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M-Turbo Ultrasound System User Guide

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1. TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 3 1 1 b Pr3 MPa 1 83 Wo mW 122 87 min of W z lrA 3 Z1 mW 2 cm 4 Zbp cm 9 S 7 5 1 s P deg Zsp cm lt fc MHz 1 84 1 88 Dim of Aaprt X cm 0 590 Y cm 1 3 PD usec 0 963 s PRF 2 4421 P P ll max MPa 2574 5 deqOPllmax cm Focal Length FL cm 1 55 m 5 FL cm 55 Ip 3 M max W cm 209 0 Control 1 Exam Type Card Abd OB 2s Control 2 Optimization Any ES 88 5 Control 3 Depth 7 47 Control 4 THI On On a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 143 Ayayes Table 20 Transducer Model P21x 5 1 Operating Mode M Mode TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 5 a a a Pr3 MPa 2 10 Wo mW
2. 2 Intended USCS ul a a iiaii a RA s abi 2 Preparing ihesystemi s s 5 Installing or removing the battery 5 Using AC power and charging the battery 6 Turning the system on or Off 222 6 CONNECTING transducers l 7 Inserting and removing USB storage devices 7 System GOMER OM S seis g u a D Bo si 9 Screen layout 12 General interaction 6 TOUCH Pad ANG c rs r suq a paqan aqa s si 13 On screen OPTIONS ssssscecsssasszadeavssascsascescsessdsanvesdscsbecedcadssasennssovsseaseesadevatssnentvicenes 13 Annotation and text aan aaa sauna 14 Preparing transd cers 16 Chapter 2 System Setup A amp B Key Footswitch setup ss sseess ees s s s e s s s a 17 Administration setup 18 Sec ritysettinds a s R R R s 18 Usersetupa ns s ri ria suba 19 Exporting or importing user accounts 225 20 Exporting and clearing the Event log 20 LO
3. a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 147 Ayayes Terms used in the acoustic output tables 148 Table 24 Acoustic Output Terms and Definitions Term Definition Ispra 3 Derated spatial peak temporal average intensity in units of millivvatts cm Tl type Applicable thermal index for the transducer imaging mode and exam type Tl value Thermal index value for the transducer imaging mode and exam type MI Mechanical index Derated pulse average intensity at the maximum MI in units of W cm TIS Soft tissue thermal index is a thermal index related to soft tissues TIS scan is the soft tissue thermal index in an auto scanning mode TIS non scan is the soft tissue thermal index in the non autoscanning mode TIB Bone thermal index is a thermal index for applications in which the ultrasound beam passes through soft tissue and a focal region is in the immediate vicinity of bone TIB non scan is the bone thermal index in the non autoscanning mode TIC Cranial bone thermal index is the thermal index for applications in which the ultra
4. min of 21 3 21 1 mW 8 2 cm y 2 Zbp cm G dieq Zsp cm lt fe 2 1 93 Dim of Aaprt X cm Y cm it PD usec 0 904 S PRF Hz 800 2 max 2 679 5 deqOPllmax cm Focal Length FL cm 9 5 FL cm Ip 3 M max W cm 237 4 Control 1 Exam Type Abd 235 ap Control 2 Optimization Gen S Res O Control 3 Depth 7 5 cm Control 4 THI On Control 5 MB On a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 144 Table 21 Transducer Model P21x 5 1 Operating Mode CPD Color TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 5 1 3 b Pr3 MPa 2 19 Wo mW 136 91 min of W z lrA 3 Z1 mW 5 21 cm o z cm uz s SP m Q daqlsp cm lt fc MHz 2 15 2 16 Dim of Aaprt X cm 0 918 Y cm 1 3 PD
5. Figure 4 Connect the Transducer To connect a transducer 1 Remove the system from the mini dock if present and turn it upside down 2 Pull the transducer latch up and rotate it clockwise 3 Align the transducer connector with the connector on the bottom of the system 4 Insert the transducer connector into the system connector 5 Turn the latch counterclockwise 6 Press the latch down securing the transducer connector to the system To remove a transducer 1 Pull the transducer latch up and rotate it clockwise 2 Pull the transducer connector away from the system Inserting and removing USB storage devices Images and clips are saved to internal storage and are organized in a sortable patient list You can archive the images and clips from the ultrasound system to a PC using a USB storage device or Ethernet connection Although the images and clips cannot be viewed from a USB storage device on the ultrasound system you can remove the device and view them on your PC Chapter 1 Getting Started 7 There are two USB ports on the system and one on the mini dock For additional USB ports you can connect a USB hub into any USB port WARNING Caution To avoid damaging the USB storage device and losing patient data from it observe the following Do not remove the USB storage device or turn off the ultrasound system while the system is exporting Do not bump or otherwise apply pressure to the USB storage devi
6. u A san 173 Images and clips storage Accessories Peripherals 2174 Temperature and humidity limits 175 Operating lilmits uu c w Suq A A 175 Shipping and storage limits 175 Electrical c ua R R 175 Battery a Saa na q sa 175 Electromechanical safety standards 2222 176 EMC standards classification 176 Airborne equipment Standards 176 DICOM standard HIPAA standard Glossary E a a A ATA T E E E EAE E 179 ABDBDrI VI3UIONS 2 aa qaa bau bukan ana Qa huabauhaiquashaaQaskas 181 Index asua asam manaqa aaa n AAA Aaa uu 191 Introduction This M Turbo Ultrasound System User Guide provides information on preparing and using the M Turbo ultrasound system and on cleaning and disinfecting the system and transducers It also provides references for calculations system specifications and safety and acoustic output information uon nposnui The user guide is for a reader familiar with ultrasound techniques It does not provide training in sonography or clinical practices Before using the system you must have ultrasound training
7. Data are not applicable for this transducer mode 134 Table 11 Transducer Model C60x 5 2 Operating Mode M Mode TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 0 a a b Pr3 MPa 1 62 Wo mW Y min of W zi lrA 3 Z1 mW 2 cm o z cm 5 z 4 7 s SP S gt idaqiz n cm m lt f MH2 2 85 Dim of Aaprt X cm Y cm PD usec 0 577 2 800 P Pllmax 2 576 5 deqOPllmax cm Focal Length FL cm 5 FL cm 3 MImax VV cm 184 3 Z Control 1 Exam Type Any Control 2 Optimization Pen o 29 5 Control 3 Depth 78 cm Control 4 MB Multi Beam Off or On a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 135 Ayayes Table 12 Transducer Model C60x 5 2 Operating Mode PW Doppler TIS TIB Index Label Non scan TIC Scan Non scan AaprtS1 Aaprt gt
8. Data are not applicable for this transducer mode Chapter 6 Safety 141 Ayayes Table 18 Transducer Model L38x 10 5 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 04 2 0 2 6 b Pr3 MPa 2 345 Wo mW 84 94 84 94 min of IV 5 z A s z 1 mW 2 cm lt T Zpp cm 2 0 8 1 3 G SP i o dag ep cm 0 4685 lt R MHz 5 01 5 05 5 05 Dim of Aaprt X cm 1 80 1 80 Y cm 0 4 0 4 PD usec 1 29 S PRF Hz 1008 8 Pr PIl max 2 693 5 deq Pllmax cm 0 2533 Focal Length FL cm 5 54 5 FLy cm 2 5 Ip 3 MI max VV cm 284 5 Control 1 Exam Type Any Vas Vas 2 Q Control 2 Sample Volume 1mm 12mm 12mm S Control 3 PRF 1008 Any Any 2 U S Control 4 Sample Volume Position Zone 7 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 are not applicable for this transducer mode 142 Table 19 Transducer Model P21x 5 1 Operating Mode 2D
9. cm lt f MHz 5 328 5 324 Dim of Aaprt X cm 0 44 Y cm 0 4 PD usec 0 525 s PRF Hz 2597 2 Pr PIl max MPa 3 187 S deqOPllmax cm Focal Length FL cm 1 32 o 5 FL cm 2 5 3 MI max W cm 325 5 Control 1 Mode Color Color Control 2 Exam Type Any Any o 9 S Control 3 Optimization Depth PRF Low 3 3 an Med ces 393 2 7 cm se 5 1938 Control 4 Color Box Position Size Top Any Short a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 137 Ayayes Table 14 Transducer Model HFL38x 13 6 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a 1 2 2 2 b MPa Wo mW 46 55 46 55 Y min of W 3 Z lta 3 21 mW 5 2 cm o z cm m BE li s p a cm 0 33 lt n MH2 4 5 33 5 33 Dim of Aaprt X cm 1 04 1 04 Y cm 0 4 0 4 PD usec PRF H 9 8 Pr Pll max MPa 5 deqOPllmax cm 0
10. Biological safety Observe the following precautions related to biological safety WARNING To avoid device damage or patient injury do not use the P10 P17 needle guide bracket on patients with pacemakers or medical electronic implants The needle guide bracket for the P10 and P17 transducers contains a magnet that is used to ensure the bracket is correctly oriented on the transducer The magnetic field in direct proximity to the pacemaker or medical electronic implant may have an adverse effect Non medical commercial grade peripheral monitors have not been verified or validated by SonoSite as being suitable for diagnosis To avoid the risk of a burn hazard do not use the transducer with high frequency surgical equipment Such a hazard may occur in the event of a defect in the high frequency surgical neutral electrode connection Do not use the system if it exhibits erratic or inconsistent behavior Discontinuities in the scanning sequence are indicative of a hardware failure that must be corrected before use Some transducer sheaths contain natural rubber latex and talc which can cause allergic reactions in some individuals Refer to 21 CFR 801 437 User labeling for devices that contain natural rubber Chapter 6 Safety 117 WARNING Perform ultrasound procedures prudently Use the ALARA as low as reasonably achievable principle and follow the prudent use information concerning MI and TI SonoSite does not curre
11. See the applicable SonoSite accessory user guide for information on using accessories and peripherals See the manufacturer s instructions for specific information about peripherals Conventions symbols and terms The user guide follows these conventions A WARNING describes precautions necessary to prevent injury or loss of life e A Caution describes precautions necessary to protect the products Numbered steps must be performed in a specific order e Bulleted lists present information in list format but do not imply a sequence Symbols and terms used on the system and transducer are explained in Chapter 2 Chapter 5 Chapter 6 and Glossary Customer comments Questions and comments are encouraged SonoSite is interested in your feedback regarding the system and the user guide Please call SonoSite at 888 482 9449 in the US Outside the US call the nearest SonoSite representative You can also e mail SonoSite at comments sonosite com Introduction vi viii For technical support please contact SonoSite as follows SonoSite Technical Support Phone US or Canada Phone Outside US and Canada Fax E mail Web site Europe Service Center 877 657 8118 425 951 1330 Or call your local representative 425 951 6700 service sonosite com www sonosite com Click Support amp Service 44 0 1462 444 800 e mail uk service sonosite com Chapter 1 Getting Started About the system The M Turbo ultr
12. To make a correction select Undo on screen or press the BACKSPACE key to delete the last segment c Press the SET key to complete the trace line d If necessary adjust or edit the measurement See IMT tool options on page 82 e Save the calculation See To save a calculation on page 62 OB calculations EFW is calculated only after appropriate measurements are completed If any one of these parameters results in an EDD greater than what the OB tables provide the EFW is not displayed WARNING Make sure that you have selected the OB exam type and the OB calculations author for the OB table you intend to use See System Defined OB Calculations and Table Authors on page 86 To avoid incorrect obstetrics calculations verify with a local clock and calendar that the systems date and time settings are correct before each use of the system The system does not automatically adjust for daylight savings time changes Chapter 4 Measurements and Calculations 83 suonein le pue s uawasnsea y To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Prior to use verify that O
13. IVRT Doppler MV SMR dP dTP CW Doppler AV Vmax Doppler VTI Doppler VTI or Vmax from LVOT Doppler VTI or Vmax from AV Doppler LV LVOT D 2D AV VTI Doppler LV LVOT D 2D E EPG APG E A PHT MVA Decel time VTI Vmax PGmax Vmean PGmean IVRT dP dT Vmax PGmax VTI Vmax PGmax Vmean PGmean AVA suonein le pue s uawasAnsea y SV Chapter 4 Measurements and Calculations 71 Cardiac Calculations Continued Menu Heading Cardiac Measurements Imaging Mode Calculation Results AV LV HR LVOT AV gt AI TV PV VTI Doppler LVOT D 2D HRa Vmax Doppler VTI Doppler PHT slope Doppler TRmax Doppler RA pressures Vmax Doppler VTI Doppler CO Vmax PGmax VTI Vmax PGmax Vmean PGmean Al PHT Al slope Vmax PGmax RVSP Vmax PGmax VTI Vmax PGmax Vmean PGmean a You can enter the HR measurement three ways Patient information form Doppler measurement See To calculate Heart Rate HR on page 78 or M Mode measurement See To measure heart rate M Mode on page 58 b Performed at 100 cm s and 300 cm s c Specified on the cardiac report See To view a vascular or cardiac report on page 92 To measure LVd and LVs 1 Ona frozen 2D image or M Mode trace press the CALCS key 2 From the calculations menu select the measurement name 72 w Position the active green caliper at the starting
14. Velocity Peak E Pressure Gradient E PG E PG 4 PE Peak A Pressure Gradient A PG A PG 4 PA Peak Pressure Gradient PGmax PGmax 4 PV Mean Pressure Gradient PGmean PGmean Average of pressure gradients Duration of flow Pressure Half Time PHT in msec Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 391 PHT DT 0 29 where DT deceleration time Proximal Isovelocity Surface Area PISA in cm 162 Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Boston Little Brown and Company 1999 125 PISA 2 r where 2n 6 28 r aliasing radius Qp Qs Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 400 Qp Qs SV Qp site SV Qs site SV sites will vary depending upon the location of the shunt Regurgitant Fraction RF in percent Oh J K J B Seward A J Tajik The Echo Manual Boston Little Brown and Company 1999 125 s RF RV MV SV 5 where RV Regurgitant Volume MV SV Mitral Stroke Volume Regurgitant Volume RV in cc Reynolds Terry The Echocardiographer s Pocket Reference School of Cardiac Ultrasound Arizona Heart Institute 2000 396 455 RV ERO MR VTI Right Ventricular Systolic Pressure RVSP in mmHg Reynolds Terry The Echocardiographer s Pocket Referen
15. 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 a Full scale for distance implies the maximum depth of the image of full scale smallest dimension 100 plus 0 5 b An RMI 413a model phantom with 0 7 dB cm MHz attenuation was used c The area accuracy is defined using the following equation tolerance 1 lateral error 1 axial error 1 100 0 5 Chapter 7 References 155 d The circumference accuracy is defined as the greater of the lateral or axial accuracy and by the following equation 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 Range 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 4 2 plus Full Acquisition Phantom 5 923 bpm Scale Heart Rate 100 a Full scale for distance implies the maximum depth of the image b An RMI 413a model phantom with 0 7 dB cm MHz attenuation was used c Full scale for time implies the total time displayed on the scrolling graphic image d SonoSite special test equipment was used Table 3 PW Doppler Mode Measurement and Calculation Accuracy and Range Doppler Mode System
16. 4 Optional If the image is frozen use the touchpad or arrow keys to pan the image up down left and right You cannot pan in Dual To exit zoom press the ZOOM key again Changing the exam type The exam types available depend on transducer used See Imaging modes and exams available by transducer on page 42 To change the exam type Do one of the following Press the EXAM key and select from the menu On the patient information form select from the Type list under Exam See Patient information form on page 45 2D imaging 34 2D is the system s default imaging mode The system displays echoes in two dimensions by assigning a brightness level based on the echo signal amplitude To achieve the best possible image quality properly adjust the display brightness gain depth settings viewing angle and exam type Also select an optimization setting that best matches your needs To display the 2D image 1 Do any of the following Turn on the system e Press the 2D key 2 Set options as desired See 2D options 2D options In 2D imaging you can select the following on screen options 2D options Option Icon Description Optimize Settings are as follows Res provides the best possible resolution e Gen provides a balance between resolution and penetration Pen provides the best possible penetration Some of the parameters optimized to provide the best image include
17. EFW HC AC FL Hadlock 1 BPD AC FL Hadlock 2 AC FL Hadlock 3 BPD TTD Hansmann BPD FTA FL Osaka U BPD AC Shepard BPD TTD APTD FL Tokyo U System Defined OB Calculations and Table Authors Continued Gestational OB Calculation Result Measurements Table Authors Ratios HC AC Campbell FL AC Hadlock FL BPD Hohler FL HC Hadlock Amniotic Fluid Index Q Q3 Jeng Growth Analysis Tables4 BPD Chitty Hadlock Jeanty HC Chitty Hadlock Jeanty AC Chitty Hadlock Jeanty FL Chitty Hadlock Jeanty EFW Hadlock Jeanty HC AC Campbell a The Gestational Age is automatically calculated and displayed next to the OB measurement you selected The average of the results is the AUA b For Toyko U APTD and TTD are used only to calculate EFW No age or growth tables are associated with these measurements c The Estimated Fetal Weight calculation uses an equation that consists of one or more fetal biometry measurements The author for the OB tables which you choose on a system setup page determines the measurements you must perform to obtain an EFW calculation See OB Calculations setup on page 26 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 d The Growth Analysis tables are used by the Report Graphs feature Three growth c
18. Femur Length British Journal of Obstetrics and Gynaecology 101 February 1994 135 Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine A Longitudinal Study of Fetal Limb Growth American Journal of Perinatology 1 January 1984 136 144 Table 5 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 182 Table 7 17 Head Circumference HC 168 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 Gynae
19. 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 Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 154 164 Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 103 105 Shepard M 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
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21. WARNING To avoid injury to the operator and to prevent damage to the ultrasound system inspect the battery for leaks prior to installing To avoid data loss and to conduct a safe system shutdown always keep a battery in the system Locking levers payers e Figure 3 Install the Battery To install the battery 1 Disconnect the power supply from the ultrasound system 2 Remove the system from the mini dock if present and turn it upside down 3 Place the battery into the battery compartment at a slight angle See Figure 3 4 Slide the battery forward until it locks into place 5 Push down on the two locking levers to secure the battery To remove the battery 1 Disconnect the power supply from the ultrasound system 2 Remove the system from the mini dock if present and turn it upside down 3 Pull up the two locking levers 4 Slide the battery back 5 Lift the battery from the compartment Chapter 1 Getting Started 5 Using AC power and charging the battery The battery charges when the system is connected to the AC power supply A fully discharged battery recharges in less than five hours The system can runon AC power and charge the battery if AC power is connected to the system directly to a mini dock or to a docking system The system can run on battery power for up to two hours depending on the imaging mode and the display brightness WARNING The equipment shall
22. distance in meters m Chapter 6 Safety 121 Table 2 Manufacturer s Declaration Electromagnetic Immunity Continued Electromagnetic Immunity Test IEC 60601 Test Level Compliance Level Environment Radiated RF Field strengths from fixed RF IEC 61000 4 3 transmitters as determined by an electromagnetic Site survey should be less than the compliance level in each frequency range continued Interference may occur in the vicinity of equipment marked with the following symbol IEC 60417 No 417 IEC 5140 Source of non ionizing radiation Note Uz is the AC mains voltage prior to application of the test level At 80 MHz and 800 MHz the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the SonoSite ultrasound system is used exceeds the applicable RF compliance level above the SonoSite ultrasound system should be observed to verify normal operation If abnormal
23. type a unique name Enter the data Select Save on screen To display the measurement for the custom table in the calculations menu see To specify gestational age and growth analysis on page 27 To edit or delete an OB custom table 1 2 3 4 5 Press the SETUP key Select OB Custom Meas or OB Calculations Select Tables on screen Select the OB custom table Select one of the following on screen e Edit Enter data and then select Save on screen e Delete to remove the custom table Presets setup The Presets setup page has settings for general preferences To set presets 1 2 3 Press the SETUP key Select Presets Select from the lists Doppler Scale Select cm s or kHz Duplex The layout for displaying M Mode trace and Doppler spectral trace 1 3 2D 2 3 Trace 1 2 2D 1 2 Trace or Full 2D Full Trace Chapter 2 System Setup 29 dn s ul 3s4S Live Trace Select Peak or Mean Thermal Index You can select TIS TIB or TIC The default setting is based on exam type OB is TIB TCD is TIC and all others are TIS Save Key Behavior of the SAVE key Image Only saves the image to internal storage Image Calcs saves the image to internal storage and saves the current calculation to the report Dynamic Range Settings include 3 2 1 0 1 2 or 3 Negative numbers show higher contrast images and positive numbers show lower contrast images Units Units for patient height and weight i
24. 2 12 5 to 16 8 PII 3 3 2 13 47 to 17 5 Labeling symbols The following symbols are used on the products packaging and containers Table 26 Labeling Symbols Symbol Definition Alternating Current AC g Class 1 device indicating manufacturer s declaration of conformance with C Annex VII of 93 42 EEC Class 1 device requiring verification by the Notified Body of sterilization or C measurement features or to a Class lla Ilb or III device requiring verification or doss auditing by the Notified Body to applicable Annex es of 93 42 EEC Attention see the user guide Device complies with relevant Australian regulations for electronic devices LOT Batch code date code or lot code type of control number A Biological risk Nee Device complies vvith relevant Brazilian regulations for electro medical devices 09 Canadian Standards Association C and US indicators next to this mark GR signify that the product has been evaluated to the applicable CSA and ANSI UL US Standards for use in Canada and the US respectively 150 Table 26 Labeling Symbols Continued Symbol Definition REF Catalog number Collect separately from other household waste see European Commission X Directive 93 86 EEC Refer to local regulations for disposal masa STERILEIEO Contents sterilized using ethylene oxide process S Corrugated recycle Corruga
25. 5 0 A Max Power Supply Output 2 12 VDC 2 3 A Max Battery The battery comprises six lithium ion cells plus electronics a temperature sensor and battery contacts Run time is up to two hours depending on imaging mode and display brightness Chapter 8 Specifications 175 Electromechanical safety standards EN 60601 1 1997 European Norm Medical Electrical Equipment Part 1 General Requirements for Safety EN 60601 1 1 2001 European Norm Medical Electrical Equipment Part 1 General Requirements for Safety Section 1 1 Collateral Standard Safety Requirements for Medical Electrical Systems EN 60601 2 37 2001 Amendment A1 2005 European Norm Particular requirements for the safety of ultrasonic medical diagnostic and monitoring equipment CAN CSA 22 2 No 601 1 M90 Canadian Standards Association Medical Electrical Equipment Part 1 General Requirements for Safety including CSA 601 1 Supplement 1 1994 and CSA 601 1 Amendment 2 1998 CEI TEC 61157 1992 International Electrotechnical Commission Requirements for the Declaration of the Acoustic Output of Medical Diagnostic Ultrasonic Equipment UL 60601 1 1st Edition Underwriters Laboratories Medical Electrical Equipment Part 1 General Requirements for Safety EMC standards classification EN 60601 1 2 2001 European Norm Medical Electrical Equipment General Requirements for Safety Collateral Standard Electromagnetic Compatibility Requirements and Tests CI
26. 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 scale a SonoSite special test equipment was used b Full scale for frequency or velocity implies the total frequency or velocity magnitude displayed on the scrolling graphic image c Full scale for time implies the total time displayed on the scrolling graphic image Sources of measurement errors In general two types of errors can be introduced into the measurement Acquisition Error Includes errors introduced by the ultrasound system electronics relating to signal acquisition signal conversion and signal processing for display Additionally computational and display errors are introduced by the generation of the pixel scale factor application of that factor to the caliper positions on the screen and the measurement display Algorithmic Error The error introduced by measurements which are input to higher order calculations This error is associated with floating point versus integer type math which is subject to errors introduced by rounding versus truncating results for display of a given level of significant digit in the calculation Measurement publications and terminology The fo
27. Color imaging mode only 3 Using the touchpad position or resize the ROI box as needed Press the SELECT key to toggle between position and size While you position or resize the ROI box a green outline shows the change The ROI box indicator on the left hand screen shows which touchpad function is active 4 Set options as desired See CPD and Color options Chapter 3 Imaging 37 CPD and Color options In CPD or Color imaging you can set the following on screen options CPD and Color options Option Icon Description Color CPD Toggle between CPD and Color fm The current selection appears in the upper left hand screen Color Shows or hides color information You can select Show or Hide while in Suppress 2 live or frozen imaging The setting shown on screen is the current selection Flow he current setting appears on screen Sensitivity PRF Scale Wall Filter Steering Variance Invert Page x x 38 e Low optimizes the system for low flow states Med optimizes the system for medium flow states High optimizes the system for high flow states Select the desired pulse repetition frequency PRF setting by pressing the control keys There is a wide range of PRF settings for each Flow Sensitivity setting Low Med and High Available on select transducers Settings include Low Med and High Available on select transducers Select the steering angle setting of the colo
28. 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 em 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 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 elevati
29. Length FL cm o x FL cm 3 MI max W cm Control 1 Exam Type Vas Nrv 2 Ven Control 2 Sample Volume 12mm 553 eu Control 3 PRF 20833 Control 4 Sample Volume Position Zone 0 Table 17 Transducer Model L38x 10 5 Operating Mode CPD Color TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 3 1 0 b Pr3 MPa 2 89 Wo mW 64 88 min of W z1 lrA 3 Z1 mW 5 7 cm Sy 1 cm Zbp cm Zp m 14 e deqiZip cm R MH2 491 491 Dim of Aaprt X cm 0 54 Y cm 0 4 PD usec 0 529 PRF Hz 9547 2 pr Pll max MPa 3 48 5 deqOPllmax cm Focal Length FL cm 1 5 m 5 FL cm 2 5 3 MI max W cm 439 3 Control 1 Mode Color CPD 2 Control 2 Exam Type Any Bre 5 S Control 3 PRF 331 2137 6 Control 4 Optimization Depth Any 3 1 Med 3 1 o GOlcontrol 5 Color Box Position Size h Def y Def Def a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line
30. MI value or 0 2 of the displayed value whichever value is larger The accuracy result for the thermal index IT is stated statistically With 90 confidence 90 of the measured TI values will be within 26 to 50 of the displayed TI value or 0 2 of the displayed value whichever value is larger The values equate to 1dB to 3dB A displayed value of 0 0 for MI or TI means that the calculated estimate for the index is less than 0 05 Factors that contribute to display uncertainty The net uncertainty of the displayed indices is derived by combining the quantified uncertainty from three sources measurement uncertainty system and transducer variability and engineering assumptions and approximations made when calculating the display values Measurement errors of the acoustic parameters when taking the reference data are the major source of error that contributes to the display uncertainty The measurement error is described in Acoustic measurement precision and uncertainty on page 149 The displayed MI and TI values are based on calculations that use a set of acoustic output measurements that were made using a single reference ultrasound system with a single reference transducer that is representative of the population of transducers of that type The reference system and transducer are chosen from a sample population of systems and transducers taken from early production units and they are selected based on having an acousti
