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MicroMaxx Ultrasound System User Guide

1. 250 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 9 Safety Table 13 Transducer Model HFL38 13 6 Operating Mode CPD Color TIS TIB Index Label M I Non scan Non TIC Scan AaprtS1 Aaprt gt 1 Can Global Maximum Index Value 1 1 1 0 b prs MPa 2 556 Wo mW 53 49 B min of W 3 Zi lrA 3 Z1 Jl mW 5 z cm z Zpp cm E Zsp cm 1 2 o diaz cm fe MHz 5 328 5 324 Dim of Aaprt X cm 0 44 Y cm 0 4 PD usec 0 525 S PRF Hz 2032 8 pr Pll max MPa 3 187 S deq Pllmax cm Focal Length FL cm 1 32 fo 5 FL cm 2 5 Ip 3 M max W cm 325 5 Control 1 Mode Color Color Control 2 Exam Type Any Any o M z gs Control 3 Optimization Depth PRF Low 3 3 cm Med TE 401 2 7 cm ay 5 1938 bx 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 neonata
2. TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a 1 0 1 8 2 1 Pra MPa Wo mW 49 02 30 07 30 07 E min of W 5 z4 lza 3 z4 mW 3 5 Z cm z Zbp cm is amp Zp em 11 8 deq zsy cm 031 e F MH2 4 36 4 36 4 36 Dim of Aaprt X cm 1 72 0 2 0 2 Y cm 0 5 0 5 0 5 PD use 5 PRF H E P Pllmax MP S deq Pllmax cm 0 27 Focal Length FL cm m 6 37 0 77 E FLy cm 2 5 2 5 lpa 3 MImax W cm Control 1 Exam Type OB or OB or Gyn OB or o 2 Gyn Gyn s g z Control 2 Sample Volume 2 mm 2 mm 2 mm a S Control 3 PRF 21563 26250 26250 O Control 4 Sample Volume Position Zone 7 Zone 0 top Zone 0 bottom top 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 254 Chapter 9 Safety Table 17 Transducer Model L25e 13 6 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 6 b
3. image Delete Select Delete from the on screen menu to delete the displayed image clip A confirmation screen is displayed Done Select Done from the on screen menu to exit patient images clips and return to the previous imaging state Chapter 3 Imaging 73 Annotations Annotations are available in both live imaging and on a frozen image You cannot annotate on a saved image Text entry and predefined labels are available within the image area Figure 9 Image with Predefined Labels Enter Text Press the Text key Use the Touchpad or arrows to position the text cursor anywhere within the image area Use the keyboard to enter delete or modify text Press the Backspace key to delete characters to the left of the cursor Pressthe Spacebar key to add spaces between words or replace characters with blank spaces to the right of the cursor Pressthe Arrow keys to move the cursor to the left right up or down Pressthe Enter key to move the cursor to the next line Select Delete Word from the on screen menu to remove the word Press the Text key to turn off text entry Text can be inserted on the following imaging layouts full screen 2D full screen trace dual or duplex Home Set 74 Chapter 3 Imaging Press the Text key Use the Touchpad or arrows to position the text cursor to the desired location Select Home Set from the on screen menu The new location is now the home position for t
4. 9 E 5 FL cm 4 75 IpA 3 MI max W cm Control 1 Mode Color D_ Control 2 Exam Type Card Control 3 Optimization Depth PRF Any a 6 2 14cm o7 8 4386 Hz Control 4 Color Box Position Size Any 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 282 Chapter 9 Safety Acoustic Measurement Precision and Uncertainty Alltable 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 45 Acoustic Measurement Precision and Uncertainty Quantity Precision u Uncertainty 96 of standard deviation 9596 confidence Pr 1 996 11 2 Pra 1 996 12 2 Wo 3 4 10 fc 0 1 4 7 PII 3 2 12 5 to 16 8 Pll
5. EE 0 0 OM Figure 21 Setup Presets Doppler Scale Press the Setup key Select Presets In the Doppler Scale list select cm s or kHz w N Duplex Press the Setup key 2 Select Presets 3 Inthe Duplex list select the desired image display Full 2D Full Trace 1 3 2D 2 3 Trace 1 2 2D 1 2 Trace Press the Setup key Select Presets In the Live Trace list select Peak or Mean Live Trace w N e Press the Setup key 2 Select Presets 3 Inthe Thermal Index list select TIS TIB or TIC The Thermal Index default setting is based on exam type OB TIB e TCD TIC All others TIS Thermal Index Chapter 2 Getting Started 45 peus 6unyo5 46 Save Key Press the Setup key Select Presets In the Save Key list select Image Only or Image Calcs to designate the function of the Save Key Selecting Image Only allows the Save Key to save the image to the CompactFlash card Selecting Image Calcs allows the Save Key to save the image to the CompactFlash card and to save the current calculation to the report Dynamic Range AUN Select the desired exam type See Exam on page 51 Press the Setup key Select Presets In the Dynamic Range list select the setting 3 2 1 0 1 2 3 Negative numbers show higher contrast images and positive numbers show lower contrast images Units Press the Setup key Select Presets
6. Gate Size Ea Note This menu option is available only in PW Doppler Select the desired gate size setting from the on screen menu A beep sounds when the minimum or maximum of the range is reached Gate size options vary with transducer and exam type Tissue Doppler Imaging TDI Note This menu option is available only in PW Doppler and cardiac exams Select TDI from the on screen menu to turn on tissue Doppler imaging TDI displays in the upper left corner of the screen when TDI is on The default for TDI is off Doppler Gate Depth H Note This menu option is available only in TCD Orb exams 1 Locate the Doppler gate depth indicator at the bottom right of the screen Doppler gate depth measures the depth of the center of the gate in the Doppler image 2 Use the Touchpad to select the desired depth Steering 66 Chapter 3 Imaging Note This menu option is available only on select transducers Select the desired steering angle setting from the on screen menu This automatically changes PW angle correction to the optimum setting Steering angle of 15 degrees has an angle correction of 60 degrees Steering angle of 0 degrees has an angle correction of 0 degrees Steering angle of 15 degrees has an angle correction of 60 degrees The angle correction can be adjusted manually after steering has been selected See Angle Correction If two modes are active CPD Color and PW CW Doppler press the
7. Select Biopsy from the on screen menu to display biopsy guidelines Select again to turn off On the P10 and P17 transducers the biopsy guides are displayed when the bracket is installed correctly If the bracket is not installed correctly the biopsy feature is not available and a dialog box is displayed to check installation of the bracket See Needle Guidance on page 78 and Biopsy User Guide for more information Guide This feature depends on transducer and exam type Select Guide from the on screen menu to turn on the guideline and select again to turn off SonoRES S E 58 Chapter 3 Imaging This feature is optional and depends on transducer and exam type When both 2D image enhancements are available SonoRES image enhancement capability and SonoMB multi beam technology share the same on screen menu See Transducer Exam Type and Imaging Mode on page 53 Select S from the on screen menu to turn on SonoRES When SonoRES is on an S is displayed in the upper left corner of the screen SonoRES is available only in 2D imaging and M Mode SonoMB MB E This feature depends on transducer and exam type When both 2D image enhancements are available SonoRES and SonoMB share the same on screen menu See Transducer Exam Type and Imaging Mode on page 53 SonoMB is on when available When SonoMB is on MB is displayed in the upper left corner of the screen SonoMB is available only in 2D imaging If
8. amp p 00 00 00 e m E STERILE amp peb 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 Fragile Gel sterilized by radiation Hot Indoor use only Device emits a static DC magnetic field Non ionizing radiation Paper recycle Chapter 9 Safety 285 Ayayes Table 46 Labeling Symbols Continued Symbol Definition SN Serial number type of control number Storage temperature conditions IPX 7 Submersible Protected against the effects of temporary immersion IPX8 Water Tight Equipment Protected against the effects of extended immersion Mobile Docking System Input 100 240V 50 60Hz 4 2A d H x Follow manufacturer s instructions for disinfecting time Handle transducer with care Disinfect transducer Type BF patient applied part B body F floating applied part Underwriter s Laboratories labeling Pollution Control Logo China only Applies to all parts products listed in the China RoHS disclosure table This logo may not appear on the exterior of some parts products due to space limitations ae WARNING Connect Only Accessories and Peripherals Recommended by SonoSite to Convenience Receptacles 286 Chapter 9 Safety Glossary This glossary includes an alphanumeric listing of terms
9. Configuring SiteLink for Wireless on page 143 The setting for SiteLink Image Manager and system configurations must correspond See the SiteLink Image Manager User Guide Chapter 5 Connectivity and Configuration 141 yAn2euuo Configuring SiteLink for Ethernet Connectto LAN 1 Connect the Ethernet cable to the Ethernet interface cable then connect to the Ethernet connection on the mini dock or docking system See the applicable SonoSite accessory user guide 2 With the system on check the LAN link light green LED next to the Ethernet connector to verify physical connection to LAN EZ 2005Sep21 22 05 Alias IP Address Subnet Mask Default Gateway il Location Host Name MicroMAXX Alias Alias 01 IP Address 172 20 20 20 T Wireless Subnet Mask 255 255 i o 0j Default Gateway K m Alternate Gateway S m 5 Network Speed Auto Negotiate New Delete Symbols Cancel Save Import Export Done Figure 1 SiteLink Configuration Page 1 142 Chapter 5 Connectivity and Configuration Configure SiteLink Location 1 Ensure the system is set up for SiteLink connectivity See System Configuration for SiteLink on page 141 Press the Setup key select Connectivity then select SiteLink Setup If the Transfer Mode is changed a dialog box is displayed to restart the system Select New and enter information in the following fields Host Name Unique n
10. KyAnm2euuo 168 AE Title Refers to the Application Entity the name by which the DICOM devices on the LAN knows the system Type Type of device archiver printer or worklist server Device Name by which the system knows the printer archiver or worklist server Status Indication of whether the device is available for use Verify Test to ensure that the selected devices can communicate with the ultrasound system Log Log file for troubleshooting DICOM problems See Reviewing the Network Log on page 166 Config Access to a series of pages for configuring network devices Done Returns to the previous page if no changes are made or restarts the system if changes are made Select Note The system must be configured before using DICOM Location 1 Press the Setup key select Connectivity then select DICOM Setup Archiver 2 Inthe Location list select the current location of the system Printer or Worklist Server In the Device list select one or more archivers printers or worklist servers Acheck mark is displayed next to each device selected A maximum of two printers four archivers and one worklist server may be selected for each location Only one archiver may be selected to receive in progress image transfers Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Verify Status of 1 Archiver 2 Printer or Worklist Serve
11. x or Systolic Diastolic S D Pulsatility Index PI End Diastolic Velocity EDV Acceleration Time AT Resistive Index RI Time Average Peak TAP Gate Depth X X Note The automatic trace tool must be used to calculate the TAM 88 Chapter 4 Measurements and Calculations Calculations Calculations may be performed and results saved to the patient report Measurements may also be viewed repeated and deleted Some measurements can be deleted from the report pages See Patient Report on page 135 Perform Measurement View or Repeat Saved Measurement Delete Measurement Select a measurement from the calculations menu by highlighting the desired measurement then pressing the Select key Perform the measurement The measurement is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Select Save from the on screen menu to save the measurement to the patient report From the calculations menu select the desired measurement The saved measurement is displayed at the bottom of the calculation menu Press the Select key or the Caliper key to select the measurement Repeat the measurement The new results are displayed in the measurement and calculation data area Youcan compare the active measurement to the saved measurement To save the new measurement select Save from the on screen
12. Electrical Power Supply Input 100 240 VAC 50 60 Hz 1 2 A Max 100 VAC Power Supply Output system on 1 15 VDC 2 7A Max system 2 12 6 VDC 0 8A Max battery charging Power Supply Output system off 1 15 VDC 2 0A Max system 2 12 6 VDC 1 8A Max battery charging Combined output not exceeding 52W Battery 6 cell rechargeable lithium ion battery pack Run time is up to two hours depending on imaging mode and display brightness Electromechanical Safety Standards 222 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 European Norm Particular requirements for the safety of ultrasonic medical diagnostic and monitoring equipment CAN CSA C22 2 No 601 1 M90 1990 Canadian Standards Association Medical Electrical Equipment Part 1 General Requirements for Safety CEI IEC 61157 1992 International Electrotechnical Commission Requirements for the Declaration of the Acoustic Output of Medical Diagnostic Ultrasonic Equipment UL 60601 1 2003 Underwriters Laboratories Medical Electrical Equipment Part 1 General Requirements for Safety Chapter 8 Specifications EMC Standards Classification EN 60601 1 2 2001 European Norm Medical Electrical Equip
13. In Situ Water e232 f where In Situ In Situ intensity value Water Water intensity value e 2 7183 a attenuation factor dB cm MHz Attenuation factor a for various tissue types are given below brain 0 53 heart 0 66 kidney 0 79 liver 0 43 muscle 0 55 skinline to measurement depth in cm f center frequency of the transducer system mode combination in MHz Since the ultrasonic path during the exam is likely to pass through varying lengths and types of tissue it is difficult to estimate the true n Situ intensity An attenuation factor of 0 3 is used for general reporting purposes therefore the n Situ value commonly reported uses the formula In Situ derated Water e 0 069 Since this value is not the true n Situ intensity the term derated is used to qualify it Chapter 9 Safety 243 Ayayes The maximum derated and the maximum water values do not always occur at the same operating conditions therefore the reported maximum water and derated values may not be related by the In Situ derated formula For example a multi zone array transducer that has maximum water value intensities in its deepest zone but also has the smallest derating factor in that zone The same transducer may have its largest derated intensity in one of its shallowest focal zones Tissue Models and Equipment Survey 244 Tissue models are necessary to estimate attenuation and acoustic exposure levels n Situ from measu
14. Insert the CompactFlash card into the front slot on the ultrasound system See Figure 1 on page 6 The front slot is used to store images The back slot is used to update systems transducers and to import export DICOM configuration information OB Tables and annotation labels The CompactFlash card is ready to use when the save icon and the image and clip counters are displayed on the screen Caution If the CompactFlash icon and image and clip counters are not displayed in the system status the CompactFlash card may be defective Turn the system off and replace the CompactFlash card The CompactFlash card may be restored if it is formatted on a PC Formatting the card erases all data If the card is physically damaged formatting will not restore it WARNING To prevent loss of data for example images clips or damage to the CompactFlash card always turn off the ultrasound system before removing the CompactFlash card Chapter 2 Getting Started Remove 1 Turn off the ultrasound system before removing the card CompactFlash 2 Press the ejector pin in the front card slot to position it to the outside of the Card system See Figure 1 on page 6 3 Pushin the ejector pin to eject the CompactFlash card Remove the card 5 Pushin the ejector pin to avoid damaging the ejector pin Using AC Power Charging Battery The battery charges when the system is connected to the AC power supply If the system is off or in the sl
15. Measurements 79 2D Measurements 79 M Mode Measurements 83 Doppler Measurements 85 Calculations 89 Percent Reduction Calculations 90 Volume Calculation 92 Volume Flow Calculation 94 Small Parts Calculations 96 Gyn Calculations 97 OB Calculations 100 Vascular Calculations 108 IMT Calculations 110 Transcranial Doppler Calculations TCD 114 Cardiac Calculations 117 Patient Report 135 Connectivity and Configuration 141 System Connectivity Setup 141 System Configuration for SiteLink 141 Configuring SiteLink for Ethernet 142 Configuring SiteLink for Wireless 143 System Configuration for DICOM 147 Creating Backup for DICOM Settings 147 Configuring Locations 148 Configuring Archivers 154 Configuring Printers 157 Configuring Worklist Servers 161 Configuring Procedures 164 Importing and Exporting Configurations 165 Reviewing the Network Log 166 DICOM Usage 167 DICOM Image Archive and Print 169 Patient Information 171 DICOM Worklists 172 Troubleshooting and Maintenance 175 Troubleshooting 175 Software Licensing 177 Upgrading the System and Transducer Software 177 Upgrading Triple Transducer Connect TTC 183 Obtaining a License Key 184 Installing a License Key 185 Maintenance 186 Recommended Disinfectant 186 Safety 186 Cleaning and Disinfecting Ultrasound System 187 Cleaning and Disinfecting Transducers 188 Sterilizing Transducers 190 Cleaning and Disinfecting Transducer Cables 190 Cleaning and Disinfecting Battery 192 Clea
16. OB Calculations Authors on page 40 if necessary Note 3 Individual selections for Hadlock s EFW equations 1 2 and 3 are not determined by the user The selected equation is determined by the measurements that have been saved to the report with priority given to the order listed above Note 4 The Growth Analysis tables are used by the Report Graphs feature Three growth curves are drawn using the table data for the selected growth parameter and published author Growth tables are only available with a user entered LMP or Estab DD gt AC 31 2cm36wid Figure 8 OB Measurement Chapter 4 Measurements and Calculations Note EFW is only calculated once appropriate measurements are completed If any one of these parameters results in a EDD greater than what the OB tables provide the EFW will not be displayed OB Select OB exam type and select LMP or Estab DD in the patient information form Select Twins if appropriate On a frozen 2D image press the Calcs key From the calculations menu select the desired measurement Fortwin calculations select Twin A or Twin B then select the desired measurement Thecaliper tool may change depending on the measurement selected but the position remains constant Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report Foreach 2D OB measurement except AFI the system stores up to three individ
