Diameter b Diameter n Number of segments n 20 L Length i Segment Left Ventricular Volume Single Plane Method in mi 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 vaz 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 where LDD Left Ventricle Dimension at Diastole LVDS Left Ventricle Dimension at Systole Left Ventricular Posterior Wall Fractional Thickening LVPWFT percent Laurenceau J L M C Malergue The Essentials of Echocardiography Le Hague Martinus Nijhoff 1981 71 LVPWFT LVPWS LVPWD LVPWD 100 where LVPWS Left Ventricular Posterior Wall Thickness at Systole LVPWD Left Ventricular Posterior Wall Thickness at Diastole References Chapter 8 References BSonoSite Mean Velocity Vmean in cm s Vmean mean velocity Mitral Valve Area MVA in cm
173. on 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 TITAN ultrasound system uses RF CISPR 11 energy only 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 TITAN ultrasound system is suitable for CISPR 11 use in 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 Complies fluctuations flicker emissions IEC 61000 3 3 Chapter 6 Safety BASo noSite 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 4 2 Electrical fast Transient burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and v
174. onal Age 5 GS Nyberg APTD None g CRL Haddock AC Hadiock 5 BPD Hadiock FTA None rA OFD None FL Hadiock ke2 HC Hadiock EFW Hadiock TTO None det hat v Growth Analysis J BPD Hadiock EFW Hadiock HC Hadiock HC AC Campbell gt AC Hadiock FL Hadiock Figure 16 Setup Screen OB Calculations Gestational Age 1 Press the Setup key Growth Analysis 2 Select OB Calculations 3 In Gestational Age or Growth Analysis lists select the desired OB authors Selecting an author places the measurement on the calculation menu and selecting None removes the measurement from the calculation menu More More displays the list of user defined custom measurements and allows you to associate a custom table for the custom measurement This is only available when a user defined custom table has been created for the custom measurement Export 1 Insert a blank CompactFlash card in the back slot of the TITAN system 2 Press the Setup key Select OB Calculations 4 Select Export from the on screen menu All user defined tables and measurements are copied to the CompactFlash card w Chapter 2 Getting Started SonoSite Import 1 Insert the CompactFlash card in the back slot of the TITAN system Press the Setup key Select OB Calculations Select Import from the on screen menu After all user defined tables and measurements are imported the system restarts Note All use
175. 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 Bl Sonosite variance 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 Acronyms Acronyms used in the user interface are listed below Table 1 Acronyms Acronym Description x Caliper x Caliper Ratio A A Wave Peak Velocity A4Cd Apical 4 Chamber diastolic A4Cs Apical 4 Chamber systolic A2Cd Apical 2 Chamber diastolic A2Cs Apical 2 Chamber systolic APG A Wave Peak Pressure Gradient abs Absolute value AC Abdominal Circumference ACC Acceleration Index AFI Amniotic Fluid Index Ao Aorta AoD Aortic Root Diameter ACS Aortic Valve Cusp Separation APTD Anteroposterior Trunk Diameter AT Acceleration Deceleration Time AUA Average Ultrasound Age AV Aortic Valve AVA Aortic Valve Area a BPD Biparietal Diameter g lt TITAN Chapter 10 Glossary 211 A b v 7 2 212 Table 1 Acronyms Continued Acronym Description BPM Beats per Minute CO Cardiac Output CCA Common Carotid Artery CPD Color Power Doppler CRL Crown Rump Length CW Continuous Wave Doppler D Diameter DCCA Distal Common Carotid Artery DCPD Directional Color Power Doppler DECA Distal
176. 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 and algorithmic error Acquisition Error 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 Algorithmic error is 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 Terminology and Measurement Publications Terminology and measurements comply with AIUM published standards TITAN Chapter 8 References SadIUZIZjJOY Cardiac References Left Atrium Aorta LA Ao Feigenbaum H Echocardiography Philadelphia Lea and Febiger 1994 206 Figure 4 49 Acceleration ACC in cm s Zwiebel W J Introduction to Vascular Ultrasonography 4th ed W B Saunders Company 2000 52
177. ore comfortably and may reduce your risk of MSDs 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 Muscoskeletal 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 e Habes D J and S Baron Health Hazard Report 99 0093 2749 University of Medicine and Dentistry of New Jersey 1999 f Vanderpool H E E A Friis B S Smith and K L Harms Prevalence of Carpal Tunnel Syndrome and Other Work related Muscoskeletal Problems in Cardiac Sonographers Journal of Medicine 35 6 1993 605 610 TITAN Chapter 2 Getting Started ao ov p 2 te S Ez 7 Position the System To promote comfortable shoulder arm and hand postures consider the following Use the TITAN mobile docking system to support the weight of the ultrasound system To minimize eye strain consider the following When the exam proce
178. ortable hand wrist and finger postures for your scanning arm consider the following Hold the transducer lightly in your fingers Minimize the pressure applied on the patient Keep your wrist in a straight position Take Breaks Minimizing scanning time and taking breaks can be very effective in allowing your body to recover from physical activity which can help you avoid any MSDs Some ultrasound tasks may require longer or more frequent breaks One way of taking a break is to stop and relax However simply changing tasks can help some muscle groups relax while others remain or become active A M faa e gt a N fad w a M a To vary your daily activities consider the following Plan your work so there are breaks in between ultrasound exams Work efficiently when performing an ultrasound exam by using the software and hardware features correctly Learn more about these features in Chapter 3 of this guide Keep moving Avoid sustaining the same posture by varying your head neck body arm and leg positions Exercise 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 TITAN Chapter 2 Getting Started System Preparation Installing or Removing Battery The battery comprises six lithium ion cells plus electronics a temperature sensor and battery contacts If the battery is being in
179. our password contact SonoSte at 1 877 657 8118 Figure 7 Setup Screens Administration and Administrator Information Press the Setup key Select Administration Administrator Login 1 2 3 In Administrator Login type Administrator in the Name field 4 5 Call SonoSite for the password 1 877 657 8118 Select Login Chapter 2 Getting Started BASonoSite TITAN Change Administrator Password User Login Setting 1 In User Information enter your new password in the Password field Enter the password again in the Confirm field To ensure passwords are secure it is recommended that passwords contain characters from the following categories Upper case characters A Z Lower case characters a z Numbers 0 9 Note The password is case sensitive In Password changes click on the check box to allow users access to change their password or leave unchecked to restrict access Optional Select Save In the User Login list select On or Off Selecting On restricts access to the TITAN system and requires the user to enter a user name and password Selecting Off allows access to the TITAN system and does not require the user to enter a user name and password After making changes in the Administration setup reboot the system to log off as administrator Chapter 2 Getting Started O M faa e gt eQ N fad w a M a U 6 N ten S Ez U v To add new users