31. MPa 5 deqOPllmax cm 0 226 Focal Length FL cm 0 77 5 FLy cm 2 5 Ipa 3 M max W cm 2 Control 1 Exam Type Any Any 5 Control 2 Sample Volume 2mm 3mm 2 Control 3 PRF 3906 gt 3906 OlControl 4 Sample Volume Position Zone 1 Zone 0 Chapter 6 Safety 133 Ayayes Table 10 Transducer Model C60x 5 2 Operating Mode 2D TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 0 a b Pr3 MPa 1 59 Wo mW min of 21 3 21 1 mW 8 2 cm y 2 Zbp cm 15 Zsp cm 5 3 G dieq Zsp cm lt fc MHz 2 86 Dim of Aaprt X cm Y cm PD usec 0 579 S PRF Hz 7923 2 max 2 679 5 deqOPllmax cm Focal Length FL cm 9 5 FLy cm Ip 3 M max W cm2 197 7 o Control 1 Exam Type Any Control 2 Optimization Pen gS S Control 3 Depth 6 6 cm lcontrol 4 THI On a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line
32. Obstetrical Occipital Frontal Diameter Orbital Phase Alternating Line Posterior Cerebral Artery Peak Abbreviations in User Interface Continued Abbreviation Definition PCCA PCoA PECA PGmax PGmean PGr PHT PI PICA PISA Plaq POST F POST N PRF Prox PSV PV PW Qp Qs RA RI RVD RVDd RVDs RVOTD Proximal Common Carotid Artery Posterior Communicating Artery Proximal External Carotid Artery Maximum Pressure Gradient Mean Pressure Gradient Pressure Gradient Pressure Half Time Pulsatility Index Proximal Internal Carotid Artery Proximal Isovelocity Surface Area Plaque Posterior Far Posterior Near Pulse Repetition Frequency Proximal Peak Systolic Velocity Pulmonic Valve Pulsed Wave Doppler Pulmonary blood flow divided by systemic blood flow Right Atrial pressure Resistive Index Right Ventricular Dimension Right Ventricular Dimension Diastolic Right Ventricular Dimension Systolic Right Ventricular Outflow Tract Diameter Glossary 187 Aaessoj5 188 Abbreviations in User Interface Continued Abbreviation Definition RVOT VTI RVSP RVW RVWd RVWs S S D SI Siphon SM SmP SO Sup SV TAM TAP TCD TDI THI TI TICA TO TRmax TT TTD Right Ventricular Outflow Tract Velocity Time Integral Right Ventricular Systolic Pressure Right Ventricular Free Wall Right Ventricular Free Wall Diastolic Right Ventricular Free Wall Systolic SonoHD Systolic Diastolic
33. Right In a duplex layout the pictograph is restricted to upper left In Dual all four positions are available m To remove the pictograph select Hide Patient information form The patient information form lets you enter patient identification exam and clinical information for the patient exam This information automatically appears in the patient report When you create a new patient information form all images and other data you save during the exam are linked to that patient See Patient report on page 92 To create a new patient information form Note Creating a new patient information form erases any unsaved patient information including any calculations and report page To save this information save the screen for each item 1 Press the PATIENT key 2 Select New 3 Fill in the form fields See Patient information form fields on page 46 4 Select Done To edit a patient information form You can edit patient information during the exam However if you change the patient name ID date of birth gender or accession after saving an image a new patient information form is created 1 Press the PATIENT key 2 If you need to change the name ID date of birth gender or accession save any data you want to keep Chapter 3 Imaging 45 3 Make changes as desired 4 Select one of the following Cancel to undo changes and return to imaging Done to save changes and return to imaging
34. Surface Area BSA After the measurements are saved the result appears in the patient report 1 CI Only Fill in the Height and Weight fields on the patient information form The BSA is calculated automatically See To edit a patient information form on page 45 2 Calculate SV See To calculate Stroke Volume SV or Stroke Index SI on page 78 3 Calculate HR See To calculate Heart Rate HR on page 78 To perform a Tissue Doppler Imaging TDI calculation 1 Ensure that TDI is on See PW Doppler options on page 40 2 Ona frozen Doppler spectral trace press the CALCS key 3 From the calculations menu select TDI and then do the following for each measurement you want to take a From the calculations menu select the measurement name b Position the calipers See Working with calipers on page 55 c Save the calculation See To save a calculation on page 62 Gynecology Gyn calculations Gynecology Gyn calculations include Uterus Ovary Follicle and Volume For instructions to calculate volume see Volume calculations on page 65 WARNING To avoid incorrect calculations verify that the patient information date and time settings are accurate To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The
35. To end the exam 1 Make sure that you have saved images and other data you want to keep See Saving images and clips on page 48 2 Press the PATIENT key 3 Do one of the following e Select End Exam Select New to begin a new patient information form See To create a new patient information form on page 45 Patient information form fields The patient information form fields available depend on exam type In some fields you can select Symbols to enter symbols and special characters See Symbols on page 15 Patient information form fields Section Field Description Patient Last Patient name First Middle ID Patient identification number Accession Enter number if applicable Date of Date of birth birth Gender Female Male Other or blank Indications Enter desired text User User initials More Displays the Reading Dr Referring Dr and Institution button fields Select Back to save entries and return to previous screen 46 Patient information form fields Continued Section Field Description Exam Type Exam types available depend on transducer See Imaging modes and exams available by transducer on page 42 For the definition of abbreviations see Glossary on page 179 LMP OB or Gyn exam In an OB exam select LMP or Estab DD Estab DD and then enter either the date of the last menstrual period or the established due date In a Gyn exam enter the date of the last
36. a user name and password at startup Off allows access to the system without a user name and password To change the administrator password or let users change passwords 1 Log in as Administrator 2 Under User List select Administrator 3 Do any of the following Change the administrator password Under User Information type the new password in the Password box and Confirm box See Choosing a secure password on page 21 Let users change their passwords Select the Password changes check box 4 Select Save User setup To add a new user 1 Log in as Administrator 2 Select New 3 Under User Information fill in the Name Password and Confirm boxes See Choosing a secure password on page 21 4 Optional In the Sonographer box type the user s initials to display them in the patient header and the User field in the patient information form 5 Optional Select the Administration Access check box to allow access to all administration privileges 6 Select Save To modify user information 1 Log in as Administrator 2 Under User List select the user 3 Under User Information make changes as desired 4 Select Save Any change to the user name replaces the previous name To delete a user 1 Log in as Administrator 2 Under User List select the user 3 Select Delete 4 Select Yes Chapter 2 System Setup 19 dn s 5 To change a user password 1 Log in as Administ
37. 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 e0349 where In Situ In Situ intensity value Water Water intensity value e 2 7183 a attenuation factor 4 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 l skinline to measurement depth in cm f center frequency of the transducer system mode combination in MHz Chapter 6 Safety 129 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 069151 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
38. before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Transducers and Exam Types for Volume Flovv Calculations Transducer Exam Types C11x Abdomen C60x Abdomen HFL38x Vascular L25x Vascular L38x Vascular P21x Abdomen The following table shows the measurements required to complete the volume flow calculation For definitions of acronyms see Glossary on page 179 Volume Flow Calculation Menu Heading Measurement Imaging Mode Calculation Result Vol Flow D 2D VF Volume Flow 1 min TAM Doppler Both a 2D and a Doppler measurement are required for the volume flow calculation The Doppler sample volume should completely insonate the vessel Consider the following factors when performing volume flow measurements e Users should follow current medical practice for volume flow calculation applications The accuracy of the volume flow calculation largely depends on the user The factors identified in the literature that affect the accuracy are as follows e Using the diameter method for 2D area e Difficulty ensuring uniform insonation of the vessel The system is limited to the following sample volume sizes e C11x transducer 1 2 3 Gate Size mm e C60x transd
39. calculation on page 62 To view the volume flow calculation see Patient report on page 92 Chapter 4 Measurements and Calculations 67 Specialized calculations In addition to the general calculations there are calculations specific to the Cardiac Gynecology Gyn IMT OB Small Parts and Vascular exam types Cardiac calculations WARNING Transducers and Exam Type for Cardiac Calculations Transducer To avoid incorrect calculations verify that the patient information date and time settings are accurate To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Exam Type P21x Cardiac The following table shows the measurements required to complete different cardiac calculations For definitions of acronyms see Glossary on page 179 Cardiac Calculations Menu Heading Cardiac Measurements Imaging Mode Calculation Results LVd LVs 68 RVW 2D RVD 2D IVS 2D LVD 2D LVPW 2D RVW 2D RVD 2D IVS 2D LVD 2D LVPW 2D HR needed for CO amp Cl CO EF SV LVESV LVEDV VSFT LVPVVFT LVDFS c SI Cardiac C
40. cm 0 49 Focal Length FL cm 13 84 o 5 FLy cm 5 5 lpa3 M max VV cm 187 5 2 Control 1 Exam Type Card Card Any g 2 Control 2 Sample Volume 1mm 3mm 14mm 6 Control 3 PRF 1563 3906 10417 control 4 Sample Volume Position Zone 1 Zone 4 Zone 0 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 23 Transducer Model P21x 5 1 Operating Mode CW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a 1 0 34 b Pr3 MPa Wo mW 88 30 min of 21 3 21 1 mW 102 54 5 _ z cm 1 386 9 g iz cm 1 71 5 7sp em l 1 255 cm 0 49 lt fe MHz 2 00 2 00 Dim of Aaprt X cm 0 7865 0 6554 Y cm 1 3 1 3 PD usec S PRF 2 P Pll max MPa 5 deqOPllmax cm 0 45 Focal Length FL cm 13 84 o Hi 5 FLy cm 5 5 3 MI max W cm Z Control 1 Exam Type Card Card So 5 x Control 2 Zone 62 Zone 4 Zone 1 oo t
41. detatteeanneatonstscersesiesaess Position the system POSITION yourself Take breaks exercise and vary activities Electrical safety classification s 113 E EEEN EEE 113 EQUIDIMEMESATELY suzan ad E Er EEEE EEEE E EIS 116 Battery Safety sscrassosiecsssscssessasasascssseceesawcssacusasnsteacasosserssansin m TEER EEEa EESE E Eea 116 Biological safety 117 Electromagnetic compatibility 5 2 118 Manufacturer s declaration 5 119 ALARA principle wee 122 Applying ALARA s 123 Direct controls 123 Indirect controls Receiver controls we 124 Acoustic artifacts 124 Guidelines for reducing MI and TI 5 22 124 Output display ku eeeessseescssesecsseecssecessseecsneceesseecssecessseeessecesusesesscessseeessceesseseneeseas 126 Mechanical and thermal indices output display accuracy 127 Factors that contribute to display uncertainty 127 Related guidance documents 127 Transducer surface temperature rise 128
42. diagnostic tool All IMT results should be interpreted in conjunction with other clinical information or risk factors To avoid measurement errors all measurements must be of the common carotid artery CCA This tool is not intended for measuring the bulb or the internal carotid artery ICA To avoid incorrect calculations verify that the patient information date and time settings are accurate To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Transducers and Exam Type for IMT Calculations Transducer Exam Type L38x IMT HFL38x IMT The following table shows available measurements for IMT calculations The IMT measurement names are specified on the IMT setup page See IMT Calculations setup on page 25 IMT Calculations 2D Menu Heading Available Measurements Right IMT Ant N Anterior Near Wall Left IMT Ant F Anterior Far Wall Lat N Lateral Near Wall Lat F Lateral Far Wall Post N Posterior Near Wall Post F Posterior Far Wall IMT 1 IMT 2 IMT 3 IMT 4 IMT 5 IMT 6 IMT 7 IMT 8 Plaque Plaq 1 Plaq 2 To calculate IMT automatically 1 On a frozen 2D i
43. focal zones aperture size frequency center and bandwidth and waveform They cannot be adjusted by the user Dynamic Range 111 Adjusts the grayscale range 3 2 1 0 1 2 3 The positive range increases the number of grays displayed and the negative range decreases the number of grays displayed Dual Displays side by side 2D images Select Dual and then press the UPDATE key to display the second screen and to toggle between the screens With both images frozen press the UPDATE key to toggle between the images To return to full screen 2D imaging select Dual or press the 2D key LVO On LVO On turns on Left Ventricular Opacification LVO Off turns off LVO Off LVU this option Use LVO for cardiac exams in 2D imaging mode when using an imaging contrast agent LVO lowers the mechanical index MI of the system to enhance visualization of the contrast agent and endocardial border This option depends on transducer and exam type Select from four image orientations U R Up Right U L Up Left Orientation N D L Down Left D R Down Right Chapter 3 Imaging 35 2D options Continued Option Icon Description Brightness Biopsy Guide SonoHD S SonoMB MB ECG Clips THI Page x x M Mode imaging e Adjusts the display brightness Settings range from 1 to 10 The display brightness affects battery life To conserve battery life adjust brightness to a l
44. 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 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 indic
45. menstrual period The LMP date must precede the current system date Twins OB exam Select the Twins check box to display Twin A and Twin B measurements on the calculations menu and to have Twin A and Twin B screens for previous exam data Previous OB exam Displays fields for five previous exams The date for Exams a previous exam must precede the current system date For button twins select Twin A B to toggle between Twin A and Twin B screens If the Twin A B option does not appear select Back and make sure that the Twins check box is selected Select Back to save changes and return to previous screen BP Cardiac IMT or Vascular exam Blood Pressure HR Heart Cardiac or Vascular exam Enter the beats per minute Saving Rate the heart rate using a measurement overwrites this entry Height Cardiac exam The patient height in feet and inches or meters and centimeters To change the units see Presets setup on page 29 Weight Cardiac exam The patient weight in pounds or kilos To change the units see Presets setup on page 29 BSA Cardiac exam Body Surface Area Automatically calculated after you enter height and weight Ethnicity IMT exam Ethnic origin Chapter 3 Imaging 47 Patient information form fields Continued Section Field Description Procedure Type Available if the DICOM Worklist feature is licensed and configured See the DICOM user guide ID Available if the DICOM Worklist
46. 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 Gynecology and Infertility Imaging Applications This system transmits ultrasound energy in the pelvis and lower abdomen using 2D M Mode color power Doppler CPD color Doppler Color 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 transvaginally Interventional Imaging Applications This system transmits ultrasound energy into the various parts of the body using 2D color Doppler Color color power Doppler CPD Tissue Harmonic Imaging THI and pulsed wave PW Doppler to obtain ultrasound images that provide guidance during interventional procedures This system can be used to provide ultrasound guidance for biopsy and drainage procedures vascular line placement peripheral nerve blocks spinal nerve blocks and taps ova harvesting amniocentesis and other obstetrical procedures and provide assistance during abdominal breast and neurological surgery Obstetrical Imaging Applications This system transmits ultrasound energy into the pelvis of pregnant women using 2D M Mode color Doppler Color color power Doppler CPD Tissue Harmonic Imaging THI and pulsed wave PW Doppler to obtain ultras
47. select names for each wall Connectivity setup 24 On the Connectivity setup page you specify options for using devices and for alerts when internal storage is full You also specify settings including Transfer Mode and Location for SiteLink and DICOM which are optional features Refer to the SiteLink and DICOM documentation To configure the system for a printer 1 Set up the printer hardware See instructions included with the printer or docking system 2 Press the SETUP key 3 Select Connectivity 4 In the Printer list select the printer To configure the system for a DVD recorder PC or bar code scanner 1 Press the SETUP key 2 Select Connectivity 3 DVD recorder In the Video Mode list select the video standard NTSC or PAL 4 In the Serial Port list select the peripheral Note Because these peripherals use the same RS 232 connector on the mini dock you connect only one of them at a time Computer PC allows report data to be sent as ASCII text from the system to a PC The PC must have third party software to acquire view or format the data into a report Check the compatibility of your software with SonoSite Technical Support See also Sending reports and viewing EMED worksheets on page 94 5 Select Yes to restart the system 6 Attach a serial cable RS 232 from the serial port on the mini dock or docking system to the peripheral To receive storage alerts 1 Press the SETUP key 2
48. usec 1 20 s PRF 2 1063 P Pll max MPa 2574 5 deqOPllmax cm Focal Length FL cm 3 68 5 FL cm 5 5 lp 3 MI max VV cm 330 4 Control 1 Mode Color CPD 2s 2 Control 2 Exam Type OB 5 5 z Control 3 PRF Depth 300 10 850 75 Control 4 Color Optimization Any Med Control 5 THI On Off Control 6 Color Box Size Short and Any Narrow a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 145 Ayayes Table 22 Transducer Model P21x 5 1 Operating Mode PW Doppler 146 TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 2 1 3 39 b Pr3 1 844 Wo mW 93 28 min of 21 3 21 1 mW 120 13 8 21 cm 3 1 og a 2 Zbp cm 2 66 amp z cm 3 718 0 6 d afz p cm 0 49 lt fe MHz 2 16 m 2 22 2 23 Dim of Aaprt X cm 1 9 0 459 Y cm 1 3 1 3 it PD usec 1 21 PRF Hz 1562 5 2 P Pll max MPa 2 432 5 deqOPllmax
49. 02 n V V V jouedodos S dI A vsn sadiM XOJ0 D V V V V ejuowwy eNO s d M naq 1d siue 3 V V V V apAyapjesain gt ynp inbi vsn sn d n V V V p u pleulud ounuo p nbr YSN VdO V V V V p u ples nio pinbry vsn Xap ayeINUeADIOSIOIO YIIG n V N V WINIPOS pinbry 8 2 0 V N V V Jouedoidos S dI A vsn sadIMIAeD n V V V 5 pinbri vsn PI 1AE n V V V yuolu odAH DeN gt p nbii vsn ype jg n V N N ulpoj UOop Mod pinbir vsn ulpe g n V n V p u ple4 1ni5 p nbr vsn pp ueg n V V V gluouuuuV 3eno 3niD pinbri naq quese ppojpeg 04021 V V V V Adoidos jouedold adi YSN s d AA nd sy n V V V loueu 4 Aeids vsn y s nd sy n V V V euowwy no YSN gH nd sy n V V V euowwy eno vsn pu sy n N N N phy n el d pinbry Vdd 0001 p xoluy 2 un n ln wapas od le Sal p nunuo2 si 3npsueul pue ul 3s4S YUM lqneduo2 s uezaJUISIG 21 lqe 1 105 Troubleshooting and Maintenance Chapter 5 n V V V uIpiX U40 UD J ue D vsn su pIq H n N V V puolu pinbi YSN sn d 101 H ePlIUOWLUY n V V V 3enO pluex u lod vu soluex H n V n V apAyapyesainj gt pinbi YSN 505 apAyapjesayn 5 n N N N aunesulajsiag pinbi naq 3J41d seBI5 n V V V euowwy eNO pinbi naq dy idasebi5 n V V V Adoidos pinbi1 vsn sodx3 n V V V JOd 5 U KU1q q us r vsn lozuq n N n V IKdoidos pinbrq vsn n V V V jouedoig pinbr
50. 1 Global Maximum Index Value a a 3 1 b Pr3 MPa Wo mW 85 64 Y min of W 3 z1 lt4 3 21 1 mW 8 2 cm 2 Zbp cm m Z m 2 1 255 S deqiz p cm 0 51 lt f MHz 2 233 Dim of Aaprt X cm 0 6552 Y cm 1 3 PD usec S PRF Hz 9 D Pll max MPa S deq Pllmax cm 0 415 Focal Length FL cm FLy cm Ipp 3 MI ax W cm 2 Control 1 Exam Type Abd S Control 2 PRF Any S 2 Control 3 Sample Volume 12mm GOlcontrol 4 Sample Volume Position Zone 1 136 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 13 Transducer Model HFL38x 13 6 Operating Mode CPD Color TIS TIB Index Label M I Non scan Non TIC Scan AaprtS1 Aaprt gt 1 Scan Global Maximum Index Value 1 1 1 0 b Pr3 MPa 2 556 Wo mW 53 49 min of W z1 lrA 3 Z1 mW 8 21 cm z Zbp cm 16 Zsp cm 1 2 a
51. 10 V V V V adi NV S XOJA N N V V eluowMy aen pinbri YSN 81 X HA n V V V puolu winiuowwy pinbr YSN 9SZ II a euayd Auayd o n V V V unipoS pinbi1 vsn IIB u uds A lan wapas Cao Sal p nunuo2 si 3 npsueul pue 5 YUM l qiyeduuo23 s uezaJUISIG 21 4 109 Troubleshooting and Maintenance Chapter 5 110 Chapter 6 Safety Ayayes This chapter contains information required by regulatory agencies including information about the ALARA as low as reasonably achievable principle the output display standard acoustic power and intensity tables and other safety information The information applies to the ultrasound system transducer accessories and peripherals Ergonomic safety These healthy scanning guidelines are intended to assist you in the comfort and effective use of your ultrasound system WARNING To prevent musculoskeletal disorders follow the guidelines in this section Use of an ultrasound system may be linked to musculoskeletal disorders Use of an ultrasound system is defined as the physical interaction between the operator the ultrasound system and the transducer When using an ultrasound system as with many similar physical activities you may experience occasional discomfort in your hands fingers arms shoulders eyes back or other parts of your body However if you exper
52. 2 Abbreviations in User Interface Continued Abbreviation Definition Apical Apical View APTD Anteroposterior Trunk Diameter AT Acceleration Deceleration Time AUA Average Ultrasound Age AV Aortic Valve AV Area Aortic Valve Area AVA Aortic Valve Area BA Basilar Artery Bifur Bifurcation BP Blood Pressure BPD Biparietal Diameter BPM Beats per Minute Bre Breast BSA Body Surface Area CCA Common Carotid Artery CI Cardiac Index CO Cardiac Output CPD Color Power Doppler Crd Cardiac CRL Crown Rump Length CW Continuous Wave Doppler D Diameter D Apical Distance Apical DCCA Distal Common Carotid Artery DECA Distal External Carotid Artery Abbreviations in User Interface Continued Abbreviation Definition DICA Dist dP dT E EPG E e E A ECA ECG ECICA ECVA EDD EDD by AUA EDD by LMP EDV EF EF SLOPE EFW Endo Epi EPSS Estab DD ET FH FHR Distal Internal Carotid Artery Distal Delta Pressure Delta Time E Wave Peak Velocity E Wave Peak Pressure Gradient E velocity Mitral Valve E velocity divided by the annular e velocity E A Ratio External Carotid Artery Electrocardiogram Extracranial Internal Carotid Artery Extracranial Vertebral Artery Estimated Date of Delivery Estimated Date of Delivery by Average Ultrasound Age Estimated Date of Delivery by Last Menstrual Period End Diastolic Velocity Ejection Fraction E F Slope Estimated Fetal We
53. 46 x Focal Length FL cm 3 72 FLy cm 2 5 Ipa 3 Mlmax W cm Control 1 Exam Type Vas Ven Vas Ven 5 IMT IMT 5 Control 2 Sample Volume 12mm 12mm ad S Control 3 PRF 10417 10417 Control 4 Sample Volume Position Zone 7 Zone 7 138 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 15 Transducer Model ICTx 8 5 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 2 a Pr3 MPa Wo mW 16 348 3 2 cm 5 2 Zbp cm 5 sp cm 1 6 deqiz cm 0 192 lt fe MHz l 4 36 Dim of Aaprt X cm 0 6 Y cm 0 5 PD usec S PRF 2 P Pll max MPa S deq Pllmax cm 0 187 Focal Length FL cm m o 2 5 FL cm Ip 3 MI max W cm 2 Control 1 Exam Type Any 2 Control 2 Sample Volume 3mm 6 S Control 3 PRF Any cont
54. 6 Transducer Surface Temperature Rise EN 60601 2 37 External Use Test 11 C60x HFL38x L25x L38x P21x 1 9 2 C 9 0 C 9 5 C 9 5 C 9 6 C 9 0 C 2 19 0 C 18 0 C 19 0 C 18 2 C 20 0 C 20 0 C Table 7 Transducer Surface Temperature Rise IEC 60601 2 37 Internal Use Test ICTx 3 5 5 C 2 12 0 C 128 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 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 Ayayes 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 UD2 2004 and the Standard for Real Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment NEMA UDe3 2004 In Situ derated and water value intensities All intensity parameters
55. 6 grayscale 35 growth analysis setup 27 tables references 167 guidance documents related 127 guideline 36 gynecology intended uses 3 H heart rate 47 heart rate HR 58 78 88 HIPAA standard 177 home position 44 humidity limits 175 image quality poor 95 images and clips archive 52 delete 52 export to USB 52 review 51 imaging modes list of 173 transducer 42 import See export and import IMT See Intima Media Thickness IMT in situ definition 179 infertility intended uses 3 intended uses 2 4 intensity derated 129 in situ 129 water value 129 interventional intended uses 3 Intima Media Thickness IMT calculations 25 80 sketch 83 trace 83 intraoperative intended uses 3 invert Color 38 spectral trace 41 iso volumic relaxation time IVRT 71 K keys 9 knobs 9 L labeling symbols 150 language 30 layout 29 LCD screen clean 98 output 127 left atrium LA 73 left ventricular diastolic LVd 72 left ventricular outflow tract diameter LVOT D 73 left ventricular systolic LVs 72 left ventricular volume LV volume 73 license key 96 live trace 30 41 x pul Index 193 194 login Administrator 18 user 18 LVO Left Ventricular Opacification 35 M M Mode imaging 36 maintenance 97 measurements See also calculations x Ratio Doppler 59 2D 56 about 55 Acceleration Doppler 59 accuracy 55 155 area 2D 57 automatic trace Doppler 60 circumference 2D 57 delete 56 d
56. 70 R recording problem 95 references cardiac 157 general 169 gestational age tables 165 growth analysis tables 167 obstetrical 164 ratio calculations 169 report patient 92 resistive index RI measurement 59 right ventricular systolic pressure RVSP 75 S safety battery 116 biological 117 electrical 113 electromagnetic compatibility 118 equipment 116 save calculations 62 image 10 measurements 55 SAVE key 30 scale 41 scanhead See transducer screen layout 12 security 18 serial port 24 setup pages 17 shipping specifications 175 shortcut keys 17 Simpson s Rule 73 skin line definition 180 sleep delay 23 small parts calculations 89 software license 96 SonoHD 36 180 SonoMB 36 180 specifications 173 spectral trace 39 standards airborne equipment 176 DICOM 176 electromechanical 176 EMC classification 176 HIPAA 177 steering CPD 38 Doppler 40 storage specifications equipment 175 images 174 stroke volume SV 78 superficial intended uses 4 sweep speed Doppler 41 ECG 53 M Mode 37 symbols labeling 150 system clean and disinfect 98 controls 9 software 2 status 13 25 vvake up 6 Technical Support viii temperature limits 175 text 44 text description 12 thermal index TI 30 127 180 THI 36 time setup 25 tissue Doppler imaging TDI 40 79 tissue models 130 touchpad 10 13 transducer cables clean and disinfect 101 clean and disinfect 99 curved array 179 definition 180 disinfect 99 exam
57. 96 Tokyo University Gestational Weeks and Computation Methods Ultrasound Imaging Diagnostics 12 1 1982 1 24 25 Table 3 Femur Length FL Chitty L S and D G Altman New charts for ultrasound dating of pregnancy Ultrasound in Obstetrics and Gynecology 10 1997 174 179 Table 8 186 Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 431 Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 101 102 University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 886 Fetal Trunk Cross Sectional Area FTA Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 99 100 166 Gestational Sac GS Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 Nyberg D A et al Transvaginal Ultrasound Mosby Yearbook 1992 76 Gestational sac measurements provide a fetal age based on the mean of one two or three distance measurements however Nyberg s gestational age equation requires all three distance measurements for an accurate estimate Tokyo University Gestational Weeks and Computation Methods Ultrasoun
58. Acoustic OUTPUT measurement 129 In Situ derated and water value intensities wee 129 Tissue models and equipment survey 130 Ac sticoutputtables L aa 131 Terms used in the acoustic output tables 148 Acoustic measurement precision and uncertainty 149 Labeling symbols u iwa Al 150 vi Chapter 7 References Measurement accuracy u uuuuu 155 Sources of measurement errors s s ss s ss s os 157 Measurement publications and terminology 157 Cardiac ref ren Ges 157 Obstetrical references siseste niaii 164 Gestational age tables 165 Growth analysis tables 167 Ratio calculations 169 Chapter 8 Specifications 173 Supported transducers 173