17. PeraSafe Sodium Perborate OK lt 15 minutes Cidex Glutaraldehyde OK lt 50 minutes Cidex OPA Ortho phthalaldehyde OK lt 15 minutes Cidex Plus Glutaraldehyde OK lt 25 minutes Cidezyme Enzol Enzymatic detergent OK lt 10 minutes Klenzyme Enzymatic detergent OK lt 15 minutes Metricide Glutaraldehyde OK lt 50 minutes Wavicide 01 Glutaraldehyde OK lt 50 minutes STERIS System 1 Peracetic acid S STERRAD Hydrogen peroxide gas plasma GS Chapter 6 Troubleshooting and Maintenance 199 Bunoouse qnoJ 200 Chapter 6 Troubleshooting and Maintenance Chapter 7 References This section includes information about clinical measurements that can be made with the system the accuracy of each measurement and factors affecting measurement accuracy Display Size The precision with which a caliper can be placed in an image can be improved by making sure the area of interest fills as much of the screen as possible In 2D imaging the distance measurement is improved by minimizing the display depth Caliper Placement When making a measurement accurate placement of the caliper is essential To improve caliper placement precision adjust the display for maximum sharpness use leading edges closest to the transducer or borders for start and stop points and maintain a consistent transducer orientation for each type of measurement When the calipers are positioned farther apart they get larger When the calipers are moved closer together they get
18. Selecting new patient erases any previously entered information including any calculations and report pages To save this information save the screen for each item for example report pages patient information calculations and graphs Chapter 3 Imaging 49 50 New Patient continued Chapter 3 Imaging 3 Enter information into appropriate fields The patient information fields vary based on the selected exam type Patient Patient Enter Last First Middle Names and ID Accession Enter number if applicable Date of birth Enter YYYY MM DD Gender Select Female Male other or leave blank Indications Enter desired text Symbols See Symbols on page 23 More User Enter initials Reading Dr and Referring Dr Enter names Institution Enter name All patient information can be edited up until the first image is saved After the first image is saved the Patient Name ID and Accession number cannot be modified Modifying these fields closes the current patient exam and starts a new exam Select Back from the on screen menu to save information and return to previous menu New Patient continued Exam Type Select desired exam type LMP or Estab DD Select LMP or Estab DD then enter either last menstrual period or established due date YYYY MM DD Estab DD only in OB exam The date for LMP must precede the current system date Twins Select the Twins check box to display Twin A
19. Table 32 Transducer Model SLA 13 6 Operating Mode 2D TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 a a Pr3 2 475 Wo B min of W 3 Z4 lza 374 ua 5 Z ge e amp S Zp 0 85 QU OQ 2 deqlZsp lt fe 6 45 Dim of Aaprt n PD 0 274 S PRF 14336 E pr Pll max 2 991 S deq Pllmax S E Focal Length 3 o lpa 3 Mlmax 331 4 m Control 1 Exam Type Any g Control 2 Optimization Pen E o a3 c Control 3 Depth 1 9 cm O o 270 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 9 Safety Table 33 Transducer Model SLA 13 6 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 Pr3 1 692 Wo m B min of W 3 Z4 lzA 374 Nn 5 Z 9g C lt a f 9 E k Zs
20. The CompactFlash card is for temporary storage of images and clips Patient exams should be archived regularly and old exams deleted from the CompactFlash card The CF Capacity Alert can be activated to alert when the CF card is near capacity See CF Capacity Alert on page 34 Storing large numbers of patient exams on the CompactFlash card may increase the time required to save an image or clip WARNING To prevent loss of data for example images clips or damage to the CompactFlash card always turn off the ultrasound system before removing the CompactFlash card Caution If the CompactFlash icon and image and clip counters are not displayed in the system status the CompactFlash card may be defective Turn off the system and replace the CompactFlash card The CompactFlash card may be restored if it is formatted on a PC Formatting the card erases all data However if the card is physically damaged formatting does not restore it Chapter 3 Imaging Save fal Verify the CompactFlash card is inserted into the front slot on the ultrasound system See Figure 1 on page 6 Turn on system The CompactFlash card is ready to use when the CompactFlash card icon and image and clip counters are displayed The counters indicate the following states Percent of storage remaining Number of stored images Number of stored clips It may take a few seconds for the image memory counter to display the available memory If the CompactFlas
21. Use the Touchpad to move the arrow over the image 3 Press the Select key to switch the arrow s orientation and then use the Touchpad to adjust the arrow s orientation 4 Pressthe Select key again to set the arrow s orientation and then use the Touchpad to move the arrow over the image 5 Pressthe Arrow key to set the arrow Thearrow changes from green to white Toremove the arrow from the image press the Arrow key and then select Hide from the on screen menu Chapter 3 Imaging 75 ECG Monitoring 76 Pictograph Press the Picto key to turn on the pictograph The on screen options for pictograph are E Show Hide Number for example 1 18 Location on screen U L D L D R U R Done Select the desired pictograph The first number changes to show which pictograph in a set of pictographs has been selected The second number shows the total number of pictographs available Thepictograph set that is available depends on transducer and exam type Use the Touchpad to position the pictograph marker Press the Select key and then use the Touchpad to rotate the pictograph marker Select one of four image positions from the on screen menu to move the pictograph to the desired location U L D L D R U R In Duplex the pictograph is restricted to the upper left position e In Dual all four positions are available Select Hide from the on screen menu to remove the pictograph Note ECG Monitoring
22. Control 3 Depth 2 6 cm S Control 4 Color Box Position Size Bottom oc amp Uo Max OQ width Max height 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 272 Chapter 9 Safety Table 35 Transducer Model SLA 13 6 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 2 b Pr3 MP Wo mW 16 83 E min of W 5 z4 lza 3 z4 mW 5 o z cm 2 Zp cm E gt cm 1 4 So P 8 a deqlZsp cm 0 25 e F MH m 6 00 Dim of Aaprt X cm m 0 52 Y cm 0 3 PD usec PRF H z pr Pll max MP S deq Pllmax cm 0 172 Focal Length FL cm NA 5 FL cm lpa 3 Mlmax W cm Control 1 Exam Type Sup amp Mus 5 Control 2 Sample Volume 2mm S 9 Control 3 PRF lt 15625 amp v 9 Control 4 Sample Volume Position Zone 0 through 6 a This index is not required for this operating mode value is lt 1 b Th
23. From the calculations menu select MV AV PV or LVOT then select VTI Position the caliper at the start of the wave form Press the Select key to start the trace Trace the wave form and select Set from the on screen menu If an error is made do one of the following to remove the caliper points Usethe Touchpad to backtrack caliper over caliper points Press Backspace key Select Undo from the on screen menu 6 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed For information on using the automatic trace tool see Automatic Trace on page 87 Ui 0 N Right Ventricular Systolic Pressure RVSP 1 Ona frozen Doppler spectral trace press the Calcs key 2 From the calculations menu select TV then select TRmax 3 Perform the measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed 5 To adjust the RA pressure press the Report key to open the report Select the appropriate number
24. In the Units list select the desired units for patient height and weight in ft Ibs or cm m kg Units settings available in cardiac exams only Footswitch Left Right Press the Setup key Select Presets In the Footswitch L and Footswitch R list select desired functionality for the left and right footswitch Save Clip Record Freeze Save Image Print Reset Chapter 2 Getting Started Select Reset from the on screen menu to return settings for this setup page to factory default System Information Setup Pages Product SonoSite MicroMAXX Boot version 30 40 304 020 ARM version 30 40 304 020 DSP version 303 114 303 0F PCBA serial number 000000 Main FPGA version 2 48 SH CPLD version 1 4 SH database version 30 40 304 091 SH serial number 000000 Modes CPD DCPD ECG M PW THI CW Color DICOM PS MWL SR DPLX EOBC IMT Clips TCD RES TM Previous license update 1958 7 140 6906 3903 6778 3090 Figure 22 Setup System Information System Information Press the Setup key 2 Select System Information To install a license key see Installing a License Key on page 185 Change to Default Settings Turn the system off 2 Connect the system to AC power See Operate System Using AC power on page 14 3 Simultaneously press and release 1 and the Power key The system beeps several times and the system displays the default settings Default settings are set at the factory and
25. Nursing amp Allied Health Dictionary 4th ed 1994 1492 SI SV BSA where SV Stroke Volume BSA Body Surface Area Chapter 7 References 209 so uaJoJay 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 Stroke Volume SV 2D and M Mode in ml Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Boston Little Brown and Company 1994 44 SV LVEDV LVESV where SV Stroke Volume LVEDV End Diastolic Volume LVEDSV End Systolic Volume Velocity Time Integral VTI in cm Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 383 VTI sum of abs velocities n where Auto Trace distance cm blood travels with each ejection period Velocities are absolute values Obstetrical References Amniotic Fluid Index AFI Jeng C J et al Amniotic Fluid Index Measurement with the Four Quadrant Technique During Pregnancy The Journal of Reproductive Medicine 35 7 July 1990 674 677 Average Ultrasound Age AUA The system provides an AUA derived from the component measurements from the measurement tables Estimated Date of Delivery EDD by Average Ultrasound Age AUA Results are displ
26. Pra MPa Wo mW 14 02 min of W3 z1 lTa3 Z1 mW 5 z cm z Zbp cm E T 5 7sp m 0 6 5 deq 2sp cm 0 155 lt fe MH 6 00 Dim of Aaprt X cm 0 16 Y cm 0 3 PD use 5 PRF H pr Pll max MP S deq Pllmax cm 0 1549 Focal Length FL cm Qq on 5 FL cm lIpa 3 Mlmax W cm o 2 Control 1 Exam Type Vas s 2 Control 2 Sample Volume 12 mm 29 Control 3 PRF 20833 O Control 4 Sample Volume Position Zone 0 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety 255 Ayayes Table 18 Transducer Model L38e 10 5 Operating Mode 2D TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 5 a b Pr3 2 645 Wo B min of W 3 Z4 lza 374 ue 5 Z Z rome ES p 14 QU OQ 2 deq z p lt fe 5 14 Dim of Aaprt PD 0 322 c PRF 7523 E P Pll max 3 390 S deq Pllmax Foca
27. Report 8 9 10 11 12 13 Figure 3 System Controls Table 1 System Controls Number sii Description 1 Power Turns system on and off 2 Alphanumeric Use to enter text and numbers 3 Annotation Text Turns the keyboard on and off for text entry Picto Turns the pictographs pictograph marker on and off Arrow Displays an arrow that can be moved and rotated within the image area 4 THI Turns Tissue Harmonic Imaging on and off 16 Chapter 2 Getting Started Table 1 System Controls Continued System ar Number Control Description 5 Depth Depth Up Decreases imaging depth Depth Down Increases imaging depth 6 Zoom Magnifies image 2x 7 Gain el Adjusts the gain applied to the near field of the image Near Adjusts the gain applied to the far field of the image Far el Adjusts the overall gain applied to the entire image A Gain Note Some keyboards may have the words instead of symbols 8 AC power A steady green light indicates AC power is connected A flashing indicator green light indicates the system is in sleep mode 9 Caliper Activates a measurement caliper on the screen Calcs Turns the calculation menu on and off 10 Touchpad Use to select adjust and move objects on the screen 11 Select Use to switch between frozen images in duplex and dual screens color and Doppler menus calipers for measurement Calipers pictograph marker position angle Picto and
28. To avoid damaging the ECG cable do not sterilize Clean and Remove the cable from the system Disinfect ECG Clean the surface using a soft cloth lightly dampened in a mild soap or Cable Using detergent cleaning solution Wipe Method Apply the solution to the cloth rather than the surface Wipe the surfaces with the following products Bleach sodium hypochlorite e Cidex disinfectants Green soap Theracide Air dry or towel dry with a clean cloth Chapter 6 Troubleshooting and Maintenance e ueuajurey pue 6unoousa qnoJ 9 4a3deyD 61 See the SonoSite website for updated cleaning and disinfectant information www sonosite com Select Quick Link and then Documentation Table 3 Disinfectants Compatible with System and Transducers Disinfectonand Country ype active ingredient L38e PI0 D2 Mrs sro CUSO Seem P17 SLA AbcoCide 14 4 USA Liquid Gluteraldehyde A U A A A A Accel Wipes CAN Wipe Hydrogen Peroxide A U A A A A Accel Plus CAN Wipe Hydrogen Peroxide N U N N N N Accel TB CAN Wipe Hydrogen Peroxide N U N N N N Aidal Plus AUS Liquid Gluteraldehyde A U A A A N Alkacide FRA Liquid Gluteraldehyde A U A A A A Alkazyme FRA Liquid Quat Ammonia A U A A A A Aquatabs 1000 IRL Tablet Sodium A U N A A A Dichloroisocyanurate Aquatabs 2000 IRL Tablet Sodium A U N A A N Dichloroisocyanurate Aquatabs 5000 IRL Tablet Sodium N U N N N N Dichloroisocyanurate Anioxyde 1000 FRA Liquid Peracetic Acid N U N N N
29. Transducer Model C60e 5 2 Operating Mode 2D TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 a b Pr3 1 62 Wo i B min of W 3 Z4 lza 374 5 Z ge e ES p 4 7 a 9 deq zsp e F 2858 amp Dim of Aaprt 5 PD 0 577 S PRF 7168 E pr Pll max 2 576 S deg Pllmax Focal Length 9 AT m O Ip 3 MI max 184 3 o 2 Control 1 Exam Type Any s Control 2 Optimization Pen gS 8 Control 3 Depth 7 8 cm O Control 4 THI Off 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 248 Chapter 9 Safety Table 11 Transducer Model C60e 5 2 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a a 3 1 b Pr3 MP Wo mW 85 64 Y min of W 5 z4 lza 3 z4 mW 2 o z cm E p Zbp cm SS Zp
30. m 1 255 8 fdeaZsp cm 0 51 e F MH 2 233 Dim of Aaprt X cm 0 6552 Y cm 1 3 PD use 5 PRF H 8 pr Pllmax MP S deq Pllmax cm 0 415 Focal Length FL cm ER FL cm lpa 3 Mlmax W cm o 2 Control 1 Exam Type Any amp Control 2 PRF Any 2 E Control 3 Sample Volume 12mm O OQ Control 4 Sample Volume Position Zone 1 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this 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 9 Safety 249 Ayayes Table 12 Transducer Model D2 2 Operating Mode CW TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 2 6 b Pr3 Wo 90 49 B min of W 3 z4 lzA 374 5 Z E 9s iim S S op 1 1 a o deqlZsp 0 66 4 f 2 00 Dim of Aaprt 0 80 0 4 PD PRF z Pr PIl max amp deq Pllmax 0 54 Focal Length 9 S e O lpa 3 Mlmax m Control 1 Exam Type Any z g Control 2 Optimization Any a9 I Control 3 Depth Any O o
31. on page 34 72 Chapter 3 Imaging Print All Images n Verify a printer is selected See Printer on page 33 Press the Review key Select List from the on screen menu Highlight the desired patient An individual patient or all patients may be selected AUN 5 Select Print from the on screen menu to print all images Each image displays briefly on the screen before printing starts Delete Select Delete from the on screen menu to delete the selected patient exam A confirmation screen is displayed Done Select Done from the on screen menu to exit the patient list and Patient Images and Clips return to the previous imaging state Patient Images Press the Review key If there is not a current patient highlight the desired patient and select Review from the on screen menu Next or Previous L1 Image Clip Select the 1 x from the on screen menu to view image clip Play If a clip select Play from the on screen menu to review the clip Select Pause to freeze the clip Theload time varies depending on the length of the clip The clip plays automatically after loading Playback Speed Select the desired playback speed from the on screen menu 1x 1 2x 1 4x Patient List EJ Select List from the on screen menu to display the patient list Print Image 1 Verify a printer is selected See Printer on page 33 2 Select Print from the on screen menu to print the displayed
32. 0 and 127 0 0 8 Subnet Mask Identifies a network subdivision The default value is 255 255 0 0 Default Gateway IP address where network connects to another network Cannot be between 127 0 0 0 and 127 0 0 8 Alternate Gateway Alternate location where network connects to another network Cannot be between 127 0 0 0 and 127 0 0 8 Select Next to display page 2 Chapter 5 Connectivity and Configuration 149 yAn euuo 150 2 2007Feb22 12 54 Locations m Alias DHCP IP Address Subnet Mask Default Gateway Alias 01 255 255 0 0 Location Transfer Images End of exam Network Speed Auto Negotiate Device Read Timeout sec jas Device Write Timeout sec 45 212 Nex New Delete Cancel Save Import Export Done Figure 5 DICOM Locations Configuration Page 2 Configure 1 Enter network information in the following fields See Figure 5 DICOM Transfer Images Select to transfer images during or at end of exam Location Network Speed Not available with wireless setup Select Auto full or half Page 2 duplex Device Read Timeout sec Time system keeps network line open when attempting but not receiving information Device Write Timeout sec Time system keeps network line open when attempting but not sending information Note If setting up a wireless connection see Configure DICOM Wireless Locations Page 3 on page 152 2 Select Sa
33. 13 Biparietal Diameter BPD Chitty Lyn S et al Charts of Fetal Size 2 Head Measurements British Journal of Obstetrics and Gynaecology 101 January 1994 43 Appendix BPD Outer Inner Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine A Longitudinal Study of Fetal Limb Growth American Journal of Perinatology 1 January 1984 136 144 Table 5 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 176 Table 7 8 Estimated Fetal Weight EFW 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 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
34. 188 Acoustic coupling gel must be used during exams Although most gels provide suitable acoustic coupling some gels are incompatible with some transducer materials SonoSite recommends Aquasonic gel and a sample is provided with the system Chapter 3 Imaging 55 General Use Apply Gel Apply a liberal amount of gel between the transducer and the body Invasive or Surgical Use 56 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 Install Transducer Sheath Chapter 3 Imaging Note SonoSite recommends the use of market cleared transducer sheaths for intracavitary or surgical applications 1 2 Place gel inside the sheath Insert the transducer into the sheath To lessen the risk of contamination install the sheath only when you are ready to perform the procedure Pull the sheath over the transducer and cable until the sheath is fully extended Secure the sheath using the bands supplied with the sheath Check for and eliminate bubbles between the face of the transducer and the sheath If any bubbles are present between the face of the transducer and the sheath the ultrasound image may be affected Inspect the sheath to ensure there are no holes or tears Modes 2D Imaging The sy