180. ove the custom table from the system OABWDN Chapter 2 Getting Started SonoSite TITAN To set Presets d 20060ct19 13 07 Figure 19 Setup Screen Presets Doppler Scale 1 Duplex 1 Live Trace 1 Thermal Index 1 Save Key 1 Presets Duplex 13 2D 23 Trace Live Trace Peak Thermalindex TS Save Key image Only Dynamic Range 2 Bre Units in ftiibs lt Footswitch L Freeze Footswitch R Save Image lt A D er e gt Q n a w e M 2 Press the Setup key Select Presets In the Doppler Scale list select cm s or kHz Press the Setup key Select Presets In the Duplex list select desired image display Full 2D Full Trace 1 3 2D 2 3 Trace 1 2 2D 1 2 Trace Press the Setup key Select Presets In the Live Trace list select Peak or Mean Press the Setup key Select Presets In the Thermal Index list select TIS TIB or TIC Press the Setup key Select Presets In the Save key list select Image Only or Image Calcs to designate the function of the Save key Selecting Image Only allows the Save key to save the image to the CF card Selecting Image Calcs allows the Save Key to save the image to the CF card and to save the current calculation to the report Chapter 2 Getting Started Reset To return settings for this setup page to factory default select Reset from the on screen menu To view System Information U 6
181. performed accurately 4 Use the touchpad to move the caliper to the next desired point on the wave form 5 Continue marking points by pressing the Select key The last point must be placed at the end of the wave form Note If an error is made use the backspace key to delete the previous position 6 Select Set from the on screen menu to complete the trace and to display the results 7 Press the Save key to save an image of the trace with the results displayed 8 If performing a VTI TAM or S D ratio select Save from the on screen menu Note The optimum trace location is provided when live trace is turned on 1 Ona frozen Doppler spectral trace press the Caliper key 2 Select Auto from the on screen menu A vertical caliper is displayed 3 Use the touchpad to position the first caliper at the beginning of the wave form 4 Press the Select key A second vertical caliper is displayed Note If calipers are not placed in the correct position the calculation will not be performed accurately 5 Use the touchpad to position the second vertical caliper at the end of the wave form 6 Select Set from the on screen menu to complete the trace and to display the results 7 Press the Save key to save an image of the trace with the results displayed 8 If performing a VTI TAM or S D ratio select Save from the on screen menu Chapter 4 Measurements and Calculations S212 9 sea wn Go v o
182. put Tables oo eee eeesseseseeeeesteeseaeseaeaes 146 Global Maximum Derated ISPTA and MI Values 0 0 155 Acoustic Measurement Precision and Uncertainty 004 157 Labeling Symbols sessirnir A 158 Chapter 7 Troubleshooting and Maintenance Troubleshooting sicrscititstvtscestect cieaes dttecenseensatveseastorsnitivasatiseessictatates 161 Software Licensing rnc nennen AR AES 163 Obtaining a License Key gnansnennenusennariemennaniiana nn 169 Installing a License Key somesonssenesiunneneniniaeenn 170 Maintenance or eE KASE IEA AEE niente 171 Recommended Disinfectant ccccceecssesessesesseeseseseeseseeseeeenens 171 SALTY ia NEE E O R R S 171 Cleaning and Disinfecting the Ultrasound System n s 172 Cleaning and Disinfecting Transducers cccsesseseeseseeeeees 173 Sterilizable Transducers c cccccccssssesseseessesessseesssseseseeesesneneeeess 174 Cleaning and Disinfecting Transducer Cables cccccee 175 Cleaning and Disinfecting the Battery ccccceeseeseneeeeees 176 Chapter 8 References Display SIZ 5 sccesessesssssecegesetassssavere etasetotacahastecaneseistnsatinharetetacesstetietavenss 189 Caliper Placement lt 2 iscininitianiaudiaidiiaainietnsieaceann aden 189 2D MeaSureMme nt ccccccccsscccsecssccccsssscessessssesecsssesesesesesessuseseseuseseeeee 189 Sources of Measurement Errors ccccccesssscesscesessceseesecsscescsseeseesseees 191 ACQUISITION EOT csisstssesesssesestasstaresete
183. quipment marked with the following symbol IEC 60417 No 417 IEC 5140 Source of non ionizing radiation Note Uy is the AC mains voltage prior to application of the test level Note At 80 MHz and 800 MHz the higher frequency range applies Note These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Chapter 6 Safety BSonoSite 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 TITAN ultrasound system is used exceeds the applicable RF compliance level above the SonoSite TITAN 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 TITAN ultrasound system b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m The 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 e
184. quires a measurement taken in 2D and one SV measurement taken in Doppler After the measurements are completed and saved the result is displayed in the patient report 2D measurement from LVOT 1 Ona frozen 2D image press the Calcs key 2 Highlight LVOT D and press the Select key 3 Perform the measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Doppler measurement from aorta 1 Ona frozen Doppler spectral trace press the Calcs key 2 Highlight AV and press the Select key 3 Select VTI and press the Select key 4 Perform the measurement See Manual Trace on page 71 or Automatic Trace on page 71 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed wn Go v o Cardiac Output Note This calculation requires a stroke volume and a heart rate After the CO measurements are completed and saved the result is displayed in the patient report 1 Ona frozen Doppl
185. r CPD DCPD and Color imaging Figure 6 Color Image CPD DCPD 1 Press the Color key for CPD DCPD or Color or Color A region of interest ROI box is displayed in the center of the 2D image A 2 Select CPD DCPD or Color from the on screen menu The current setting is displayed in the upper left corner of the screen and in the on screen menu In DCPD and Color mode the color indicator bar is displayed in the upper left corner of the screen The color bar displays velocity in cm s Flow ill Select the desired flow sensitivity from the on screen menu Sensitivity Low optimizes the system for low flow states Med optimizes the system for medium flow states High optimizes the system for high flow states The current setting is displayed in the top left portion of the screen and in the on screen menu PRF Scale PRF Select the desired pulse repetition frequency PRF setting from the Color on screen menu only Note There is a wide range of PRF settings for each flow sensitivity selection Wall Filter Wr Select the desired wall filter setting from the on screen menu low med Color high only Chapter 3 Imaging BSonoSite Steering lt gt Select the desired steering angle setting from the on screen menu L38 and This automatically changes pulsed wave PW Doppler angle correction HST only to the optimum setting Steering angle of 15 degrees has an angle correction of 60 degrees Steering angle of 0 degrees h