59. B custom table data entries are correct The system does not confirm the accuracy of the custom table data entered by the user Transducers and Exam Types for OB Calculations Transducer Exam Type C60x OB ICTx OB P21x OB OB Calculation Terms in Patient Report and Patient Information Form Acronym Term Definition AUA EDD by AUA EDD by LMP EFW Estab DD 84 Average Ultrasound Age Calculated by averaging the individual ultrasound ages for the fetal biometry measurements performed during the exam The measurements used to determine the AUA are based on the selected OB calculation authors Estimated Date of Delivery by Average Ultrasound Age The estimated date of delivery calculated from the measurements performed during the exam Estimated Date of Delivery by Last Menstrual Period The due date calculated from the user entered LMP Estimated Fetal Weight Calculated from the measurements performed during the exam The measurements used to determine EFW are defined by the currently selected EFW calculation author Established Due Date 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 OB Calculation Terms in Patient Report and Patient Information Form Continued Acronym Term y Definition GA by LMP Gestational Age by Last Menstrual Period The fetal age calculated using
60. CALCS key b From the calculations menu select Radius c Position the calipers d Save the calculation 3 Ona frozen Doppler spectral trace press the CALCS key 4 Do the following to measure from MR VTI and again to measure from MV VTI Doppler a From the calculations menu select PISA and then select MR VTI or MV VTI b Position the caliper at the start of the waveform and press the SELECT key to start the trace c Using the touchpad trace the waveform To make a correction select Undo on screen backtrack with the touchpad or press the BACKSPACE key d Press the SET key to complete the trace e Save the calculation For information on the automatic trace tool see To trace automatically Doppler on page 60 To calculate Isovolumic Relaxation Time IVRT 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select MV and then select IVRT A vertical caliper appears 3 Using the touchpad position the caliper at the aortic valve closure 4 Press the SELECT key A second vertical caliper appears 5 Using the touchpad position the second caliper at onset of mitral inflow 6 Save the calculation See To save a calculation on page 62 To calculate Delta Pressure Delta Time dP dT To perform the dP dT measurements the CW Doppler scale must include velocities of 300 cm s or greater on the negative side of the baseline See Spectral trace options on page 41 1 Ona frozen CW
61. Devices setup on page 30 1 Insert the USB storage device 2 In the patient list select the patients whose images and clips you want to export 3 Select Exp USB on screen A list of USB devices appears 4 Select the USB storage device and select Export Only available USB devices for example not password protected are selectable The files are finished exporting approximately five seconds after the USB animation stops Removing the USB storage device or turning off the system while exporting may cause exported files to be corrupted or incomplete To stop in progress exporting select Cancel Export To delete images and clips 1 Select one or more patients in the patient list 2 Select Delete to delete the selected patients A confirmation screen appears To archive images and clips You can send patient exams to a DICOM printer or archiver or to a PC using SiteLink DICOM and SiteLink are optional features 1 Select one or more patients in the patient list 2 Select Archive ECG Monitoring 52 ECG Monitoring is an optional feature and requires a SonoSite ECG cable WARNING To prevent misdiagnosis do not use the ECG trace to diagnose cardiac rhythms The SonoSite ECG option is a non diagnostic feature To avoid electrical interference with aircraft systems do not use the ECG cable on aircraft Such interference may have safety consequences Caution Use only accessories recommended by SonoSite with the system You
62. Doppler spectral trace press the CALCS key 2 From the calculations menu select MV and then select dP dT A horizontal dotted line with an active caliper appears at 100 cm s 3 Position the first caliper along the waveform at 100 cm s 4 Press the SELECT key A second horizontal dotted line with an active caliper appears at 300 cm s 5 Position the second caliper along the waveform at 300 cm s 6 Save the calculation See To save a calculation on page 62 To calculate Aortic Valve Area AVA The AVA calculation requires a measurement in 2D and two measurements in Doppler After the measurements are saved the result appears in the patient report 1 Measure from LVOT 2D a Ona frozen 2D image press the CALCS key b From the calculations menu select LVOT D c Position the calipers See Working with calipers on page 55 d Save the calculation See To save a calculation on page 62 2 Measure from LVOT and then measure from AV Doppler For Vmax see To perform peak velocity measurements in the calculation package on page 74 From the calculations menu select AV select sample site and then select Vmax For VTI see To calculate Velocity Time Integral VTI on page 74 From the calculations menu select AV select sample site and then select VTI To calculate Qp Qs The Qp Qs calculation requires two measurements in 2D and two measurements in Doppler After the measurements are saved th
63. ECG cable 6 ft 1 8 m External display Footswitch e Mini Dock Mobile Docking System M Series MDSm Mobile Docking System Lite II MDS Lite ID Needle Guide Power supply SiteLink Image Manager SonoCalc IMT System AC power cord 10 ft 3 1 m Triple Transducer Connect Peripherals See the manufacturer s specifications for the following peripherals Medical Black and white printer grade Recommended sources for printer paper Contact Sony at 800 686 7669 or www sony com professional to order supplies or to find the local distributor e Color printer e DVD recorder 174 Non medical Kensington Security Cable grade Temperature and humidity limits Note The temperature pressure and humidity limits apply only to the ultrasound system transducers and battery Operating limits System Battery Transducer 10 40 C 50 104 F 10 40 C 50 104 F 10 40 C 50 104 F 15 95 R H 15 95 R H 15 95 R H 700 to 1060hPa 0 7 to 700 to 1060hPa 0 7 to 1 05 ATM 1 05 ATM 5 A Shipping and storage limits System without Battery Transducer Battery 35 65 C 31 149 F 20 60 C 4 140 F 35 65 C 31 149 F 15 95 R H 15 95 R H 15 95 R H 500 to 1060hPa 0 5 to 500 to 1060hPa 0 5 to 1 05 ATM 1 05 ATM For storage longer than 30 days store at or below room temperature Electrical Power Supply Input 100 240 VAC 50 60 Hz 2 0 A Max 100 VAC Power Supply Output 1 15 VDC
64. GGING in as USEF E 21 Choosing a secure password 21 Annotations SETUP 22 Audio Battery setup 57 a 23 Cardiac Calculations setup ss ss ss o s 23 24 Date and Time aS unanqa sipas 25 Display Information setup s s 25 IMT Calculations setup ss s sss sssss s ss s s s s ssss sss ess ss sss s 25 Network Status setup U u ss s s esse sss es ss s 26 OB Calculations setup a i 26 OB Custom Measurements setup 2222 27 OB Custom Tables setup l u 28 Preset ss et Bu sg sasa s DROP 29 System Information Setup 30 USB Devices setup 30 Restoring default settings s s ss sssss sss ss ss o 31 Chapter 3 Imaging magingimoadesa une a u a a n n s 33 Adjusting depth an
65. In the calculations menu locate Area and then select MV or AV 3 Position the caliper where you want to begin the trace and press the SELECT key 4 Using the touchpad trace the desired area To make a correction select Undo on screen or press the BACKSPACE key 5 Complete the trace and press the SET key 6 Save the calculation See To save a calculation on page 62 Chapter 4 Measurements and Calculations 73 74 To calculate LV Mass 1 Ona frozen 2D image press the CALCS key 2 In the calculations menu locate LV Mass 3 Do the following for EPI and then for Endo a Select the measurement name from the calculations menu b Position the caliper where you want to begin the trace and press the SELECT key c Using the touchpad trace the desired area To make a correction select Undo on screen or press the BACKSPACE key d Complete the trace and press the SET key e Save the calculation See To save a calculation on page 62 4 Select Apical from the calculations menu 5 Positioning the calipers measure the ventricular length See Working with calipers on page 55 6 Save the calculation To perform peak velocity measurements in the calculation package For each cardiac measurement the system saves up to five individual measurements and calculates their average If you take more than five measurements the most recent measurement replaces the fifth one If you delete a saved measurement from the report th
66. M Turbo Ultrasound System User Guide 6l Sonosite M Turbo Ultrasound System User Guide SonoSite Inc 21919 30th Drive SE Bothell WA 98021 USA T 1 888 482 9449 or 1 425 951 1200 F 1 425 951 1201 SonoSite Ltd Alexander House 40A Wilbury Way Hitchin Herts SG4 0AP UK T 44 1462 444800 F 44 1462 444801 Caution Federal United States law restricts this device to sale by or on the order of a physician M Turbo SiteLink SonoCalc SonoHD SonoMB and SonoSite are registered trademarks or trademarks of SonoSite Inc DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information Non SonoSite product names may be trademarks or registered trademarks of their respective owners Protected by U S patents 5722412 5817024 5893363 6135961 6364839 6371918 6383139 6416475 6471651 6569101 6648826 6962566 7169108 D456509 D538432 Patents pending P07662 01 11 2007 Copyright 2007 by SonoSite Inc All rights reserved Contents Introduction Conventions symbols and terms CUustomereornmiWenitu gu Q u l a vli Chapter 1 Getting Started Abo tth syst myta s S u A An s s n 1 About the system a 2 Transducers accessories and Peripherals
67. Meas 3 In the Custom Measurements list highlight the last measurement 4 Select Delete Last 5 Select Yes Any tables and report data associated with the measurement are removed from the system OB Custom Tables setup 28 On the OB Custom Tables setup pages you can customize growth tables that appear in the calculations menu and patient report Gestational Age Table Measurements The system provides gestational age measurements by selected authors for CRL GS BPD OFD HC AC FL APTD TTD FTA and 5 additional custom measurement labels Growth Analysis Table Measurements The system provides growth graphs or curves for BPD HC AC FL EFW and HC AC WARNING Prior to use verify that custom table data entries are correct The system does not confirm the accuracy of the custom table data entered by the user To view OB tables 1 Press the SETUP key 2 Select OB Custom Meas or OB Calculations 3 Select Tables on screen 4 Select the desired table and measurement author To create a new OB custom table You can create two custom tables for each OB measurement Growth analysis tables cannot be created for custom OB measurements 1 On U bU M Press the SETUP key Select OB Custom Meas or OB Calculations Select Tables on screen Select the desired table Gestational Age or Grovvth Analysis In the Measurement list select the measurement for the custom table Select New on screen In the Author box
68. No TIC TIB or TIS No No Yes HFL38x 13 6 MI No Yes No TIC TIB or TIS No Yes Yes ICTx 8 5 MI No No No TIC TIB or TIS No No Yes L25x 13 6 MI No No No TIC TIB or TIS No No Yes L38x 10 5 MI No Yes Yes TIC TIB or TIS No Yes Yes P21x 5 1 MI Yes Yes Yes No TIC TIB or TIS Yes Yes Yes Yes Even when MI is less than 1 0 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 Color M Mode or PW Doppler imaging mode The index is displayed in increments of 0 1 The thermal index consists of three user selectable indices 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 on page 127 Mechanical and thermal indices output display accuracy The accuracy result for the mechanical index MI is stated statistically With 90 confidence 90 of the measured MI values will be within 16 to 31 of the displayed
69. Paul L et al Clinical Doppler Ultrasound 4th ed Harcourt Publishers Limited 2000 36 38 VF CSA TAM 06 Chapter 7 References 171 172 Chapter 8 Specifications This chapter contains system and accessory specifications and standards The specifications for recommended peripherals are in the manufacturers instructions Dimensions System Display Length 11 8 in 29 97 cm Width 10 8 in 27 43 cm Height 3 1 in 7 87 cm Weight 8 5 Ibs 3 9 kg with the C60x transducer and battery installed Supported transducers C11x 8 5 MHz 6 ft 1 8 m C60x 5 2 MHz 5 5 ft 1 7 m HFL38x 13 6 MHz 5 6 ft 1 7 m ICTx 8 5 MHz 5 5 ft 1 7 m Imaging modes e 2D 256 gray shades Color power Doppler CPD 256 colors Color Doppler Color 256 colors e M Mode Length 8 4 in 21 34 cm Height 6 3 in 16 cm Diagonal 10 4 in 26 4 cm suone onu ds L25x 13 6 MHz 7 5 ft 2 3 m e L38x 10 5 MHz 5 5 ft 1 7 m e P21x 5 1 MHz 6 ft 1 8 m Pulsed vvave PVV Doppler Continuous vvave CVV Doppler Tissue Doppler Imaging TDI Tissue Harmonic Imaging THI Chapter 8 Specifications 173 Images and clips storage Internal storage The number of images and clips you can save depends on imaging mode and file format Accessories The following items are either included with or available for use on the ultrasound system e Battery Biopsy Guide Carry case
70. RA principle is to set the MI or TI values to a low index value and then modifying this level until a satisfactory image or Doppler mode is obtained For more information on MI and TI see BS EN 60601 2 37 2001 Annex HH Indirect controls The controls that indirectly affect output are controls affecting imaging mode freeze and depth The imaging mode determines the nature of the ultrasound beam Tissue attenuation is directly related to transducer frequency The higher the PRF pulse repetition frequency the more output pulses occur over a period of time Receiver controls The receiver controls are the gain controls Receiver controls do not affect output They should be used if possible to improve image quality before using controls that directly or indirectly affect output Acoustic artifacts An acoustic artifact is information present or absent in an image that does not properly indicate the structure or flow being imaged There are helpful artifacts that aid in diagnosis and those that hinder proper interpretation Examples of artifacts include e Shadowing e Through transmission e Aliasing Reverberations Comet tails For more information on detecting and interpreting acoustic artifacts see the following reference Kremkau Frederick W Diagnostic Ultrasound Principles and Instruments 7th ed W B Saunders Company Oct 17 2005 Guidelines for reducing MI and TI The following are general guidelines fo
71. Ratio Stroke Index Siphon internal carotid artery Submandibular Small Parts Suboccipital Superficial Stroke Volume Time Average Mean Time Average Peak Transcranial Doppler Tissue Doppler Imaging Tissue Harmonic Imaging Thermal Index Terminal Internal Carotid Artery Transorbital Tricuspid Regurgitation peak velocity Transtemporal Transverse Trunk Diameter Abbreviations in User Interface Continued Abbreviation Definition TV UA UmbA VA VArty Vas Ven VF Vmax Vmean Vol VTI Tricuspid Valve Ultrasound Age Umbilical Artery Vertebral Artery Vertebral Artery Vascular Venous Volume Flovv Peak Velocity Mean Velocity Volume Velocity Time Integral Glossary 189 Aiessoj5 190 Index Symbols x measurement 59 Numerics 2D imaging 34 2D options 35 A A amp B shortcut keys 17 abbreviations 181 abdominal intended uses 2 AC power indicator 10 acceleration ACC index 59 accessories list 174 acoustic measurement precision 149 acoustic output measurement 129 tables 131 148 acquisition error 157 add new user 19 Administrator 18 age gestational 86 airborne equipment standards 176 ALARA principle 122 123 179 alphanumeric keys 9 angle correction 39 40 annotations keys 9 place 43 predefine label groups 22 setup 22 aorta Ao 73 aortic valve area AVA 77 arrow graphic 44 ascending aorta AAo 73 audio 23 baseline 41 battery clean 102 safety 116 se
72. SPR11 2004 International Electrotechnical Commission International Special Committee on Radio Interference Industrial Scientific and Medical ISM Radio Frequency Equipment Electromagnetic Disturbance Characteristics Limits and Methods of Measurement The Classification for the ultrasound system docking system accessories and peripherals when configured together is Group 1 Class A Airborne equipment standards RTCA DO 160E 2004 Radio Technical Commission for Aeronautics Environmental Conditions and Test Procedures for Airborne Equipment Section 21 0 Emission of Radio Frequency Energy Category B DICOM standard NEMA PS 3 15 2000 Digital Imaging and Communications in Medicine DICOM Part 15 Security Profiles 176 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 Chapter 8 Specifications 177 178 Glossary Terms For ultrasound terms not included in this glossary refer to Recommended Ultrasound Terminology Second Edition published in 1997 by the American Institute of Ultrasound in Medicine AIUM as low as reasonably achievable ALARA curved array transducer depth in situ LCD linear array transducer mechanical index MI MI TI NTSC PAL phased array The guiding principle of ultrasound use which states that you should keep patient exposu
73. See color povver Doppler CPD imaging customer assistance vii CVV Doppler See continuous vvave CVV Doppler maging D date 25 ndex default settings 31 delta pressure delta time dP dT 76 depth adiust 33 definition 179 keys 9 marker 13 DICOM standard 176 dimensions system and display 173 disinfect battery 102 ECG cable 102 system 98 transducer cables 101 transducers 99 disinfectants compatibility 104 display setup 25 distance measurements 2D 57 M mode 58 D line 39 Doppler measurements 59 scale setup 29 dual images 35 duplex 29 DVD recorder 24 95 Dynamic Range 30 E ECG Monitoring 36 52 options 53 elapsed time ET measurement 59 electrical safety 113 specifications 175 electromagnetic compatibility 118 electromechanical safety standards 176 EMC classification standards 176 EMED worksheets 94 equipment safety 116 error message 115 errors acquisition 157 algorithmic 157 measurement 157 estimated date of delivery EDD 164 estimated fetal weight EFW 164 Event log 20 exam change type 34 end 46 type and transducer 42 export and import OB calculation tables 27 predefined label groups 22 user accounts 20 F far 10 fetal heart rate FHR 88 flow sensitivity 38 focal zones optimize 35 footswitch setup 17 forms 10 freeze 33 G gain adjust 33 ECG 53 knob 10 gate size 40 gestational age setup 27 tables references 165 gestational growth measure 87 grace period 9
74. Select Connectivity 3 Select Internal Storage Capacity Alert The system displays a message if internal storage is near capacity when you end an exam The system then deletes archived patient exams if specified in DICOM Date and Time setup WARNING To obtain accurate obstetrics calculations an accurate date and time are critical Verify that the date and time are accurate before each use of the system The system does not automatically adjust for daylight saving time changes To set the date and time 1 Press the SETUP key 2 Select Date and Time 3 In the Date box type the current date 4 In the Time box type the current time in 24 hour format hours and minutes dn s 5 Display Information setup On the Display Information setup page you can specify vvhich details appear on screen during imaging To specify display information 1 Press the SETUP key 2 Select Display Information 3 Select settings in the follovving sections Patient Header Information that appears in the patient header e Mode Data Imaging information Network Status System status information IMT Calculations setup On the IMT Calculations setup page you can customize the IMT calculations menu You can specify up to eight measurement names for both right side and left side calculations The measurement names also appear in the patient report See also IMT calculations on page 80 To customize the IMT calculations m
75. Vascular and cardiac reports To view a vascular or cardiac report 1 After or during the vascular or cardiac exam press the REPORT key 2 Do any of the following e To view additional pages select 1 x on screen To view details or the summary select Details or Summary on screen The mean of the detail entries is used in the summary To delete a measurement use the touchpad on the Details page to select the measurement The selected measurement is green Select Delete on screen Deleting some measurements also deletes related measurements Deleted measurements are not included in the summary information 3 Vascular Only In the Ratio list select measurements for the ICA CCA ratio for both the right and left sides 4 Cardiac Only To adjust the RA pressure select from the RA list Changing the RA pressure from the default number 5 affects the RVSP calculation result OB reports 92 The OB report pages have a signature space for signing printed reports To view the OB Twins report individual 1 After or during the OB exam press the REPORT key 2 Select Twin A B on screen to view individual twin reports To view the OB Twins report combined 1 After or during the OB exam press the REPORT key 2 Select Compare on screen to view both twins in a single report To delete an OB measurement 1 After or during the OB exam press the REPORT key 2 Using the touchpad select the desired OB measurement The selec
76. a setup page s Select Done on screen A amp B Key Footswitch setup On the A amp B Key Footswitch setup page you can program the shortcut keys and footswitch to perform common tasks To program the shortcut keys and footswitch 1 Press the SETUP key 2 Select A amp B Key Footswitch dn s 5 3 Select from the lists A Key B Key The function of the shortcut keys By default the A shortcut key is set to Print and the B shortcut key is set to Record The shortcut keys are below the alphanumeric keypad Footswitch L Footswitch R The function of the left and right footswitches Save Clip Record Freeze Save Image or Print See also To connect the footswitch on page 17 To connect the footswitch The SonoSite footswitch allows hands free operation with a customizable two pedal footswitch The footswitch is an optional feature WARNING To avoid contamination do not use the footswitch in a sterile environment The footswitch is not sterilized 1 Connect the cables Y adapter cable to the ECG connector on the mini dock or docking system e Footswitch cable to Y adapter cable 2 On the A amp B Key Footswitch setup page select a function for the left and right footswitches Chapter 2 System Setup 17 Administration setup On the Administration setup page you can configure the system to require users to log in and enter passwords Required login helps protect patient data You ca
77. abel 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 cable immersion method 1 2 3 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 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 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 Chapter 5 Troubleshooting and Maintenance 101 7 Using the instructions on the disinfectant label rinse the transducer cable and then air dry or towel dry with a clean cloth 8 Examine the transducer and cable for damage such as cracks splitting or fluid leaks If damage is evident disc
78. age 92 Calculation packages depend on exam type and transducer Calculations menu The calculations menu contains measurements available for the imaging mode and exam type After you perform and save a measurement the result saves to the patient report See Patient report on page 92 Also a check mark appears next to the measurement name in the calculations menu If you highlight the checked measurement name the results appear below the menu If you repeat the measurement the results below the menu reflect either the last measurement or the average depending on the measurement Menu items followed by ellipses have subentries To select from the calculations menu 1 Ona frozen image press the CALCS key The calculations menu appears Chapter 4 Measurements and Calculations 61 suonein le pue 5 2 Using the touchpad or arrow keys highlight the desired measurement name To display additional measurement names highlight Next Prev or a measurement name that has ellipses Then press the SELECT key Only measurement names available for the imaging mode are selectable 3 Press the SELECT key To close the calculations menu press the CALCS key once if the menu is active or twice if the menu is inactive Performing and saving measurements in calculations In performing a measurement within a calculation you select from the calculations menu position the calipers that a
79. alculations Continued Menu Heading Cardiac Measurements Imaging Mode Calculation Results LV LVd LVs HR Area Ao 2D or M Mode AAo 2D LA 2D or M Mode LVOT D 2D ACS M Mode LVET M Mode EF Slope M Mode EPSS M Mode RVW M Mode RVD M Mode IVS M Mode LVD M Mode LVPW M Mode RVW M Mode RVD M Mode IVS M Mode LVD M Mode LVPW M Mode HR AV 2D MV 2D Ao LA Ao AAo LA LA Ao LVOT D LVOT area ACS LVET EF SLOPE EPSS CO EF SV LVESV LVEDV IVSFT LVPVVFT LVDFS c SI LV Mass suonein le pue sau ul snsP l yi AV Area MV Area Chapter 4 Measurements and Calculations 69 70 Cardiac Calculations Continued Menu Heading Cardiac Measurements Imaging Mode Calculation Results LV Vol LV mass PISA Qp Qs A4Cd 2D A4Cs 2D A2Cd 2D A2Cs 2D Epi 2D Endo 2D Apical 2D Ann D 2D Radius Color MR VTI Doppler MV VTI Doppler LVOT D 2D RVOT D 2D LVOT VTI Doppler RVOT VTI Doppler LV Vol LV Area EF CO SV c SI Biplane LV Mass Epi Area Endo Area D Apical PISA Area ERO MV Rate Regurgitant Volume Regurgitant Fraction D VTI VMax PGmax Vmean PGmean SV Qp Qs Cardiac Calculations Continued Menu Heading Cardiac Measurements Imaging Mode Calculation Results MV E Doppler A Doppler PHT deceleration time Doppler VTI Doppler
80. ally See To create a new patient information form on page 45 2 Measure from LVOT 2D a Ona frozen 2D image press the CALCS key b From the calculations menu select LVOT D c Position the calipers See Working with calipers on page 55 d Save the calculation See To save a calculation on page 62 3 Measure from aorta Doppler See To calculate Velocity Time Integral VTI on page 74 From the calculations menu select AV and then select VTI For information on the automatic trace tool see To trace automatically Doppler on page 60 To calculate Heart Rate HR Heart Rate is available in all cardiac packages The Heart Rate is not calculated using the ECG trace Saving the heart rate to the patient report overwrites any heart rate entered on the patient information form 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select HR A vertical caliper appears 3 Using the touchpad position the first vertical caliper at the peak of the heartbeat 4 Press the SELECT key A second vertical caliper appears The active caliper is highlighted green 5 Using the touchpad position the second vertical caliper at the peak of the next heartbeat 6 Save the calculation See To save a calculation on page 62 To calculate Cardiac Output CO or Cardiac Index Cl The CO and CI calculations require Stroke Volume and Heart Rate calculations CI also requires Body
81. angle manually press the SELECT key and then use the touchpad to adjust the angle in 2 increments from 74 to 74 Press the SELECT key again to set the desired angle The SELECT key toggles between the D line and angle correction To display the spectral trace 1 Display the D line 2 Press the DOPPLER key The time scale above the trace has small marks at 200 ms intervals and large marks at one second intervals 3 Do any of the following as needed Set options See Spectral trace options on page 41 Press the UPDATE key to toggle between the D line and spectral trace If using a duplex layout press the DOPPLER key to toggle between the full screen D line and the duplex layout To set a duplex layout see Presets setup on page 29 Chapter 3 Imaging 39 PW Doppler options In PW Doppler imaging you can set the following on screen options PW Doppler options Option Icon Description PW CW Cardiac exam only Toggle between PW Doppler and CW Doppler EA The current selection appears in the upper left hand screen Angle Corrects the angle to 0 60 or 60 Correction Gate Size A Settings depend on transducer and exam type r TDI On Select TDI On to turn on tissue Doppler imaging When on TD appears TDI Off in the upper left hand screen The default is TDI off Available only in cardiac exams Steering af Select the desired steering angle setting The PW Doppler angle corr