35. 226 WARNING To avoid discomfort or minor risk of patient injury keep hot surfaces away from the patient Under certain circumstances the transducer connector and back of the display enclosure can reach temperatures that exceed EN60601 1 limits for patient contact therefore only the operator shall handle the system This does not include the transducer face To avoid discomfort or minor risk of operator injury when handling the transducer connector the system should not be operated for more than 60 minutes continuously in a live scan mode as opposed to freeze or sleep modes To avoid the risk of electrical shock or injury do not open the system enclosures All internal adjustments and replacements except battery replacement must be made by a qualified technician To avoid the risk of injury do not operate the system in the presence of flammable gasses or anesthetics Explosion can result To avoid the risk of electrical shock use only properly grounded equipment Shock hazards exist if the power supply is not properly grounded Grounding reliability can only be achieved when equipment is connected to a receptacle marked Hospital Only or Hospital Grade or the equivalent The grounding wire must not be removed or defeated To avoid the risk of electrical shock when using the system in an environment where the integrity of the protective earth conductor arrangement is in doubt operate the system on battery power only wi
36. 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 Tl 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 m de ne oue To C11e 8 5 MI No No No No TIC TIB or TIS No No Yes C60e 5 2 MI Yes No No TIC TIB or TIS No No Yes D2 2 MI No TIC TIB or TIS Yes HFL38 13 6 MI No Yes No TIC TIB or TIS No Yes Yes ICT 8 5 MI No No No TIC TIB or TIS No Yes Yes LAP 12 5 MI Yes No No TIC TIB or TIS Yes No Yes L25e 13 6 MI No No No TIC TIB or TIS No No Yes L38e 10 5 MI Yes Yes Yes TIC TIB or TIS Yes Yes Yes P10 8 4 MI Yes No Yes No TIC TIB or TIS No Yes Yes Yes P17 5 1 MI Yes Yes Yes No TIC TIB or TIS Yes Yes Yes Yes SLA 13 6 MI Yes Yes No TIC TIB or TIS No No Yes Chapter 9 Safety 239 Ayayes Table 5 Cases Where Either a Thermal or Mechanical Index is gt 1 0 Continued Transducer Model Index M FADA vid Doo olet Benoit SLT 10 5 MI Yes Yes No TIC TIB or TIS Yes No Yes TEE 8 3 MI Yes No No No TIC TIB or TIS Yes Yes Yes Yes Even when Ml 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
37. 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 and Intraoperative Imaging Applications This system transmits ultrasound energy into the various parts of the body using 2D color Doppler Color color power Doppler CPD Tissue Harmonic Imaging THI and pulsed wave PW Doppler to obtain ultrasound images that provide guidance during interventional and intraoperative procedures This system can be used to provide ultrasound guidance for biopsy and drainage procedures vascular line placement peripheral nerve blocks spinal nerve blocks and taps ova harvesting amniocentesis and other obstetrical procedures and provide assistance during abdominal breast neurological surgery and vascular intraoperative procedures 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 ultrasound images The fetal anatomy viability estimated fetal weight gestational age amniotic fluid and surrounding anatomical structures can be assessed for the presence or absence of pathology transabdominally or transvaginally CPD and color D
38. 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 Chapter 7 References University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 886 Fetal Trunk Cross Sectional Area FTA Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 99 100 Gestational Sac GS Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 Nyberg D A et al Transvaginal Ultrasound Mosby Yearbook 1992 76 Gestational sac measurements provide a fetal age based on the mean of one two or three distance measurements however Nyberg s gestational age equation requires all three distance measurements for an accurate estimate Tokyo University Gestational Weeks and Computation Methods Ultrasound Imaging Diagnostics 12 1 1982 1 Head Circumference HC Chitty L S and D G Altman New charts for ultrasound dating of pregnancy Ultrasound in Obstetrics and Gyn
39. 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 17 214 Chapter 7 References Head Circumference HC Chitty Lyn S et al Charts of Fetal Size 2 Head Measurements British Journal of Obstetrics and Gynaecology 101 January 1994 43 Appendix HC Derived Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine A longitudinal study of Fetal Head Biometry American J of Perinatology 1 January 1984 118 128 Table 3 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 176 Table 7 8 Head Circumference HC Abdominal Circumference AC Campbell S Thoms Alison Ultrasound Measurements of the Fetal Head to Abdomen Circumference Ratio in the Assessment of Growth Retardation British Journal of Obstetrics and Gynaecology 84 March 1977 165 174 Ratio Calculations FL AC Ratio Hadlock F P R L Deter R B Harrist E Roecker and S K Park A Date Independent Predictor of Intrauterine Growth Retardation Femur Length Abdominal Circumferenc
40. 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 208 Chapter 7 References Proximal Isovelocity Surface Area PISA in cm Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Boston Little Brown and Company 1999 125 PISA 2x where 27 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 Op 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 RF RV MV SV where RV Regurgitant Volume MV SV Mitral Stroke Volume Regurgitant Volume RV in cc Reynolds Terry The Echocardiographer s Pocket Reference School of Cardiac Ultrasound Arizona Heart Institute 2000 396 455 RV ERO MR VTI Right Ventricular Systolic Pressure RVSP in mmHg Reynolds Terry The Echocardiographer s Pocket Reference School of Cardiac Ultrasound Arizona Heart Institute 1993 152 RVSP 4 Vmax TR RAP where RAP Right Atrial Pressure Stroke Index SI in cc m Mosby s Medical
41. Pressure Half Time AL Atlas Loop Ann D Annulus Diameter ANT F Anterior Far ANTN Anterior Near Ao Aorta AoD Aortic Root Diameter 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 BPD Biparietal Diameter BPM Beats per Minute 290 Glossary Table 1 Acronyms Continued Acronym Description Bifur Bifurcation CCA Common Carotid Artery CO Cardiac Output CI Cardiac Index CPD Color Power Doppler CRL Crown Rump Length CW Continuous Wave Doppler D Diameter D Apical Distance Apical DCCA Distal Common Carotid Artery DECA Distal External Carotid Artery DICA Distal Internal Carotid Artery Dist Distal dP dT Delta Pressure Delta Time E E Wave Peak Velocity EPG E Wave Peak Pressure Gradient E A E A Ratio ECA External Carotid Artery ECG Electrocardiogram ECICA Extracranial Internal Carotid Artery ECVA Extracranial Vertebral Artery EDD Estimated Date of Delivery EDD by AUA Estimated Date of Delivery by Average Ultrasound Age EDD by LMP Estimated Date of Delivery by Last Menstrual Period EDV End Diastolic Velocity Glossary 291 Aiessoj5 Table 1 Acronyms Continued Acronym Description E e E velocity Mitral Valve E velocity divided by the annular e velocity EF Ejection Fraction EF SLOPE E F Slope EFW Estimated Fetal Weight Endo E
42. Reduction 1 D2 cm D1 cm 100 where D1 original diameter of the vessel in cm D2 reduced diameter of the vessel in cm Pressure Gradient PGr in mmHG Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 64 4 Velocity Peak E Pressure Gradient E PG E PG 4 PE Peak A Pressure Gradient A PG A PG 4 PA2 Peak Pressure Gradient PGmax PGmax 4 PV2 Mean Pressure Gradient PGmean PGmean 4 Vmax Pulsatility Index PI Kurtz A B W D Middleton Ultrasound the Requisites Mosby Year Book Inc 1996 469 PI PSV EDV V where PSV peak systolic velocity EDV end diastolic velocity V mean flow velocity throughout the entire cardiac cycle Resistive Index RI Kurtz A B W D Middleton Ultrasound the Requisites Mosby Year Book Inc 1996 467 RI abs Velocity A Velocity B Velocity A in measurements where A velocity cursor B velocity cursor x Time Averaged Mean TAM in cm s TAM mean mean Trace Volume Vol Beyer W H Standard Mathematical Tables 28th ed CRC Press Boca Raton FL 1987 131 Volume Flow VF in l m Allan Paul L et al Clinical Doppler Ultrasound 4th ed Harcourt Publishers Limited 2000 36 38 VF CSA TAM 06 Chapter 7 References 217 so uaJoJay 218 Chapter 7 References Chapter 8 Specifications This chapter contains system and accessory specifications and agency app
43. Reset Chapter 2 Getting Started 1 Insert the CompactFlash card in the back slot of the system See Installing or Removing CompactFlash Card on page 12 Press the Setup key 3 Select Administration 4 Select Import from the on screen menu Adialog boxis displayed After all user names and passwords are imported the system restarts All user names and passwords currently on the system are replaced with the imported data Select Reset from the on screen menu to return settings for this setup page to factory default Export and Clear Event Log The Event Log collects errors and events and can be exported to a CompactFlash card and read by a CompactFlash reader Figure 9 Event Log d 2005May04 13 58 Event Log 2008 06 04 13 56 User Useri added 2005 05 04 13 56 User User2 added 2005 05 04 13 57 User User3 added 2005 05 04 13 57 User User3 deleted 2005 06 04 13 57 User User modified Only the most recent 200 entries are shown above Older entries are automatically deleted View Event Log 1 Press the Setup key Select Administration 3 Select Log from the on screen menu The Event Log is displayed 4 Select Back to return to the previous menu Export Event Log Note The Event log and the DICOM network log have the same filename log txt When you export either one to the same CompactFlash card it will overwrite the existing log txt file 1 Insert the CompactFlash card in the back slot of the
44. TI values and adjust the controls to reduce these values See Guidelines for Reducing MI and TI on page 237 Additionally one means for meeting the ALARA 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 236 An acoustic artifact is information present or absent in an image that does not properly indicate the structure or flow being imaged There are helpful artifacts that aid in diagnosis and those that hinder proper interpretation Examples of artifacts include Shadowing Through transmission Aliasing Reverberations Comet tails For more information on detecting and interpreting acoustic artifacts see the following reference Kremkau Frederick W Diagnostic Ultrasoun
45. Transmits at one frequency and receives at a higher harmonic frequency to reduce noise and clutter and improve resolution A device that transforms one form of energy into another form of energy Ultrasound transducers contain piezoelectric elements which when excited electrically emit acoustic energy When the acoustic energy is transmitted into the body it travels until it encounters an interface or change in tissue properties At the interface an echo is formed that returns to the transducer where this acoustic energy is transformed into electrical energy processed and displayed as anatomical information Displays a variation in Color Doppler flow imaging within a given sample Variance is mapped to the color green and is used to detect turbulence Acronyms used in the user interface are listed below Table 1 Acronyms Acronym Description x 4 Caliper x Caliper Ratio A A Wave Peak Velocity APG A Wave Peak Pressure Gradient A2Cd Apical 2 Chamber diastolic A2Cs Apical 2 Chamber systolic A4Cd Apical 4 Chamber diastolic A4Cs Apical 4 Chamber systolic AAo Ascending Aorta Glossary 289 Aiessoj5 Table 1 Acronyms Continued Acronym Description abs Absolute value AC Abdominal Circumference ACA Anterior Cerebral Artery ACC Acceleration Index ACoA Anterior Communicating Artery ACS Aortic Valve Cusp Separation AFI Amniotic Fluid Index Al Aortic Insufficiency Al PHT Aortic Insufficiency
46. 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 Chapter 2 Getting Started 9 peus bunya Position the System Promote comfortable shoulder arm and hand postures Use a stand to support the weight of the ultrasound system Minimize eye strain When the exam procedure allows position the system within reach Adjust the angle of the system display to minimize glare from overhead or outside lighting Minimize neck strain If using a stand adjust the stand height such that the display is at or slightly below eye level Position Yourself Support your back during an exam Use a chair that has support for your lower back Use a chair that adjusts to your work surface height and promotes a natural body posture Use a chair that allows for quick height adjustments Always sit or stand in an upright manner Avoid bending or stooping Minimize reaching and twisting Use a bed that is height adjustable Position the patient as close to you as possible Face forward Avoid twisting your head or body Move your entire body front to back and position your scanning arm next to or slightly in front of you Stand for difficult exams to minimize reaching Promote comfortable shoulder and arm postures for your scanning arm Keep your elbow close to your side Relax your shoulders in a level
47. Volume Elapsed Time ET in msec ET time between velocity cursors in milliseconds Chapter 7 References 205 so uaJoJay Heart Rate HR in bpm HR 3 digit value input by user or measured on M Mode and Doppler image in one heart cycle Interventricular Septum IVS Fractional Thickening percent Laurenceau J L M C Malergue The Essentials of Echocardiography Le Hague Martinus Nijhoff 1981 71 IVSFT IVSS IVSD IVSD 100 where IVSS Interventricular Septal Thickness at Systole IVSD Interventricular Septal Thickness at Diastole Isovolumic Relaxation Time IVRT in msec Reynolds Terry The Echocardiographer s Pocket Reference School of Cardiac Ultrasound Arizona Heart Institute 1993 146 time a time b Left Atrium Aorta LA Ao Feigenbaum H Echocardiography Philadelphia Lea and Febiger 1994 206 Figure 4 49 Left Ventricular End Volumes Teichholz in ml Teichholz L E T Kreulen M V Herman et al Problems in echocardiographic volume determinations echocardiographic angiographic correlations in the presence or absence of asynergy American Journal of Cardiology 1976 37 7 LVESV 7 0 LVDS 2 4 LVDS where LVESV Left Ventricular End Systolic Volume LVDS Left Ventricular Dimension at Systole LVEDV 7 0 LVDD 2 4 LVDD where LVEDV Left Ventricular End Diastolic Volume LVDD Left Ventricular Dimension at Diastole Left Ventricular Mas
48. and Twin B measurements on the calculation menu only in OB exam and report Previous Exams only in OB exam e Enter data from previous exams Data from five previous exams may be entered e For twins select Twin A B from the on screen menu to enter data for each twin The date for a previous exam must precede the current system date Select Back from the on screen menu to save information and return to previous menu BP Enter blood pressure only in cardiac vascular and IMT exams HR Enter the Heart Rate only in cardiac vascular and IMT exams If the heart rate is obtained and saved using M Mode the values override the number entered on the patient information screen Height Enter the patient height in feet and inches or meters and centimeters only in cardiac exam Weight Enter the patient weight in pounds or kilos only in cardiac exam BSA Body Surface Area This number is automatically generated after height and weight are entered only in cardiac exam Ethnicity Select the applicable ethnic origin only in IMT exam End Exam Press the Patient key Select End Exam from the on screen menu to close the current patient exam Selecting End Exam selecting New Patient or modifying patient name or ID erases any previously entered information including any calculations and report page To save this information save the screen for each item for example report pages patient information
49. arrow position orientation Arrow 12 Print Prints the active image to the printer 13 Save Saves an image to the CompactFlash card and saves measurements calculation to the report when configured in system setup 14 Menu controls Controls features on the on screen menu which are adjusted based on the system state Chapter 2 Getting Started 17 pares bunje5 Table 1 System Controls Continued Number SAREE Description 15 Forms Setup Access to the system settings Report Access to the patient report and EMED worksheets Review Access to the patient list and saved patient images and archive functions Patient Access to patient information 16 AA Delta key Use as a shortcut to existing functionality in the system 17 Save Clip Saves a clip to the CompactFlash card Record Turns DVD VCR record on and off 18 Freeze Stops the live imaging and displays a frozen image Cine back Review images stored in the cine buffer back forward through forward last in first out sequence All mode images can be stored and reviewed in the cine buffer 19 Update Toggles between dual and duplex screens and image modes in M Mode and Doppler for example between D line and Doppler spectral trace 20 Modes M Mode Turns M Mode on and toggles between M line and M Mode trace Doppler Turns Doppler on and toggles between D line and Doppler trace Color Turns CPD Color on and off 2D Turns 2D on 18 Chapter 2 Getting Started Screen Layo
50. by SonoSite To avoid the risk of electrical shock use commercial grade peripherals recommended by SonoSite on battery power only Do not connect these products to AC mains power when using the system to scan or diagnose a patient subject Contact SonoSite or your local representative for a list of the commercial grade peripherals available from or recommended by SonoSite To avoid the risk of electrical shock 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 Standa
51. duplex image press the Calcs key From the calculations menu under Volume Flow select TAM Press the Select key to display the first vertical caliper Use the Touchpad to position the first vertical caliper at the beginning of the wave form Press the Select key to display the second vertical caliper If calipers are not placed in the correct position the calculation will not be performed accurately Use the Touchpad to position the second vertical caliper at the end of the wave form Select Set from the on screen menu to complete the trace and to display the results Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement To view the volume flow calculation go to the report See Patient Report on page 135 If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations 95 suone n je pue sjuauleansea y Small Parts Calculations Small Parts calculations consist of Volume Hip Angle and d D Ratio For information on volume calculations see Volume Calculation on page 92 References for measurements and calculations are in Chapter 7 References The following table shows the transducers and exam types that provide Hip Angle and d D Ratio calculations Table 6 Transduc