186. r defined tables and measurements currently on the system are replaced with imported data 6 Select Done from the on screen menu to return to live imaging ma BWN A M faa e gt a N fad w a M a Tables Tables displays system OB tables or is used to create custom OB tables See To view and set up OB custom tables on page 37 Reset To return settings for this setup page to factory default select Reset from the on screen menu TITAN Chapter 2 Getting Started To set up OB custom measurements 2004Sep11 20 03 Setup Pages OB Custom Measurements ABC Distance New Delete Last U 6 N te c Ez u v Name OEF 4 character max Type fra is Save J Cancel j Figure 17 Setup Screen OB Custom Measurements OB Custom 1 Press the Setup key Measurements 2 Select OB Custom Meas 3 Select New 4 Inthe Name field enter a unique name 5 Inthe Type list select the desired measurement type 6 Select Save The new measurement is displayed in the calculations menu and the OB report Up to five custom measurements may be saved Delete OB Custom 1 Press the Setup key Measurement 2 Select OB Custom Meas 3 Inthe Custom Measurements list highlight the last measurement 4 Select Delete Last Note If associated tables and report data exist for the measurement they will be removed from the system Tables Select Tables from the on screen menu to create Gestational Age
187. rd 23 25 27 patient header 17 patient images delete 62 next or previous 62 patient list 62 turn on 62 patient information DICOM 126 patient list archive 61 delete 62 print all images 61 review images 61 turn on 61 patient report 101 PC setup 29 pediatric intended uses 143 percent reduction calculation 72 peripherals 205 pictograph 17 59 power 14 precision acoustic measurement 157 pressure half time PHT 98 pressure limits 205 PRF setting 56 print all images 61 print image 15 60 printer problem 162 printer setup 29 probe See transducer prostate intended uses 144 pulsed wave Doppler sample line 54 spectral trace 55 R recording problem 162 references cardiac 192 general 201 obstetrical 196 Bl Sonosite remappable controls 15 19 reports patient 101 resistive index RI measurement 69 review images 61 ROI box 53 S safety battery 131 biological 132 disinfectants 171 electrical 129 electromagnetic compatibility 133 equipment 131 ergonomic 7 sample line M Mode 50 PW Doppler 54 save image 15 60 scale 56 scanhead See transducer screen layout calcs menu 17 context menu 17 depth marker 17 image 17 measurement and calcs data 17 mode data 17 orientation marker 17 patient header 17 picto 17 system status 17 text 17 security setup 22 select 15 select all patient list 61 serial port 29 shipping specifications 205 SiteLink connectivity 29 skin line definition 210 software DICOM 105 l
188. reen to white To remove the arrow from the image press the Arrow key and then select Hide from the on screen menu BASonoSite Pictograph 1 Press the Picto key to turn on the pictograph The on screen options for pictograph are d Show Hide Number e g 1 18 Done 2 Select the desired pictograph The first number changes to show which pictograph in a set of pictographs has been selected The second number shows the total number of pictographs available Note The pictograph set that is available is dependent on transducer and exam type 3 Use the touchpad to position the pictograph marker 4 Press the Select key and then use the touchpad to rotate the pictograph marker 5 Select Hide from the on screen menu to remove the pictograph F keys 1 Press the Text key or the Spacebar key A green flashing data entry cursor is displayed in the upper left corner 2 Press the f key and then a number key to enter predefined text See To set up Delta Key and F Keys on page 32 Biopsy The ultrasound system is equipped with a biopsy feature Biopsy guides are used to assist in the guidance of a biopsy needle The system generates guidelines that represent the anticipated path of the biopsy needle The echoes of the anatomical target and the needle are displayed on the system display and assist in guiding the biopsy needle to the target For detailed instructions on the use of the system and biopsy guide accessories and a list of compatible
189. rent imaging mode information e g Gen Res a THI and PW 2 gt 2 Orientation Provides indication for image orientation In dual and duplex S Marker images the orientation marker is green on the active screen Rj ag M 3 Text Displays text entered using keyboard 2 4 Picto Displays pictograph to indicate anatomy and transducer position 5 Calcs Menu Displays available calculations 6 Image Displays ultrasound image 7 Measurement Displays current measurement and calculation data and Calcs Data 8 Context Menu Provides context sensitive controls based on the system state 9 Patient Header Displays current patient name ID number institution sonographer and date time 10 System Status Displays information related to system status e g exam type transducer and AC connected 11 Depth Marker Displays marks in 5 cm 1 cm and 5 cm increments depending on the depth TITAN Chapter 2 Getting Started General Interaction Touchpad The touchpad is used to select adjust and move objects on the screen For example it controls the caliper position CPD DCPD Color box position and size floating cursor and more Note The arrow keys control much of the same functionality as the touchpad Context Menus The context menu located at the bottom of the screen provides controls that can be adjusted based on the system state For example in 2D with a C60 transducer attached the following options are available ao
190. rmation and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 DICOM Connectivity B So nosite Configuring Archivers 2004Sep29 16 13 Configure Archivers z Alias Model IP Address Port AE Title Archiver Name New_Name IP Address 120 20 20 1120 Alias Alias _02 Port 104 Model _Secondary_Cap z AE Title New_AE_Title Ping 4 2 __ Next New Delete Symbols Cancel L Save n Log Import Export Done Figure 3 Archivers Configuration Page 1 Name Network hostname for an archiver Alias Personalized name for an archiver Model List of generic archiver models based on capture type IP Address Unique identifier for the archiver Port Device port number IP port 104 is normally assigned for DICOM AE Title Archiver DICOM Application Entity Title Ping Utility to determine whether a specific IP address is accessible TITAN Chapter 5 DICOM Connectivity R 2004May18 10 52 Configure Archivers Alias Model IP Address Port AE Title Archiver Settings RGB Color by Pixel Capture Type Ultrasound Retired Attempts 3 Interval sec 5 212 Next New Delete Cancel Save Log Import Export Done Figure 4 Archivers Configuration Page 2 Settings Defines how images are sent to the archiver either as Color RGB or Monochrome images Capture Type Type of DICOM image sent to the archiver Ultrasound Ultrasound Ret