82. ansducer connector temperature do not block the airflow to the ventilation holes on the side of the system Chapter 6 Safety 115 Equipment safety To protect your ultrasound system transducer and accessories follow these precautions Caution Excessive bending or twisting of cables can cause a failure or intermittent operation Improper cleaning or disinfecting of any part of the system can cause permanent damage For cleaning and disinfecting instructions see Chapter 5 Troubleshooting and Maintenance Do not submerge the transducer connector in solution The cable is not liquid tight beyond the transducer connector cable interface Do not use solvents such as thinner or benzene or abrasive cleaners on any part of the system Remove the battery from the system if the system is not likely to be used for some time Do not spill liquid on the system Battery safety To prevent the battery from bursting igniting or emitting fumes and causing personal injury or equipment damage observe the following precautions WARNING 116 The battery has a safety device Do not disassemble or alter the battery Charge the batteries only when the ambient temperature is between 0 and 40 C 32 and 104 F Do not short circuit the battery by directly connecting the positive and negative terminals with metal objects Do not heat the battery or discard it in a fire Do not expose the battery to temperatures o
83. any 1994 43 44 LVDFS LVDD LVDS LVDD 100 where LVDD Left Ventricle Dimension at Diastole LVDS Left Ventricle Dimension at Systole Left Ventricular Posterior Wall Fractional Thickening LVPWFT percent Laurenceau J L M C Malergue The Essentials of Echocardiography Le Hague Martinus Nijhoff 1981 71 LVPWFT LVPWS LVPVVD LVPVVD 100 where LVPWS Left Ventricular Posterior Wall Thickness at Systole LVPWD Left Ventricular Posterior Wall Thickness at Diastole Mean Velocity Vmean in cm s Vmean mean velocity Mitral Valve Area MVA in cm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 391 452 MVA 220 PHT where PHT pressure half time Chapter 7 References 161 Note 220 is an empirical derived constant and may not accurately predict mitral valve area in mitral prosthetic heart valves The mitral valve area continuity equation may be utilized in mitral prosthetic heart valves to predict effective orifice area MV Flow Rate in cc sec Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 396 Flow 6 28 r Va where r radius Va aliasing Velocity Pressure Gradient PGr in mmHG Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 64 PGr 4
84. any products sold in the People s Republic of China Contains mercury Applies to the LCD and may apply to other components in the ultrasound system 6 bil WARNING WARNING Connect Only Connect Only Accessories and Accessories and Peripherals Peripherals Recommended by Recommended by SonoSite SonoSite Chapter 6 Safety 153 154 Chapter 7 References Measurement accuracy The measurements provided by the system do not define a specific physiological or anatomical parameter Rather the measurements are of a physical property such as distance for evaluation by the clinician The accuracy values require that you can place the calipers over one pixel The values do not include acoustic anomalies of the body The 2D linear distance measurement results are displayed in centimeters with one place past the decimal point if the measurement is ten or greater two places past the decimal point if the measurement is less than ten s u s u The linear distance measurement components have the accuracy and range shown in the following tables Table 1 2D Measurement Accuracy and Range 2D Measure Accuracy System Accuracy Test Range cm and Range Tolerancea By Methodb 9 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 Diagonal Distance lt 2 plus 1 of Acquisition Phantom 0 44 cm full scale Area
85. asound system is a portable software controlled device using all digital architecture The system has multiple configurations and feature sets used to acquire and display high resolution real time ultrasound images Features available on your system depend on system configuration transducer and exam type Figure 1 System Front Features 1 Control panel 2 Handle 3 Display 4 USB ports for storage updates importing and exporting I 2 3 4 Figure 2 System Back Connectors 1 DC input connector 2 I O connector 3 Battery and 4 ECG connector Chapter 1 Getting Started payers To use the ultrasound system 1 Turn the system on For power switch location see System controls on page 9 2 Attach a transducer 3 Press the PATIENT key and complete the patient information form 4 Press an imaging mode key e 2D M MODE COLOR DOPPLER About the system software The ultrasound system contains softvvare that controls its operation A license key is required to activate the softvvare See Softvvare licensing on page 96 On occasion a software upgrade may be required SonoSite provides a USB device containing the software One USB device can be used to upgrade multiple systems Transducers accessories and peripherals The ultrasound system may include transducers accessories and peripherals Peripherals include medical
86. ated in the referenced table This results in the gestational age always increasing with an increase in AC Chapter 7 References 165 s u s u Anteroposterior Trunk Diameter APTD University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 885 Biparietal Diameter BPD Chitty L S and D G Altman New charts for ultrasound dating of pregnancy Ultrasound in Obstetrics and Gynecology 10 1997 174 179 Table 3 Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 440 Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 98 University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 885 Crown Rump Length CRL Hadlock F et al Fetal Crown Rump Length Re evaluation of Relation to Menstrual 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
87. aved Small Parts calculations Small Parts calculations include volume hip angle and d D ratio For instructions to calculate volume see Volume calculations on page 65 Transducers and Exam Types for Hip Angle and d D Ratio Calculations Transducer Exam Type HFL38x Small Parts L38x Small Parts To calculate hip angle 1 Ona frozen 2D image press the CALCS key suonein le pue syu uu inse lw 2 From the calculations menu select Right or Left 3 Select Baseline under Hip Angle A baseline appears on screen 4 Position the baseline and press the SET key See Working with calipers on page 55 Line A alpha line appears on screen and Line A is selected in the calculations menu Position Line A and save the measurement See To save a calculation on page 62 Line B beta line appears on screen and Line B is selected in the calculations menu Chapter 4 Measurements and Calculations 89 6 Position Line B and save the measurement To calculate d D ratio 1 Ona frozen 2D image press the CALCS key 2 From the calculations menu select Right or Left 3 Under d D Ratio select Fem Hd femoral head 4 Using the touchpad position and resize the circle The SELECT key toggles between position and size 5 Press the SET key The baseline automatically appears with the left caliper active 6 Position the caliper See Working with calipers on page 55 7 Save the measureme
88. 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 that the hospital supply voltage corresponds to the power supply voltage range See Electrical on page 175 To operate the system using AC power 1 Connect the DC power cable from the power supply to the connector on the system See Figure 2 on page 1 2 Connect the AC power cord to the power supply and to a hospital grade electrical outlet Turning the system on or off Caution Do not use the system if an error message appears on the display Note the error code and turn off the system Call SonoSite or your local representative To turn the system on or off s Press the power switch See System controls on page 9 To wake up the system To conserve battery life while the system is on the system goes into sleep mode if the lid is closed or if the system is untouched for a preset time To adjust the time for sleep delay see Audio Battery setup on page 23 s Press a key touch the touchpad or open the lid Connecting transducers WARNING To avoid injury to the patient do not place the connector on the patient Operate the ultrasound system in a docking system or on a flat hard surface to allow air flow past the connector Caution To avoid damaging the transducer connector do not allow foreign material in the connector payers
89. between D line and Doppler spectral trace Turns M Mode on toggles between M line and M Mode trace Turns Doppler on toggles between D line and Doppler trace Turns CPD Color on and off Turns 2D on Chapter 1 Getting Started 11 Screen layout 12 PATIENT D 2 89cm Vol Home Home Set Label Symbols Word Done Figure 5 Screen Layout Mode Data Area Orientation Marker Text Picto Calculations Menu Image Measurement and Calculations Data Area On screen Options 123456 2009Aug29 16 00 Semmi gt e Current imaging mode information for example Gen Res THI and PW Provides indication for image orientation In dual and duplex images the orientation marker is green on the active screen Text entered using keyboard Pictograph to indicate anatomy and transducer position Displays pictograph options allowing anatomy and screen location selection Contains available measurements Ultrasound image Current data on measurements and calculations Options available in the current context 9 Patient Header Includes current patient name patient ID number institution user and date time 10 System Status Information on system status for example exam type transducer AC connected battery charging and USB 11 Depth Marker Marks in 5 cm 1 cm and 5 cm increments depending on depth General interaction Touchpad and
90. between position and size See To save a measurement to a calculation and patient report on page 55 Chapter 4 Measurements and Calculations suonein le pue sau ul snsP l yi To trace manually 2D 1 Ona frozen 2D image press the CALIPER key 2 Select Manual on screen Note If you exceed the allowed number of measurements Manual is not available 3 Using the touchpad position the caliper where you want to begin 4 Press the SELECT key 5 Using the touchpad complete the trace and press the SET key See To save a measurement to a calculation and patient report on page 55 M Mode measurements 58 The basic measurements that you can perform in M Mode imaging are as follows e Distance in cm Time in seconds e Heart Rate HR in beats per minute bpm The time scale above the trace has small marks at 200 ms intervals and large marks at one second intervals To measure distance M Mode You can perform up to four distance measurements on an image 1 Ona frozen M Mode trace press the CALIPER key A single caliper appears 2 Using the touchpad position the caliper 3 Press the SELECT key to display the second caliper 4 Using the touchpad position the second caliper See To save a measurement to a calculation and patient report on page 55 To measure heart rate M Mode 1 Ona frozen M Mode trace press the CALIPER key 2 Select HR on screen A vertical caliper appears 3 Using the touchpad position th
91. c output that is representative of the nominal expected acoustic output for all transducer system combinations that might occur Of course every transducer system combination has its own unique characteristic acoustic output and will not match the nominal output on which the display estimates are based This variability between systems and transducers introduces an error into displayed value By doing acoustic output sampling testing during production the amount of error introduced by the variability is bounded The sampling testing ensures that the acoustic output of transducers and systems being manufactured stays within a specified range of the nominal acoustic output Another source of error arises from the assumptions and approximations that are made when deriving the estimates for the display indices Chief among these assumptions is that the acoustic output and thus the derived display indices are linearly correlated with the transmit drive voltage of the transducer Generally this assumption is very good but it is not exact and thus some error in the display can be attributed to the assumption of voltage linearity Related guidance documents Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers FDA 1997 e Medical Ultrasound Safety American Institute of Ultrasound in Medicine ATUM 1994 A copy is included with each system Chapter 6 Safety 127 Ayayes Acoustic Outp
92. ce School of Cardiac Ultrasound Arizona Heart Institute 1993 152 RVSP 4 Vmax TR RAP where RAP Right Atrial Pressure Stroke Index SI in cc m Mosby s Medical Nursing amp Allied Health Dictionary 4th ed 1994 1492 51 SV BSA where SV Stroke Volume BSA Body Surface Area Stroke Volume SV Doppler in ml Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 40 59 62 SV CSA VTI where CSA Cross Sectional Area of the orifice LVOT area VTI Velocity Time Integral of the aortic valve Chapter 7 References 163 Stroke Volume SV 2D and M Mode in ml Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Boston Little Brown and Company 1994 44 SV LVEDV LVESV where SV Stroke Volume LVEDV End Diastolic Volume LVEDSV End Systolic Volume Velocity Time Integral VTI in cm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 383 VTI sum of abs velocities n where Auto Trace distance cm blood travels with each ejection period Velocities are absolute values Obstetrical references Amniotic Fluid Index AFI Jeng C J et al Amniotic Fluid Index Measurement with the Four Quadrant Technique During Pregnancy The Journal of Reproductive Medicine 35 7 July 1990 674 677 Average Ultrasound Age AUA
93. ce icon appears on the system screen Software licensing SonoSite software is controlled by a license key After you install new software the system prompts you for a license key You must obtain one key for each system or transducer that uses the software The software will operate for a short time the grace period without a license key During the grace period all system functions are available After the grace period the system is not usable until you enter a valid license key Grace period time is not used while the system is off or asleep Grace period time remaining appears on the license update screen Caution After the grace period expires all system functions except licensing are unavailable until a valid license key is entered To obtain a license key for your software contact SonoSite Technical Support See SonoSite Technical Support on page viii You need to provide the following information See System Information setup on page 30 Software License Key Information System Software Transducer Software Name of person installing the upgrade Name of person installing the upgrade Serial number on bottom of system Transducer serial number ARM version Transducer part number REF or model number for example C60x PCBA serial number Transducer bundle version After you obtain a license key you must enter it into the system 96 To enter a license key 1 Turn on the system The licens
94. ce while it is ina USB port on the ultrasound system The connector could break If the USB icon does not appear in the system status area on screen the USB storage device may be defective or password protected Turn the system off and replace the device To insert a USB storage device s Insert the USB storage device into any USB port on the system or mini dock See Figure 1 on page 1 The USB storage device is ready when the USB icon appears To view information about the device see USB Devices setup on page 30 To remove a USB storage device Removing the USB storage device while the system is exporting to it may cause the exported files to be corrupted or incomplete 1 Wait five seconds after the USB animation stops 2 Remove the USB storage device from the port System controls 1 Power switch 2 Alphanumeric keys 3 Annotation keys 4 ZOOM 5 DEPTH UP DEPTH DOWN 6 AUTO GAIN 8 9 10 11 12 13 Turns system on and off Use to enter text and numbers See Alphanumeric keyboard on page 14 Magnifies the image 100 Decreases and increases imaging depth Adjusts gain automatically Chapter 1 Getting Started payes Gain ei gt Near A Far Gain Cine Buffer AC power indicator CALIPER CALCS Touchpad FREEZE SAVE CLIP Control keys Forms SETUP REPORT REVIEW PATIENT Adjusts the gain applied to th
95. cology 84 March 1977 165 174 Ratio calculations FL AC Ratio Hadlock F P R L Deter R B Harrist E Roecker and S K Park A Date Independent Predictor of Intrauterine Growth Retardation Femur Length Abdominal Circumference Ratio American Journal of Roentgenology 141 November 1983 979 984 FL BPD Ratio Hohler C W and T A Quetel Comparison of Ultrasound Femur Length and Biparietal Diameter in Late Pregnancy American Journal of Obstetrics and Gynecology 141 7 Dec 1 1981 759 762 FL HC Ratio Hadlock F P R B Harrist Y Shah and S K Park The Femur Length Head Circumference Relation in Obstetric Sonography Journal of Ultrasound in Medicine 3 October 1984 439 442 HC AC Ratio Campbell S Thoms Alison Ultrasound Measurements of the Fetal Head to Abdomen Circumference Ratio in the Assessment of Growth Retardation British Journal of Obstetrics and Gynaecology 84 March 1977 165 174 General references x or S D Ratio x abs Velocity A Velocity B where A velocity cursor B velocity cursor x Acceleration Index ACC Zwiebel W J Introduction to Vascular Ultrasonography 4th ed W B Saunders Company 2000 52 ACC abs delta velocity delta time Elapsed Time ET ET time between velocity cursors in milliseconds Chapter 7 References 169 Hip Angle d D Ratio Graf R Fundamentals of Sonographic Diagno
96. cursor Use the touchpad to adjust and move objects on screen The touchpad controls caliper position CPD or Color box position and size the cursor and more The arrow keys control much of the same functionality as the touchpad The cursor appears in the setup pages the patient information form and patient report You control the cursor through the touchpad For example in the patient information form place the cursor over the last name field and press the SELECT key to activate that field Additionally you can use the cursor to select check boxes and items in lists On screen options The on screen options let you make adjustments and select settings The options available depend on context Each option is controlled by the pair of keys below it Depending on the option the control keys function in one of four ways Cycle Moves through a list of settings continuously The upper control key cycles upward The lower control key cycles downward Up Down Moves through a list of settings stopping at the top or bottom The upper control key moves upward The lower control key moves downward By default a beep sounds when you reach either end of the range See To change audio and battery settings on page 23 On Off Turns a feature on or off You can press either control key In forms you can instead select the option by using the touchpad and the SELECT key Action Performs an action You can press either control key Or you can ins
97. d Avoid twisting your head or body e Move your entire body front to back and position your scanning arm next to or slightly in front of you e Stand for difficult exams to minimize reaching Promote comfortable shoulder and arm postures Keep your elbow close to your side Relax your shoulders in a level position e Support your arm using a support cushion or pillow or rest it on the bed Minimize neck bending and twisting e Position the ultrasound system display directly in front of you e Provide an auxiliary monitor for patient viewing Promote comfortable hand wrist and finger postures e Hold the transducer lightly in your fingers e Minimize the pressure applied on the patient Keep your wrist in a straight position Ayayes Take breaks exercise and vary activities e Minimizing scanning time and taking breaks can effectively allow your body to recover from physical activity and help you avoid MSDs Some ultrasound tasks may require longer or more frequent breaks 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 e Work efficiently by using the software and hardware features correctly e Keep moving Avoid sustaining the same posture by varying your head neck body arm and leg positions Targeted exercises can strengthen muscle groups which may help you avoid MSDs Contact a qualified health pr
98. d Imaging Diagnostics 12 1 1982 1 s u s u 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 Springer Verlag 1986 431 Transverse Trunk Diameter TTD Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 431 University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 885 Growth analysis tables Abdominal Circumference AC Chitty Lyn S et al Charts of Fetal Size 3 Abdominal Measurements British Journal 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 Ja
99. d gain 5222 33 Freezing viewing frames and zooming Changing the exam type 2D imaging M Mode imaging 236 CPD and color Doppler imaging wa 37 PW and CW Doppler imaging 39 Imaging modes and exams available by transducer 42 ANNOTATIONS cicsiccsssssccssscsssccasiscsssos cssascosscoczeasssssciacsensseoasscdooeosseounacoaistsberdassaasesssasasseniazes 43 Patient information form l u 45 SAVING images and CliBS u u amna pasananpaq asss 48 Patient R R usasqa 50 EGG MOniltofifi8g au ARALAR R S M s 52 Chapter 4 Measurements and Calculations IVE AS LIGNE ni AAE IAA EE A AE 55 Working With Cali PON asa aananaaqasassiqiawsssisnaqssawhasqyayskassqascassa 55 2D measurements 56 M Mode measurements Doppler measurements 59 General calculations 61 Calculations menu 2 uuu 61 Performing and saving measurements in Calculations 62 Viewing repeating and deleting saved measurements in calculations s ss sssss sss s s u 62 Percent reduction calculations 63 Volume calculations I uuu 65 Volume flow calculations 5 2 u uu 66 Specialized calcula
100. 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 130 Tissue models are necessary to estimate attenuation and acoustic exposure levels In Situ from measurements of acoustic output made in water Currently available models may be limited in their accuracy because of varying tissue paths during diagnostic ultrasound exposures and uncertainties in the acoustic properties of soft tissues No single tissue model is adequate for predicting exposures in all situations from measurements made in water and continued improvement and verification of these models is necessary for making exposure assessments for specific exam types A homogeneous tissue model with attenuation coefficient of 0 3 dB em 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
101. diography May1997 357 362 d Wihlidal L M and S Kumar An Injury Profile of Practicing Diagnostic Medical Sonographers in Alberta International Journal of Industrial Ergonomics 19 1997 205 216 Chapter 6 Safety 111 e Habes D J and S Baron Health Hazard Report 99 0093 27497 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 Musculoskeletal Problems in Cardiac Sonographers Journal of Medicine 35 6 1993 605 610 Position the system Promote comfortable shoulder arm and hand postures Use a stand to support the weight of the ultrasound system Minimize eye and neck strain When the exam or procedure allows position the system within reach Adjust the angle of the system and display to minimize glare from overhead or outside lighting If using a stand adjust its height so that the display is at or slightly below eye level Position yourself 112 Support your back during an exam e Use a chair that has support for your lower back that adjusts to your work surface height that promotes a natural body posture and that allovvs for quick height adiustments e Always sit or stand in an upright manner Avoid bending or stooping Minimize reaching and twisting Use a bed that is height adjustable e Position the patient as close to you as possible Face forwar
102. e LVEDV 7 0 LVDD3 2 4 LVDD where LVEDV Left Ventricular End Diastolic Volume LVDD Left Ventricular Dimension at Diastole Left Ventricular Mass in gm Oh J K J B Seward A J Tajik The Echo Manual 2nd Edition Boston Little Brown and Company 1999 39 LV Mass 1 04 LVID PWT IVST LVID 0 8 0 6 where LVID Internal Dimension PWT Posterior Wall Thickness IVST Interventricular Septal Thickness 1 04 Specific gravity of the myocardium 0 8 Correction factor Left Ventricular Volume Biplane Method in ml Schiller N B P M Shah M Crawford et al Recommendations for Quantitation of the Left Ventricle by Two Dimensional Echocardiography Journal of American Society of Echocardiography September October 1989 2 362 r Z l where V Volume in ml a Diameter b Diameter 160 n Number of segments n 20 L Length i Segment Left Ventricular Volume Single Plane Method in ml Schiller N B P M Shah M Crawford et al Recommendations for Quantitation of the Left Ventricle by Two Dimensional Echocardiography Journal of American Society of Echocardiography September October 1989 2 362 2 29 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 Comp
103. e next measurement taken replaces the deleted one in the report The most recently saved measurement appears at the bottom of the calculations menu 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select MV TV or TDI 3 Do the following for each measurement you want to take a Select the measurement name from the calculations menu b Position the calipers See Working with calipers on page 55 c Save the calculation See To save a calculation on page 62 To calculate Velocity Time Integral VTI Note This calculation computes other results in addition to VTI See the table Cardiac Calculations on page 68 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select MV AV PV or LVOT and then select VTI 3 Position the caliper at the start of the waveform and press the SELECT key to start the trace 4 Using the touchpad trace the waveform To make a correction select Undo on screen backtrack with the touchpad or press the BACKSPACE key 5 Press the SET key to complete the trace 6 Save the calculation See To save a calculation on page 62 For information on the automatic trace tool see To trace automatically Doppler on page 60 To calculate Right Ventricular Systolic Pressure RVSP 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select TV and then select TRmax 3 Position th
104. e M line does not appear make sure that the system is in live imaging 36 2 Use the touchpad to position the M line where desired 3 Set options as desired Many optimization and depth options available in 2D imaging are also available in M Mode imaging See 2D options on page 35 To display the M Mode trace 1 Display the M line 2 Adjust the depth if necessary See To adjust depth on page 33 3 Press the M MODE key The time scale above the trace has small marks at 200ms intervals and large marks at one second intervals 4 Do any of the following as needed Select the sweep speed gt Slow Med or Fast Press the UPDATE key to toggle between the M line and M Mode trace If using a duplex layout press the M MODE key to toggle between the full screen M line and the duplex layout To set a duplex layout see Presets setup on page 29 CPD and color Doppler imaging Color power Doppler CPD and color Doppler Color are optional features CPD is used to visualize the presence of detectable blood flow Color is used to visualize the presence velocity and direction of blood flow in a wide range of flow states To display the CPD or Color image 1 Press the COLOR key A ROI box appears in the center of the 2D image Select CPD or Color N The current selection also appears in the upper left hand screen The Color indicator bar on the upper left hand screen displays velocity in cm s in
105. e SAVE CALC key The new measurement saves to the patient report and overwrites the previously saved measurement To delete a saved measurement 1 Select the measurement name from the calculations menu 2 Select Delete on screen The measurement last saved is deleted from the patient report If it is the only measurement the check mark is deleted from the calculations menu Some measurements can be deleted directly from the report pages See Patient report on page 92 Percent reduction calculations WARNING To avoid incorrect calculations verify that the patient information date and time settings are accurate To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Transducers and Exam Types for Percent Reduction Calculations 5 20 Transducer Exam Types g 20 11 Abdomen s 3 60 Abdomen an HFL38x IMT Small Parts Vascular L25x Vascular Muscle L38x IMT Small Parts Vascular P21x Abdomen Chapter 4 Measurements and Calculations 63 A 0 39cm 1 A 0 22cm Area Red 43 6 Figure 2 Percent area reduction calculation of right carotid bu
106. e caliper See Working with calipers on page 55 4 Save the calculation See To save a calculation on page 62 5 To adjust the RA pressure see To view a vascular or cardiac report on page 92 Changing the RA pressure from the default 5 affects the RVSP calculation in the report To calculate Pressure Half Time PHT in MV or AV 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select MV or AV and then select PHT 3 Position the first caliper at the peak and press the SELECT key A second caliper appears 4 Position the second caliper In MV position the caliper along the EF slope In AV position the caliper at the end diastole 5 Save the calculation See To save a calculation on page 62 To calculate Proximal Isovelocity Surface Area PISA The PISA calculation requires a measurement in 2D a measurement in Color and two measurements in Doppler spectral trace After all measurements are saved the result appears in the patient report 1 Measure from Ann D 2D a Ona frozen 2D image press the CALCS key suonein le pue s uawasAnsea y b From the calculations menu locate PISA and then select Ann D c Position the calipers See Working with calipers on page 55 d Save the calculation See To save a calculation on page 62 Chapter 4 Measurements and Calculations 75 76 2 Measure from Radius Color a Ona frozen Color image press the