52. each imaging mode Based on the measurements performed the SonoSite system automatically calculates specific information and displays the results Some of the options described in the user guide may not apply to your system System features are dependent on your configuration transducer and exam type 2D Measurements The basic measurements that can be performed in 2D are Distance in cm Areain cm Circumference in cm 2006May1li 04 10 A A 0 16cm C 1 59cm B 0 33cm Figure 1 2D Measurement with Two Linear and One Trace Chapter 4 Measurements and Calculations 79 suonejnje pue s uawasnsealy 80 Distance Measurement On a frozen 2D image press the Caliper key Aset of calipers and the following on screen menu options are available Ellipse circumference area Manual trace Delete The two calipers are connected by a dotted line When the calipers get close together they decrease in size and the caliper line is removed Use the Touchpad to position the first caliper Press the Select key to activate the other caliper The result is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Press the Caliper key to activate each additional caliper set The active caliper is highlighted green Uptoeight calipers are available for distance measurements Acombination of distance area circu
53. exam type The following instructions cover PW and CW Doppler imaging Doppler D Line Figure 6 Doppler with D Line Image and ROI Box D Line ES 1 Press the Doppler key for the D line Use the Touchpad to position the D line over the area of interest on the image 3 Press the Select key to set the D line and to toggle between the D line and angle correction e An indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling If PW or CW Doppler mode does not come on make sure the system is in live imaging e The color ROI box is tied to the D line PW CW Note CW Doppler is available only in cardiac exams Doppler 1 Press the Doppler key 2 Select PW from the on screen menu to toggle between PW Doppler and CW Doppler Chapter 3 Imaging 65 Angle Correction Note This menu option is available only in PW Doppler There are two ways to adjust the angle correction in PW Doppler imaging Select Angle Correction from the on screen menu to adjust the angle correction to 0 60 or 60 degrees OR 1 Press the Select key to highlight angle correction and to toggle between the D line and angle correction An indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling 2 Use the Touchpad to adjust the angle in two degree increments from 74 to 74 degrees 3 Press the Select key again to set the desired angle
54. for the duration of the transducer cable immersion Using the instructions on the disinfectant label rinse the transducer cable and then air dry or towel dry with a clean cloth Examine the transducer and cable for damage such as cracks splitting or fluid leaks If damage is evident discontinue use of the transducer and contact SonoSite or your local representative Chapter 6 Troubleshooting and Maintenance 191 Bunoouse qnoJ Cleaning and Disinfecting Battery Cleaning Footswitch Caution To avoid damaging the battery do not allow cleaning solution or disinfectant to come in contact with the battery terminals Clean and Disinfect Battery Using Wipe Method Remove the battery from the system Clean the surface using a soft cloth lightly dampened in a mild soap or detergent cleaning solution Apply the solution to the cloth rather than the surface Wipe the surfaces with the disinfection solution Theracide disinfectant is recommended Air dry or towel dry with a clean cloth Caution To avoid damaging the footswitch do not sterilize It is not intended for use in a sterile environment Clean Dampen a non abrasive cloth with one of the following products Footswitch Isopropyl alcohol Soapand water Cidex Sodium Hypochlorite 5 2596 Bleach diluted 10 1 Wring out cloth until slightly wet and then gently rub soiled area until clean Cleaning and Disinfecting ECG Cables 192 Caution
55. from the on screen menu Chapter 5 Connectivity and Configuration 145 yAnm2euuo Select SiteLink 1 Press the Setup key then select Connectivity Wireless 2 Inthe Location list select the desired location Location A dialog box is displayed to restart the system Verify Wireless 1 On your PC open SiteLink Image Manager then select Configure menu Connection 2 Onthe Configure menu select TCP IP Port 3 Verify that the IP address in SiteLink matches the IP address in the ultrasound system Wireless is connected properly when the connection icon with strength bars and ultrasound system connected icon are displayed in system status on the ultrasound system See SiteLink Image Manager User Guide 146 Chapter 5 Connectivity and Configuration System Configuration for DICOM Note DICOM is an optional feature The system provides configuration pages for setting up DICOM devices for network connectivity DICOM configuration pages typically are configured by network administrators or PACS managers Locations List of locations for the system Archivers Devices for storing patient images and clips Printers Film printers for printing patient exam images Worklist List of scheduled patient procedures used to enter patient data in the Patient Information form Procedure List of system and user defined procedures Perform the following procedures before beginning the ultrasound system configuration System Connectivity
56. instructions for configuring SiteLink or configuring and using DICOM SiteLink is an optional feature that works with the system software on MicroMaxx to transfer saved images and video clips from the system to a personal computer PC For more information see the SiteLink Image Manager User Guide DICOM is an optional data transfer feature that allows the system to connect over a local area network LAN to PACS archivers to film printers and to worklist servers System Connectivity Setup Set Up System 1 Press the Setup key then select Connectivity Connectivity 2 In the Transfer Mode list select DICOM or SiteLink If the transfer mode is changed a dialog box is displayed to restart the system 3 Select DICOM Setup or SiteLink Setup The system is now ready to configure SiteLink or DICOM See Configuring SiteLink for Ethernet on page 142 or Configure DICOM for Ethernet on page 148 System Configuration for SiteLink Note SiteLink is an optional feature The system provides configuration pages for setting up SiteLink network configuration SiteLink configuration pages typically are set up by network administrators If transferring images using USB or CompactFlash reader see the SiteLink Image Manager User Guide for information Perform the System Connectivity Setup on page 141 to establish SiteLink as the transfer mode before configuring the ultrasound system If your ultrasound system is wireless compatible see
57. is an optional feature and requires a SonoSite ECG cable WARNING To prevent misdiagnosis do not use the ECG trace to diagnosis cardiac rhythms The SonoSite ECG option is a non diagnostic feature To prevent misdiagnosis do not use the SonoSite ECG option for long term cardiac rhythm monitoring Caution Use only accessories recommended by SonoSite with the system Your system can Chapter 3 Imaging be damaged by connecting an accessory not recommended by SonoSite ECG Show Hide This menu option is displayed only when the ECG cable is connected If SonoMB is available on the transducer ECG monitoring is not available 1 2 Connect the ECG cable to the ECG connector on the mini dock or docking system When the ECG cable is connected ECG monitoring turns on automatically Anexternal ECG monitor may cause a lag in the timing of the ECG trace corresponding with the 2D image e Biopsy guidelines are not available when ECG is connected Select ECG from the on screen menu Select Show Hide from the on screen menu to turn on off ECG trace Gain Selectthe desired gain from the on screen menu to increase or decrease ECG gain 0 20 Position Select the desired position of the ECG trace from the on screen menu Sweep Speed Footswitch Select the desired sweep speed from the on screen menu slow med fast Note The footswitch is an optional feature and requires a SonoSite footswit
58. is displayed in the top left portion of the screen next to the optimization setting 2 Press the THI key again to turn off THI The THI icon is removed from the screen Chapter 3 Imaging 59 60 Zoom 1 Press the Zoom key A region of interest ROI box is displayed on the screen 2 Use the Touchpad to position and size the ROI box within the image area 3 Press the Zoom key again The image is magnified by a factor of two inside the ROI box 4 Pressthe Zoom key again to exit zoom To exit any zoomed state and return to 2D live in 1x press the 2D key Zoom Pan Note Panning is available on a frozen zoomed image You cannot pan on a frozen image in Dual 1 Onafrozen 2D image press the Zoom key A zoom box is displayed on the screen 2 Use the Touchpad to position the zoom box within the image area 3 Press the Zoom key again The image is magnified by a factor of two at the position of the zoom box Use the Touchpad to pan the image up down and left right 5 Pressthe Zoom key again to exit zoom Freeze 1 Press the Freeze key The cine icon and frame number are displayed in the system status area of the screen 2 Pressthe Freeze key again to return to live imaging The cine icon is removed from the system status area of the screen and live imaging resumes Cine Buffer au Chapter 3 Imaging On a frozen image press the Cine keys to view individual frames in the cine buffer The frame number changes dynamica
59. measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Color measurement from Radius 1 Onafrozen Color image press the Calcs key 2 From the calculations menu select Radius 3 Perform the measurement 4 Select Save from the on screen menu to save the measurement to the patient report Chapter 4 Measurements and Calculations PISA continued Doppler measurement from MR VTI and MV VTI 1 2 3 On a frozen Doppler spectral trace press the Calcs key From the calculations menu select PISA then select MRVTI Position the caliper at the start of the waveform and press the Select key to start the trace Trace the waveform and select Set from the on screen menu Select Save from the on screen menu or press the Enter key to save the measurement to the patient report Select MVVTI Position the caliper at the start of the waveform and press the Select key to start the trace Trace the waveform and select Set from the on screen menu Select Save from the on screen menu to save the measurement to the patient report For information on using the automatic trace tool see Automatic Trace on page 87 Isovolumic Relaxation Time IVR
60. new patient exam to delete the previous measurements See New Patient on page 49 References for measurements and calculations are in Chapter 7 References The following table shows the transducers and exam types that provide Gyn calculations Table 7 Transducers and Exam Type Transducer Exam Type C60e Gyn ICT Gyn Width 2 99cmVol 41 0cm Figure 6 Gyn Measurements Chapter 4 Measurements and Calculations 97 suone n je pue sjueuloaJnseaIwy 98 Gyn Select Gyn exam type On a frozen 2D image press the Calcs key From the calculations menu select Gyn then select the desired measurement Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Select the next measurement Repeat these steps until all measurements are performed Chapter 4 Measurements and Calculations A0 50 v B051 C055 D 0 69 E 0 54 cm Figure 7 Follicle Measurements Follicle Note You may save up to six follicular measurements One distance measurement is provided for each follicle 1 2 3 Select Gyn exam type On a frozen 2D image press the Calcs key From the calculations menu select Follicle then s
61. of the new position or the new size is displayed as it moves on the display 2 Press the Select key to toggle between the position and size of the ROI box The ROI box indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling Color a 1 Select Color Suppress from the on screen menu to hide or show color Suppress information when in Color or CPD mode 2 Select Hide or Show while in live or frozen imaging The setting shown on the on screen menu is the current state Color Suppress returns to default state when returning to live imaging from a frozen state Chapter 3 Imaging 63 64 Flow Sensitivity R Select the desired flow sensitivity from the on screen menu Low optimizes the system for low flow states Med optimizes the system for medium flow states High optimizes the system for high flow states The current setting is displayed in the top left portion of the screen and in the on screen menu PRF Scale PRF Note This menu option is available in Color and in CPD on select transducers Select the desired pulse repetition frequency PRF setting from the on screen menu A beep sounds when the minimum or maximum of the range is reached There is a wide range of PRF settings for each flow sensitivity selection Wall Filter WF Note This menu option is available in Color and in CPD on select transducers Select the desired wall filter setting from the on s
62. 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 9 Safety 267 Ayayes Table 30 Transducer Model P17 5 1 Operating Mode PW Doppler TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 1 1 2 3 5 2 5 Pr3 MPa 1 853 Wo mW 83 41 83 41 9 min of W 3 z1 lr 3 z1 mW 103 6 3 5 2 cm 1 9 LT Zbp cm 1 82 ES z cm 49 17 Som sp gt g 9 gt deqlZsp cm 0 6 lt fe MHz 2 20 3 67 2 23 2 23 Dim of Aaprt cm 0 90 0 424 0 424 cm 1 3 1 3 1 3 PD use 1 17 S PRF H2 1562 5 E D Pllmax MPa 2 339 S deq Pllmax cm 0 46 Focal Length FL cm 3 43 1 55 E FL cm 7 0 7 0 Ipa3 M max W cm 164 0 E Control 1 Exam Type Card Card Abd or OB ed E Control 2 Sample Volume 1mm 3 mm 3 mm 3 mm ad S Control 3 PRF 1563 gt 1563 Any Any Control 4 Sample Volume Position Zone 3 Zone 1 Zone 0 Zone 0 Control 5 TDI On 268 a This index is not required for this operating mode value is lt 1 b This transducer is not intend
63. or CW Doppler Imaging hWN Press Doppler key for the D line Select PW CW to toggle between PW and CW Doppler cardiac only Use the Touchpad to position the D line Press Doppler key again for Doppler trace On screen menu items for this mode Control Description Angle E Select to adjust angle correction 0 60 or 60 degrees Correction Gate Size E Select the desired gate size varies by transducer and exam type TDI Turn tissue Doppler imaging TDI on or off PW Doppler cardiac only Steering iw Select correct steering angle for pulsed wave PW Doppler 15 0 or 15 degrees L38e and HFL38 transducers only Scale zx Select the scale pulse repetition frequency PRF setting Line E Adjust the baseline position Invert Select to vertically flip the spectral trace Volume a Adjust Doppler speaker volume to increase or decrease 0 to 10 Wall Filter WF Select wall filter setting low med or high Sweep Speed Select sweep speed slow med or fast Live Trace Display a live trace of the peak or mean ra Measurements 1 From the imaging mode press the Freeze key 2 Pressthe Caliper key 3 Perform one of the following measurements Distance Area Circumference Calculations Calculation packages vary depending on exam type and transducer 1 Fromthe imaging mode press the Freeze key 2 Pressthe Calcs key Calculations Package Exam Type Transducer Cardiac Crd P10 P17 TEE Gyn Gyn C6
64. plus 1 4 Acquisition Phantom 0 01 96 cm of full scale smallest dimension 100 plus 0 5 a Full scale for distance implies the maximum depth of the image An RMI 413a model phantom with 0 7 dB cm MHz attenuation was used c The area accuracy is defined using the following equation 96 tolerance 1 lateral error 1 axial error 1 100 0 5 d The circumference accuracy is defined as the greater of the lateral or axial accuracy and by the following equation 96 tolerance 4 2 maximum of 2 errors 100 0 5 Table 2 M Mode Measurement and Calculation Accuracy and Range M Mode Measurement System Accuracy Test Hara Accuracy and Range Tolerance By Method 9 Distance lt 2 plus 1 Acquisition Phantom 0 26 cm of full scale Time lt 2 plus 1 Acquisition Phantom 0 01 10 sec of full scales Heart Rate lt 2 plus Full Acquisition Phantom 5 923 bpm Scale Heart Rate 100 Full scale for distance implies the maximum depth of the image An RMI 413a model phantom with 0 7 dB cm MHz attenuation was used Full scale for time implies the total time displayed on the scrolling graphic image SonoSite special test equipment was used onoco 202 Chapter 7 References Table 3 PW Doppler Mode Measurement and Calculation Accuracy and Range Doppler Mode Measurement Accuracy system Accuracy Test Range Tolerance By Method and Range Velocity cursor lt 2 plus 1 Acquisit
65. position Support your arm using a support cushion or pillow or rest it on the bed Minimize neck bending and twisting Position the ultrasound system display directly in front of you Provide an auxiliary monitor for patient viewing Promote comfortable hand wrist and finger postures for your scanning arm Hold the transducer lightly in your fingers Minimize the pressure applied on the patient Keep your wrist in a straight position 10 Chapter 2 Getting Started Take Breaks Minimizing scanning time and taking breaks can be very effective in allowing your body to recover from physical activity which can help you avoid any MSDs Some ultrasound tasks may require longer or more frequent breaks One way of taking a break is to stop and relax However simply changing tasks can help some muscle groups relax while others remain or become active Vary your daily activities Plan your work so there are breaks in between ultrasound exams Work efficiently when performing an ultrasound exam by using the software and hardware features correctly Learn more about these features in Chapter 3 of this guide Keep moving Avoid sustaining the same posture by varying your head neck body arm and leg positions Exercise Targeted exercises can strengthen muscle groups which may help you avoid MSDs Contact a qualified health professional to determine stretches and exercises that are right for you System Preparation Installing or Removing Batte
66. smaller The caliper line disappears as the calipers get closer together 2D Measurements The measurements provided by the system do not define a specific physiological or anatomical parameter Rather what is provided is a measurement of a physical property such as distance for evaluation by the clinician The accuracy values require that you can place the calipers over one pixel The values do not include acoustic anomalies of the body The 2D linear distance measurement results are displayed in centimeters with one place past the decimal point if the measurement is ten or greater two places past the decimal point if the measurement is less than ten The linear distance measurement components have the accuracy and range shown in the following tables Table 1 2D Measurement Accuracy and Range 2D Measure Accuracy System Accuracy Test and Range Tolerance By Method Range om Axial Distance lt 2 plus 196 of Acquisition Phantom 0 26 cm full scale Lateral Distance lt 2 plus 196 of Acquisition Phantom 0 35 cm full scale Chapter 7 References 201 se uaJojay Table 1 2D Measurement Accuracy and Range Continued 2D Measure Accuracy System Accuracy Test and Range Tolerance By Method Range cm Diagonal Distance lt 2 plus 1 of Acquisition Phantom 0 44 cm full scale Area lt 4 plus 2 of Acquisition Phantom 0 01 720 cm full scale smallest dimension 100 plus 0 5 Circumference lt 3