191. rrist 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 Chapter 8 References BSonoSite 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 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 Percent Area Reduction Taylor K J W P N Burns P Breslau 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 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
192. rticulate matter or body fluids Apply the solution to the cloth rather than the surface Rinse with water or a wipe with water dampened cloth then wipe with a dry cloth Mix the disinfectant solution compatible with the transducer cable following disinfectant label instructions for solution strengths and disinfectant contact duration Immerse the transducer cable into the disinfection solution Follow the instructions on the disinfectant label for the duration of the transducer cable immersion Using the instructions on the disinfectant label rinse the transducer cable and then air dry or towel dry with a clean cloth 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 f c z o 2 gt e a gt Co Chapter 7 Troubleshooting and Maintenance Cleaning and Disinfecting the Battery To clean and disinfect the battery using the wipe method Caution To avoid damaging the battery do not allow cleaning solution or disinfectant to come in contact with the battery terminals 1 Remove the battery 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 Wipe the surfaces with the disinfection solution Theracide disinfectant is recommended 4 Air
193. ry X Start Time X To configure a new worklist server 1 Ensure the TITAN system is set up for DICOM connectivity See To set up the TITAN system for DICOM connectivity on page 105 Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu In the Configure list select Worklist Servers Select New Enter information in the fields pages 1 and 2 The Name cannot contain special characters The Alias and AE Title may contain special characters The IP address and port must be entered before the information is saved Note To use special characters select Symbols See To enter a symbol special character on page 20 Note Use the space bar on the keyboard to enter the underscore symbol Select Cancel to undo last change 7 Select Save 8 Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Ann BWN To set up an automatic query update Press the Setup key and select Connectivity and then DICOM Setup Select Config from the on screen menu In the Configure list select Worklist Servers In Automatic Query page 2 select On In the Occurs Every list select the desired length of time between automatic updates In the Start Time list select the start time for the automatic updates Select Done from the on screen menu A dialog box is displayed to restart the system NOW BPWDN Chapter 5 DIC
194. s are available First caliper set gt lt Second caliper set Heart rate X Delete 2 Use the touchpad to position the first caliper Press the Select key to activate the second caliper 4 Use the touchpad to position the second caliper The active caliper is highlighted green The results are displayed in the measurement and calculation data area and are updated as the caliper moves The measurement is complete when you finish moving the calipers 5 If desired press the Save key to save the image with the measurements displayed w Nn v o Chapter 4 Measurements and Calculations So nosite TITAN Heart Rate HR Fetal Heart Rate FHR Delete Measurement 1 N On a frozen M Mode trace press the Caliper key or press the Calcs key for FHR OB exam only The following on screen menu options are available First caliper set gt lt Second caliper set Heart rate X Delete VY Save only available when heart rate measurement can be saved to report Select HR from the on screen menu or select FHR from the calculation menu A vertical caliper is displayed on the screen Use the touchpad to position the first vertical caliper at the peak of the heart beat Press the Select key A second vertical caliper is displayed on the screen The active caliper is highlighted green Use the touchpad to position the second vertical caliper at the peak of the next heart beat The re
195. sducer Warning The transducer connector can become hot during operation This is normal Operate the system in the docking system or ona flat hard surface to allow air flow past the connector Caution The electrical contacts inside the system transducer connector may be damaged by foreign material Keep foreign material out of the connector A D er e gt Co N faa w e M Q Figure 2 Connect the Transducer To connect the transducer Turn the system upside down if not in docking system Pull the transducer latch up and rotate it clockwise Align the transducer connector with the connector on the bottom of the system Insert the transducer connector into the system connector Turn the latch counterclockwise Press the latch down securing the transducer connector to the system AuBRWN To remove the transducer 1 Pull the latch up and rotate it clockwise 2 Pull the transducer connector away from the system TITAN Chapter 2 Getting Started ao J 7 w 7a ten c B i v System Controls Figure 3 System Controls Table 1 System Controls 10 11 12 13 Number a i Description 1 Power Turns system on and off 2 Alphanumeric Use to enter text and numbers 3 Annotation Text Turns the keyboard on and off for text entry Picto Turns the pictographs pictograph marker on and Arrow aT an arrow that can
196. se the touchpad to position the second vertical caliper at the end of the wave form Select SET from the on screen menu to complete the trace and to display the results Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is shown at the bottom of the calculation menu and a check mark is put in front of the measurement To view the volume flow calculation go to the report See Patient Report on page 101 If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations Gyn Calculations Warning Verify the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 41 References for measurements and calculations are in Chapter 8 References The following table shows the transducers and exam types that provide Gyn calculations Table 6 Transducers and Exam Type Transducer Exam Type C8 Gyn C60 Gyn ICT Gyn wn Go v o X Delete Figure 7 Gyn Measurements 78 Chapter 4 Measurements and Calculations So nosite Gyn Calculation Select Gyn exam type On a frozen 2D image press the Calcs key Select Gyn Highlight the desired measurement from the calculations menu and press the Select key Perform the measurement Sele
197. seisteacstasesstessisdtaearesesasaseeutastegeerebes 191 Algorithmic Error cccecesseeeseeseessseessesessssesessssesssssssssssessessseessnees 191 Terminology and Measurement Publications 0ccccseseseeeees 191 Cardiac Reference ccccccccccsssssssssescesecsscsecesscssesecssesscesscssesecesseseessenses 192 Obstetrical References ccccccccssesccssessceseesessecescsscesscsecsecesssseesseeseeseenes 196 Gestational Age Tables wi cccceessseseesesssseseseseeaserseseseseeesaeanaeas 197 Growth Analysis Tables cccccesesesssseeseesssessesesssseseeseseeneeens 199 Ratio Calculations ccccccccsscccsscssscessessscessesseccsscessecsseessecessesseeees 200 General References cccccccccsssscessesecssceseesccssesecesecsessecesccscsseceseseesseeaes 201 TITAN Chapter 9 Specifications System Dimensions ccceccccsesceseececeseeseesseseeesenseesssesessesssesensnensenes 203 Display Dimensions 00 cece ececteseeeeeeeeeteseseseeeeeeeessneseseseanenenenenenes 203 Transducers ssiri soisissa pea ieksaa kariais asis 203 Imaging Modes ssri tiioreosiiridkiaeaaiae o aaiae aia aE 203 APPUCAtiOMS vescassisscesesssetstatasausassssiatacatsticresesssatalatesesebesttatatatastieess database 204 IMAGE Storage i cssscrsscsssssisssnssvesssssssssotsssecrvesssnssseevoseseonsnssssssssebesenedasebees 204 ee a E E E E E E 204 Hardware Software and Documentation cee 204 B101 E E EETA 205 aae E EE E T EET 205 Medical Grade s c