107. e near field of the image Adjusts the gain applied to the far field of the image In live imaging adjusts the overall gain applied to the entire image On a frozen image moves the cine buffer A steady light indicates that AC power is connected A flashing light indicates that the system is asleep Displays calipers on screen for measuring Turns the calculations menu on and off Selects adjusts and moves items on screen Stops live imaging and displays a frozen image Saves an image to internal storage If configured also saves calculations to the report See Presets setup on page 29 Saves a clip to internal storage Control on screen options Displays the system settings Accesses the patient report and EMED worksheets Accesses the patient list saved images and archiving functions Accesses patient information 20 EXAM Shortcut keys SET SELECT SAVE CALC UPDATE Imaging Modes M MODE DOPPLER COLOR 2D Opens exam menu Keys that you can program to perform common tasks Sets a trace measurement Used with the touchpad to select items on screen Also switches between Color and Doppler options calipers for measurement pictograph marker position and angle frozen images in duplex and dual screens and arrow position and orientation Saves calculations and their measurements to the patient report Toggles between dual and duplex screens and imaging modes in M Mode and Doppler for example
108. e result appears in the patient report 1 Ona frozen 2D image press the CALCS key 2 Do the following to measure from LVOT D and again to measure from RVOT D a From the calculations menu locate Qp Qs and then select LVOT D or RVOT D b Position the calipers See Working with calipers on page 55 c Save the calculation See To save a calculation on page 62 suonein le pue syu uu inse lw 3 On a frozen Doppler spectral trace press the CALCS key 4 Do the following to measure from LVOT VTI and again to measure from RVOT VTI a From the calculations menu select Qp Qs and then select LVOT VTI or RVOT VTI b Press the SELECT key to start the trace c Using the touchpad trace the waveform To make a correction select Undo on screen backtrack with the touchpad or press the BACKSPACE key d Press the SET key to complete the trace Chapter 4 Measurements and Calculations 77 78 e Save the calculation See To save a calculation on page 62 For information on the automatic trace tool see To trace automatically Doppler on page 60 To calculate Stroke Volume SV or Stroke Index SI The SV and SI calculations require a measurement in 2D and a measurement in Doppler SI also requires Body Surface Area BSA After the measurements are saved the result appears in the patient report 1 SI Only Fill in the Height and Weight fields on the patient information form The BSA is calculated automatic
109. e 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 5 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 Caution To avoid the risk of electrical shock and fire hazard the power cord set that connects the power supply of the ultrasound system or MDS to mains power must only be used with the power supply or MDS and cannot be used to connect other devices to mains power Ayayes 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 electrical shock use commercial grade peripherals recommended by SonoSite on battery power only Do not connect these products to AC mains power when using the system to scan or diagnose a patient subject Contact SonoSite or your local representative for a list of the commercia
110. e update screen appears 2 Enter the license key in the Enter license number field 3 Select Done on screen If you entered a valid license key but the license update screen appears verify that you entered the license key correctly If the license update screen still appears contact SonoSite Technical Support See SonoSite Technical Support on page viii Maintenance 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 No periodic or preventive maintenance is required for the system transducer or accessories other than cleaning and disinfecting the transducer after every use See Cleaning and disinfecting transducers on page 99 There are no internal components that require periodic testing or calibration All maintenance requirements are described in this chapter and in the ultrasound system service manual Performing maintenance procedures not described in the user guide or service manual may void the product warranty Contact SonoSite Technical Support for any maintenance questions See SonoSite Technical Support on page viii WARNING Disinfectants and cleaning methods listed are recommended by SonoSite for compatibility with product materials not for biological effectiveness Refer to the disinfectant label instruc
111. e vertical caliper at the peak of the heartbeat 4 Press the SELECT key A second vertical caliper appears 5 Using the touchpad position the second vertical caliper at the peak of the next heartbeat See To save a measurement to a calculation and patient report on page 55 Saving the heart rate measurement to the patient report overwrites any heart rate entered on the patient information form See also To measure fetal heart rate M Mode on page 88 Doppler measurements The basic measurements that you can perform in Doppler imaging are Velocity cm s Pressure Gradient Elapsed Time x Ratio Resistive Index RI and Acceleration You can also trace manually or automatically For Doppler measurements the Doppler scale must be set to cm s See Presets setup on page 29 To measure Velocity cm s and Pressure Gradient Doppler 1 Ona frozen Doppler spectral trace press the CALIPER key A single caliper appears 2 Using the touchpad position the caliper to a peak velocity waveform This measurement involves a single caliper from the baseline See To save a measurement to a calculation and patient report on page 55 To measure Velocities Elapsed Time x Ratio Resistive Index RI and Acceleration Doppler 1 Ona frozen Doppler spectral trace press the CALIPER key A single caliper appears 2 Using the touchpad position the caliper to a peak systolic waveform 3 Press the SELECT key A second calipe
112. ean 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 immersion 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 compatible cleaning 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 and 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 con
113. ection automatically changes to the optimum setting 15 has an angle correction of 60 0 has an angle correction of 0 15 has an angle correction of 60 You can manually correct the angle after selecting a steering angle setting See To display the D line on page 39 Available on select transducers Page x x Indicates which page of options is displayed Select to display the next page 40 Spectral trace options In spectral trace imaging you can set the following on screen options Spectral trace options Option Icon Description Scale Select the desired scale pulse repetition frequency PRF setting To change the Doppler scale to cm s or kHz see Presets setup on page 29 Line 515 the baseline position ki On a frozen trace the baseline can be adjusted if Live Trace is off Invert 5 Vertically flips the spectral trace On a frozen trace Invert is available if Live Trace is off Volume c Increases or decreases Doppler speaker volume 0 10 Wall Filter Settings include Lovv Med High Sweep Speed gt Settings include Slow Med Fast 3 Live Trace Displays a live trace of the peak or mean See Presets setup on a rd page 29 to specify peak or mean Page Indicates which page of options is displayed Select to display the next page Chapter 3 Imaging 41 Imaging modes and exams available by transducer WARNING To prevent misdiagno
114. elect 5 x x to cycle to the image or clip you want to review 4 Clip Only Select Play The clip plays automatically after loading The load time depends on clip length You can select Pause to freeze the clip and can select a playback speed gt 1x 1 2x 1 4x 5 Select 4 x x to cycle to the next image or clip you want to view To return to the patient list select List To return to imaging select Done To print an image 1 Verify that a printer is selected See To configure the system for a printer on page 24 2 Do one of the following In the patient list review the patient s images Select Print when the image appears e With the image displayed press the A shortcut key By default the A shortcut key prints To reprogram the A and B shortcut keys see To set presets on page 29 To print multiple images 1 Verify that a printer is selected See To configure the system for a printer on page 24 2 Do one of the following Chapter 3 Imaging 51 Print all images for multiple patients Select one or more patients in the patient list Then select Print e Print all images for one patient Highlight the patient in the patient list and then select Print Each image appears briefly on screen while printing To export images or clips to a USB storage device A USB storage device is for temporary storage of images and clips Patient exams should be archived regularly To specify file format see USB
115. ent due to transducer surface temperature The system has been designed to ensure that temperature at the face of the transducer will not exceed the limits established in Section 42 of EN 60601 2 37 Particular requirement for the safety of ultrasound medical diagnostic and monitoring equipment See Transducer surface temperature rise on page 128 In the event of a device malfunction there are redundant controls that limit transducer power This is accomplished by an electrical design that limits both power supply current and voltage to the transducer The sonographer uses the system controls to adjust image quality and limit ultrasound output The system controls are divided into three categories relative to output controls that directly affect output controls that indirectly affect output and receiver controls Direct controls The system does not exceed a spatial peak temporal average intensity ISPTA of 720 mW cm for all imaging modes For opthalmic use the Orb exam mode is limited to the following values ISPTA does not exceed 50 mW cm TI does not exceed 1 0 and MI does not exceed 0 23 The mechanical index MI and thermal index TI may exceed values greater than 1 0 on some transducers in some imaging modes One may monitor the MI and TI values and adjust the controls to reduce these values See Guidelines for reducing MI and TI on page 124 Chapter 6 Safety 123 Ayayes Additionally one means for meeting the ALA
116. enu 1 Press the SETUP key Chapter 2 System Setup 25 2 Select IMT Calculations 3 Under IMT Calculations select measurement names from the lists or select None The selected names appear in the calculations menu and in the patient report 4 Type the desired width in the Region width mm box Network Status setup The Network Status setup page displays information on system IP address Location WLAN Profile Active WLAN SSID and Ethernet MAC address To display network status information 1 Press the SETUP key 2 Select Network Status OB Calculations setup On the OB Calculations setup page you select authors for OB calculation tables You can also import or export additional OB calculation tables See also OB calculations on page 83 Nyberg Hadlock Hadlock None Hadlock None Hadlock Hadlock Hadlock Hadlock Figure 1 OB Calculations Setup Page 26 None Hadlock TA None Hadlock Hadlock Hadlock Campbell To specify gestational age and growth analysis 1 Press the SETUP key 2 Select OB Calculations 3 In the measurement lists under Gestational Age and Growth Analysis select the desired OB authors or select None Selecting an author places the associated measurement on the calculations menu 4 Optional Select More to display the list of user defined custom measurements and to associate a custom table for the custom measurement This option is available only whe
117. environment If the user of the SonoSite ultrasound system requires continued operation during power mains interruptions it is recommended that the SonoSite ultrasound system be powered from an uninterruptible power supply ora battery Table 2 Manufacturer s Declaration Electromagnetic Immunity Continued Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Power Frequency Magnetic Field IEC 61000 4 8 Conducted RF IEC 61000 4 6 Radiated RF IEC 61000 4 3 3 A m 3 Vrms 150 kHz to 80 MHz 3 Vim 80 MHz to 2 5 GHz 3 A m 3 Vrms 3V m Ayayes If image distortion occurs it may be necessary to position the SonoSite ultrasound system further from sources of power frequency magnetic fields or to install magnetic shielding The power frequency magnetic field should be measured in the Intended installation location to assure that it is sufficiently low Portable and mobile RF communications equipment should be used no closer to any part of the SonoSite ultrasound system including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended Separation Distance d 1 2 P d 1 2P 80 MHz to 800 MHz d 23 P 800 MHz to 2 5 GHz VVhere P is the maximum output povver rating of the transmitter in vvatts VV according to the transmitter manufacturer and dis the recommended separation
118. erator shall handle the system This does not include the transducer face To avoid discomfort or minor risk of operator injury when handling the transducer connector the system should not be operated for more than 60 minutes continuously in a live scan mode as opposed to freeze or sleep modes To avoid the risk of electrical shock or injury do not open the system enclosures All internal adjustments and replacements except battery replacement must be made by a qualified technician To avoid the risk of injury do not operate the system in the presence of flammable gasses or anesthetics Explosion can result To avoid the risk of electrical shock use only properly grounded equipment Shock hazards exist if the power supply is not properly grounded Grounding reliability can only be achieved when equipment is connected to a receptacle marked Hospital Only or Hospital Grade or the equivalent The grounding wire must not be removed or defeated To avoid the risk of electrical shock when using the system in an environment where the integrity of the protective earth conductor arrangement is in doubt operate the system on battery power only without using the power supply To avoid the risk of electrical shock do not connect the system s power supply ora docking system to an MPSO or extension cord To avoid the risk of electrical shock before using the transducer inspect the transducer face housing and cable Do not use th
119. erials only SonoSite does not test for biological effectiveness For information see the disinfectant label instructions and the recommendations of the Association for Professionals in Infection Control and Epidemiology APIC and FDA Caution Transducers must be cleaned after every use Cleaning transducers is necessary prior to effective disinfection Ensure that you follow the manufacturer s instructions when using disinfectants Do not use a surgeon s brush when cleaning transducers Even the use of soft brushes can damage a transducer Use a soft cloth 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 warranty Do not allow cleaning solution or disinfectant into the transducer connector Do not allow disinfectant to contact metal surfaces Use a soft cloth lightly dampened in a mild soap or compatible cleaning solution to remove any disinfectant that remains on metal surfaces Attempting to disinfect a transducer or transducer cable using a method other than the one included here can damage the transducer and void the warranty Chapter 5 Troubleshooting and Maintenance 99 100 To clean and disinfect a transducer wipe method 1 2 3 Disconnect the transducer from the system Remove any transducer sheath Cl
120. essel in square cm Percent Diameter Reduction Handa Nobuo et al Echo Doppler Velocimeter in the Diagnosis of Hypertensive Patients The Renal Artery Doppler Technique Ultrasound in Medicine and Biology 12 12 1986 945 952 Diameter Reduction 1 D2 cm D1 cm 100 where D1 original diameter of the vessel in cm D2 reduced diameter of the vessel in cm Pressure Gradient PGr in mmHG 170 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
121. ew patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Transducers and Exam Types for Volume Calculations Transducer Exam Types 11 Abdomen Nerve 60 Gyn Abdomen HFL38x Breast Nerve Small Parts Vascular ICTx Gyn L25x Nerve Vascular Superficial Muscle L38x Breast Nerve Small Parts Vascular P21x Abdomen To calculate volume The volume calculation involves three 2D distance measurements Dt D and D After all measurements are saved the result appears on screen and in the patient report s Do the following for each image you need to measure a On the frozen 2D image press the CALCS key b Do the following for each measurement you need to take i From the calculations menu select the measurement name under Volume ii Position the calipers See Working with calipers on page 55 ili Save the measurement See To save a calculation on page 62 Chapter 4 Measurements and Calculations 65 suonein le pue s uawasAnseal y Volume flow calculations 66 WARNING To avoid incorrect calculations verify that the patient information date and time settings are accurate To avoid misdiagnosis or harming the patient outcome start a new patient information form
122. feature is licensed and configured See the DICOM user guide Saving images and clips Clips an optional feature lets you capture preview and save clips When you save an image or clip it saves to internal storage The system beeps afterward if Beep Alert is on and the percentage icon flashes See Audio Battery setup on page 23 To access saved images and clips open the patient list See Patient list on page 50 The percentage icon in the system status area shows the percentage of space used in internal storage To receive alerts when storage is near capacity see To receive storage alerts on page 24 To save an image s Press the SAVE key The image saves to internal storage By default the SAVE key saves only the image As a shortcut during calculations the SAVE key can save both the image to internal storage and the calculation to the patient report See To set presets on page 29 To capture and save a clip 1 Set Clips options See To set Clips options on page 49 2 Press the CLIP key One of the follovving occurs If Prev Off is selected the clip saves directly to internal storage If Prev On is selected the clip plays back in preview mode You can select any of the following on screen A playback speed 1x 1 2x 1 4x Pause to interrupt playback Left x or Right x to remove frames from the left or right sides of the clip where x is the beginning or endi
123. ge format affects only still images For DICOM export type the image format affects both still images and clips 6 For SiteLink export type select a sort order under Sort By To return to the previous screen select Devices Restoring default settings To restore default settings for a setup page On the setup page select Reset on screen dnjas 5 To restore all default settings 1 Turn the system off 2 Connect the system to AC power See To operate the system using AC power on page 6 3 Simultaneously press 1 and the power key The system beeps several times Chapter 2 System Setup 31 32 Chapter 3 Imaging Imaging modes The system has a high performance LCD and advanced image optimization technology that greatly simplifies user controls Imaging modes available depend on the transducer and exam type See Imaging modes and exams available by transducer on page 42 Adjusting depth and gain To adjust depth You can adjust the depth in all imaging modes but the trace modes The vertical depth scale is marked in 0 5 cm 1 cm and 5 cm increments depending on the depth Press the following keys UP DEPTH key to decrease the displayed depth e DOWN DEPTH key to increase the displayed depth As you adjust the depth the maximum depth number changes in the lower right screen To adjust gain Do one of the following e To adjust gain automatically press the AUTO GAIN key The ga
124. grade conforming to EN60601 1 requirements and non medical grade commercial products Manufacturer s instructions accompany each peripheral See Chapter 8 Specifications for a complete list of compatible transducers accessories and peripherals Intended uses The intended uses for each exam type are as follows For the intended transducer for each exam type see Imaging modes and exams available by transducer on page 42 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 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 pulsed wave tissue Doppler TDI PW 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 patients electrocardiogram ECG may be obtained and is used for timing
125. he system from the power supply or remove it from the mini dock or docking system 3 Clean the exterior surfaces using a soft cloth lightly dampened in a mild soap or detergent cleaning solution to remove any particulate matter or body fluids Apply the solution to the cloth rather than the surface 98 4 Mix the disinfectant solution compatible with the system following disinfectant label instructions for solution strengths and disinfectant contact duration 5 Wipe surfaces with the disinfectant solution 6 Air dry or towel dry with a clean cloth Cleaning and disinfecting transducers To disinfect the transducer and its cable use the immersion method or the wipe method Immersible transducers can be disinfected only if the product labeling indicates they can be used with an immersion method See Table 1 Disinfectants Compatible with System and Transducers on page 104 WARNING To avoid electrical shock before cleaning disconnect the transducer from the system To avoid injury always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection ensure that the solution expiration date has not passed To avoid infection the level of disinfection required for a transducer is dictated by the type of tissue it contacts during use Ensure that the solution strength and duration of contact are appropriate for the equipment SonoSite tests products for compatibility of mat
126. ic 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 voltage variations on power supply input lines IEC 61000 4 11 2 0KV 4 0KV 6 0KV contact 2 0KV 4 0KV 8 0KV air 2KV on the mains 1KV on signal lines 0 5KV 1 0KV 2 0KV on AC power lines to ground 0 5KV 1 0KV on AC power lines to lines gt 5 Ur gt 95 dip in Uz for 0 5 cycle 40 Uz 60 dip in Uz for 5 cycles 70 Ur 30 dip in Uz for 25 cycles gt 5 Ur gt 95 dip in Uz for 5s 2 0KV 4 0KV 6 0KV contact 2 0KV 4 0KV 8 0KV air 2KV on the mains 1KV on signal lines 0 5KV 1 0KV 2 0KV on AC power lines to ground 0 5KV 1 0KV on AC power lines to lines gt 5 gt 95 dip in Uz for 0 5 cycle 40 Ur 60 dip in Uz for 5 eycles 70 Ur 30 dip in Ur for 25 cycles gt 5 Ur gt 95 dip in Uz for 5s Floors should be vvood 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
127. ical caliper appears 5 Using the touchpad position the second caliper at the end of the waveform 6 Press the SET key The measurement results appear See To save a measurement to a calculation and patient report on page 55 Automatic Trace Measurement Results for Exam Type Doppler Exam Type Automatic Trace Results Abdomen Cardiac Neo OB Gyn Vascular Velocity Time Integral VTI X Peak Velocity Vmax X X X X Mean Pressure Gradient X PGmean Mean Velocity on Peak Trace X Vmean Pressure Gradient PGmax X Automatic Trace Measurement Results for Exam Type Doppler Continued Exam Type Automatic Trace Results Abdomen Cardiac Neo OB Gyn Vascular Cardiac Output CO X Peak Systolic Velocity PSV X Time Average Mean TAM X x or Systolic Diastolic S D X X X X Pulsatility Index PI X X X X End Diastolic Velocity EDV X X X X Acceleration Time AT X Resistive Index RI X X X X Time Average Peak TAP X Gate Depth X The automatic trace tool must be used to calculate the TAM General calculations VVithin calculations you can save measurement resulits to the patient report You can vievv repeat and delete measurements from a calculation Some measurements can be deleted directly from the patient report pages See Patient report on p
128. ience 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 more comfortably and may reduce your risk of MSDsef a Magnavita N L Bevilacqua P Mirk A Fileni and N Castellino Work related Musculoskeletal Complaints in Sonologists Occupational Environmental Medicine 41 11 1999 981 988 b Craig M Sonography An Occupational Hazard Journal of Diagnostic Medical Sonography 3 1985 121 125 c Smith C S G W Wolf G Y Xie and M D Smith Musculoskeletal Pain in Cardiac Ultrasonographers Results of a Random Survey Journal of American Society of Echocar
129. ight Endocardial Epicardial E Point Septal Separation Established Due Date Elapsed Time Femoral Head Fetal Heart Rate Glossary 183 Aaessoj5 184 Abbreviations in User Interface Continued Abbreviation Definition FL Femur Length FM Right and Left Foramen Magnum same as SO FTA Fetal Trunk Area GA Gestational Age GA by LMP Gestational Age by Last Menstrual Period GA by LMPd Gestational Age by derived Last Menstrual Period Gate Depth of Doppler Gate GS Gestational Sac Gyn Gynecology HC Head Circumference HR Heart Rate ICA Internal Carotid Artery IMT Intima Media Thickness IVRT Iso Volumic Relaxation Time IVS Interventricular Septum IVSd Interventricular Septum Diastolic IVSFT Interventricular Septum Fractional Shortening IVSs Interventricular Septum Systolic LA Left Atrium LA Ao Left Atrium Aorta Ratio LATF Lateral Far LATN Lateral Near LMP Last Menstrual Period LMPd derived Last Menstrual Period LV Left Ventricular Abbreviations in User Interface Continued Abbreviation Definition LV Area LV mass LV Volume LVd LVD LVDd LVDFS LVDs LVEDV LVESV LVET LVO LVOT LVOT Area LVOT D LVOT VTI LVPW LVPWd LVPWFT LVPWs LVs MB MCA MCCA MECA Left Ventricular Area Left Ventricular mass Left Ventricular Volume Left Ventricular diastolic Left Ventricular Dimension Left Ventricular Dimension Diastolic Left Ventricular Dimension Fractional Shortening Lef
130. in adjusts each time you press this key e To adjust gain manually turn the NEAR T FAR j and GAIN knobs These knobs 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 on other ultrasound systems In PW and CW Doppler imaging the GAIN knob affects Doppler gain In CPD or Color imaging the GAIN knob affects the color gain applied to the region of interest ROI box The NEAR and FAR knobs affect only the 2D image Freezing viewing frames and zooming To freeze or unfreeze an image Press the FREEZE key On a frozen image the cine icon and frame number appear in the system status area Chapter 3 Imaging 33 To move forward or backward in the cine buffer Freeze the image and do one of the following e Turn the knob Use the touchpad Right moves forward and left moves backward Press the LEFT ARROW and RIGHT ARROW keys The frame number changes as you move forward or backward The total number of frames in the buffer appears on screen in the system status area To zoom in on an image You can zoom in 2D and Color imaging You can freeze or unfreeze the image or change the imaging mode at any time while zooming 1 Press the ZOOM key A ROI box appears 2 Using the touchpad position the ROI box as desired 3 Press the ZOOM key again The image in the ROI box is magnified by 100
131. ins 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 TVSS IVSD IVSD 100 where IVSS Interventricular Septal Thickness at Systole IVSD Interventricular Septal Thickness at Diastole Chapter 7 References 159 Isovolumic Relaxation Time IVRT in msec Reynolds Terry The Echocardiographer s Pocket Reference School of Cardiac Ultrasound Arizona Heart Institute 1993 146 time a time bl Left Atrium Aorta LA Ao Feigenbaum H Echocardiography Philadelphia Lea and Febiger 1994 206 Figure 4 49 Left Ventricular End Volumes Teichholz in ml Teichholz L E T Kreulen M V Herman et al Problems in echocardiographic volume determinations echocardiographic angiographic correlations in the presence or absence of asynergy American Journal of Cardiology 1976 37 7 LVESV 7 0 LVDS 2 4 LVDS where LVESV Left Ventricular End Systolic Volume LVDS Left Ventricular Dimension at Systol