67. system 2 Select Log and then Export from the on screen menu 3 View the files on a CompactFlash reader The log is a text file that can be opened by a text file application for example Microsoft Word or Notepad The log file is named log txt Clear Event Log 1 Select Clear from the on screen menu 2 Select Yes to delete or No to cancel Chapter 2 Getting Started 29 peueis 6unyo5 Login to System as User 30 User Login Please enter your user name and password then click OK Clicking Guest allows you to scan but will block access to patient information Name Usero Password 1 OK Guest Password Figure 10 User Login and Change Password Change Password Please enter your old password new password confirm the new password and then click OK Passwords must be 6 12 characters and are case sensitive Name Usei Old Password New Password Cofim OK Can Note User Login is displayed when system access is turned on User Login In User Login enter Name and Password and select OK Guest Login In User Login select Guest In Guest mode the user is able to scan but is restricted from accessing system setup and patient information Change 1 In User Login select Password Password 2 select OK Enter your old password new password confirm the new password and then To ensure passwords are secure it is recommended that passwords contain chara
68. the end of an OB exam press the Report key Select Twin A B from the on screen menu to view individual twin reports OB Twins At the end of an OB exam press the Report key Report Select Compare from the on screen menu to view both twins in a Combined single report Delete OB At the end of an OB exam press the Report key Measurement Send Report Use the Touchpad to select the desired OB measurement The selected measurement is highlighted green Select Delete from the on screen menu To delete all measurements select the measurement label and press the Select key then select Delete from the on screen menu Ensure the printer is configured for serial port data export See Connectivity on page 33 Select Send Rep from the on screen menu Data is sent to the computer as a text file This function can be used for all reports Chapter 4 Measurements and Calculations 137 suone n je pue s uawasnsealy 138 Anatomy Checklist Fac Figure 15 Anatomy Demonstrated Anatomy 1 At the end of an OB exam press the Report key Demonstrated 2 Onthe page for Anatomy Demonstrated select the check boxes to document reviewed anatomy Use the Tab key to move between fields and the Spacebar to check and uncheck items from the checklist Biophysical Profile 1 Atthe end of an OB exam press the Report key 2 On page 2 ofthe report select values for the biophysical profile BPP 0 1 2 The total sco
69. the on screen menu to display a live trace of the peak or mean See Live Trace on page 45 Gain Turn the Gain knob to increase or decrease the amount of Doppler gain Chapter 3 Imaging 67 Freeze 1 Press the Freeze key The cine icon is displayed in the system status area of the screen 2 Press the Freeze key again to return to live imaging The cine icon is removed from the system status area of the screen and live imaging resumes Cine Buffer gay On a frozen image press the Cine keys to view the trace at different points in time 2D Imaging Clips Press the 2D key to return to 2D imaging Note This feature is optional Time ECG Select Clips from the on screen menu Select Time from the on screen menu if desired acquisition is based on number of seconds Select the desired time duration 2s 4s 6s Select ECG from the on screen menu if desired acquisition is based on the number of heart beats Select the desired number of beats 1 2 3 4 6 8 10 beats Preview On Off Prospective Retrospective Select PrevOn from the on screen menu to turn on the preview feature and select PrevOff to turn off preview feature When Prev On is selected the Save Clip key automatically plays the acquired clip on the screen rather than storing to the CompactFlash card Only in Prev On can the clip be trimmed saved or deleted When Prev Off is selected the clip is automatically saved an
70. 0e ICT IMT IMT HFL38 L38e OB OB C60e ICT P17 Percent Reduction Abd Hep IMT Msk SmP Vas C60e HFL38 L38e P10 P17 SLA SLT Transcranial Doppler Orb TCD P17 Vascular Vas HFL38 L38e P10 SLA Volume Abd Bre Gyn Hep Msk Neo Nrv C60e HFL38 ICT L38e P10 P17 SLA SmP Sup Vas SLT Volume Flow Abd Hep Vas C60e HFL38 L38e P10 P17 SLA SLT 6 See MicroMaxx Ultrasound System User Guide for more information 6l SonoSite P06435 07 HART
71. 2 Getting Started Configure system to protect patient data by requiring users to log on and enter passwords Configure for type of Key click Audio alert Sleep delay and Power delay Customize predefined labels to display in Tissue Doppler Imaging TDI calculation menu and on report page Configure Printer Video Mode Serial Port CF Capacity Alert and Transfer Mode DICOM or SiteLink setup DICOM and SiteLink are optional features Configure Date and Time functions Configure existing system functionality as a shortcut customize predefined labels and set preference for managing text when unfreezing images Configure information displayed on image Patient Header Mode Data and System Status Customize predefined labels to display in the IMT calculation menu and on the report page Select OB calculation table authors and import export additional OB tables Customize system for user defined measurements to display in the OB calculations menu and on the report page OB Custom Measurements are an optional feature Configure Preset functions Doppler Scale Duplex Live Trace Thermal Index Save Key Dynamic Range Units and Footswitch settings Displays system hardware and software versions and license information Displays system IP address Location WLAN Profile Active WLAN SSID Ethernet MAC address and Wireless MAC address Set Security Settings Security Setup WARNING Health care providers wh
72. 2 59 5 54 4 PATIENT2 29384 9587 2005Jun01 14 02 0 48 Suspended AE 0 98 5746 2005Jun01 16 33 32 1 Pending archive El Status Archived E Archive in progress Images clips archiving icon Suspended and message Select All Review 9 Archive X Delete Done Figure 18 Patient List Automatically Images and clips are automatically transferred to the selected devices Pending Archive or Print exams are archived or printed starting at the top of the list The network Images connection icon in the system status area is animated during DICOM network activity 1 Ensure the current location is selected in the DICOM main screen 2 Ensure connection to LAN See Connect to LAN on page 148 With the system on check the LAN link light green LED next to the mini dock connector to verify physical connection to LAN 3 Verify patient exam is closed See Patient Information on page 49 Images and clips saved on the ultrasound system are stored on a CompactFlash See Image and Clip Storage on page 70 Images and clips transferred to DICOM devices are automatically sent from the CompactFlash after you end the exam All images and clips in the patient exams are sent at once to the DICOM devices rather than the individual images The DICOM formatted files are not saved to the CompactFlash card File transfer of pending patient exams occurs only when you end the exam or create a new patient Chapter 5 Connect
73. 246 Table 9 through Table 44 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 Chapter 9 Safety Table 9 Transducer Model C1 1e 8 5 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 8 b Pra MPa Wo mW 26 29 Y min of W 5 z4 lza 3 z4 mW 5 o z cm E P Zbp cm SS ini NE y oy HER cm i e F MHz s m 4 36 Dim of Aaprt X cm m 0 28 Y cm 0 5 PD usec S PRF H 8 P Pllmax MP S deqGPllia cm 0 226 Focal Length FL cm Ll FLy cm m lpa 3 Mlmax W cm o 2 Control 1 Exam Type Any s z Control 2 Sample Volume 2mm y S E Control 3 PRF 3906 O Control 4 Sample Volume Position Zone 1 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this 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 9 Safety 247 Ayayes Table 10
74. 259 Ayayes Table 22 Transducer Model P10 8 4 Operating Mode 2D Index Label Global Maximum Index Value M TIS TIB Non scan TIC A aprt lt Aaprt gt 1 Non scan Associated Acoustic Parameter min of W 3 z4 JlrA 321 Z1 Zbp Zsp deqlZsp fe Dim of Aaprt Other Information Operating Control Conditions PD PRF pr Pll max deq Pllmax Focal Length lpa3 M max Control 1 Exam Type Control 2 Optimization Control 3 Depth Control 4 THI 260 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 9 Safety Table 23 Transducer Model P10 8 4 Operating Mode M Mode Index Label Global Maximum Index Value M TIS TIB Scan Non scan TIC Aaprt lt 1 aprt a Non scan Aaprt gt 1 min of W 3 z4 JA 3 Z1 Z1 Zbp Zsp deqlZsp Associated Acoustic Parameter fe Dim of Aaprt He HE FE HE Gt PD PRF pr Pll max deq Pl
75. 3 2 13 47 to 17 5 Labeling Symbols The following symbols are found on the products packaging and containers Table 46 Labeling Symbols Symbol Definition Alternating Current AC NU 9 Affixed to a Class 1 device indicating manufacturer s declaration of C C conformance with Annex VII of 93 42 EEC Affixed to a Class 1 device requiring verification by the Notified Body of C sterilization or measurement features or to a Class lla llb or III device requiring gase verification or auditing by the Notified Body to applicable Annex es of 93 42 EEC Attention see the User Guide Chapter 9 Safety 283 Ayayes Table 46 Labeling Symbols Continued Symbol Definition Device complies with relevant Australian regulations for electronic devices Batch code date code or lot code type of control number LOT ON Biological risk V Device complies with relevant Brazilian regulations for electro medical devices Canadian Standards Association Catalog number Collect separately from other household waste see European Commission Directive 93 86 EEC Refer to local regulations for disposal STERILE EO Contents sterilized using ethylene oxide process G Corrugated recycle i Dangerous voltage j Date of manufacture Direct Current DC Do not get wet tad T 284 Chapter 9 Safety Table 46 Labeling Symbols Continued Definition
76. 38e Bre SmP Vas IMT x X X X X 04 X X X Nrv LAP Abd xX X X X X X X XxX X X X XxX X Pel P10 Crd Neo Abd Vas Nrv P17 Abd lt X XxX X X X OB Crd TCD xX X X X X X X X X X X X XxX X X X X XxX X X X XxX X x X X X X X X X X X X X XxX X X X X XxX X X X XxX X X X X X X X X X X X X X 04 X X X X XxX X X X XxX X xXx X X X X X X X X X Orb 54 Chapter 3 Imaging Table 2 Transducer Exam Type and Imaging Mode Continued Imaging Mode Hid Pd d THI E Fx CPD Color PW ns cw SLA Msk X FR X X X X La ex Sup X X X X X e Vas X X X X X Nrv X X X X X E SLT Abd X ET Ux X X Z S Hep X X X X TEE Crd X PSU MEME X X X X Transducer Preparation WARNING Caution Some transducer sheaths contain natural rubber latex and talc which can cause allergic reactions in some individuals Refer to 21 CFR 801 437 User labeling for devices that contain natural rubber Some gels and sterilants can cause an allergic reaction on some individuals To avoid damage to the transducer use only gels recommended by 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 you clean transducers after each use See Cleaning and Disinfecting Transducers on page
77. 38e Vascular P10 Vascular SLA Vascular Carotid vascular measurements may be performed and saved to the patient report The specific measurements that can be stored to the patient report are provided in the following table For definitions of acronyms see Glossary on page 287 Table 13 Carotid Vascular Measurements Vascular Measurement Systolic Diastolic PCCA X X MCCA X X DCCA X X Bulb X X PICA X X MICA X X DICA X X PECA X X MECA X X DECA X X 108 Chapter 4 Measurements and Calculations Table 13 Carotid Vascular Measurements Continued Vascular Measurement Systolic Diastolic VArty X X PCCA s 95 2cm s PCCA d22 8cm s Figure 10 Vascular Measurement Label Vascular Measurement Note After vascular measurements are performed values used in the ICA CCA ratio are selectable on the vascular report page 1 2 On a frozen Doppler spectral trace press the Calcs key From the calculations menu select Left or Right then select the desired measurement Use the Touchpad to position the caliper at the peak systolic wave form Press the Select key A second caliper is displayed on the screen The active caliper is highlighted green Use the Touchpad to position the second caliper at end diastole on the waveform Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calcu
78. 96 dip in Ur for 29596 dip in Ur typical commercial or hospital interruptions 0 5 cycle for 0 5 cycle environment If the user of the SonoSite and voltage 40 Ur 40 U ultrasound system requires continued variations on 60 dip in Uy for 5 6096 dip in Uz for operation during power mains power supply interruptions it is recommended that input lines cycles 5 cycles the SonoSite ultrasound system be IEC 61000 4 11 70 Ur 70 Ur powered from an uninterruptible power 30 dip in U7 for 25 3096 dip in Ur for supply or a battery cycles 25 cycles gt 5 Ur 2596 Ur Power Frequency Magnetic Field IEC 61000 4 8 Conducted RF IEC 61000 4 6 gt 95 dip in U7 for 5s 3 A m 3 Vrms 150 kHz to 80 MHz 29596 dip in Ur for 5s 3 A m 3 Vrms 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 ded2JP Chapter 9 Safety 233 Ayayes Table 2 Manufacturer s Declaration Elec
79. Chitty Hadlock Hansmann TTD Hansmann Tokyo U APTD Tokyo U AC Hadlock Hansmann Tokyo U FTA Osaka FL Chitty Hadlock Hansmann Osaka Tokyo U For Toyko U APTD and TTD are only used to calculate EFW No age or growth tables are associated with these measurements Chapter 4 Measurements and Calculations Table 10 System Defined OB Calculations and Table Authors Continued Calculation Result Gestational OB Table Authors Measurements Estimated Fetal Weight HC AC FL Hadlock 1 EFW See notes 2 and 3 BPD AC FL Hadlock 2 AC FL Hadlock 3 BPD TTD Hansmann BPD FTA FL Osaka U BPD AC Shepard BPD TTD APTD FL Tokyo U Ratios HC AC Campbell FL AC Hadlock FL BPD Hohler FL HC Hadlock Amniotic Fluid Index Q Q2 Q3 Q4 Jeng Growth Analysis Tables BPD Chitty See note 4 Hadlock Jeanty HC Chitty Hadlock Jeanty AC Chitty Hadlock Jeanty FL Chitty Hadlock Jeanty EFW Hadlock Jeanty HC AC Campbell Chapter 4 Measurements and Calculations 103 suone n je pue sjuauleansea y 104 Note 1 The Gestational Age is automatically calculated and displayed next to the OB measurement you selected The average of the results is the AUA Note 2 The Estimated Fetal Weight calculation uses an equation that consists of one or more fetal biometry measurements The author for the OB tables which you choose in system setup determines the measurements you must perform to obtain an EFW calculation See
80. Create New OB Custom Tables Oo ON A Press the Setup key Select OB Custom Meas or OB Calculations Select Tables from the on screen menu Select the desired table Age or Growth In the measurement list select the desired measurement for the custom table Select New from the on screen menu In the Author field enter a unique name Enter the data Select Save from the on screen menu Two custom tables may be created for each OB measurement To display the measurement for the custom table in the calculation menu see OB Calculations Authors on page 40 and select More Growth analysis tables cannot be created for custom OB measurements Edit OB Custom Tables Press the Setup key Select OB Custom Meas or OB Calculations Select Tables from the on screen menu Select the desired custom OB table Select Edit and enter data and then select Save from the on screen menu Delete OB Custom Tables Chapter 2 Getting Started Press the Setup key Select OB Custom Meas or OB Calculations Select Tables from the on screen menu Select the desired custom OB table Select Delete from the on screen menu to remove the custom table from the system Presets Setup Pages Presets Doppler Scale cm s Duplex 1 3 2D 2 3 Trace Live Trace Peak Thermalindex TiS Save Key Image Only DynamicRange 2 Bre Units ms gt Footswitch L Freeze Footswitch R Save Image
81. Depth Control 4 THI 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 266 Chapter 9 Safety Table 29 Transducer Model P17 5 1 Operating Mode CPD Color TIS TIB Index Label M Non scan Non TIC Scan AaprtS1 Aaprt gt 1 scan Global Maximum Index Value 1 1 1 0 2 2 Pr3 1 612 Wo 100 83 92 91 Y min of W 5 z4 lza 3 z4 2 Z1 Pears g S Zz 3 8 z Sg SP i 9 E deq z p lt fe M 2 10 2 21 2 19 Dim of Aaprt X 0 9 0 424 Y 1 3 1 3 PD use 0 824 S PRF 1005 E pr Pllmax M 2 127 S deq Pllmax Focal Length FL cm 3 68 1 55 8 FLy 7 0 7 0 Ipa 3 M max W cm 126 3 Control 1 Mode Color Color Color D Control 2 Exam Type Abd amp OB TCD TCD I E amp jControl 3 Optimization Depth Low 7 5 Low 7 5 Low ad B cm 300 cm Any remi O O Any Control 4 THI On Control 5 Color Box Any Top Top Position Size Narrow Narrow a This index is not required for this
82. Done from the on screen menu Reset Select Reset from the on screen menu to return settings for this setup page to factory default 32 Chapter 2 Getting Started Connectivity Setup Pages Audio Battery Connecti Connecti scd 3 Connectivity Ow 0 i Date and Time mode NTSC gt NTSC ets a Serial Port None Serial Port None OB Calculations Transfer Mode DICOM Transfer Mode SteLink lt OB Custom Meas Presets Location Not connected Location Not connected System Information p DT LES gemitus CF Capacity Alert F CF Capacity Alert ENN 1 1I 1 1 ENN ENN 3 NER Figure 13 Setup Connectivity DICOM and SiteLink Printer 1 Press the Setup key Select Connectivity 3 In the Printer list select the desired printer from the list of recommended printers Video Mode 1 Press the Setup key Select Connectivity 3 Inthe Video Mode list select NTSC or PAL for the desired mini dock video output Serial Port 1 Press the Setup key Select Connectivity 3 Inthe Serial Port list select the desired peripheral VCR DVD Computer PC or Bar Code Scanner Note Because these peripherals use the same RS 232 connector on the mini dock you can connect only one of these peripherals at a time Restart the system to activate connectivity to the new peripheral 5 Attach a serial cable RS 232 to the serial port from the mini dock or docking system to the des
83. E 8 3 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 3 a a a Pr3 2 04 Wo B min of W 3 Z4 lza 374 Nn 5 Z ge e E S Zsp 2 61 QU OQ 2 deq Zsp lt fe 3 97 Dim of Aaprt PD 0 558 5 PRF 800 E p GPIli 2 915 Es deq Pllmax E Focal Length O lpa 3 Mlmax 176 61 m Control 1 Exam Type Card g Control 2 Optimization Pen TO a3 c Control 3 Depth 4 0 cm O o 280 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 9 Safety Table 43 Transducer Model TEE 8 3 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a 1 3 2 8 b Pr3 MPa Wo mW 73 15 58 10 9 min of W 5 z4 lza 3 z4 mW 3 LZ cm lt P Zpp cm amp