198. sity 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 References Nyberg D A et al Transvaginal Ultrasound Mosby Yearbook 1992 76 Gestational sac measurements provide a fetal age based on the mean of one two or three distance measurements however Nyberg s gestational age equation requires all three distance measurements for an accurate estimate Tokyo University Gestational Weeks and Computation Methods Ultrasound Imaging Diagnostics 12 1 1982 1 Chapter 8 References BSonoSite 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 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 Spri
199. sssisssseessne 43 Transducer Preparation os css sssccsssisastesscstessitasanistasssssetasadasateasassnsssstsacteee 45 General Use sensdeir rinmi inna 45 Invasive U S scsccccsssscisedecsctttiaiaed dastetsasiiisdhassdesietaciedaasiiatdeacticaness 46 MOCOS euna a TR 47 2D IMa ging onean R OE RRR 47 M Mode IMAC DE csi23s tsesesatassescs tases estas aE S 50 Color Doppler Imaging cece eeeeseseseeeeeeeeteneaeseaeeeeeees 52 Pulsed Wave PW and Continuous Wave CW Doppler Imaging eranan aa AERAR meat NARS 54 ECG MOnitoring rennnsnemii uriini a E E EE 57 AMMOtLALON sesiapa n EE a E A E E S 58 Biopsy siege ssisssevestesscipessusistivds advastss R a 59 TITAN Image Storage weiss ceed kendas aa dannata EEEE Esa 60 Save to Compacth lash sr 4 lt ccs yi socscsssegitaceteecsivaesstusnterastecsescopersaneos 60 Print to Local Printer s 3 c csiavnsiiseeinnniacdani aniadaninn 60 Image REV AW serseri neer E EEES 61 Patient List sarrin annin NEE EEEE 61 Patient Images 4 i sei isi senssiscsscessathensesesiastesescaedsscessaptensvencesscassseterenenss 62 Chapter 4 Measurements and Calculations MeEaSULEMENHS 5 sccsesssscavsscsscnsstavsavesccsescesotesasavescevedesdaosersavessscesdeventevanees 63 2D MeasSureMenttS ccscccsscssscssscessccsscessecesccsseceseceseecsscessecstceaeenes 63 M Mode Measurements ccccccsccesscscesscescsscesecssesscsscseeesecsecsecessens 65 Doppler Measurement cccccccseseesessseseeseses
200. stalled for the first time it will need to be charged Warning To avoid injury to the operator and to prevent damage to the ultrasound system inspect the battery for leaks prior to installing ao J 7 w 7a ten c B i v Figure 1 Insert Battery into System To install the battery 1 Turn the system upside down 2 Place the battery into the battery compartment at a slight angle See Figure 1 3 Slide the battery forward until it locks into place 4 Push down on the two locking levers to secure battery To remove battery 1 Push up on the two locking levers 2 Slide the battery back 3 Lift the battery from the compartment Chapter 2 Getting Started BASonoSite Installing and Removing the CompactFlash Card Images are saved to a CompactFlash card and are organized in a patient list The images in the patient list are organized alphabetically by the patient name and ID Images are archived from the system to a PC using a USB or Ethernet connection Images on the CompactFlash card cannot be read directly from a CompactFlash card reader To install the CompactFlash card 1 Verify the ejector pin is fully pushed in 2 Insert the CompactFlash card into the front slot on the ultrasound system See Figure 1 on page 3 The front slot is used to store images The back slot is used to update systems transducers and to import export DICOM configuration information and OB Tables The CompactFlash car
201. sult is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Select Save from the on screen menu to save the heart rate measurement to the patient report Note This will overwrite the previous heart rate value entered under exam patient information Note In OB exam only the fetal heart rate can be saved to the report If desired press the Save key to save the image with the measurements displayed S212 9 sea Select the first or second caliper set from the on screen menu Select Delete from the on screen menu This will remove the active set of calipers from the screen Chapter 4 Measurements and Calculations wn Go v o Doppler Measurements Note The Doppler scale must be set to cm s for the following measurements See System Setup on page 21 40 W ASA Wa i 1 Pya AN cm s gt 87 8cm s 27 7cm s ET 760 0ms x 3 17 RI 0 68 ACC 79 1cm s Cali Cali gt lt Cal2 Trace X Delete Figure 3 Doppler Trace with Two Velocity Measurements Velocity cm s 1 Ona frozen Doppler spectral trace press the Caliper key Pressure Gradient A single caliper is displayed on the screen with the following on screen menu options First caliper gt lt Second caliper f Manual X Delete 2 Use the touchpad to position the active green caliper to a peak systolic wave form
202. t server status 123 worklist update 127 DICOM configuration archiver 109 import and export 120 introduction 106 location 106 network log 121 printers 112 procedure 119 worklist servers 116 directional color power Doppler imaging See Color Doppler imaging disinfectants compatibility table 177 187 safety 171 disinfecting battery 176 system 172 transducer cables 175 transducers 173 distance measurement 2D 64 M mode 66 Doppler amplitude mode See CPD imaging dual images 48 duplex images 39 DVD setup 29 E E A and VMax 97 ECG turn on 48 ECG monitoring 57 elapsed time ET measurement 69 BASonoSite electrical safety 129 specifications 206 electromagnetic compatibility 133 electromechanical safety standards 206 EMC classification standards 206 end exam 42 energy mode See CPD imaging enter text 58 equipment safety 131 ergonomic safety 7 error message 131 errors acquisition 191 algorithmic 191 measurement 191 estimated date of delivery EDD 196 estimated fetal weight EFW 196 Ethernet 30 event log 26 exam type abbreviations 43 transducer 44 export user account 25 F F keys 32 59 fetal age inaccurate calculation 162 fetal heart rate FHR 67 flow sensitivity 52 focal zones optimize 47 follicle measurement 80 forms 15 freeze description 16 turn on off 49 G gain adjust 48 description 15 gate size 55 gel 45 global maximum values 155 grace period 163 TITAN guidance documents related 1
203. t the ALARA as low as reasonably achievable principle the output display standard acoustic power and intensity tables intended uses and other safety information Chapter 7 Troubleshooting Contains information to assist in the correction of and Maintenance problems with system operation Also contains information about proper care of the system transducers and accessories Chapter 8 References Contains information about measurement accuracy and the sources from which the system measurements and calculations are derived TITAN Chapter 1 Introduction S 2 e v ao ce PA Chapter 9 Specifications Contains system and accessory specifications and agency approvals Specifications for recommended peripherals can be found in the manufacturers instructions Chapter10 Glossary Contains definitions of ultrasound system terms and features Conventions Used in This User Guide These conventions are used in this user guide A Warning describes precautions necessary to prevent injury or loss of life A Caution describes precautions necessary to protect the products When the steps in the operating instructions must be performed ina specific order the steps are numbered Bulleted lists present information in list format but they do not imply a sequence The system handle is on the front of the system and the battery compartment is on the back of the system Symbols and Terms Used in Th