132. istance 2D 57 distance M Mode 58 Doppler 59 edit 56 Elapsed Time Doppler 59 errors 157 fetal heart rate 88 heart rate 58 88 M Mode 58 manual trace 58 59 Pressure Gradient Doppler 59 publications 157 Resistive Index Doppler 59 save to calculation and report 55 terminology 157 vascular 90 Velocities Doppler 59 mechanical index MI 127 179 mitral valve aortic valve MV AV 73 M line 36 mode data 12 25 modes keys 11 N near 10 network 26 NTSC definition 179 option 24 Index OB calculations 26 83 custom measurements setup 27 custom tables setup 28 graphs 94 intended uses 3 references 164 tables setup 28 on screen controls 10 optimize 35 orientation marker 12 option 35 output display 127 P PAL definition 179 option 24 passvvord 19 20 21 patient header 13 25 patient information form 45 patient list 50 patient report about 92 cardiac 92 general 92 OB 92 save measurement to 55 vascular 92 PC 24 pediatric intended uses 3 percent reduction calculation 63 peripherals 174 pictographs PICTO key 12 placing 45 povver delay 23 povver key 9 precision acoustic measurement 149 preferences 29 presets 29 pressure half time PHT 75 pressure limits 175 PRF 38 41 print 51 printer problem 95 setup 24 probe See transducer prostate intended uses 4 proximal isovelocity surface area PISA 70 pulsed wave PW Doppler imaging 39 PW Doppler See pulsed wave PW Doppler imaging Q Qp Qs
133. itable acoustic coupling some gels are incompatible with some transducer materials SonoSite recommends Aquasonic gel and provides a sample with the system For general use apply a liberal amount of gel between the transducer and the body For invasive or surgical use install a transducer sheath WARNING To prevent contamination the use of sterile transducer sheaths and sterile coupling gel is recommended for clinical applications of an invasive or surgical nature Do not apply the transducer sheath and gel until you are ready to perform the procedure To install a transducer sheath SonoSite recommends the use of market cleared transducer sheaths for intracavitary or surgical applications To lessen the risk of contamination install the sheath only when you are ready to perform the procedure 1 Place gel inside the sheath 2 Insert the transducer into the sheath 3 Pull the sheath over the transducer and cable until the sheath is fully extended 4 Secure the sheath using the bands supplied with the sheath 5 Check for and eliminate bubbles between the face of the transducer and the sheath Bubbles between the face of the transducer and the sheath may affect the ultrasound image 6 Inspect the sheath to ensure that there are no holes or tears 16 Chapter 2 System Setup The system setup pages let you customize the system and set preferences To access the setup pages Press the SETUP key To return to imaging from
134. ition frequency associated with the transmit pattern giving rise to the reported value of MI in Hertz P Pll max Peak rarefactional pressure at the point where the free field spatial peak pulse intensity integral is a maximum in Megapascals deq Pllmax Equivalent beam diameter at the point where the free field spatial peak pulse intensity integral is a maximum in centimeters FL Focal length or azimuthal x and elevational y lengths if different measured in centimeters Acoustic measurement precision and uncertainty All 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 25 Acoustic Measurement Precision and Uncertainty Quantity Pr Pr Wo fc Precision Uncertainty of standard deviation 95 confidence 1 9 11 2 1 9 12 2 3 4 10 0 1 4 7 Chapter 6 Safety 149 Table 25 Acoustic Measurement Precision and Uncertainty Continued Quantit Precision Uncertainty y of standard deviation 95 confidence PII 3
135. l 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 ITE Do not use the system if an error message appears on the image display note the error code call SonoSite or your local representative turn off the system by pressing and holding the power key until the system powers down To avoid increasing the system and tr
136. lb To calculate percent area reduction The percent area reduction calculation involves two manual trace measurements 1 Ona frozen 2D image press the CALCS key 2 Do the following for AT and then for A a From the calculations menu select the measurement name under Area Red b Using the touchpad move the caliper to the trace starting point and press the SELECT key c Using the touchpad trace the desired area To make a correction select Undo on screen or press the BACKSPACE key d Complete the trace and press the SET key e Save the calculation See To save a calculation on page 62 The percent area reduction result appears on screen in the measurement and calculation data area and in the patient report To calculate percent diameter reduction 1 On a frozen 2D image press the CALCS key 2 Do the follovving for D and then for D a From the calculations menu select the measurement name under Dia Red b Position the calipers See VVorking vvith calipers on page 55 64 c Save the calculation See To save a calculation on page 62 The percent diameter reduction result appears in the measurement and calculation data area and in the patient report Volume calculations WARNING To avoid incorrect calculations verify that the patient information date and time settings are accurate To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a n
137. lect the USB storage device and select Export The Event log is a text file that you can open in a text editing application for example Microsoft Word or Notepad To clear the Event log 1 View the Event log 2 Select Clear on screen 3 Select Yes Logging in as user If user login is required the User Login screen appears when you turn on the system See To require user login on page 18 dn s ul 3s4S To log in as user 1 Turn on the system 2 In the User Login screen type your name and passvvord and select OK To log in as guest Guests can scan but can t access system setup and patient information 1 Turn on the system 2 In the User Login screen select Guest To change your passvvord 1 Turn on the system 2 In the User Login screen select Passvvord 3 Type your old and new passwords confirm the new password and then select OK Choosing a secure passvvord To ensure security choose a passvvord that contains uppercase characters A Z lovvercase characters a z and numbers 0 9 Passvvords are case sensitive Chapter 2 System Setup 21 Annotations setup 22 On the Annotations setup page you can customize predefined labels and set the preference for managing text when unfreezing images For instructions to annotate images see Annotations on page 43 To predefine a label group You can specify which labels are available for an exam type when annotating an image See To
138. liams and Wilkins 1999 59 CO SV HR 1000 where CO Cardiac Output SV Stroke Volume HR Heart Rate Cross Sectional Area CSA in cm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 383 CSA 0 785 D where D diameter of the anatomy of interest Deceleration Time in msec Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 453 time a time bl 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 158 E A Ratio in cm sec E A velocity E velocity A E Ea Ratio Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 225 E Velocity Ea velocity where E velocity Mitral Valve E velocity Ea annular E velocity also known as E prime Effective Regurgitant Orifice ERO in mm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 455 ERO 6 28 r Va MR Vel s u s u where r radius Va aliasing velocity Ejection Fraction EF percent Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilk
139. llowing sections list the publications and terminology used for each calculation result Terminology and measurements comply with AIUM published standards Cardiac references Acceleration ACC in cm s Zwiebel W J Introduction to Vascular Ultrasonography 4th ed W B Saunders Company 2000 52 ACC abs delta velocity delta time Acceleration Time AT in msec Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 219 Aortic Valve Area AVA by Continuity Equation in cm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 393 442 Az Ay V V gt where A gt Ao valve area area V LVOT velocity V Ao valve velocity LVOT Left Ventricular Outflow Tract AVA PVryor PVAo SAryor AVA VTikyor VTlAo CSALvor Chapter 7 References 157 Body Surface Area BSA in m Grossman W Cardiac Catheterization and Angiography Philadelphia Lea and Febiger 1980 90 BSA 0 007184 Weight0425 Height0775 Weight kilograms Height centimeters Cardiac Index CI in I min m2 Oh J K J B Seward A J Tajik The Echo Manual 2nd Edition Boston Little Brown and Company 1999 59 CI CO BSA where CO Cardiac Output BSA Body Surface Area Cardiac Output CO in l min Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Wil
140. lution A device that transforms one form of energy into another form of energy Ultrasound transducers contain piezoelectric elements which when excited electrically emit acoustic energy When the acoustic energy is transmitted into the body it travels until it encounters an interface or change in tissue properties At the interface an echo is formed that returns to the transducer where this acoustic energy is transformed into electrical energy processed and displayed as anatomical information Displays a variation in Color Doppler flow imaging within a given sample Variance is mapped to the color green and is used to detect turbulence Abbreviations Abbreviations in User Interface Abbreviation Definition x A APG A2Cd A2Cs A4Cd A4Cs AAo Abd abs AC ACA ACC ACoA ACS AFI Al Al PHT AL Ann D ANT F ANT N Ao AoD Caliper x Caliper Ratio A Wave Peak Velocity A Wave Peak Pressure Gradient Apical 2 Chamber diastolic Apical 2 Chamber systolic Apical 4 Chamber diastolic Apical 4 Chamber systolic Ascending Aorta Abdomen Absolute value Abdominal Circumference Anterior Cerebral Artery Acceleration Index Anterior Communicating Artery Aortic Valve Cusp Separation Amniotic Fluid Index Aortic Insufficiency Aortic Insufficiency Pressure Half Time Atlas Loop Annulus Diameter Anterior Far Anterior Near Aorta Aortic Root Diameter Glossary 181 Aiessoj5 18
141. m 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 EMl related problems Eliminate or reduce EMI with technical solutions such as shielding e Restrict use of personal communicators cell phones computers in areas with devices susceptible to EMI Share relevant EMI information with others particularly when evaluating new equipment purchases which may generate EMI Purchase medical devices that comply with IEC 60601 1 2 EMC Standards Caution To avoid the risk of increased electromagnetic emissions or decreased immunity use Manufacturer s declaration only accessories and peripherals recommended by SonoSite Connection of accessories and peripherals not recommended by SonoSite could result in malfunctioning of your ultrasound system or other medical electrical devices in the area Contact SonoSite or your local representative for a list of accessories and peripherals available from or recommended by SonoSite See the SonoSite accessories user guide Ayayes 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 elec
142. mage press the CALCS key 2 From the calculations menu select the measurement 3 Using the touchpad or arrow keys position the IMT tool over the area of interest until the measurement results appear 4 Adjust the tool and edit as needed See IMT tool options on page 82 5 Save the calculation See To save a calculation on page 62 Chapter 4 Measurements and Calculations 81 suonein le pue syu u inse lw IMT tool options 82 When using the IMT tool you can select the following options on screen IMT Tool Options Option Icon Description Hide Use to check results Hides the measurement results and trace line Select Show to redisplay them Move Repositions the tool horizontally by several pixels The 4 ib upper key moves the tool right and the lovver key moves the tool left VVidth Adjusts the tool width by 1 mm The upper key increases di ib the vvidth and the lovver key decreases the vvidth Edit Displays Smooth Adven and Lumen Smooth Adjusts the IMT line smoothing Select Edit to display this option Adven FA Adjusts the adventitia media line The upper key moves the line upward The lower key moves the line downward Select Edit to display this option Lumen FA Adjusts the lumen intima line The upper key moves the line upward The lower key moves the line downward Each of the two IMT lines can be adjusted independently Select Edit to display this option To trace IMT man
143. mation form Last First Middle Patient ID Accession Indications Procedure ID User Reading Dr Referring Dr and Institution fields DICOM or SiteLink configuration page Alias and AE Title fields A amp B Key Footswitch setup page Text field Text mode imaging Annotation field EZ EH He Es R F Fi ER EZ EZ Rs EA r A Em mi Figure 7 Symbols Dialog Box To enter symbols or special characters 1 Select the field and then select Symbols 2 Select the desired symbol or character You can also press the keys on the keyboard 3 Select OK Chapter 1 Getting Started 15 payers Preparing transducers WARNING Some transducer sheaths contain natural rubber latex and talc which can cause allergic reactions in some individuals Refer to 21 CFR 801 437 User labeling for devices that contain natural rubber Some gels and sterilants can cause an allergic reaction on some individuals Caution To avoid damage to the transducer use only gels recommended by SonoSite Using gels other than the one recommended by SonoSite can damage the transducer and void the warranty If you have questions about gel compatibility contact SonoSite or your local representative SonoSite recommends that you clean transducers after each use See Cleaning and disinfecting transducers on page 99 Acoustic coupling gel must be used during exams Although most gels provide su
144. n a user defined custom table has been created for the custom measurement To export OB calculation tables 1 Insert a USB storage device 2 Press the SETUP key 3 Select OB Calculations 4 Select Export A list of USB devices appears dn s ul 3s4S 5 Select the USB storage device and select Export All user defined tables and measurements are copied to the USB storage device To import OB calculation tables Imported OB calculation tables replace all user defined tables and measurements on the system 1 Insert the USB storage device that contains the tables 2 Press the SETUP key 3 Select OB Calculations 4 Select Import on screen 5 Select the USB storage device and then select Import 6 Select Done in the dialog box that appears The system restarts OB Custom Measurements setup On the OB Custom Measurements setup page you can define measurements that appear in the OB calculations menu and OB report OB Custom Measurements is an optional feature See also OB calculations on page 83 Chapter 2 System Setup 27 To set up OB custom measurements You can save up to five custom measurements that appear in the OB calculations menu and OB report 1 Press the SETUP key 2 Select OB Custom Meas 3 Select New 4 In the Name box type a unique name 5 In the Type list select the desired measurement type 6 Select Save To delete an OB custom measurement 1 Press the SETUP key 2 Select OB Custom
145. n also add and delete users change passwords import and export user accounts and view the event log Security settings 18 WARNING Health care providers who maintain or transmit health information are required by the Health Insurance Portability and Accountability Act HIPAA of 1996 and the European Union Data Protection Directive 95 46 EC to implement appropriate procedures to ensure the integrity and confidentiality of information to protect against any reasonably anticipated threats or hazards to the security or integrity of the information or unauthorized uses or disclosures of the information Security settings on the system allow you to meet the applicable security requirements listed in the HIPAA standard Users are ultimately responsible for ensuring the security and protection of all electronic protected health information collected stored reviewed and transmitted on the system To log in as Administrator 1 Press the SETUP key 2 Select Administration 3 Type Administrator in the Name box 4 Type the administrator password in the Password box If you don t have the administrator password contact SonoSite See SonoSite Technical Support on page viii 5 Select Login To log out as Administrator Turn off or restart the system To require user login You can set the system to display the User Login screen at startup 1 Log in as Administrator 2 In the User Login list select On On requires
146. n cardiac exams in ft Ibs or cm m kg Language The system language Changing the language requires restarting the system Color Scheme The background color of the display Auto save Pat Form Automatically saves the patient information form as an image in the patient s file System Information setup The System Information setup page displays system hardware and software versions and license information See also To enter a license key on page 97 To display system information 1 Press the SETUP key 2 Select System Information USB Devices setup 30 On the USB Devices setup page you can vievv information about connected USB devices including space availability You can also specify a file format for images and clips you export to a USB storage device See To export images or clips to a USB storage device on page 52 To specify a file format for exported images 1 Press the SETUP key 2 Select USB Devices 3 Select Export 4 Under USB Export select an export type SiteLink organizes files in a SiteLink style folder structure Clips export in H 264 video saved as MP4 files To view them SonoSite recommends QuickTime 7 0 or later DICOM creates files readable by a DICOM server DICOM is an optional feature 5 Select an image format for your export type For JPEG image format also select a JPEG compression A high compression has a smaller file size but less detail For SiteLink export type the ima
147. nector 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 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 WARNING To avoid infection ensure that the solution expiration date has not passed Caution Attempting to disinfect a transducer cable using a method other than the one included here can damage the transducer and void the warranty To clean and disinfect a transducer cable wipe method 1 2 3 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 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 l
148. ng frame number 48 Save to save the clip to internal storage Delete to delete the clip To set Clips options Setting Clips options ensures that clips are captured to your specifications 1 In 2D imaging mode select Clips on screen 2 Set options as desired Clips options Option con Description Time ECG a Time and EGG share the same location on screen e With Time capturing is based on number of seconds Select the time duration With ECG capturing is based on the number of heart beats Select the number of beats Preview On 22 PrevOn and PrevOff turn the preview feature on and off Preview Off e With Prev On the captured clip automatically plays on screen The clip can be trimmed saved or deleted e With Prev Off the clip saves to internal storage and the trim and delete options are not available Prospective T Pro and Retro determine how clips are captured Retrospective HHH With Pro a clip is captured prospectively after you press the CLIP key e With Retro a clip is captured retrospectively from pre saved data before you press the CLIP key Chapter 3 Imaging 49 Patient list WARNING To avoid damaging the USB storage device and losing patient data from it observe the following Do not remove the USB storage device or turn off the ultrasound system while the system is exporting Do not bump or otherwise apply pressure to the USB storage device while it is in a USB port on
149. noMB Tissue Doppler Imaging TDI thermal index TI TIB bone thermal index TIC cranial bone thermal index TIS soft tissue thermal index Tissue Harmonic maging transducer variance A depth on the display that corresponds to the skin transducer interface A subset of the 2D imaging mode in which the 2D image is enhanced by reducing speckle noise artifact at tissue margins and improving contrast resolution by reducing artifacts and improving visualization of texture patterns within the image A subset of the 2D imaging mode in which the 2D image is enhanced by looking at a target from three angles and then merging or averaging the scanned data together to improve overall image quality and in parallel reducing noise and artifacts A pulsed wave Doppler technique used to detect myocardial motion The ratio of total 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 reso
150. nt See To save a calculation on page 62 Vascular calculations WARNING To avoid misdiagnosis or harming the patient outcome start a new patient information form before starting a new patient exam and performing calculations Starting a new patient information form clears the previous patient s data The previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 To avoid incorrect calculations verify that the patient information date and time settings are accurate Transducers and Exam Types for Vascular Calculations Transducer Exam Type HFL38x Vascular L25x Vascular L38x Vascular P10x Vascular 90 The vascular measurements that you can save to the patient report are listed in the following table For definitions of acronyms see Glossary on page 179 Vascular Calculations Menu Heading Vascular Measurement Calculation Results CCA Prox s systolic d diastolic Mid s systolic d diastolic Dist s systolic d diastolic Bulb s systolic d diastolic ICA Prox s systolic d diastolic Mid s systolic d diastolic Dist s systolic d diastolic ECA Prox s systolic d diastolic Mid s systolic d diastolic Dist s systolic d diastolic VArty s systolic d diastolic To perform a Vascular calculation After you perform vascular measurements values in the ICA CCA
151. ntly recommend a specific brand of acoustic standoff If an acoustic standoff is used it must have a minimum attentuation of 3dB cm MHz Some SonoSite transducers are approved for intraoperative applications if a market cleared sheath is used Electromagnetic compatibility The ultrasound system has been tested and found to comply with the electromagnetic compatibility EMC limits for medical devices to IEC 60601 1 2 2001 These limits are designed to provide reasonable protection against harmful interference in a typical medical installation Caution 118 Medical electrical equipment requires special precautions regarding EMC and must be installed and operated according to these instructions It is possible that high levels of radiated or conducted radio frequency electromagnetic interference EMI from portable and mobile RF communications equipment or other strong or nearby radio frequency sources could result in performance disruption of the ultrasound system Evidence of disruption may include image degradation or distortion erratic readings equipment ceasing to operate or other incorrect functioning If this occurs survey the site to determine the source of disruption and take the following actions to eliminate the source s e Turn equipment in the vicinity off and on to isolate disruptive equipment Relocate or re orient interfering equipment e Increase distance between interfering equipment and your ultrasound syste
152. nuary 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 Chapter 7 References 167 Biparietal Diameter BPD Chitty Lyn S et al Charts of Fetal Size 2 Head Measurements British Journal of Obstetrics and Gynaecology 101 January 1994 43 Appendix BPD Outer Inner Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine A Longitudinal Study of Fetal Limb Growth American Journal of Perinatology 1 January 1984 136 144 Table 5 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 176 Table 7 8 Estimated Fetal Weight EFW Hadlock F et al In Utero Analysis of Fetal Growth A Sonographic Weight Standard Radiology 181 1991 129 133 Jeanty Philippe F Cantraine R Romero E Cousaert 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
153. o avoid infection always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection ensure that the solution expiration date has not passed To avoid infection the level of disinfection required for a product is dictated by the type of tissue it contacts during use Ensure that 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 warranty Do not use strong solvents such as thinner or benzene or abrasive cleansers since these will damage the exterior surfaces Use only recommended cleaners or disinfectants on system surfaces Immersion type disinfectants are not approved for use on system surfaces When you clean the system ensure that the solution does not get inside the system controls or the battery compartment Do not scratch the LCD screen To clean the LCD screen Dampen a clean non abrasive cotton cloth with an ammonia based window cleaner and wipe the screen clean Apply the cleaner to the cloth rather than the surface of the screen To clean and disinfect system surfaces 1 Turn off the system 2 Disconnect t
154. ofessional to determine stretches and exercises that are right for you Electrical safety classification Class equipment Internally powered equipment Type BF applied parts Type CF applied parts IPX 7 watertight equipment IPX 8 watertight equipment Non AP APG Electrical safety Ultrasound system powered from power supply or part of the Mobile Docking System Ultrasound system not connected to the power supply battery only Ultrasound transducers ECG module ECG leads Ultrasound transducers Footswitch Ultrasound system power supply Mobile Docking System and peripherals Equipment is not suitable for use in the presence of flammable anaesthetics This system meets EN60601 1 Class I internally powered equipment requirements and Type BF isolated patient applied parts safety requirements Chapter 6 Safety 113 114 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 8 Specifications For maximum safety observe the following warnings and cautions WARNING To avoid discomfort or minor risk of patient injury keep hot surfaces away from the patient Under certain circumstances the transducer connector and back of the display enclosure can reach temperatures that exceed EN60601 1 limits for patient contact therefore only the op
155. ojy pinbiH TIV Joyor y jouedoudos V V V V pixoij d pinbi YSN pixos q u Boip H mne eel iln wapas Cao esse O p nunuo2 si 3npsueul pue 5 YUM lqiyeduuo2 s1ue13 jJuisiG L lqe 1 107 Troubleshooting and Maintenance Chapter 5 V N N N p xolq uLolu d M yg s d I 1SHL n V V V p xolq ulolu pi nbn 80 l si n N N N louooly q s m YSN 3nd sueul n N V V euowwy ero pinbH vsn 101 S dI A V V V V gluouluuV 3enO vsn V V V V eluowwy Jeno pinbiH YSN sn d PpPeyL n V V V pinby vsn 81 n V V V euowwy yeno Xeds YSN SOL ASYL n V V V puolu 11v Aesds vsn II Aesds 1 N N V V eNO AKeids vsn Keds N N N N louooly Adodos YSN uhlo D tues J dns n V V V pinbr vu solue1 1s N V N V loueu4 heads vsn u ude1s N V V V jouaud d M ysn ulpinods n V V V jouayd vsn n N V V Iouedoidos pinbr vsn 1145 V V V V 3enO adi vsn sn d u3ol2 1u5 V N V V gluouluuy eNO vsn gH uhol2 tues r b 0 p nunuo2 si 3 npsueul pue uu 1s s YUM ajqiyedwos s1ue15 jJuisiGq L lqeL 108 Troubleshooting sn 104 oq p ls un n sn 104 oq ON N qe1d 55v V n V V V jouaydiAuayd Q pinbr vsn pI2 X AA n V V V pinbr vsn 90 PI 1AEAA n N N N apyapesain pinbri YSN
156. ols on page 15 4 Optional To add a predefined label select Label and then select the desired label group 1 x There are three label groups See Annotations setup on page 22 To turn off text entry press the TEXT key To reset the home position 1 Press the TEXT key 2 Using the touchpad or arrow keys position the cursor where desired 3 Select Home Set To place an arrow on an image You can add an arrow graphic to point out a specific part of the image 1 Press the ARROW key ES 2 If you need to adjust the arrow s orientation press the SELECT key and then use the touchpad When the orientation is correct press the SELECT key again 3 Use the touchpad to move the arrow to the desired location 4 Press the ARROW key to set the arrow The arrow changes from green to white To remove the arrow press the ARROW key and then select Hide To place a pictograph on an image The pictograph set available depends on transducer and exam type 1 Press the PICTO key 2 Select El x x to display the desired pictograph and then press the SELECT key The first number shows which pictograph in the set has been selected The second number is the number of pictographs available 3 Use the touchpad to position the pictograph marker 4 Optional To rotate the pictograph marker press the SELECT key and then use the touchpad Select a screen location for the pictograph U L Up Left D L Down Left D R Down Right U R Up
157. ons given here are for a fixed path tissue model and are for devices having spra 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 Acoustic output tables Table 8 through Table 23 indicate the acoustic output for the system and transducer combinations with a thermal index or mechanical index equal to or greater than one These tables are organized by transducer model and imaging mode For a definition of terms used in the tables see Terms used in the acoustic output tables on page 148 Chapter 6 Safety 131 Ayayes Table 8 Transducer Model C71x 8 5 Operating Mode CPD Color TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 2 Pr3 MPa Wo mW 40 50 9 min of W zi lrA 3 Z1 mW 5 2 cm o z cm a z 50 u deg Zsp cm lt f MH2 4 38 Dim of Aaprt X cm 0 36 Y cm 0 5 PD usec S PRF H Pr Pll max MPa 5 deqOPllmax cm x Focal Length FL cm 1 56 5 FLy cm m 2 5 3 MI max W cm 2 Control 1 Mode CPD 2 Control 2 Exam Type Vas 6 Cont