84. Edit E Measurement Select Switch from the on screen menu until the desired measurement is highlighted Move the caliper to the desired position Theresult displayed in the measurement and data area is updated Trace measurements in 2D or Doppler can not be edited once set Delete Measurement Select Switch from the on screen menu until the desired measurement is highlighted Select Delete from the on screen menu The highlighted measurement is removed from the screen and the most recent previous measurement is highlighted Chapter 4 Measurements and Calculations M Mode Measurements The basic measurements and calculations that can be performed in M Mode are e Distance in cm Time in seconds e Heart Rate HR in beats per minute bpm The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals Figure 2 M Mode Trace Image with Heart Rate Distance 1 Ona frozen M Mode trace press the Caliper key Measurement A single caliper is displayed on the screen and the following on screen menu options are available Eg Heart rate HR Delete Use the Touchpad to position the first caliper 3 Press the Select key to display the second caliper The active caliper is highlighted green Uptofour distance measurements can be performed on an image Select Switch from the on screen menu to move between measurements 4 Tosavethe highlighted measurement to a calcu
85. J 9 4a3deyD S6L Table 3 Disinfectants Compatible with System and Transducers Continued Disinfection and Country ype active ingredient L38e P1o D2 Hase sro CUSO Seem P17 SLA End Bac II USA Liquid Quat Ammonia A U A A A A Endozime AW Plus FRA Liquid Propanol A U A A A A Envirocide 4 USA Liquid Isopropyl A U U A N A Enzol USA Cleaner Ethylene Glycol A U A A A N Expose USA Liquid Isopropyl A U A A A A Gigasept AF 3 DEU Liquid Quat Ammonia A U A A A N Gigasept FF DEU Liquid Bersteinsaure N U N A N N Gluteraldehyde SDS USA Liquid Gluteraldehyde A U U A A A Hexanios FRA Liquid Polyhexanide Quat A U A A A A Ammonia Hi Tor Plus USA Liquid Chloride A U A A N N Hibiclens USA Cleaner Chlorhexidine A U A A A A Hydrogen Peroxide USA Liquid Hydrogen Peroxide A A A A A N Isopropanol Alcohol ALL Liquid Alcohol N U N N N N Kodan T cher DEU Liquid Propanol A U A A A N Kohrsolin ff DEU Liquid Gluteraldehyde A U U A A N Korsolex basic 3 DEU Liquid Gluteraldehyde N U N A N A LpHse 4 USA Liquid O phenylphenol A U A A A A Lysol USA Spray Ethanol N U N N N N Lysol IC 4 USA Liquid O phenylphenol A U N A A A Bunoouse qnoJ 961 e xueuajureyy pue Bunoouse qnoJ 9 193deu Table 3 Disinfectants Compatible with System and Transducers Continued Disinfectonand County qoe active ingredient L38e PI0 D2 Hase sro Ce Seem P17 SLA Madacide 4 USA Liquid Isopropanol A N A A N N Matar 4 USA Liquid O phenylphenol A U A N Me
86. M Mode UJ CON A UN fF On a frozen 2D image or M Mode trace press the Calcs key Select the measurement Position the active caliper at the starting point The active caliper is highlighted green Press the Select key to highlight and activate the second caliper Position the second caliper Press the Select key to advance to the next measurement Repeat until all measurements in that calculation group are completed Select Save from the on screen menu or press the Enter key to save the measurements to the patient report The saved measurements are displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Ao LA AAo and LVOT D On a frozen 2D image or M Mode trace press the Calcs key From the calculations menu select the desired measurement Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurements to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations 121 suone n je pue sjuauleansea y 122 LV Volume Simpson s Rule N o N On a frozen 2D image press the Calcs key From the calculations me
87. MImax W cm Control 1 Exam Type Any Any 2 5 Control 2 Sample Volume 3mm 10mm Control 3 PRF 15625 amp as E Jens 20833 Control 4 Sample Volume Position Zone 7 Zone 0 a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety 277 Ayayes Table 40 Transducer Model TEE 8 3 Operating Mode 2D TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a 1 0 b Pr3 Wo 54 91 B min of W 3 Z4 lza 374 5 Z ge e Ss 5 a 9 deq zsp lt fe 3 97 Dim of Aaprt 0 812 0 9 PD 5 PRF E pr GPlli ax 9 deq Pllmax Focal Length 3 61 9 E 8 4 75 Ip 3 MI max m Control 1 Exam Type Card X g g Control 2 Optimization Pen TO a3 c Control 3 Depth 4 0 cm O o a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data
88. MicroMaxx Ultrasound System User Guide CE EA SonoSite MicroMaxx 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 OAP 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 MicroMaxx SiteLink SonoCalc SonoMB SonoRES and SonoSite are registered trademarks or trademarks of SonoSite Inc CompactFlash is a registered trademark of Symbol Technologies DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information Non SonoSite product names may be trademarks or registered trademarks of their respective owners The SonoSite product s referenced in this document may be covered by one or more of the following patents 5722412 5817024 5893363 6135961 6203498 6364839 6371918 6383139 6416475 6447451 6471651 6569101 6648826 6575908 6604630 6817982 6835177 6962566 7169108 D456509 D461895 D509900 D538432 D544962 D558351 D559390 Patents pending Other international patents may also apply P06435 07 07 2008 Copyright 2008 by SonoSite Inc All rights reserved Contents Introduction 1 About the User Guide 1 Intended Uses 1 Conv
89. N Ascend 4 USA Liquid Quat Ammonia A U A A A A Asepti HB USA Liquid Quat Ammonia A U A A A N Asepti Steryl USA Spray Ethanol A U A A A N Asepti Wipes USA Wipe Propanol Isopropyl A U A A A A Buljooysajqnoly Alcohol v6L e ueuajureyy pue bunoouse qnoJ 9 4a3dey gt D Table 3 Disinfectants Compatible with System and Transducers Continued Disinfection ang country Type Active Ingredient PE D2 HFL38 SLT e ur System Cleaning Solutions of Origin P17 SLA L25e Surfaces Bacillocid rasant DEU Liquid Glut Quat Ammonia A U A A A N Banicide 4 USA Liquid Gluteraldehyde A U U A A N Betadine USA Liquid Providone lodine N U N N A N Bleach 4 USA Liquid NaCl Hypochlorite A U A A A N Cavicide 4 USA Liquid Isopropyl A U A A A A Caviwipes USA Wipes Isopropanol A U A A N A Chlor Clean GBR Liquid Sodium A U N A A N Dichloroisocyanurate Cidex 14 2 4 5 USA Liquid Gluteraldehyde U A Cidex OPA 2 3 4 USA Liquid Ortho phthaldehyde A A A 5 Cidex Plus 2 4 5 USA Liquid Gluteraldehyde A U A A A A Clorox Wipes USA Wipes Isopropanol A U A A A N Control Ill 4 USA Liquid Quat Ammonia A U A A N A Coverage Spray 4 USA Spray Quat Ammonia A U A A N N DentaSept FRA Liquid Quat Ammonia N U N A N N Dentured Alcohol USA Liquid Ethanol N U N N N N DisCide Wipes USA Wipes Isopropyl Alcohol A U A A A N DisOPA JPN Liquid Ortho phthaldehyde A A A A A N Dispatch 4 USA Spray NaCl Hypochlorite A A A A A N e ueuajurey pue 6unoouse qno
90. S Zp cm 1 1 Br Ies cm 0 5321 lt fe MH 3 81 3 82 Dim of Aaprt X cm 0 9 0 9 Y cm 0 9 0 9 PD usec S PRF H 8 P Pllmax MP O deqGPllia cm 0 320 Focal Length FL cm 8 83 amp FLy cm 4 75 Ip 3 MI max W cm o 2 Control 1 Exam Type Card Card s g Control 2 Sample Volume 1mm 1mm 2 E Control 3 PRF 1563 1563 O OQ Control 4 Sample Volume Position Zone 6 Zone 1 a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this 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 9 Safety 281 Ayayes Table 44 Transducer Model TEE 8 3 Operating Mode Color TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a 1 3 b Pr3 MPa Wo mW 72 66 7 min of W 3 Z4 lza 374 mW TA 5 z cm E Zpp cm S s Zp m Z a o das cm 5 fe MH2 3 82 Dim of Aaprt X cm 0 9 Y cm 0 9 PD usec 5 PRF Hz E D Pll ax MPa S deq Pllmax cm Focal Length FL cm 11 78
91. Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations LV Mass 11 12 13 On a frozen 2D image press the Calcs key From the calculations menu locate LV Mass then select EPI Position the caliper at the trace start point and press the Select key to start the tracing function Use the Touchpad to trace the desired area If an error is made select Undo from the on screen menu to delete the previous position Complete the trace and select Set from the on screen menu Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Select Endo Position the caliper at the trace start point and press the Select key to start the tracing function Complete the trace and select Set from the on screen menu Select Save from the on screen menu to save the measurement to the patient report Select Apical Measure the ventricular length Select Save from the on screen menu to save the measurement to the patient report Chapter 4 Measurements and Calculations 123 suone n je pue sjuauleansea y Doppler Cardiac Calculations Remove On a trace performed in Doppler mode if an error is made do one of the following t
92. See Figure 3 on On Off page 16 2 Pressthe Power key once to turn on and once to turn off Wake Up To conserve battery life the system is configured to go into sleep mode The system System goes into sleep mode when the lid is closed or if the system has not been touched for a preset amount of time Press any key touch the touchpad or open the lid to wake up the system To adjust the time for sleep delay see Audio and Battery on page 31 14 Chapter 2 Getting Started Connecting or Removing Transducer 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 Figure 2 Connect the Transducer Connect 1 Turn the system upside down if not in docking system Transducerto 2 Pullthe transducer latch up and rotate it clockwise System 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 Pressthe latch down securing the transducer connector to the system Remove 1 Pull the latch up and rotate it clockwise Transducer 2 Pullthe transducer connector away from the system Chapter 2 Getting Started 15 pares bunje5 System Controls
93. Select key to toggle between on screen menus Doppler Spectral Trace Figure 7 Doppler Trace Image Spectral Trace 1 Press the Doppler key again to acquire the Doppler trace Press the Update key to toggle between the 2D D line and trace 3 In duplex press the Doppler key to return to the full screen D line The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals Youcan choose from one of three screen layouts For duplex imaging see Duplex on page 45 Scale RH Select the desired scale pulse repetition frequency PRF setting from the on screen menu A beep sounds when the minimum or maximum of the range is reached Line Select the desired baseline position from the on screen menu Baseline can be adjusted on a frozen trace if Live Trace is not displayed Invert m p Select Invert from the on screen menu to vertically flip the spectral trace Invert can be adjusted on a frozen trace if Live Trace is not displayed Volume Select the desired Doppler volume setting from the on screen menu to increase or decrease Doppler speaker volume 0 10 A beep sounds when the minimum or maximum of the range is reached Wall Filter WF Select the desired wall filter setting from the on screen menu low med high Sweep Speed Select the desired sweep speed from the on screen menu slow med fast Live Trace Select Trace from
94. Setup on page 141 e Creating Backup for DICOM Settings on page 147 If your ultrasound system is wireless compatible perform the standard DICOM setup then continue with Configure Wireless DICOM Creating Backup for DICOM Settings Before configuring the system SonoSite highly recommends saving the DICOM factory settings to a CompactFlash card and storing the card in a secure location Create Backup 1 Inserta blank CompactFlash card in the back slot See Installing or Removing CompactFlash Card on page 12 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu Select Export from the on screen menu Turn the system off then remove the CompactFlash card Un d MN Chapter 5 Connectivity and Configuration 147 yAnm2euuo Configuring Locations You can create up to 16 different locations on your MicroMaxx system Locations must be set up prior to information transfer When configuring your system for wireless use it is done through the location setup process Note Only one location can be set up to receive in progress image transfers Configure DICOM for Ethernet Connect to LAN 1 Connect the Ethernet cable to the Ethernet interface cable then connect to the Ethernet connection on the mini dock or docking system See the applicable SonoSite accessory user guide 2 With the system on check the LAN link light green LED next to the Ethernet connecto
95. SonoMB is available on the transducer ECG monitoring is not available ECG This feature is optional and requires a SonoSite ECG cable 1 Connect the ECG cable See Figure 2 System Back View on page 7 2 Select ECG from the on screen menu to display the ECG trace See ECG Monitoring on page 76 If SonoMB is available on the transducer ECG monitoring is not available Clips This feature is optional Select Clips from the on screen menu to display the clips menu See Clips on page 68 Gain Turn the Near Far or Gain knobs on the lower left side of the control panel to increase or decrease the amount of gain applied to the near field far field orthe overall image Near and far correspond to the time gain compensation TGC controls found on other ultrasound systems Auto Gain This feature depends on transducer type Select Auto Gain from the on screen menu Auto Gain automatically adjusts gain each time it is selected Depth The vertical depth scale is marked in 5 cm 1 cm and 5 cm increments depending on the depth Press the Depth key up to decrease or down to increase the displayed depth As you adjust the depth the maximum depth number changes in the lower right corner of the screen A beep sounds when the minimum or maximum of the range is reached Tissue Harmonic Imaging This feature is optional and depends on transducer and exam type 1 Press the THI key to turn on THI THI
96. T On a frozen Doppler spectral trace press the Calcs key From the calculations menu select MV then select IVRT A vertical caliper is displayed Use the Touchpad to position the caliper at the aortic valve closure Press the Select key A second vertical caliper is displayed Use the Touchpad to position the second caliper at onset of mitral inflow Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations 129 suone n je pue sjuauleansea y 130 Delta Pressure Delta Time dP dT Note 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 1 Ona frozen CW Doppler spectral trace press the Calcs key 2 Fromthe calculations menu select MV then select dP dT A horizontal dotted line with an active caliper is displayed at 100 cm s 3 Position the first caliper along the wave form at 100 cm s Press the Select key A second horizontal dotted line with an active caliper is displayed at 300 cm s 5 Position the second caliper along the wave form at 300 cm s Select Save from the on screen menu or press the Enter key to save the measureme
97. Table 1 Exam Type Abbreviations Abbreviation Exam Type Abd Bre Crd Gyn Hep IMT Msk Neo Nrv OB Orb Abdomen Breast Cardiac Gynecology Hepatic Intima Media Thickness Muscle Neonatal Nerve Obstetrical Orbital 52 Chapter 3 Imaging Table 1 Exam Type Abbreviations Continued Abbreviation Exam Type Pel Pelvic SmP Small Parts Sup Superficial TCD Transcranial Doppler Vas Vascular The following table describes the transducer s exam type and imaging mode that may be available with your system The optimization settings for 2D are Res Gen and Pen The optimization settings for color power Doppler CPD and color Doppler Color are low medium and high flow sensitivity with a range of PRF settings for Color depending on the application Table 2 Transducer Exam Type and Imaging Mode Imaging Mode pie DE end THI oe CPD Color PW ie cw Clle Abd X NT X X X Nrv X e em x X X X C60e OB X X Eme X X X X Gyn X X cx X X X X E Abd X Xt ux X X X X D2 Crd ee ee ee EX X HFL38 Bre X X X X X X SmP X X X X X X Vas X X X X X X IMT X X X X X X Nrv X OX X X X X Chapter 3 Imaging 53 Buibeui Table 2 Transducer Exam Type and Imaging Mode Continued Imaging Mode Trans Exam 2D 2D 2D TDI dicar Type MM THI MB S CPD Color PW PW Cw ICTe Gyn OB L25e Msk Vas Nrv Sup L
98. The American Institute of Ultrasound in Medicine AIUM has published Recommended Ultrasound Terminology Second Edition 1997 Refer to it for ultrasound terms not contained in this glossary Terms 2D two dimensional image as low as reasonably achievable ALARA color power Doppler CPD image color Doppler Color image color suppress continuous wave CW Doppler mode curved array transducer depth in situ A way to display echoes in two dimensions on a video display Video pixels are assigned a brightness level based on echo signal amplitude See also CPD image and Color Doppler Color image The guiding principle of ultrasound use which states that you should keep patient exposure to ultrasound energy as low as reasonably achievable for diagnostic results A Doppler imaging mode used to visualize the presence of detectable blood flow See also 2D image and Color image A Doppler imaging mode used to visualize the presence velocity and direction of blood flow in a wide range of flow states See 2D image and CPD image A way to hide or show color information while still in color Doppler mode A Doppler recording of blood flow velocities along the length of the beam 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 characterist
99. The positive range increases and the negative range decreases the number of grays displayed A beep sounds when the minimum or maximum of the range is reached Chapter 3 Imaging 57 Duallmages mm 1 Select Dual from the on screen menu to display side by side 2D images 2 Pressthe 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 3 Select Dual from the on screen menu or press the 2D key to return to full screen 2D imaging LVO Left Ventricular Opacification This feature depends on transducer and exam type Use LVO for cardiac exams in 2D 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 1 Ona2D image select LVO On on page 2 of the on screen menu to turn on LVO 2 Select LVO Off to turn off this option Orientation Select from four image orientations Up Right Up Left Down Left Down Right Brightness E Select the desired brightness setting from the on screen menu to adjust display brightness 1 10 A beep sounds when the minimum or maximum of the range is reached The display brightness affects battery life To conserve battery life adjust brightness to a lower setting Biopsy cT This feature depends on transducer type Biopsy is not available when ECG cable is connected
100. Ventricular Posterior Wall Fractional Thickening LVPWFT percent Laurenceau J L M C Malergue The Essentials of Echocardiography Le Hague Martinus Nijhoff 1981 71 LVPWFT LVPWS LVPWD LVPWD 100 where LVPWS Left Ventricular Posterior Wall Thickness at Systole LVPWD Left Ventricular Posterior Wall Thickness at Diastole Chapter 7 References 207 so uaJoJay 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 Note 220 is an empirical derived constant and may not accurately predict mitral valve area in mitral prosthetic heart valves The mitral valve area continuity equation may be utilized in mitral prosthetic heart valves to predict effective orifice area MV Flow Rate in cc sec Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 396 Flow 6 28 r Va where r radius Va aliasing Velocity Pressure Gradient PGr in mmHG Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 64 PGr 4 Velocity Peak E Pressure Gradient E PG E PG 4 PE Peak A Pressure Gradient A PG A PG 4 PA Peak Pressure Gradient PGmax PGmax 4 PV2 Mean