204. ter Film Type Film medium supported by the printer Destination Location film is placed after it is printed Format Number of columns and rows in the image printout Orientation Film layout Attempts Number of times the TITAN system tries to resend a failed image transfer Interval Amount of time between attempts Copies Number of copies to print for each image Priority Importance of the print job TITAN Chapter 5 DICOM Connectivity 2003Jan05 02 08 Configure Printers m Alias Model IP Address Port AE Title Printer Density Settings Monochrome E Max jo Magnification None Min fo Configure Oo Border p o Empty peo 3 3 Next X New Delete Cancel Save Log Import Export Done Figure 7 Printers Configuration Page 3 Max Density Maximum density of the black value Min Density Minimum density of the white value Border Density Density of the areas surrounding and between film images Empty Density Empty image density Settings Defines how images are sent to the printer either as Color RGB or Monochrome images Magnification Type of interpolation used during printing Configure Printer specific configuration value If using generic printer settings no configuration strings are available In hundredths of optical density OD Chapter 5 DICOM Connectivity SonoSsite To configure a new printer 1 NOB WNDN N To delete a printer 1 2 TITAN Ensure the TITA
205. teraldehyde N N N N T U A A Korsolex FF Germany Liquid Gluteraldehyde T T T U T N A z Korsolex pret a l emploi Germany Liquid Gluteraldehyde U U U T C U U U x Kutasept Germany U U U N U U U E Linget anios France Towelette Quat Ammonia U U U N U U U 3 LpHse 4 USA Liquid O phenylphenol T C N N N T C N A 2 Lysertol V Neu 3 Germany Liquid Gluteraldehyde U U U T U U U 5 Formaldahyde Quat Ammonium 5 chloride z Lysol IC 4 USA Liquid O phenylphenol T C N N N TC TC A 8 Bunooysajqnoiy Q a gt w U e oO 2 x o e Cc ex oO n a gt O las Q w Qa z a 3 oO fe a oO auISouos ea Troubleshooting Table 3 Disinfectants Compatibility with System and Transducers Continued Cleaning Solutions of Origin Pe Activelngredient 3g cm ICT HST C8 L25 geet Lysol Spray USA Spray Ethanol U U U U T C U A Madacide 4 USA Liquid Isopropanol T C N N N T C N N Matar 4 USA Liquid O phenylphenol TC TC N N TC TC N Medi Swab Sweden Wipe Isopropyl Alcohol U U U N U U U Medside Medallion USA Liquid Quat Ammonia U U U N U U U MetriCide 14 2 4 5 USA Liquid Gluteraldehyde T T T T U U U MetriCide 28 2 4 5 USA Liquid Gluteraldehyde T C N T C T T C U A MetriCide Plus 30 4 5 USA Liquid Gluteraldehyde TC TC lt TC U U T C U Metriguard 4 USA Liquid Ammonium U U N T U U U Chloride MetriZyme USA Cleaner Propylene Glycol TC TC N U TC TC A Mikrobak forte Germany Liquid Ammonium
206. that the date has not passed Warning To avoid infection if a pre mixed disinfection solution is used observe the solution included here can damage the transducer and void the warranty Caution Attempting to disinfect a transducer cable using a method other than the one To clean and disinfect the transducer cable using the wipe method 1 2 3 To clean and disinfect the transducer cable using the immersion method 1 2 3 TITAN Disconnect the transducer from the system Remove any transducer sheath 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 Rinse with water or wipe with water dampened cloth then wipe with a dry cloth Mix the disinfectant solution compatible with the transducer cable following disinfectant label instructions for solution strengths and disinfectant contact duration Wipe surfaces with the disinfectant solution Air dry or towel dry with a clean cloth 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 Disconnect the transducer from the system Remove any transducer sheath Clean the transducer cable using a soft cloth lightly dampened in a mild soap or compatible cleaning solution to remove any pa
207. the Acoustic Output of Medical Diagnostic Ultrasonic Equipment UL 2601 1 1997 Second Edition Underwriters Laboratories Medical Electrical Equipment Part 1 General Requirements for Safety EMC Standards Classification EN 60601 1 2 2001 European Norm Medical Electrical Equipment General Requirements for Safety Collateral Standard Electromagnetic Compatibility Requirements and Tests CISPR11 97 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 SonoSite system SiteStand accessories and peripherals when configured together is Group 1 Class A Specifications Chapter 9 Specifications BASonoSite Airborne Equipment Standards RTCA DO160D 1997 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 45 CFR 164 Security and Privacy 7 o A e f 5 v TITAN Chapter 9 Specifications PIYA
208. 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 Turn equipment in the vicinity off and on to isolate disruptive equipment 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 internal 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 suc
209. the new measurement to the patient report and overwrite the previously saved measurement Note You must remeasure systolic measurement to remeasure diastolic measurement Use the touchpad to highlight the measurement Select Delete from the on screen menu This will remove the last saved measurement from the patient report Chapter 4 Measurements and Calculations Cardiac Calculations Warning Verify the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 41 References for measurements and calculations are in Chapter 8 References The following table shows the transducers and exam types that provide cardiac calculations Table 13 Transducer and Exam Types for Cardiac Transducer Exam Types C11 Cardiac C15 Cardiac 2D and M Mode Cardiac Calculations The following table shows the measurements required to complete the desired cardiac calculation The cardiac measurements are done in 2D and M Mode For definition of acronyms see Acronyms on page 211 Table 14 Cardiac Calculations in 2D and M Mode wn Go v o Imaging Anatomy Cardiac Measurement Calculation Result Mode 2D M Mode LV RVWs co RVDs EF IVSs SV LVDs LVESV LVPWs LVEDV RVWd IVSFT RVDd LVPWFT IVSd LVDFS LVDd LVPWd HR in M Mode or Doppler Ao Ao Ao LA Ao LA LA LA LA Ao Chapter 4
210. tom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Doppler measurement from LVOT 1 Ona frozen Doppler spectral trace press the Calcs key 2 Highlight LVOT and press the Select key 3 Select VTI or Vmax and press the Select key 4 Perform the measurement See Manual Trace on page 71 or Automatic Trace on page 71 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed S212 9 sea Doppler measurement from aorta 1 Ona frozen Doppler spectral trace press the Calcs key 2 Highlight AV and press the Select key 3 Select VTI or Vmax and press the Select key 4 Perform the measurement See Manual Trace on page 71 or Automatic Trace on page 71 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations Stroke Volume Note This calculation re