158. ontinue use of the transducer and contact SonoSite or your local representative Cleaning and disinfecting the battery Caution To avoid damaging the battery do not allow cleaning solution or disinfectant to come in contact with the battery terminals To clean and disinfect a battery wipe method 1 Remove the battery from the system 2 Clean the surface using a soft cloth lightly dampened in a mild soap or detergent cleaning solution Apply the solution to the cloth rather than the surface 3 Wipe the surfaces with the disinfection solution Theracide disinfectant is recommended 4 Air dry or towel dry with a clean cloth Cleaning the footswitch Caution To avoid damaging the footswitch do not sterilize It is not intended for use ina sterile environment To clean the footswitch 1 Dampen a non abrasive cloth with one of the following products Isopropyl alcohol Soap and water Cidex e Sodium Hypochlorite 5 25 Bleach diluted 10 1 2 Wring out cloth until slightly wet and then gently rub soiled area until clean Cleaning and disinfecting ECG cables Caution To avoid damaging the ECG cable do not sterilize To clean and disinfect the ECG cable wipe method 1 Remove the cable from the system 102 2 Clean the surface using a soft cloth lightly dampened in a mild soap or detergent cleaning solution Apply the solution to the cloth rather than the surface 3 Wipe the surfaces with any of the following prod
159. ou can measure for quick reference or you can measure within a calculation You can perform fe P general calculations as well as calculations specific to an exam type Measurements are performed on frozen images For references used see Chapter 7 References Measurements You can perform basic measurements in any imaging mode and can save the image with the measurements displayed See To save an image on page 48 Except for the M Mode HR measurement the results do not automatically save to a calculation and the patient report If you prefer you can first begin a calculation and then measure See Performing and saving measurements in calculations on page 62 Some options may not apply to your system Options available depend on your configuration transducer and exam type To save a measurement to a calculation and patient report 1 With the measurement active green press the CALCS key 2 From the calculations menu select a measurement name Only measurement names available for the imaging mode and exam type are selectable 3 Save the calculation See To save a calculation on page 62 To start a calculation before measuring see Performing and saving measurements in calculations on page 62 Working with calipers When measuring you work with calipers often in pairs Results based on the calipers position appear at the bottom of the screen The results update as you reposition the caliper
160. ound 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 and color Doppler Color imaging is intended for high risk pregnant women High risk pregnancy indications include but are not limited to multiple pregnancy fetal hydrops placental abnormalities as well as maternal hypertension diabetes and lupus WARNING To prevent injury or misdiagnosis do not use this system for Percutaneous Umbilical Blood Sampling PUBS or in vitro Fertilization IVF The system has not been validated to be proven effective for these two uses CPD or Color images can be used as an adjunctive method not as a screening tool for the detection of structural anomalies of the fetal heart and as an adjunctive method not as a screening tool for the diagnosis of Intrauterine Growth Retardation IUGR Pediatric Imaging Applications This system transmits ultrasound energy into the pediatric patients using 2D M Mode color Doppler Color color power Doppler CPD pulsed wave PW Doppler pulsed wave tissue Doppler TDI PW and continuous wave CW Doppler to Chapter 1 Getting Started 3 payers obtain ultrasound images The pediatric abdominal pelvic and cardiac anatomy pediatric hips neonatal head and surrounding anatomical structures can be assessed for the pre
161. ower connections Remove the DC input connector and battery wait 10 seconds and then reinstall them Ensure that the battery is charged System image quality is poor Adjust the LCD screen to improve viewing angle Adjust the brightness Adjust the gain No CPD image Adjust the gain No Color image Adjust the gain or the scale No OB measurement Select the OB exam type selections Print does not work Select the printer on the Connectivity setup page See To configure the system for a printer on page 24 Check the printer connections Ensure that the printer is turned on and set up properly See the printer manufacturer s instructions if necessary DVD recorder does not record Check the DVD recorder connections Ensure that the DVD recorder is turned on and set up properly See the applicable SonoSite accessory user guide and the manufacturers instructions Chapter 5 Troubleshooting and Maintenance 95 Troubleshooting Continued Symptom Solution External monitor does not Check the monitor connections work Check the monitor to ensure that it is turned on and set up properly See the monitor manufacturers instructions if necessary System does not recognize the Disconnect and reconnect the transducer transducer System maintenance may be required Record the number in parentheses on the C line and contact SonoSite or your SonoSite representative A maintenan
162. ower setting Turns biopsy guidelines on and off This feature depends on transducer type See the SonoSite Biopsy user guide Biopsy is not available when the ECG cable is connected Turns the guideline on and off This feature depends on transducer and exam type See the user guide for L25x transducer and needle guide S On and S Off turn SonoHD Imaging Technology on and off When SonoHD is on S appears in the upper left hand screen SonoHD is optional and depends on transducer and exam type MB On and MB Off turn SonoMB multi beam technology on and off When SonoMB is on MB appears in the upper left hand screen SonoMB depends on transducer and exam type Displays the ECG trace See ECG Monitoring on page 52 This feature is optional and requires a SonoSite ECG cable Displays the clips options See To capture and save a clip on page 48 This feature is optional Turns Tissue Harmonic Imaging on and off When on THI appears in the upper left hand screen This feature is optional and depends on transducer and exam type Indicates which page of options is displayed Select to display the next page Motion mode M Mode is an extension of 2D It provides a trace of the 2D image displayed over time A single beam of ultrasound is transmitted and reflected signals are displayed as dots of varying intensities which create lines across the screen To display the M line 1 Press the M MODE key Note If th
163. performance is observed additional measures may be necessary such as re orienting or relocating the SonoSite ultrasound system b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m ALARA principle 122 ALARA is the guiding principle for the use of diagnostic ultrasound Sonographers and other qualified ultrasound users using good judgment and insight determine the exposure that is as low as reasonably achievable There are no set rules to determine the correct exposure for every situation The qualified ultrasound user determines the most appropriate way to keep exposure low and bioeffects to a minimum while obtaining a diagnostic examination A thorough knowledge of the imaging modes transducer capability system setup and scanning technique is necessary The imaging mode determines the nature of the ultrasound beam A stationary beam results in a more concentrated exposure than a scanned beam which spreads that exposure over that area The transducer capability depends upon the frequency 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 rela
164. place text on an image on page 44 1 Press the SETUP key 2 Select Annotations 3 In the Exam list select the exam type whose labels you want to specify 4 For Group select A B or C for the label group you want associated with that exam The preset labels appear for the selected group 5 Do any of the following e Add a custom label to the group Type the label in the Text box and select Add e Rename a label Select the label type the new name in the Text box and select Rename e Move a label within the group Select the label and then select the on screen up or down arrow Delete a label from a group Select the label and select Delete You can use symbols in labels See Symbols on page 15 To specify text retention when unfreezing You can specify which text to keep when you unfreeze an image or change the imaging layout 1 Press the SETUP key 2 Select Annotations 3 In the Unfreeze list select Keep All Text Keep Home Text or Clear All Text The default setting is Keep All Text For information on setting the home position see To reset the home position on page 44 To export predefined label groups 1 Insert a USB storage device 2 Press the SETUP key 3 Select Annotations 4 Select Export A list of USB devices appears 5 Select the USB storage device and select Export A copy of all predefined label groups for all exams saves to the USB storage device To import predefined label grou
165. point See Working with calipers on page 55 4 Press the SELECT key and position the second caliper 5 Press the SELECT key Another caliper appears and the calculations menu highlights the next measurement name 6 Position the caliper and press the SELECT key Repeat for each measurement name in the calculation group Each time you press the SELECT key another caliper appears and the calculations menu highlights the next measurement name 7 Save the calculation See To save a calculation on page 62 To measure Ao LA AAo or LVOT D 1 Ona frozen 2D image or M Mode trace press the CALCS key 2 From the calculations menu select the measurement name 3 Position the calipers See Working with calipers on page 55 4 Save the calculation See To save a calculation on page 62 To calculate LV Volume Simpson s Rule 1 Ona frozen 2D image press the CALCS key 2 Do the following for each measurement a From the calculations menu select the desired view and phase b Position the caliper at the mitral annulus and press the SELECT key to start the trace c Using the touchpad trace the left ventricular LV cavity To make a correction select Undo on screen or press the BACKSPACE key d Complete the trace and press the SET key e Save the calculation See To save a calculation on page 62 To calculate MV or AV area 1 Ona frozen 2D image press the CALCS key suonein le pue syu uu inse l 2
166. ppear and then save the calculation Unlike measurements performed outside a calculation the calipers appear by selecting from the calculations menu not by pressing the CALIPER key The type of calipers that appear depends on the measurement To save a calculation Do one of the following e Save the calculation only Press the SAVE CALC key or select Save on screen The calculation saves to the patient report To save the image with the measurements displayed see To save an image on page 48 Save both the image and calculation Press the SAVE key if the SAVE key functionality is set to Image Calcs See To set presets on page 29 The calculation saves to the patient report and the image saves to internal storage with the measurements displayed Viewing repeating and deleting saved measurements in calculations 62 To view a saved measurement Do one of the following Highlight the measurement name in the calculations menu The result appears below the menu Open the patient report See Patient report on page 92 To repeat a saved measurement 1 Highlight the measurement name in the calculations menu 2 Press the SELECT key or the CALIPER key 3 Perform the measurement again The new results appear on screen in the measurement and calculations data area See Screen layout on page 12 You can compare them to the saved results below the menu 4 To save the new measurement press th
167. previous patient s data will be combined with the current patient if the form is not first cleared See To create a new patient information form on page 45 Transducers and Exam Types for Gynecology Gyn Calculations Transducer Exam Type C60x Gyn suonein le pue s uawasAnsea y ICTx Gyn To measure uterus or ovary 1 Ona frozen 2D image press the CALCS key 2 From the calculations menu select Gyn 3 Do the following for each measurement you want to take a Select the measurement name from the calculations menu b Position the calipers See Working with calipers on page 55 Chapter 4 Measurements and Calculations 79 c Save the calculation See To save a calculation on page 62 To measure follicles You can save up to six follicular measurements one distance measurement for each of up to six follicles 1 Ona frozen 2D image press the CALCS key 2 From the calculations menu select Follicle 3 Do the following for each follicle you want to measure a From the calculations menu select the measurement name under Right Fol or Left Fol b Position the calipers See Working with calipers on page 55 c Save the calculation See To save a calculation on page 62 IMT calculations 80 WARNING To ensure high quality images all patient images must be obtained by qualified and trained individuals To avoid patient injury IMT results should not be used as a sole
168. ps 1 Insert the USB storage device that contains the label groups Press the SETUP key Select Annotations Select Import on screen Select the USB storage device and then select Import a uu A UN Select Done in the dialog box that appears The system restarts All predefined label groups for all exams are replaced with those from the USB storage device Audio Battery setup On the Audio Battery setup page you can specify sounds and the length of time for Sleep Delay and Power Delay To change audio and battery settings 1 Press the SETUP key 2 Select Audio Battery 3 Specify options in the following lists Key click Select On or Off for keys to click when pressed Beep alert Select On or Off for the system to beep when saving warning starting or shutting down Sleep delay Select Off or 5 or 10 minutes to specify the period of inactivity before the system goes into sleep mode Power delay Select Off or 15 or 30 minutes to specify the period of inactivity before the system automatically turns off Cardiac Calculations setup On the Cardiac Calculations setup page you can specify measurement names that appear in the Tissue Doppler Imaging TDI calculations menu and on the report page See also Cardiac calculations on page 68 Chapter 2 System Setup 23 dn s 5 To specify cardiac measurement names 1 Press the SETUP key 2 Select Cardiac Calculations 3 In the TDI Walls lists
169. r ROI box 15 0 or 15 If adding PW Doppler see PW Doppler options on page 40 Available on select transducers Turns variance on and off Available only for cardiac exam Switches the displayed direction of flow Available in Color imaging Indicates which page of options is displayed Select to display the next page PW and CW Doppler imaging Pulsed wave PW Doppler and continuous wave CW Doppler imaging modes are optional features PW Doppler is a Doppler recording of blood flow velocities in a range specific area along the length of the beam CW Doppler is a Doppler recording of blood flow velocities along the length of the beam You can use PW CW Doppler and CPD Color and simultaneously If CPD Color imaging is on the color ROI box is tied to the D line The SELECT key cycles among color ROI box position color ROI box size the D line and in PW Doppler angle correction The active selection is green Also the indicator on the left hand screen shows which touchpad function is active To display the D line The default Doppler imaging mode is PW Doppler In cardiac exams you can select the CW Doppler on screen option 1 Press the DOPPLER key Note If the D line does not appear make sure that the system is in live imaging 2 Do any of the following as needed Set options See PW Doppler options on page 40 e Using the touchpad position the D line where desired PW Doppler To correct the
170. r appears 4 Using the touchpad position the second caliper at the end diastole on the waveform See To save a measurement to a calculation and patient report on page 55 suonein le pue s uawasnsea y To trace manually Doppler 1 Ona frozen Doppler spectral trace press the CALIPER key 2 Select Manual on screen A single caliper appears 3 Using the touchpad position the caliper at the beginning of the desired waveform and press the SELECT key If calipers are not positioned correctly the result is inaccurate Chapter 4 Measurements and Calculations 59 60 4 Using the touchpad trace the waveform To make a correction select Undo on screen backtrack with the touchpad or press the BACKSPACE key 5 Press the SET key The measurement results appear See To save a measurement to a calculation and patient report on page 55 To trace automatically Doppler After tracing automatically confirm that the system generated boundary is correct If you are not satisfied with the trace obtain a high quality Doppler spectral trace image or trace manually See To trace manually Doppler on page 59 1 Ona frozen Doppler spectral trace press the CALIPER key 2 Select Auto on screen A vertical caliper appears 3 Using the touchpad position the caliper at the beginning of the waveform If calipers are not positioned correctly the calculation result is inaccurate 4 Press the SELECT key A second vert
171. r reducing MI or TI If multiple parameters are given then the best results may be achieved by minimizing these parameters simultaneously In some modes changing these parameters will not affect MI or TI Changes to other parameters may also result in MI and TI reductions Please note the MI or TI read out on the right side of the LCD screen means to decrease or lower setting of parameter to reduce MI or TI 124 1 means to raise or increase setting of parameter to reduce MI or TI Table 3 MI Transducer Depth Ayayes 11 1 C60x HFL38x ICTx L25x L38x gt gt gt gt gt gt P21x Table 4 TI TIS TIC TIB Color Power Doppler Settings PW Settings PRE Depth Opti Width Height Depth mize C11x il t Depth C60x 4 1 4 il 4 PRF HFL38x t t t 4 Depth i 1 1 l Poi L PRF Gyn L25x 4 il Y PRF L38x Depth P21x 4 4 1 Y PRF Chapter 6 Safety 125 Output display 126 The system meets the AIUM output display standard for MI and TI see last reference listed in Related guidance documents below Table 5 indicates for each transducer and operating mode when either the TI or MI is greater than or equal to a value of 1 0 thus requiring display Table 5 Cases Where Either a Thermal or Mechanical Index is gt 1 0 Transducer Model Index M de 7 11 8 5 MI No No No TIC TIB or TIS No Yes Yes C60x 5 2 MI Yes No
172. r system can be damaged by connecting an accessory not recommended by SonoSite To monitor ECG 1 Connect the ECG cable to the ECG connector on the ultrasound system mini dock or docking system ECG Monitoring turns on automatically Note An external ECG monitor may cause a lag in the timing of the ECG trace corresponding with the 2D image Biopsy guidelines are not available when ECG is connected 2 Select ECG on screen ECG may be on another page It appears only if the ECG cable is connected 3 Select options as desired ECG Monitoring options Option Icon Description Show Hide Gain Position Sweep Speed wp Delay Line el Save Turns on and off ECG trace Increases or decreases ECG gain Settings are 0 20 Sets the position of the ECG trace Settings are Slow Med and Fast Displays Line and Save for clip acquisition delay For instructions to capture clips see To capture and save a clip on page 48 The position of the delay line on the ECG trace The delay line indicates where the clip acquisition is triggered Saves the current position of the delay line on the ECG trace You can change the position of the delay line temporarily Starting a new patient information form or cycling system power reverts the delay line to the most recently saved position Select Delay to display these options Chapter 3 Imaging 53 54 Chapter 4 Measurements and Calculations Y
173. raphs on screen 3 In the Graphs list select the desired measurement author The graph for the selected measurement appears You can select another measurement author or select 1 x on screen For twins both measurement sets are plotted on the same graph 4 Optional Press the SAVE key to save the current graph page 5 Select one of the following on screen Report to return to the previous report page Done to return to live imaging Sending reports and viewing EMED worksheets 94 To send a report to a PC You can send a report to a PC as a text file 1 Ensure correct configuration See To configure the system for a DVD recorder PC or bar code scanner on page 24 2 Select Send Rep on screen To view EMED Worksheets This feature is optional 1 At the end of an exam press the REPORT key 2 Select EMED on screen 3 Select the desired worksheet AAA FAST Gallbladder GB Kidney Chapter 5 Troubleshooting and Maintenance This chapter contains information to help correct problems with system operation to enter a software license and to take proper care of the system transducer and accessories Troubleshooting If you encounter difficulty with the system use the following table to help troubleshoot the problem If the problem persists contact SonoSite Technical Support See SonoSite Technical Support on page viii Troubleshooting Symptom Solution System does not turn on Check all p
174. ratios are selectable on the vascular page of the patient report 1 Ona frozen Doppler spectral trace press the CALCS key 2 From the calculations menu select Left or Right 3 Do the following for each measurement you want to take a From the calculations menu select the measurement name b Using the touchpad position the caliper at the peak systolic waveform c Press the SELECT key A second caliper appears d Using the touchpad position the second caliper at the end diastole on the waveform e Save the calculation See To save a calculation on page 62 Chapter 4 Measurements and Calculations 91 suonein le pue syu uu inse lw Patient report The patient report contains calculation results The last page contains patient information The patient report for Cardiac OB and Vascular exams have additional details and features You can view the patient report at any time during the exam The value for a calculation appears only if the calculation has been performed The pound symbol indicates a value that is out of range for example too large or small Calculation values that are out of range are not included in derived calculations for example mean To view a patient report 1 Press the REPORT key 2 To view additional pages select El 1 x on screen 3 Optional Press the SAVE key to save the current page of the patient report To exit the patient report and return to imaging select Done
175. rator 2 Inthe User List select the user 3 Type the new password in the Password box and Confirm box 4 Select Save Exporting or importing user accounts The export and import commands let you configure multiple systems and back up user account information To export user accounts 1 Insert a USB storage device 2 Log in as Administrator 3 Select Export on screen A list of USB devices appears 4 Select the USB storage device and select Export All user names and passwords are copied to the USB storage device To import user accounts 1 Insert the USB storage device that contains the accounts 2 Log in as Administrator 3 Select Import on screen 4 Select the USB storage device and select Import 5 Select Done in the dialog box that appears The system restarts All user names and passwords on the system are replaced with the imported data Exporting and clearing the Event log 20 The Event log collects errors and events and can be exported to a USB storage device and read ona PC To view the Event log 1 Log in as Administrator 2 Select Log on screen The Event log appears To return to the previous screen select Back To export the Event log The Event log and the DICOM network log have the same file name log txt Exporting either one to a USB storage device overwrites any existing log txt file 1 Insert a USB storage device 2 Select Log and then select Export on screen A list of USB devices appears 3 Se
176. re to ultrasound energy as low as reasonably achievable for diagnostic results Identified by the letter C curved or curvilinear and a number 60 The number corresponds to the radius of curvature of the array expressed in millimeters The transducer elements are electrically configured to control the characteristics and direction of the acoustic beam For example C15 C60e Refers to the depth of the display A constant speed of sound of 1538 5 meters second is assumed in the calculation of echo position in the image In the natural or original position liquid crystal display Identified by the letter L linear and a number 38 The number corresponds to the radius of width of the array expressed in millimeters The transducer elements are electrically configured to control the characteristics and direction of the acoustic beam For example L38 550 2 An indication of the likelihood of mechanical bioeffects occurring the higher the MI the greater the likelihood of mechanical bioeffects See Chapter 6 Safety for a more complete description of MI See mechanical index MI and thermal index TI National Television Standards Committee A video format setting See also PAL Phase Alternating Line A video format setting See also NTSC A transducer designed primarily for cardiac scanning Forms a sector image by electronically steering the beam direction and focus Glossary 179 skinline SonoHD So
177. rol 3 PRF 2841 Gl Control 4 Optimization Depth Med 2 0 Control 5 Color Box Top Position Size Short 132 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Table 9 Transducer Model C11x 8 5 Operating Mode PW Doppler a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 8 1 7 Pr3 MPa Wo mW 26 29 24 65 Y min of W 3 z1 lt4 3 Zz1 mW 5 Z cm 2 2 zep cm kO sp cm 1 1 Q idel cm 0 236 lt F MH2 4 36 4 36 Dim of Aaprt X cm 0 28 0 2 Y cm 0 5 0 5 PD usec S PRF Hz P Pll max
178. rol4 Sample Volume Position Zone 1 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 6 Safety 139 Ayayes Table 16 Transducer Model L25x 13 6 Operating Mode PW Doppler a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode 140 TIS TIB Index Label M I Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 1 6 b Pr3 MPa Wo mW 14 02 min of 21 3 21 1 mW 8 21 cm v 2 Zbp cm sp m 0 6 deg Zsp cm 0 155 lt i MHz 6 00 Dim of Aaprt X cm 0 16 Y cm it 0 3 8 usec m PRF H2 pr Pll max MPa 5 deq Pllmax cm 0 1549 Focal
179. s by using the touchpad In trace measurements the results appear after you complete the trace Outside a calculation you can add calipers by pressing the CALIPER key You can have multiple sets of calipers and can switch from one set to another repositioning them as needed Each set shows the measurement result The active calipers and measurement result are highlighted green A measurement is complete when you finish moving its calipers Within a calculation calipers appear when you select from the calculations menu See To select from the calculations menu on page 61 For an accurate measurement accurate placement of calipers is essential Chapter 4 Measurements and Calculations 55 suonein le pue s uawasnseal y To switch the active calipers s Do one of the following To switch the active caliper within a set press the SELECT key To switch the active set when measuring outside a calculation select Switch on screen To delete or edit a measurement s With the measurement active highlighted do one of the following e To delete select Delete on screen To edit use the touchpad to move the calipers Note Trace measurements cannot be edited once set To improve precision of caliper placement Do any of the following e Adjust the display for maximum sharpness Use leading edges closest to the transducer or borders for starting and stopping points e Maintain a consistent transducer orien
180. sence or absence of pathology Prostate Imaging Applications This system transmits ultrasound energy into the prostate of an adult male using 2D M Mode color power Doppler CPD color Doppler Color 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 This system transmits ultrasound energy into various parts of the body using 2D M Mode color Doppler Color color power Doppler CPD 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 peripheral nerve blocks and spinal nerve blocks and taps 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 and pulsed wave PW Doppler to obtain ultrasound images The carotid arteries deep veins and arteries in the arms and legs superficial veins in the arms and legs great vessels in the abdomen and various small vessels feeding organs can be assessed for the presence or absence of pathology Preparing the system Installing or removing the battery