101. a Left Ventricular Outflow Tract Area LVOT D Left Ventricular Outflow Tract Diameter Glossary 293 Aiessoj5 Table 1 Acronyms Continued Acronym Description LVOT VTI Left Ventricular Outflow Tract Velocity Time Integral LVPW Left Ventricular Posterior Wall LVPWd Left Ventricular Posterior Wall Diastolic LVPWFT Left Ventricular Posterior Wall Fractional Thickening LVPWs Left Ventricular Posterior Wall Systolic LVs Left Ventricular systolic MB SonoMB MCA Middle Cerebral Artery MCCA Mid Common Carotid Artery MECA Mid External Carotid Artery MI Mechanical Index MICA Mid Internal Carotid Artery Mid Middle MM M Mode MR PISA Mitral Regurgitation Proximal Iso Velocity Surface Area MR VTI Mitral Regurgitation Velocity Time Integral MV Mitral Valve MV Area Mitral Valve Area MV ERO Mitral Valve Effective Regurgitant Orifice MV PISA Area Mitral Valve Proximal Iso Velocity Surface Area MV Rate Mitral Valve Rate MV Regurgitant Mitral Valve Regurgitant Fraction Fraction MV Regurgitant Volume MVA MV VTI Glossary Mitral Valve Regurgitant Volume Mitral Valve Area Mitral Valve Velocity Time Integral Table 1 Acronyms Continued Acronym Description NTSC National Television Standards Committee OA Ophthalmic Artery OFD Occipital Frontal Diameter PAL Phase Alternating Line PCAp1 Posterior Cerebral Artery Peak PCAp2 PCCA Proximal Common Carotid Artery PCoA Posterior Communicating Artery PECA Proximal Ex
102. a and query the worklist server for a matching patient procedure The system s worklist capability functions only when the following is set up The system is configured before using DICOM See System Configuration for DICOM on page 147 The system is connected to a LAN See Connect to LAN on page 148 Aworklist server has been configured for the active location 172 Chapter 5 Connectivity and Configuration Manual Patient 1 Query io 00 N Ensure that a worklist server is configured and is communicating with the system by selecting Verify on the main DICOM configuration screen Press the Patient key Select New from the on screen menu This ends the current patient procedure Selecting new patient ends the existing exam and erases any previously entered information including any calculations and report pages To save this information save the screen for each item for example report pages patient information calculations and graphs Enter data in any of the following six fields Patient Last First Middle Accession Number Patient ID or Procedure ID A query is made on the character or characters for example searching for Smith will return Smith Smithson Smithy Select Query from the on screen menu After the query has completed the total number of patient procedures matching the query is displayed in the lower right corner of the screen Highlight the desired patient procedure and then Selec
103. abels are allowed for both Right and Left side calculations The labels may be selected in system Setup within the IMT calculations page In addition to the IMT labels two distance plaque calculations are allowed Table 15 IMT Calculations for 2D Mode Imaging Mode Calculation Label 2D IMT 2D Plaque Ant N Anterior Near Wall Ant F Anterior Far Wall Lat N Lateral Near Wall Lat F Lateral Far Wall Post N Posterior Near Wall Post F Posterior Far Wall IMT 1 IMT 2 IMT 3 IMT 4 IMT 5 IMT 6 IMT 7 IMT 8 Plaq 1 Plaq2 IMT Automatic zw 1 Calculation 2 A On a frozen 2D image 1x or zoomed press the Calcs key From the calculations menu select the desired measurement Use the Touchpad to position the IMT tool over the area of interest until the tool displays results Select Hide from the on screen menu to check results To save the measurement to the report ensure the IMT trace is displayed Select Save from the on screen menu or press the Enter key to save the measurement to the patient report Chapter 4 Measurements and Calculations 111 suone n je pue sjuauleansea y 112 IMT Tool Note The IMT tool may be adjusted for horizontal position and width Adjustments Note The arrow keys may be used to adjust the tool position 1 Select Move from the on screen menu to adjust the IMT tool position horizontally The top key moves the tool several pixels to the right The bottom k
104. active image ino OaPIA S Q23451004 553 Ll CEC SY ynoolpny OL youJeyiy ino OapIA ayisodwo gt 6 asn ino OAPIA g5H 10 AG 8 J91uld Ul O9plA S L JoMod LL OL6 8 L9 S vec ON m TN NO 14 pem el T D A e ae lo TAX zur 6 o a gt re Sp suon euuo oq uuiw uonpoe es NUaW uaaJ2s uQ Jayiew yidap abew UOIEUOJU Sn3e1s W JS S ejep ujexe 1uened quan ejep uone n e 1ususJnseauu uan nuaw suone n je5 Aejdsip udej6032ld e dsip 1x91 Jox1euJ uonequano abew ejep apow Burbeuuir 3usun e NM TN OR OO DO Bulbew qz 0 uin3aJ 0 Ady AZ AY SSA Jej ddoq Jejddoq 10j0o gt POWNW az Ady epoui Buibeuur paursep ay ssaidg uoneuuojur Lexa pue zuaned e3e duuo pue Aay 3uaned ssaJd Je3npsueg u eny uo Ulajs s WNL Ke o NO pexieys 6un3ye5 0L 4M129 0S OAU288 Z Q ued I L uia era 681 9Sv CL weed c v c L woke ueaJ45g MicroMaxx Quick Start Cards 2D and M Mode Imaging 2D MicroMaxx automatically defaults to 2D imaging M Mode 1 Press M Mode key for M line 2 Press M Mode key again for M Mode trace On screen menu items for these modes Control Description Optimize E Select Gen Res or Pen to optimize resolution and penetration Dynamic m Adjust gray scale range to control image contrast 3 2 1 0 1 2 3 Range Dual
105. afety 9 error message 227 errors acquisition 203 algorithmic 203 measurement 203 estimated date of delivery EDD 210 estimated fetal weight EFW 211 event log 29 exam type abbreviations 52 transducer 53 export user account 28 E far description 17 fetal age inaccurate calculation 176 fetal heart rate FHR 84 flow sensitivity 64 focal zones optimize 57 follicle measurement 99 footswitch 46 77 forms 18 freeze description 18 turn on off 60 G gain adjust 59 description 17 gate size 66 gel 56 grace period 177 guidance documents related 241 gynecological gyn calculations 98 gynecology intended uses 2 Index 301 xepu 302 H heart rate HR 84 133 hip angle 96 humidity limits 221 image problem 175 review 72 save to CompactFlash 71 image mode 2D color Doppler 63 M Mode 61 PW and CW Doppler 65 transducer 53 image storage specifications 220 imaging CW Doppler 287 import user account 28 IMT calculations 110 sketch 113 trace 111 in situ definition 287 infertility intended uses 2 intended uses 1 3 intensity derated 243 in situ 243 water value 243 interventional intended uses 2 Intima Media Thickness IMT calculations 110 intraoperative intended uses 2 invert CPD 64 Doppler 67 iso volumic relaxation time IVRT 124 L labeling symbols 283 LCD screen clean 187 output 240 specifications 219 left atrium LA 121 left ventricular diastolic LVd 121 left ve
106. age immediately remove it and stop using it If you have any questions about the battery consult SonoSite or your local representative Store the battery between 20 C 4 F and 60 C 140 F Use only SonoSite batteries Do not use or charge the battery with non SonoSite equipment Only charge the battery with the system Chapter 9 Safety 229 Ayayes 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
107. al TO Select the Orbital Orb exam type On a frozen Doppler spectral trace press the Calcs key N 3 From the calculations menu select Left or Right then locate TO and select OA or Siphon Use the Touchpad to position the caliper UA Complete the trace and select Set from the on screen menu 6 Select Save from the on screen menu or press the Enter key to savet measurement to the patient report 7 Select the next measurement he For information on using the automatic trace tool see Automatic Trace on page 87 Cardiac Calculations WARNING Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 References for measurements and calculations are in Chapter 7 References The following table shows the transducers and exam types that provide cardiac calculations See the TEE User Guide a TEE Care Instructions for information on using the TEE transducer Table 18 Transducer and Exam Types for Cardiac Transducer Exam Types D2 Cardiac P17 Cardiac TEE Cardiac P10 Cardiac Chapter 4 Measurements and Calculations nd 117 suone n je pue sjuauleansea y 2D and M Mode Cardiac Calculations The following table shows the measurements required to complete the desired cardiac calculation The cardiac measurements are done in 2D and M Mode For definitions
108. and calculations Cancel Select Cancel from the on screen menu to undo any changes to the patient information form and return to the previous imaging state Pressing Cancel does not close the current patient exam Chapter 3 Imaging 51 Done Select Done from the on screen menu to save information and return to the previous imaging state Information is saved when exiting the patient information form unless Cancel is selected from the on screen menu If any changes are made to the current patient s name ID or accession number that patient exam is closed and a new one is started Transducer Exam Type and Imaging Mode The system has various configurations and options All are described in this user guide and may not apply to your system System features depend on your configuration transducer and exam type WARNING The diagnostic capability differs for each transducer exam type and imaging mode Verify your system s capabilities prior to diagnosis Transducers have been developed to specific criteria depending on their application This criteria includes biocompatability requirements To avoid injury to the patient use only an orbital exam type Orb when performing imaging through the eye The FDA has established lower acoustic energy limits for opthalmic use The system will not exceed these limits only if the Orb exam type is selected The following table describes the abbreviations for exam types
109. anstemporal TTD Transverse Trunk Diameter TV Tricuspid Valve UA Ultrasound Age Umb A Umbilical Artery VA Vertebral Artery VArty Vertebral Artery Vmax Peak Velocity Vmean Mean Velocity Vol Volume VF Volume Flow vil Velocity Time Integral Glossary 297 Kaesso 5 298 Glossary Index Symbols x measurement 86 Numerics 2D imaging 57 287 2D measurements 79 A a 126 abbreviations exam type 52 abdominal intended uses 1 AC power indicator 17 acceleration ACC index measurement 86 accessories list 220 acoustic measurement precision 283 acoustic output measurement 243 tables 245 246 282 acquisition error 203 acronyms 289 add new user 27 administrator login 25 age gestational 102 airborne equipment standards 223 ALARA principle 235 287 alphanumeric 16 angle correction 66 annotation annotate images 74 arrow 75 description 16 home 75 label 75 set home 74 set up 36 aorta Ao 121 aortic valve area AVA 130 archive patient list 72 area circumference measurement 81 arrow 75 ascending aorta AAo 121 assistance customer 4 bar code scanner 78 baseline 67 battery clean 192 install 12 remove 12 safety 228 specifications 221 222 storage and shipping 221 biological safety 230 biopsy 58 b mode See 2D imaging bodymarker See pictograph brightness 58 brightness mode See 2D imaging C cable clean and disinfect transducer cables 190 specifications 221 calcs menu 19 cal
110. 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 278 Chapter 9 Safety Table 41 Transducer Model TEE 8 3 Operating Mode CW TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a 1 1 2 3 b Pr3 MPa Wo mW 55 67 54 47 2 min of W 3 zi lzA 3 Z1 Jl mW 5 Zz cm E Zpp cm EX SS Z cm 1 1 a 9 deq 2sp cm 0 39 lt fe MH 4 00 4 00 Dim of Aaprt X cm 0 435 0 435 Y cm 0 9 0 9 PD usec 5 PRF H z pr Pll max MP deq Pllmax cm 0 34 Focal Length FL cm 4 45 fo on 8 FLy cm 4 75 Ipa 3 MImax W cm D_2 Control 1 Exam Type Card Card a S Control 4 Sample Volume Position Jog Zone 3 Zone 2 Qu 6 O oO a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety 279 Ayayes Table 42 Transducer Model TE
111. ave form Press the Caliper or Select key A second caliper is displayed on the screen Use the Touchpad to position the second caliper at the end diastole on the wave form If desired press the Save key to save the image with the measurements displayed To save the highlighted measurement to a calculation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Chapter 4 Measurements and Calculations Trace Measurements Manual On a frozen Doppler spectral trace press the Caliper key Trace Select Manual from the on screen menu A single caliper is displayed on the screen Use the Touchpad to position the caliper at the beginning of the desired wave form and press the Select key If calipers are not placed in the correct position the calculation is not performed accurately Use the Touchpad to move the caliper to trace the wave form If an error is made do one of the following to remove the caliper points e Use the Touchpad to backtrack caliper over caliper points Press Backspace key Select Undo from the on screen menu Select Set from the on screen menu to complete the trace and display the results Press the Save key to save an image of the trace with the results displayed To save the highlighted measurement to a calculation press the Calcs key select the appropriate measureme
112. ayed 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 210 Chapter 7 References Estimated Fetal Weight EFW Hadlock F et al Estimation of Fetal Weight with the Use of Head Body and Femur Measurements A Prospective Study American Journal of Obstetrics and Gynecology 151 3 February 1 1985 333 337 Hansmann M et al Ultrasound Diagnosis in Obstetrics and Gynecology New York Springer Verlag 1986 154 Osaka University Ultrasound in Obstetrics and Gynecology July 20 1990 103 105 Shepard M J V A Richards R L Berkowitz et al An Evaluation of Two Equations for Predicting Fetal Weight by Ultrasound American Journal of Obstetrics and Gynecology 142 1 January 1 1982 47 54 University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 880 Equation 1 Gestational Age GA by Last Menstrual Period LMP The gestational age derived from the LMP date entered on the patient information form Results are displayed in weeks and days and is calculated as follows GA LMP System date LMP date Gestational Age GA by Last Menstrual Period LMPd Derived from Established Due Da
113. based on the type of patient exam type patient history ease or difficulty of obtaining diagnostically useful information and potential localized heating of the patient due to transducer surface temperature The system has been designed to ensure that temperature at the face of the transducer will 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 242 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 Chapter 9 Safety 235 Ayayes 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
114. ble data entries are correct The system does not confirm the accuracy of the custom table data entered by the user References for measurements and calculations are in Chapter 7 References The following table shows the transducers and exam types that provide OB calculations Table 8 Transducers and Exam Type Transducer Exam Type C60e OB ICT OB P17 OB The following terms describe the measurements and calculations performed by the system Table 9 OB Calculation Terms Acronym Definition AUA The AUA Average Ultrasound Age is calculated by averaging the individual ultrasound ages for the fetal biometry measurements performed during the exam The measurements used to determine the AUA are based on the selected OB calculation authors EDD by AUA The EDD by AUA Estimated Date of Delivery by Average Ultrasound Age is the estimated date of delivery calculated from the measurements performed during the exam 100 Chapter 4 Measurements and Calculations Table 9 OB Calculation Terms Continued Acronym Definition EDD by LMP The EDD by LMP Estimated Date of Delivery by Last Menstrual Period is the due date calculated from the user entered LMP EFW The EFW Estimated Fetal Weight is calculated from the measurements performed during the exam The measurements used to determine EFW are defined by the currently selected EFW calculation author Estab DD The Estab DD Established Due Date is a user entered due date bas
115. bles and measurements are imported the system restarts All user defined tables and measurements currently on the system are replaced with imported data 6 Select Done from the on screen menu to return to live imaging Ui U0 PK Tables Select Tables from the on screen menu to display system OB tables or to create custom OB tables See OB Custom Tables on page 43 Reset Select Reset from the on screen menu to return settings for this setup page to factory default Chapter 2 Getting Started 41 pees bunya OB Custom Measurements Name Type Exam New J Delete Last j 4 character max Save Cancel EN 7 NM Figure 19 Setup OB Custom Measurements OB Custom Measurements Press the Setup key Select OB Custom Meas Select New In the Name field enter a unique name In the Type list select the desired measurement type Select Save The new measurement is displayed in the calculations menu and the OB report Upto five custom measurements may be saved OU UNS Delete OB Custom 1 Press the Setup key Measurement 2 Select OB Custom Meas 3 Inthe Custom Measurements list highlight the last measurement Select Delete Last 5 Select Yes to delete the measurement or No to cancel If associated tables and report data exist for the measurement they are removed from the system Tables Select Tables from the on screen menu to display system OB tables or to create Ges
116. cannot be changed by the user Chapter 2 Getting Started 47 peueis 6Bunyo5 Network Status Figure 23 Setup Network Status Network Status 1 Press the Setup key 2 Select Network Status 48 Chapter 2 Getting Started Chapter 3 Imaging Patient Information The patient information form allows information to be entered into the system for the patient exam Information which can be entered includes patient demographics exam information and clinical information This information is automatically placed on the last page of the patient report Once a patient is entered all saved images are linked to that patient To end the exam a New Patient can be created or End Exam can be selected Patient information can be edited during the exam by pressing the Patient key However if the patient name ID or Accession changes a new patient is created ed 2005Apr22 14 01 Pd 2005Apr22 14 02 Patient Exam Previous Exam Data Last me o Jj Exam Date f amp LMP Estab DO YYYY MM DD BPD HC AC FL MHC AC EFWig ma TT a 9 very o 0o I II E ZMENE M j Ascension Previous Exams Dats of btn U If a www mu oo SIT I IL L1 4 Gender z Measurement units cm Indications Symbols More Figure 1 Patient Information Form New Patient E 1 Press the Patient key 2 Select New from the on screen menu This clears the existing patient information
117. ces 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 b Delta Pressure Delta Time dP dT in mmHg s Otto C M Textbook of Clinical Echocardiography 2nd ed W B Saunders Company 2000 117 118 32 mmHg time interval in seconds E A Ratio in cm sec E A velocity E velocity A E Ea Ratio Reynolds Terry The Echocardiographer s Pocket Reference 2nd ed School of Cardiac Ultrasound Arizona Heart Institute 2000 225 E Velocity Ea velocity where E velocity Mitral Valve E velocity Ea annular E velocity also known as E prime Effective Regurgitant Orifice ERO in 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 where r radius Va aliasing velocity Ejection Fraction EF percent Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 40 EF LVEDV LVESV LVEDV 100 where EF Ejection Fraction LVEDV Left Ventricular End Diastolic Volume LVESV Left Ventricular End Systolic