211. troke Volume TAM Time Average Mean THI Tissue Harmonic Imaging TI Thermal Index TRmax Tricuspid Regurgitation peak velocity TTD Transverse Trunk Diameter TV Tricuspid Valve Umb A Umbilical Artery VArty Vertebral Artery Vmax Peak Velocity Vmean Mean Velocity Vol Volume VF Volume Flow VTI Velocity Time Integral TITAN Chapter 10 Glossary Q io v wv i lt N 7 2 216 Chapter 10 Glossary BSonoSite Index Symbols x measurement 69 Numerics 2D imaging 47 209 A abbreviations exam type 43 abdominal intended uses 142 AC power indicator 15 acceleration ACC index measurement 69 accessories list 204 acoustic measurement precision 157 acoustic output measurement 140 tables 144 146 154 acquisition error 191 acronyms 211 add new user 24 administrator login 22 age gestational 83 airborne equipment standards 207 ALARA principle 137 209 alphanumeric 14 angle correction 55 annotation annotate images 58 description 14 Aortic Valve Area AVA 99 applications 204 archive patient list 61 area circumference measurement 65 arrow 58 assistance customer 2 baseline 56 battery clean 176 install 10 TITAN remove 10 safety 131 specifications 205 206 storage and shipping 205 biological safety 132 biopsy 48 b mode See 2D imaging bodymarker See pictograph brightness 48 brightness mode See 2D imaging C cable clean and disinfect transducer cables 175
212. trol 4 Sample Vol Position zone 7 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 is not applicable for this transducer mode Chapter 6 Safety BASo nosite Global Maximum Derated Ispra and MI Values The following values represent worst case values of the Ispra 3 and MI for each transducer and each mode over all operating conditions for that mode These tables fulfill the requirements of Appendix G Section C2 of the September 30 1997 issue of the FDA document Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers Table 14 C8 8 5 Transducer Transducer Model Imaging Mode Derated lspra MI C8 8 5 MHz 2D 10 0 8 CPD 362 0 9 M Mode 78 0 8 PW Doppler 474 0 9 Table 15 C11 8 5 Transducer Transducer Model Imaging Mode Derated l pra MI C11 8 5 MHz 2D 3 0 4 CPD Color 58 0 5 M Mode 21 0 4 PW Doppler 340 0 5 CW Doppler 73 lt 0 1 Table 16 C15 4 2 Transducer Transducer Model Imaging Mode Derated lspra MI C15 4 2 MHz 2D 12 0 7 CPD Color 137 0 7 M Mode 73 0 7 PW Doppler 423 0 7 CW Doppler 289 0 1 TITAN Chapter 6 Safety Table 17 C60 5 2 Transducer
213. uchpad 15 18 transducer cables clean and disinfect 175 clean and disinfect 173 connect 13 curved array 209 definition 210 disinfect 173 exam type 44 72 74 76 78 81 89 92 imaging modes 44 linear array 209 problems 162 remove 13 sheath 46 specifications 203 206 sterilizable 174 storage and shipping 206 upgrade software 163 troubleshooting 161 U ultrasound terminology 209 update 16 upgrade system software 163 upgrade transducer software 163 user account 25 user guide conventions used 2 user login 23 uses intended 142 144 V variance 53 vascular calculations 89 intended uses 144 VCR problem 162 VCR setup 29 velocity measurement 69 velocity time integral VTI 97 vertical flip 47 video recording 15 volume adjust Doppler volume 56 calculation 74 75 volume flow 76 Bl Sonosite WwW wall filter 52 56 warnings definition 129 Z zoom description 15 problem 161 turn on off 49 TITAN Index Index BSonoSite P03322 08 AUN ACTA
214. umber 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 E g C15 C60 A menu item used to adjust 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 A Doppler imaging mode used to visualize the presence of detectable blood flow and the direction of blood flow See also 2D image Color image and CPD image In the natural or original position 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 E g L38 Aiesso 5 Chapter 10 Glossary 209 A N 7 2 M Mode mechanical index MI MI TI NTSC PAL pulsed wave PW Doppler mode skinline thermal index TI TIB bone thermal index TIC cranial bone thermal index TIS soft tissue thermal index Tissue Harmonic Imaging transducer Chapter 10 Glossary Motion Mode showing the phasic motions of the cardiac structures A single beam of ultrasound is transmitted and reflected signals are displayed as dots of varying intensities which create lines across the screen An indication of th
215. up to save calculations to the report See Delta Key on page 32 or Save Key on page 39 If desired press the Save key to save the image with the measurements displayed 6 Highlight the next measurement and press the Select key 7 Repeat these steps until all measurements have been performed View or Repeat 1 Use the touchpad to highlight the desired measurement from the Saved calculations menu Measurement The saved measurement is shown at the bottom of the calculation menu 2 Press Select key or the Caliper key to select the measurement 3 Repeat the measurement The new results are displayed in the measurement and calculation data area You can compare the active measurement to the saved measurement 4 To save anew measurement select Save from the on screen menu or press the Enter key Note For measurements that are not averaged this will save the new measurement to the patient report and overwrite the previously saved measurement Delete 1 Use the touchpad to highlight the measurement Measurement Select Delete from the on screen menu This will remove the last saved measurement from the patient report N Chapter 4 Measurements and Calculations B So nosite The following table lists the ratios available for OB Doppler calculations Table 10 OB Doppler Calculations Measurement Description S D RI PI MCA Middle Cerebral Artery X X X Umb A Umbilical Artery X X X Calculation requires a trace 20
216. ur system and transducer software Note If you are upgrading additional transducers it is recommended to upgrade all items before calling SonoSite Technical Support for your license keys To postpone obtaining a license key press Cancel from the on screen menu Obtaining a License Key j A license key is required to update your system It may be obtained by contacting SonoSite Inc E Technical Support Department D 5 Technical support 1 877 657 8118 2 gt International technical support Contact your local representative or call 425 951 1330 s Technical support fax 1 425 951 6700 Technical support e mail service sonosite com SonoSite website www sonosite com and select Products amp Solutions and then Technical Support TITAN Chapter 7 Troubleshooting and Maintenance To receive your license key you will need to provide the following information which is displayed on the system information screen of your system Table 2 Software License Key Information System Software Transducer Software Name of the person installing the upgrade Name of the person installing the upgrade Serial number located on the bottom of your Serial number system ARM version REF number PCBA serial number SH database version Installing a License Key When you have obtained a license key for your software you must enter it into the system Once a valid license key has been entered the system remains licensed until the next time