181. sis of Infant Hip Dysplasia Journal of Pediatric Orthopedics Vol 4 No 6 735 740 1984 Morin C Harcke H MacEwen G The Infant Hip Real Time US Assessment of Acetabular Development Radiology 177 673 677 December 1985 Intima Media Thickness IMT Howard G Sharrett AR Heiss G Evans GW Chambless LE Riley WA et al Carotid Artery Intima Medial Thickness Distribution in General Populations As Evaluated by B Mode Ultrasound ARIC Investigators Atherosclerosis Risk in Communities Stroke 1993 24 1297 1304 O Leary Daniel H MD and Polak Joseph F MD et al Use of Sonography to Evaluate Carotid Atherosclerosis in the Elderly The Cardiovascular Health Study Stroke September 1991 22 1155 1163 Redberg Rita F MD and Vogel Robert A MD et al Task force 3 What is the Spectrum of Current and Emerging Techniques for the Noninvasive Measurement of Atherosclerosis Journal of the American College of Cardiology June 4 2003 41 11 1886 1898 Percent Area Reduction Taylor K J W P N Burns P Breslau Clinical Applications of Doppler Ultrasound Raven Press N Y 1988 130 136 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 2 A1 cm2 100 where A1 original area of the vessel in square cm A2 reduced area of the v
182. sis or harm to the patient understand your system s capabilities prior to use The diagnostic capability differs for each transducer exam type and imaging mode In addition transducers have been developed to specific criteria depending on their physical application These criteria include biocompatability requirements The transducer you use determines which exam types are available In addition the exam type you select determines which imaging modes are available Imaging modes and exams available by transducer Imaging Mode Exam 2D 3 3 PW cw Transducer Type M Mode CPD Color Doppler Doppler 11 Abd X Neo Nrv Vas C60x OB Gyn Abd Nrv HFL38x Bre SmP Vas Msk IMT Nrv Ven ICTx Gyn 2 gt j XxX X gt gt gt gt xx x X X x gt x x X x gt j j gt X X gt gt gt gt gt gt X X x gt x x X x gt j j gt gt gt gt gt gt gt 2 gt X X X XX x x X X gt gt gt gt gt gt gt X X X X X XxX x X OB 42 Imaging modes and exams available by transducer Continued Imaging Mode Exam 2D PW Transducer Type M Mode CPD Color Doppler Doppler L25x Msk X Vas Nrv Sup Ven L38x Bre SmP Vas IMT Nrv Ven P21x Abd x gt K X X X X X X X X X X x gt XxX X X X X X XxX X X X OB x X X XxX X gt X X X X X x X X X gt b X X X X X X X X X X X Crd X X 1 Exam type abbreviations are as follo
183. sound beam passes through bone near the beam entrance into the body Aaprt Area of the active aperture measured in cm P 3 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 z Derated ultrasonic power at axial distance z in units of milliwatts Ispta 3 Z1 Derated spatial peak temporal average intensity at axial distance z milliwatts per square centimeter 21 Axial distance corresponding to the location of maximum min W 3 z 3 2 x 1 cm2 where z gt zbp in centimeters Zbp 1 69 in centimeters Zsp For MI the axial distance at which is measured For TIB the axial distance at which TIB is a global maximum for example z p Zp 3 in centimeters Table 24 Acoustic Output Terms and Definitions Continued Ayayes Term Definition deqiz Equivalent beam diameter as a function of axial distance z and is equal to J 4 z Wo ITA 2 where HA 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 repet
184. t Ventricular Dimension Systolic Left Ventricular End Diastolic Volume Left Ventricular End Systolic Volume Left Ventricular Ejection Time Left Ventricular Opacification Left Ventricular Outflow Tract Left Ventricular Outflow Tract Area Left Ventricular Outflow Tract Diameter Left Ventricular Outflow Tract Velocity Time Integral Left Ventricular Posterior Wall Left Ventricular Posterior Wall Diastolic Left Ventricular Posterior Wall Fractional Thickening Left Ventricular Posterior Wall Systolic Left Ventricular systolic SonoMB Middle Cerebral Artery Mid Common Carotid Artery Mid External Carotid Artery Glossary Aaessoj5 185 186 Abbreviations in User Interface Continued Abbreviation Definition MI MICA Mid MM MR PISA MR VTI Msk MV MV Area MV ERO MV PISA Area MV Rate MV Regurgitant Fraction MV Regurgitant Volume MV VTI MVA Neo Nrv NTSC OA OB OFD Orb PAL PCAp Mechanical Index Mid Internal Carotid Artery Middle M Mode Mitral Regurgitation Proximal Iso Velocity Surface Area Mitral Regurgitation Velocity Time Integral Muscle Mitral Valve Mitral Valve Area Mitral Valve Effective Regurgitant Orifice Mitral Valve Proximal Iso Velocity Surface Area Mitral Valve Rate Mitral Valve Regurgitant Fraction Mitral Valve Regurgitant Volume Mitral Valve Velocity Time Integral Mitral Valve Area Neonatal Nerve National Television Standards Committee Ophthalmic Artery
185. tation for each type of measurement Make sure that the area of interest fills as much of the screen as possible 2D Minimize the depth or zoom 2D measurements 56 The basic measurements that you can perform in 2D imaging are as follows e Distance in cm e Area in cm e Circumference in cm You can also measure area or circumference by manually tracing You can perform a combination of distance area circumference and manual trace measurements at one time The total number possible depends on their order and type A 0 73cm A 0 42cm 2 31 B 0 96cm Figure 1 2D image with two distance and one circumference measurement To measure distance 2D You can perform up to eight distance measurements on a 2D image 1 Ona frozen 2D image press the CALIPER key A pair of calipers appears connected by a dotted line 2 Using the touchpad position the first caliper and then press the SELECT key The other caliper becomes active 3 Using the touchpad position the other caliper If you move the calipers close together they shrink and the dotted line disappears See To save a measurement to a calculation and patient report on page 55 To measure area or circumference 2D 1 Ona frozen 2D image press the CALIPER key 2 Select Ellipse on screen Note If you exceed the allowed number of measurements Ellipse is not available 3 Use the touchpad to adjust the size and position of the ellipse The SELECT key toggles
186. tead select the option by using the touchpad and the SELECT key Figure 6 On screen options 2D imaging shown Chapter 1 Getting Started 13 Annotation and text Alphanumeric keyboard un KE ES EE ES ES ES EB 1 IZ Ee EN KE KS KEE BB EZ Ka Ku wawam a 6 7 1 TAB 2 CAPS LOCK 3 SHIFT 4 TEXT 5 PICTO 6 ARROW 7 SPACEBAR 8 DELETE 9 Arrow Keys 10 BACKSPACE 11 ENTER Moves cursor among fields in the forms and tabs between text position in dual screens Sets the keyboard to capital letters Allows entry of capitalized characters and international characters Turns the keyboard on and off for text entry Turns pictographs on and off Displays an arrow graphic that can be moved and rotated within the image area Turns the keyboard on for text entry In text entry adds a space Removes all text from the screen during text entry and when not measuring Move highlighted selection in calculations menu move cursor one space when entering text move caliper position move cine buffer forward and backward and move among pages in image review and reports Removes the character left of the cursor in text entry mode Moves cursor among fields in forms and saves calculations to report Symbols You can enter symbols and special characters in select fields and forms The symbols and special characters available depend on context Patient infor
187. ted 00 00 00 9 r Dangerous voltage Date of manufacture Direct Current DC Do not get wet Do not stack over 2 high Do not stack over 5 high Do not stack over 10 high Electrostatic sensitive devices Device complies with relevant FCC regulations for electronic devices Chapter 6 Safety 151 Ayayes Table 26 Labeling Symbols Continued 152 Symbol Definition P m STERILE Fragile Gel sterilized by radiation Hot Indoor use only Device emits a static DC magnetic field Non ionizing radiation Paper recycle Serial number type of control number Storage temperature conditions Submersible Protected against the effects of temporary immersion Water Tight Equipment Protected against the effects of extended immersion Handle transducer with care Follow manufacturer s instructions for disinfecting time Disinfect transducer Table 26 Labeling Symbols Continued Definition Ayayes Type BF patient applied part B body F floating applied part Underwriter s Laboratories labeling Pollution Control Logo Applies to all parts products listed in the China RoHS disclosure table May not appear on the exterior of some parts products because of space limitations China Compulsory Certificate mark CCC Mark A compulsory safety mark for compliance to Chinese national standards for m
188. ted measurement is highlighted green 3 Select Delete on screen To delete all measurements select the measurement label and press the SELECT key and then select Delete on screen m 2009Aug29 15 46 3 4 Anatomy Checklist fi Face 13 V Cord Fetal Lie GNose Lips EH Stomach yoa E Profile E Bladder Plac Location E Lateral Vent o Kidneys 2 Cisterna Magna E Spine Gender 23 Nuchal E Upper Extrem G4 Ch Heart Gj Lower Extrem GAortic Arch Maternal K ASL mF e GLVOT G Cervix o Diaphragm 21 Fibroids o Cord Insert Fetal o Cord Insert Plac D 3 4 IEEEGraphs EMED Done Figure 3 OB Anatomy Checklist Page To view the OB Anatomy Checklist page 1 After or during the OB exam press the REPORT key 2 On the page for Anatomy Demonstrated select the check boxes to document reviewed anatomy Press the TAB key to move between fields and the SPACEBAR to select and deselect items in the checklist Chapter 4 Measurements and Calculations 93 suonein le pue syu uu inse lw To view the OB Biophysical Profile page 1 After or during the OB exam press the REPORT key 2 On page 2 of the report select values for the biophysical profile BPP 0 1 2 The total score is calculated when values are entered NST non stress test is optional To view OB graphs OB Graphs may be viewed if LMP or Estab DD is entered in the patient information form 1 After or during the OB exam press the REPORT key 2 Select G
189. the date of the Last Menstrual Period LMP GA by LMPd Gestational Age by derived Last Menstrual Period The fetal age calculated using the Last Menstrual Period LMPd derived from the Estab DD LMP Last Menstrual Period The first day of the last menstrual period Used to calculate gestational age and EDD LMPd derived Last Menstrual Period Calculated from the user entered Estab DD UA Ultrasound Age Calculated on the mean measurements taken for a particular fetal biometry If you change the calculation author during the exam the common measurements are retained suonein le pue syu uu inse lW Chapter 4 Measurements and Calculations 85 86 The following table shows the system defined measurements available for OB calculations by author For definition of the acronyms see Glossary on page 179 To select authors see OB Calculations setup on page 26 See also OB Custom Measurements setup on page 27 and OB Custom Tables setup on page 28 System Defined OB Calculations and Table Authors Calculation Result Gestational OB Table Authors Measurements Gestational Age GS Hansmann Nyberg Tokyo U CRL Hadlock Hansmann Osaka Tokyo U BPD Chitty Hadlock Hansmann Osaka Tokyo U OFD Hansmann HC Chitty Hadlock Hansmann TTD Hansmann Tokyo U APTD Tokyo U P AC Hadlock Hansmann Tokyo U FTA Osaka FL Chitty Hadlock Hansmann Osaka Tokyo U Estimated Fetal Weight
190. the ultrasound system The connector could break Caution If the internal storage icon does not appear in the system status area internal storage may be defective Contact SonoSite Technical Support See SonoSite Technical Support on page viii The patient list lets you organize saved images and clips from a central location You can delete view print or archive them You can also copy them to a USB storage device O PAT ENT1 O 2 34 2009Aug25 PATIENTS 2009Aug29 15 39 1 Date Time 15 Delete Done Figure 1 Patient List To open the patient list 1 Press the REVIEW key 2 If there is a current patient select List on screen 50 To sort the patient list After the system starts the patient list is arranged by date and time with the most recent patient file first You can re sort the patient list as needed s Select the column heading that you want to sort by Select it again if sorting in reverse order Note The M column heading is selectable To select patients in the patient list Using the touchpad select the check box for one or more patients Select All selects all patients To deselect patients select checked boxes or Clear All To review images and clips You can review only one patient s images and clips at a time 1 In the patient list highlight the patient whose images and clips you want to review 2 Select Review on screen 3 S
191. tions 8 Cardiac calculations 68 Gynecology Gyn calculations we 79 IMT caleulations u a a S a aaa sua Sasa 80 OB cale lations uu u D A s s 83 Small Parts Calculations sesssscsssecssecssecsseccnsecssecssecsssccsecesscseasesseecseesscessees 89 Vascular calculations sessssscsssesssesssscsssecssesssecssscessecsscssaceeseeesssesssecseesssessneesss 90 Patiehtreport a a 92 Vascular and Cardiac reports 2222 92 OB T eDOriSuy quqa aa kaa qaa aaa qa aqusapa 92 Sending reports and viewing EMED worksheets 94 Chapter 5 Troubleshooting and Maintenance TroubleshootIN8 q a ana aa A MO aan maaa uaualashaqhaiusihaas 95 Softvrarelicensing san ku s s n hana as 96 97 Cleaning and disinfecting the ultrasound system 98 Cleaning and disinfecting transducers 99 Cleaning and disinfecting transducer cables 101 Cleaning and disinfecting the battery Cleaning the footswitch Cleaning and disinfecting ECG cables Chapter 6 Safety Ergonomic Safety cs sccosccsssaxssactsscsacccesacvasenansasszaceceassassansaactessta
192. tions for guidance on disinfection efficacy and appropriate clinical uses The level of disinfection required for a device is dictated by the type of tissue it will contact during use To avoid infection ensure that 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 the U S Food and Drug Administration FDA To prevent contamination the use of sterile transducer sheaths and sterile coupling gel is recommended for clinical applications of an invasive or surgical nature Do not apply the transducer sheath and gel until you are ready to perform the procedure Caution Some transducer sheaths contain natural rubber latex and talc which can cause allergic reactions in some individuals Refer to 21 CFR 801 437 User labeling for devices that contain natural rubber Chapter 5 Troubleshooting and Maintenance 97 Cleaning and disinfecting the ultrasound system The exterior surface of the ultrasound system and the accessories can be cleaned and disinfected using a recommended cleaner or disinfectant See Table 1 Disinfectants Compatible with System and Transducers on page 104 WARNING Caution To avoid electrical shock before cleaning disconnect the system from the power supply or remove from the mini dock or docking system T
193. tive 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 anatomical information CPD imaging provides information about the energy or amplitude strength of the Doppler signal over time at a given anatomical location and is used for detecting the presence of blood flow Color imaging provides information about the energy or amplitude strength of the Doppler signal over time at a given anatomical location and is used for detecting the presence velocity and direction of blood flow Tissue Harmonic Imaging uses higher received frequencies to reduce clutter artifact and improve resolution on the 2D image Understanding the nature of the imaging mode used allows the qualified ultrasound user to apply the ALARA principle Prudent use of ultrasound requires that patient exposure to ultrasound be limited to the lowest ultrasound output for the shortest time necessary to achieve acceptable diagnostic results Decisions that support prudent use are based on the type of patient exam type patient history ease or difficulty of obtaining diagnostically useful information and potential localized heating of the pati
194. trical 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 Table 1 and Table 2 document the intended use environment and EMC compliance levels of the system For maximum performance ensure that the system is used in the environments described in this table The system is intended for use in the electromagnetic environment specified below Table 1 Manufacturer s Declaration Electromagnetic Emissions Emissions Test Compliance Electromagnetic Environment RF emissions Group 1 The SonoSite ultrasound system uses RF energy only CISPR 11 for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions Class A The SonoSite ultrasound system is suitable for use in CISPR 11 all establishments other than domestic and those directly connected to the public low voltage power supply network which supplies buildings used for domestic purposes Harmonic emissions Class A IEC 61000 3 2 Voltage fluctuations Complies flicker emissions IEC 61000 3 3 Chapter 6 Safety 119 The system is intended for use in the electromagnetic environment specified below Table 2 Manufacturer s Declaration Electromagnet
195. tup 23 specifications 175 biological safety 117 biopsy 36 bodymarker See pictographs brightness 36 C cables clean and disinfect ECG 102 clean and disinfect transducer 101 connect power 6 calculations authors 86 cardiac See cardiac calculations delete measurement 62 63 general 61 gynecology Gyn 79 IMT 80 menu 12 61 OB83 percent area 64 percent diameter 64 percent reduction 63 perform measurement 62 performing 62 repeat measurement 62 save 62 small parts 89 specialized 68 vascular 90 view measurement 62 volume 65 volume flow 66 calipers 55 cardiac calculations AAo 73 Ao 73 AVA 77 C 78 CO 78 dP dT 76 HR 78 VRT 71 LA 73 LV volume Simpson s Rule 73 ndex x pul 191 192 LVd 72 LVOT D 73 LVs 72 MV AV area 73 overview 68 PHT 75 PISA 70 Qp Qs 70 RVSP 75 setup 23 SV 78 TDI 79 VTI 74 cardiac index Cl 78 cardiac output CO 78 cardiac references 157 cardiac intended uses 2 cautions definition vii cine buffer 10 34 clean battery 102 ECG cable 102 footsvvitch 102 LCD screen 98 system 98 transducer cables 101 transducers 99 clip acquisition delay 53 clips See also images and clips options 36 49 color Doppler Color imaging 37 color povver Doppler CPD imaging 37 color scheme background 30 color suppress 38 Color See color Doppler Color imaging connectivity setup 24 continuous vvave CVV Doppler imaging 39 40 controls direct 123 indirect 124 receiver 124 CPD
196. type 42 Index x pul 195 general use 16 imaging modes 42 invasive or surgical use 16 linear array 179 preparation 16 problems 96 specifications 173 troubleshoot 95 U ultrasound terminology 179 unfreeze text 22 USB storage device export to 52 user account 20 user guide conventions used vii user setup 19 uses intended 2 4 V variance 38 vascular calculations 90 intended uses 4 velocity measurement 59 velocity time integral VTI 74 volume calculation 65 Doppler adjust 41 volume flow 66 Ww wall filter 38 41 warnings definition vii worksheets EMED 94 Z zoom 34 196 Index BSonoSite P07662 01 III
197. ually In manually tracing IMT the user defines the location 1 Ona frozen 2D image press the CALCS key 2 From the calculations menu select a measurement name 3 Select Edit on screen and then select Manual and then select Sketch A single caliper appears and Trace appears next to the measurement 4 Do the following for the desired adventitia media boundary and then for the lumen intima boundary a Position the caliper at the beginning of the boundary and press the SELECT key b Using the touchpad mark points by moving the caliper to the next desired point and pressing the SELECT key To make a correction select Undo on screen or press the BACKSPACE key to delete the last segment c Press the SET key to complete the trace line 5 Save the calculation See To save a calculation on page 62 To sketch IMT The IMT sketch measurement involves two user defined sketch lines that you can adjust manually 1 Ona frozen 2D image press the CALCS key 2 From the calculations menu select a measurement name 3 Select Edit on screen and then select Manual A single caliper appears on screen and Sketch appears next to the measurement 4 Do the following for the desired adventitia media boundary and then for the lumen intima boundary a Position the caliper at the beginning of the boundary and press the SELECT key b Using the touchpad mark points by moving the caliper to the next desired point and pressing the SELECT key
198. ucer 2 3 5 7 10 12 Gate Size mm e HFL38x L25x and L38x transducers 1 3 5 7 10 12 Gate Size mm P21x transducer 2 3 5 7 11 5 14 Gate Size mm Precision in placing the caliper e Accuracy in angle correction The considerations and degree of accuracy for volume flow measurements and calculations are discussed in the following reference Allan Paul L et al Clinical Doppler Ultrasound 4th Ed Harcourt Publishers Limited 2000 36 38 To calculate volume flow 1 Perform the 2D measurement a Ona frozen full screen 2D image or duplex image press the CALCS key b From the calculations menu select D distance under Vol Flow c Position the calipers See Working with calipers on page 55 d Save the calculation See To save a calculation on page 62 2 Perform the Doppler measurement a Ona frozen Doppler spectral trace press the CALCS key b From the calculations menu select TAM under Vol Flow c Press the SELECT key to display a vertical caliper d Using the touchpad position the vertical caliper at the beginning of the waveform If calipers are not positioned correctly the calculation result is inaccurate e Press the SELECT key to display a second vertical caliper suonein le pue s uawasANseal y f Using the touchpad position the second vertical caliper at the end of the waveform g Press the SET key to complete the trace and to display the results h Save the calculation See To save a
199. ucts Bleach sodium hypochlorite e Cidex disinfectants Green soap Theracide 4 Air dry or tovvel dry vvith a clean cloth Chapter 5 Troubleshooting and Maintenance 103 ayeinueAdosSIOJO YIIG n N N N unpos l lqel J41 0006 sqeyenby ayeinueADOSIOIO YIIG n V N V ulnipos Y lqer Tal 0002 sqeyenby ajeinueAdOSIOIO YIIG n V N V wnIpos Y lqel T l 0001 sqeyenby n V V V euowwy eNO pinbii vu uu zeyiy n V V V PDEVIV n V V V apAyapyesain pinbri Sny sn d eply n N N N apixosag dI A NV g1 1222y n N N N p xos d u Bosp4H dI A NV sn d 922 n V V V pixol q u B5oip H dIAA NV sadiM l 22V n V V V p u ples nnio p nbr YSN Yl PIDOqY moe sn zin wapas ee si 3 npsueul pue ul 3s4S YUM qi eduuo2 sjuezaUISIG L 4 PIP Uy pue y r y lno r UoeuLsojur pue Surue 5 payepdn qoy wiod a ISOUOS MMM asn pue uon lpsiunf anog Jo ayelidoidde 51 Jue DaJUISIP BY JO SNIS AJOJe NGaJ BY YY uulJuo2 BSN o 0114 jeaoidde q ue yulsip I A ulu uey s pinbil auesea gt 4 OLS Ydd uonens S M Vd3 syue132 Julsip 104 uoneuuojJui By BAeY JOU SBOP qe 104 Troubleshooting n N V V ejuowwy enO p nbr YSN ill 10110
200. urves 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 suonein le pue s uawasAnsea y To measure gestational growth 2D For each 2D OB measurement except AFI the system saves up to three individual measurements and their average If you take more than three measurements the earliest measurement is deleted 1 In the patient information form select OB exam type and select LMP or Estab DD Select Twins if appropriate 2 Ona frozen 2D image press the CALCS key Chapter 4 Measurements and Calculations 87 3 Do the following for each measurement you want to take a From the calculations menu select the measurement name For twins select Twin A or Twin B and then select the measurement name The caliper tool may change depending on the measurement selected but the position remains constant b Position the calipers See Working with calipers on page 55 c Save the calculation See To save a calculation on page 62 To measure fetal heart rate M Mode 1 Ona frozen M Mode trace press the CALCS key 2 Select FHR from the calculations menu A vertical caliper appears 3 Using the touchpad position the vertical caliper at the peak of the heartbeat 4 Press the SELECT key A second vertical caliper appears 5 Using the touchpad position the second vertical caliper at the peak of the next heartbeat 6 Sa
201. ut Measurement Standard for Diagnostic Ultrasound Equipment NEMA UD2 2004 Acoustic Output Measurement and Labeling Standard for Diagnostic Ultrasound Equipment American Institute of Ultrasound in Medicine 1993 Standard for Real Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment NEMA UD3 2004 e Guidance on the interpretation of TI and MI to be used to inform the operator Annex HH BS EN 60601 2 37 reprinted at P05699 Transducer surface temperature rise Table 6 and Table 7 list the measured surface temperature rise from ambient of transducers used on the ultrasound system The temperatures were measured in accordance with EN 60601 2 37 section 42 where controls and settings were positioned to give maximum temperatures Test 1 The transducer surface temperature test on tissue mimicking material TMM is based on the following standard 42 3 a 1 Test Method B IEC 60601 2 37 Amendment 1 The limit is a 10 C rise from ambient as measured on the TMM Test 2 The transducer surface temperature test in air is based on the following standard 42 9 a 2 IEC 60601 2 37 Amendment 1 The limit is a 27 C rise from ambient Test 3 The transducer surface temperature test on TMM is based on the following standard 42 3 a 1 Test Method B IEC 60601 2 37 Amendment 1 The limit is a 6 C rise from ambient as measured on the TMM The ambient temperature shall be 23 C 3 C Table
202. ve the calculation See To save a calculation on page 62 Saving the heart rate measurement to the patient report overwrites any heart rate entered on the patient information form OB Doppler Calculations Menu Heading OB Calculation Results MCA Middle Cerebral Artery S D RI SD RI S D RI PI SD RI PI Umb A Umbilical Artery S D RI SD RI S D RI PI SD RI PI Calculation requires a trace measurement 88 To calculate MCA or Umba Doppler Note The system does not provide an MCA UmbA ratio from the PI Pulsatility Index 1 Select OB exam type and select LMP or Estab DD in the patient information form 2 Ona frozen Doppler spectral trace press the CALCS key 3 Do the following for each measurement you need to take a From the calculations menu select the measurement name under MCA Middle Cerebral Artery or UmbA Umbilical Artery b Position the calipers For SID RI position the first caliper at the peak systolic waveform Press the SELECT key and position the second caliper at the end diastole on the waveform For S D RI PI position the caliper at the beginning of the desired waveform and press the SELECT key Use the touchpad to manually trace the desired area Press the SET key If calipers are not positioned correctly the calculation result is inaccurate c Save the calculation See To save a calculation on page 62 Only one calculation S D RI or S D RI PI can be s
203. ver 60 C 140 F Keep it away from fire and other heat sources Do not charge the battery near a heat source such as a fire or heater Do not leave the battery in direct sunlight Do not pierce the battery with a sharp object hit it or step on it Do not use a damaged battery Do not solder a battery The polarity of the battery terminals are fixed and cannot be switched or reversed Do not force the battery into the system Do not connect the battery to an electrical power outlet WARNING Caution Do not continue recharging the battery if it does not recharge after two successive six hour charging cycles If the battery leaks or emits an odor remove it from all possible flammable sources Ayayes 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 emits an odor or heat is deformed or discolored or in any way appears abnormal during use recharging or storage immediately remove it and stop using it If you have any questions about the battery consult SonoSite or your local representative Store the battery between 20 C 4 F and 60 C 140 F Use only SonoSite batteries Do not use or charge the battery with non SonoSite equipment Only charge the battery with the system
204. ws Abd Abdomen Bre Breast Crd Cardiac Gyn Gynecology IMT Intima Media Thickness Msk Muscle Neo Neonatal Nrv Nerve OB Obstetrical SmP Small Parts Sup Superficial Vas Vascular Ven Venous 2 The optimization settings for 2D are Res Gen and Pen 3 The optimization settings for CPD and Color are low medium and high flow sensitivity with a range of PRF settings for Color depending on the setting selected Annotations You can annotate live images as well as frozen images You cannot annotate a saved image You can place text including predefined labels an arrow or a pictograph To set preferences for annotations see Annotations setup on page 22 Chapter 3 Imaging 43 To place text on an image You can place text in the following imaging layouts full screen 2D full screen trace dual or duplex You can place text manually or add a predefined label 1 Press the TEXT key A green cursor appears 2 Move the cursor where desired e Use the touchpad or arrow keys Select Home to move the cursor to the home position The default home position depends on the imaging screen layout You can reset the home position See To reset the home position on page 44 3 Using the keyboard type text The arrow keys move the cursor left right up and down e The DELETE key deletes all text e The X Word option removes a word Select Symbols to enter special characters See Symb

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