217. vice 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 The selection of exam type limits acoustic output through default The acoustic output parameters that are set at default levels based on exam type are the mechanical index MI and the spatial peak temporal average intensity ISPTA The system does not exceed an MI of 1 0 or an ISPTA of 720 mW cm for all imaging modes Thermal index TI values greater than 1 0 occur on some transducers in some imaging modes See Table 3 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
218. xport Event Log Note The Event log and the DICOM network log have the same filename log txt When you export either one to the same CF card it will overwrite the existing log txt file 1 Insert the CompactFlash card in the back slot of the TITAN system 2 Select Log and then Export from the on screen menu 3 View the files on a CompactFlash card reader The log is a text file that can be opened by a text file application e g Microsoft Word or Notepad The log file is named log txt Clear Event Log 1 Select Clear from the on screen menu 2 Select Yes to delete or No to cancel Chapter 2 Getting Started BASonoSite To login to system as user E EE Change Password Please enter your old password new password confirm the new password and then click OK 9 foe Passwords must be 6 12 characters and are D Please enter your user name and password case sensitive a then click OK Clicking Guest allows you to scan but will block access to patient information Q N Name Userd Name Useri Password Old Password j ri New Password a OK j Guest R Confirm Password R OK Cancel i eee Figure 10 User Login and Change Password Note User Login is displayed when system access is turned on User Login In User Login enter Name and Password and click OK Guest Login In User Login select Guest In Guest mode the user is able to scan but is restricted from accessing system setup and patient information
219. xposure 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 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 the 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 a
220. y 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 D D Table 1 2D Measurement Accuracy and Range a 5 A 2D Measure Accuracy System Accuracy Test R A Range cm lt and Range Tolerance By Method Axial Distance lt 2 plus 1 of Acquisition Phantom 0 26 cm full scale Lateral Distance lt 2 plus 1 of Acquisition Phantom 0 35 cm full scale TITAN Chapter 8 References References Table 1 2D Measurement Accuracy and Range Continued 2D Measure Accuracy System Accuracy Test Range lent and Range Tolerance By Method g Diagonal Distance lt 2 plus 1 of Acquisition Phantom 0 44 cm full scale Area lt 4 plus 2 of Acquisition Phantom 0 01 720 cm full scale smallest dimension 100 plus 0 5 Circumference lt 3 plus 1 4 Acquisition Phantom 0 01 96 cm of full scale smallest dimension 100 plus 0 5 Full scale for distance implies the maximum depth of the image An RMI 413a model phantom with 0 7 dB cm MHz attenuation was used Based upon C15 imaging at maximum depth with calipers in rectangular imaging area The area accuracy is defined using the following equation tolerance 1 lateral error 1 axi
221. y Quat Ammonia T C N N N T C N A 5 Sagrosept Germany Liquid Propanol N N N N U U U oO 3 Sagrosept Germany Wipe Proponal T C N N U T C T C N MD Bunooys jqnoIL Q a gt w U e oO 2 x o e Cc ex oO n a gt O las Q w Qa z a 3 oO fe a oO auISouos ea Troubleshooting Table 3 Disinfectants Compatibility with System and Transducers Continued Cleaning Solutions of Origin Pe Activelngredient 3g cm CT HST C8 L25 Surfaces Salvanios pH 10 France Liquid Quat Ammonia U U U T C U U U Sani Cloth 4 USA Wipe Quat Ammonia U U U N U U U Sani Cloth Plus USA Wipe Quat Ammonia TC TC N N TC TC N Seku Extra Germany Liquid Gluteraldehyde U U U T U U U Sekucid France Liquid Gluteraldehyde U U U T C U U U Sekucid N 3 France Liquid Gluteraldehyde U U U T C U U U Sekulyse France Liquid Biguanide U U U T U U U Sekusept Extra Germany Liquid Glyoxal Glut U U U N U U U Sekusept forte Germany Liquid Formaldahyde U U U N U U U Sekusept forte S Germany Liquid Formaldehyde U U U N U U U Glyoxal Gluteraldehyde Quat Ammonia Sekusept Plus Germany Liquid Glucoprotamin U U U N U U U Sekusept Pulver Germany Liquid Natriumperborat U U U N U U U Sklar 4 USA Liquid lsopropanol TC TC N N T C N N Softasept N Germany Spray Ethanol U U U N U U U Sporadyne France Liquid Didecyldimethy U U U T U U U Sporadyne pret a l empoi France Liquid Gluteraldehyde U U U T U U U 3 Sporicidin 2 4 USA Liqu
222. y indications include but are not limited to multiple pregnancy fetal hydrops placental abnormalities as well as maternal hypertension diabetes and lupus Warning To prevent injury or misdiagnosis do not use this system for Percutaneous Umbilical Blood Sampling PUBS or in vitro Fertilization IVF The system has not been validated to be proven effective for these two uses CPD DCPD 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 This system transmits ultrasound energy into the pediatric or neonatal patients using 2D M Mode color Doppler Color color power Doppler CPD pulsed wave PW Doppler and continuous wave CW Doppler to obtain ultrasound images The pediatric abdominal pelvic and cardiac anatomy pediatric hips neonatal heads and surrounding anatomical structures can be assessed for the presence or absence of pathology TITAN Chapter 6 Safety Prostate Imaging Applications This system transmits ultrasound energy into the prostate of an adult male using 2D M Mode color power Doppler CPD and pulsed wave PW Doppler to obtain ultrasound images The prostate gland can be assessed for the presence or absence of pathology Superficial Imaging Applications T
223. ype of control number SN F Storage temperature conditions IPX7 Submersible Protected against the effects of temporary immersion TITAN Mobile Docking System Input 100 240V 50 60Hz 4 2A TITAN Chapter 6 Safety Table 23 Labeling Symbols Continued Symbol Definition Type BF patient applied part B body F floating applied part Underwriter s Laboratories labeling WARNING Connect Only Accessories and Peripherals Recommended by SonoSite to Convenience Receptacles Chapter 6 Safety BSonoSite Chapter 7 Troubleshooting and Maintenance This chapter contains information to help you correct problems with system operation and provides instructions on the proper care of the system transducer and accessories Troubleshooting If you encounter difficulty with the system use the information in this chapter to help correct the problem If the problem is not covered here contact SonoSite technical support at the following numbers or addresses Technical support International technical support Technical support fax Technical support e mail SonoSite website Table 1 Troubleshooting Symptom 1 877 657 8118 Contact your local representative or call 425 951 1330 1 425 951 6700 service sonosite com www sonosite com and select Products amp Solutions and then Technical Support Solution System will not power on System image quality is poor Zoom does

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