118. ch WARNING To avoid contamination do not use the footswitch in a sterile environment The footswitch is not sterilized Connect Footswitch Connect cables Y adapter cable to the ECG connector on the mini dock or docking system Footswitch cable to Y adapter cable Select the desired functionality for the left and right footswitches See Footswitch on page 46 Chapter 3 Imaging 77 Bar Code Scanner Connect Bar Code 1 Ensure that the mini dock is connected to the system Scanner 2 Connect cables Bar code scanner interface cable to bar code scanner adapter Bar code scanner adapter to mini dock Power supply cable to bar code scanner interface cable Power cord to bar code scanner power supply Power cord to power strip Connect system power cord to a hospital grade electrical outlet 3 Select Bar Code Scanner for serial port connectivity See Serial Port on page 33 Needle Guidance Note The biopsy and needle guide features depend on transducer type The ultrasound system is equipped with a needle guidance feature For detailed instructions on the use of the system needle guidance accessories and a list of compatible transducers see the user guides for Biopsy and L25 Bracket and Needle 78 Chapter 3 Imaging Chapter 4 Measurements and Calculations Measurements Measurements and calculations are performed on frozen images The following sections explain how to perform basic measurements in
119. ck or docking system To avoid infection always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection if a pre mixed disinfection solution is used observe the solution expiration date and ensure that the date has not passed To avoid infection the level of disinfection required for a product is dictated by the type of tissue it contacts during use Ensure the solution strength and duration of contact are appropriate for the equipment For information see the disinfectant label instructions and the recommendations of the Association for Professionals in Infection Control and Epidemiology APIC and FDA Caution Do not spray cleaners or disinfectant directly on the system surfaces Doing so may cause solution to leak into the system damaging the system and voiding the warranty Do not use strong solvents such as thinner or benzene or abrasive cleansers since these will damage the exterior surfaces Use only recommended cleaners or disinfectants on system surfaces Immersion type disinfectants are not tested for use on system surfaces When you clean the system ensure the solution does not get inside the system keys or the battery compartment Do not scratch the LCD screen Clean LCD Dampen a clean non abrasive cotton cloth with an ammonia based window Screen cleaner and wipe the screen clean It is recommended to apply the cleaning solution to the cloth rather than th
120. ck regarding the system and the user guide Please call SonoSite at 1 888 482 9449 If you are outside the USA call the nearest SonoSite representative You can also e mail SonoSite at comments sonosite com 4 Chapter 1 Introduction Contact Information For SonoSite technical support contact us at the following numbers or addresses Technical Support USA Canada Technical Support fax Technical Support e mail SonoSite website International Technical Support Europe Service Center 1 877 657 8118 1 425 951 6700 service sonosite com www sonosite com and select Support Contact your local representative or call USA 1 425 951 1330 44 0 1462 444 800 e mail uk service sonosite com Chapter 1 Introduction uon npoanu About the System The ultrasound system is a portable software controlled ultrasound system using all digital architecture The system has multiple configurations and feature sets used to acquire and display high resolution real time ultrasound images All are described in this user guide but not every option may apply to your system Features are dependent on system configuration transducer and exam type Figure 1 System Front View Table 1 System Front Features Number Feature 1 Control panel 2 Handle 3 Display 4 CompactFlash slots front for image storage back for system and transducer updates import export OB tables custom annotations and user names passwords and Di
121. ckness 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 96 Area Reduction 1 A2 cm2 A1 cm 100 where A1 original area of the vessel in square cm A2 reduced area of the vessel in square cm 216 Chapter 7 References 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
122. creen menu low med high Steering c Note This menu option is available only on select transducers Select the desired steering angle setting from the on screen menu This automatically changes pulsed wave PW Doppler angle correction to the optimum setting Steering angle of 15 degrees has an angle correction of 60 degrees Steering angle of 0 degrees has an angle correction of 0 degrees Steering angle of 15 degrees has an angle correction of 60 degrees If two modes are active CPD Color and PW CW Doppler press the Select key to toggle between the on screen menus Variance g Note This menu option is available only for cardiac exams Select Variance from the on screen menu to turn on Invert pe m Select Invert from the on screen menu to switch the displayed direction of flow Invert is only displayed when Color is selected Gain Turn the Gain knob on the lower left side of the control panel to increase or decrease the amount of color gain applied to the CPD or Color ROI box While in CPD or Color imaging Near and Far knobs affect only the 2D image 2D Imaging Chapter 3 Imaging Press the 2D or Color key to return to 2D imaging If two modes are active CPD Color and PW Doppler press the Select key to toggle between on screen menus Pulsed Wave PW and Continuous Wave CW Doppler Imaging Note PW Doppler and CW Doppler are optional features and depend on transducer and
123. cters are available in fields and forms Symbols special characters can be entered in selected fields and forms Patient Information Last First Middle ID Accession Indications Procedure ID User Reading Dr Referring Dr and Institution Connectivity DICOM and SiteLink Configure Alias AE Title Delta Key Annotations Text Text mode Imaging Annotation field Figure 6 Symbols Special Characters Enter Symbol 1 Selectthe desired field and then select Symbols Special 2 Click the desired symbol character Character In the Symbols dialog box the keyboard controls may also be used 3 Click OK Forms A floating cursor is available in the setup patient and report forms The floating cursor allows interaction through the touchpad and the Select key For example in the patient form placing the floating cursor over the last name field and pressing the Select key activates that field Additionally the floating cursor can be used to interact with the list and check boxes Chapter 2 Getting Started 23 peus 6unyo5 System Setup System setup is used to customize the system Press the Setup key to access and set up the following system functions Administration Audio Battery Cardiac Calculations Connectivity Date and Time Delta Key Annotations Display Information IMT calculations OB Calculations OB Custom Measurements Presets System Information Network Status Chapter
124. cters from the following categories Upper case characters A Z e Lower case characters a z Numbers 0 9 The password is case sensitive Chapter 2 Getting Started Audio and Battery d 20060ct19 13 06 Setup Pages Key click On Beep alert On Battery and Power Steep delay min 10 Power detay min 30 MZ WEM Figure 11 Setup Audio Battery Key Click 1 Press the Setup key 2 Select Audio Battery 3 In the Key click list select On or Off Beep Alert 1 Press the Setup key 2 Select Audio Battery 3 Inthe Beep alert list select On or Off Sleep Delay 1 Press the Setup key 2 Select Audio Battery 3 Inthe Sleep delay list select Off 5 or 10 minutes Power Delay 1 Press the Setup key 2 Select Audio Battery 3 In the Power delay list select Off 15 or 30 minutes Reset Select Reset from the on screen menu to return settings for this setup page to factory default Chapter 2 Getting Started 31 peueis 6Bunjo5 Cardiac Calculations Setup Pages Cardiac Calculations TOI Walls wat SDE Wali 2 Lateral Lat Wall 3 inferior Inf E Wall4 Anterior Ant Figure 12 Setup Cardiac Calculations Set Cardiac Calculations 1 Press the Setup key Select Cardiac Calculations In the TDI Walls lists select the desired labels for each of the walls The labels selected are displayed in the TDI calculation menu and on the report 4 Select
125. culations authors 102 cardiac 117 delete measurement 89 gyn 96 IMT 110 OB 100 OB Doppler 107 percent reduction 90 perform measurements 89 small parts 96 vascular 108 view or repeat measurements 89 volume 93 volume flow 94 caliper calcs 17 cardiac calculations 2D and M Mode 118 AAo 121 Ao 121 AVA 130 CI 133 CO 133 Index 299 xepu 300 Doppler 124 126 dP dT 130 E A and VMax 126 e anda 126 HR 133 IVRT 124 LA 121 LV mass 123 LV volume Simpson s Rule 122 LVd 121 LVOT D 121 LVs 121 MV AV area 122 PHT 128 PISA 119 Qp Qs 119 RVSP 127 SI 132 SV 132 TDI 134 TRmax 126 VTI 127 cardiac index CI 133 cardiac output CO 133 cardiac references 204 cardiac intended uses 1 cautions definition 225 CF capacity alert 34 cine buffer 60 cleaning battery 192 ECG cable 192 footswitch 192 LCD screen 187 system 187 transducer cables 190 transducers 188 clip acquisition delay 69 delete 69 preview 68 review 72 save 68 setup 68 storage 70 trim 69 color Doppler imaging 63 color power Doppler imaging See color Doppler imaging color suppress 63 Index CompactFlash capacity alert 34 install 12 remove 13 configuration archivers 154 DICOM 147 import and export 165 network log 166 printers 157 procedure 164 SiteLink 141 worklist servers 161 continuous wave Doppler CW D line 65 spectral trace 67 controls direct 236 indirect 236 menu 21 receiver 236 CW D
126. d Principles and Instruments 7th ed W B Saunders Company Oct 17 2005 Chapter 9 Safety Guidelines for Reducing MI and TI The following are general guidelines for 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 Tl Changes to other parameters may also result in MI and Tl reductions Please note the MI or Tl read out on the right side of the LCD screen means to decrease or lower setting of parameter to reduce MI or TI T means to raise or increase setting of parameter to reduce MI or TI The D2 2 transducer has a static continuous wave CW output This output is fixed thus TI and MI values cannot be changed by any of the system controls available to the user Table 3 MI Transducer Depth Clle T C60e HFL38 ICT LAP L25e L38e P10 P17 SLA SLT el gt gt gt e gt gt gt gt gt gt TEE Chapter 9 Safety 237 Ayayes 238 Table 4 TI TIS TIC TIB Color Power Doppler Settings PW Settings Transducer Wade tid PRE Depth Ms Clle T l 1 Depth C60e 4 T 4 V PRF HFL38 T T 4 Depth ICT T i Exam V PRF Gyn LAP V Depth L25e Y V PRF L38e 4 1 Depth P10 T i 4 PRF P17 1 T 4 PRF SLA A 4 T V PRF SLT 4 T 4 PRF TEE i i Gen Y Depth Color High Chapter 9 Safety Output Display The system meets the
127. d the trim and delete features are not available Select Pro from the on screen menu to acquire clips prospectively or select Retro to acquire clips retrospectively e If Pro is selected a clip is acquired after the Save Clip key is pressed e If Retro is selected a clip is acquired from pre saved data before the Save Clip key is pressed Save Clip 68 Chapter 3 Imaging 1 Select Clips from the on screen menu 2 Select clip settings as desired To trim a clip Prev On must be selected at this point 3 Press the Save Clip key The clip is saved to CompactFlash card or plays back depending on the preview setting selected Trim Clip Frames from the left and right ends of the clip can be removed 1 Select Clips from the on screen menu 2 Select PrevOn from the on screen menu 3 Press the Save Clip key The clip is taken when a beep sounds and the clip is displayed in preview mode 4 Select Left x from the on screen menu to remove frames from the left side of the clip The number displayed represents the beginning frame number 5 Select Right x from the on screen menu to remove frames from the right side of the clip The number displayed represents the ending frame number 6 Select Save from the on screen menu Delete Clip Select Delete from the on screen menu to delete a clip before saving to Clip Acquisition Delay Patient List Delay Note This menu option is displayed within the ECG on screen menu and
128. dditional measurement edits 9 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report Chapter 4 Measurements and Calculations 113 suone n je pue sjuauleansea y Transcranial Doppler Calculations TCD WARNING To avoid injury to the patient use only an orbital exam type Orb when performing imaging through the eye Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 The following table shows the transducer and exam type that provides TCD calculations Table 16 Transducer and Exam Types for Transcranial Doppler Transducer Exam Types P17 Transcranial TCD Orbital Orb The following table shows the measurements required to complete the TCD calculation For definitions of acronyms see Glossary on page 287 Table 17 Transcranial Calculations in Doppler Anatomy Condition Measurement Calculation Result TT Right and Left MCA TAP Prox PSV Mid EDV Dist PI Bifur RI ACA S D ACoA Gate Size TICA PCAp1 PCAp2 PCoA TO Opthalmic Artery OA TAP Siphon PSV EDV Pl RI S D Gate Size Chapter 4 Measurements and Calculations Table 17 Transcranial Calculations in Doppler Continued Anatomy Condition Measurement Calculation Result SM Extracranial Internal Carotid Artery ECICA FM Righ
129. description 17 pan 60 turn on off 60 Index 305 x pul 306 Index MicroMaxx Quick Start Cards On off Turn system on off Text Turn keyboard on off for text entry Control Panel Picto Turn pictograph on off THI Turn Tissue Harmonic Imaging on off Depth Increase decrease imaging depth Near Far Gain Adjust near far gain adjust overall gain Zoom Magnify image 2X Freeze Cine Stop live imaging review images in cine buffer a Li Ags ga N O WAN DAU KRWN l o 2 a B Caps 6 Shift t Ez Eg c Ga EB N m ES A O Calcs Turn calculation menu on off Caliper Activate measurement caliper 1 ru 1 Mil Bg z jr OND Uii UN o O 12 13 14 15 16 17 18 19 20 21 Select Select Calcs menu and select place measurement caliper On screen menu controls Access controls for each system state Forms Access system setup patient report saved images and patient exam information Delta key Shortcut to programmable functionality Record Turn DVD VCR on off Save Clip Save clip to CompactFlash card Update Toggle between dual duplex screens and M Mode Doppler image modes CompactFlash slots Use slots for CompactFlash cards to store images and update system transducers Imaging modes Access M Mode Doppler Color and 2D Save Save image to CompactFlash card Print Print
130. 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 241 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 MI value or 0 2 of the displayed value whichever value is larger The accuracy result for the thermal index TI 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 Tl means that the calculated estimate for the index is less than 0 05 Factors that Contribute to Display Uncertainty The n
131. distance z milliwatts per square centimeter Zi Axial distance corresponding to the location of maximum min W 3 z lz 3 z x 1 cm where z gt zbp in centimeters bp 1 69 Aaprr in centimeters Chapter 9 Safety 245 Ayayes Table 8 Acoustic Output Terms and Definitions Continued Term Definition Zsp For MI it is the axial distance at which p 3 is measured For TIB it is the axial distance at which TIB is a global maximum for example Zsp Zp3 in centimeters deq z Equivalent beam diameter as a function of axial distance z and is equal to A 4 x Wo ITA Z where lz z is the temporal average intensity as a function of z in centimeters fc Center frequency in MHz Dim of Aaprt Active aperture dimensions for the azimuthal x and elevational y planes in centimeters PD Pulse duration microseconds associated with the transmit pattern giving rise to the reported value of MI PRF Pulse repetition frequency associated with the transmit pattern giving rise to the reported value of MI in Hertz P Pll wax 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 Output Tables
132. dures Select Delete Select Done from the on screen menu Importing and Exporting Configurations All configuration data for the locations except IP addresses and AE titles archivers printers and worklists can be imported and exported This allows you to share configuration data between systems The import and export functions are accessed on any DICOM configuration page Export Configuration Data Complete all pages of the configuration for one system Insert a blank CompactFlash card in the back slot See Installing or Removing CompactFlash Card on page 12 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu Select Export from the on screen menu All configuration data for the locations archivers printers and worklists except system location IP addresses are copied to the CompactFlash card Remove the CompactFlash card Import Configuration Data Insert the CompactFlash card in the back slot of the system See Installing or Removing CompactFlash Card on page 12 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu Select Import from the on screen menu After all files are imported the system restarts All configurations currently on the system are replaced with imported data Manually enter the IP addresses and AE titles for locations on the receiving system Complete all configuration inf
133. e Ultrasound Interval sec 45 Clips JPEG Send images only 2 2 Next New Delete Cancel Save Import Export Done Figure 8 Archivers Configuration Page2 Images Defines how images are sent to the archiver selections include RGB uncompressed Mono uncompressed and JPEG Image Type List of archiver image types based on capture mode Clips Defines how clips are sent to the archiver selections include RGB uncompressed Mono uncompressed and JPEG Attempts Number of times the system tries to resend a failed transfer Interval Amount of time between attempts Send Images Only Limits transfer to images only clips are not sent available only when Image Type is set to Ultrasound Chapter 5 Connectivity and Configuration 155 A apuu 156 Configure New 1 Archiver Ann AUN Ensure the system is set up for DICOM connectivity See System Configuration for DICOM on page 147 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu In the Configure list select Archivers Select New Enter information in the fields pages 1 and 2 Name Cannot contain special characters Alias and AE Title May contain special characters IP Address and Port Must be entered before the information is saved To use special characters select Symbols See Enter Symbol Special Character on page 23 Use the spacebar on the keyboard
134. e a a 1 7 Pr3 Wo 110 43 B min of W 3 Z4 lzA 374 5 Z Z ge E k Zsp a o 2 deqlZsp lt fe 2 09 Dim of Aaprt lt zm 0 5294 1 3 PD 5 PRF E Pr Pll max amp deg Pllmax Focal Length 1 55 9 lt 5 7 0 Ip 3 MI max o 2 Control 1 Exam Type OB s Control 2 Optimization Any gS 8 Control 3 Depth 4 7 O Control 4 THI On a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety 265 Ayayes Table 28 Transducer Model P17 5 1 Operating Mode M Mode Index Label Global Maximum Index Value M TIS TIB Scan Non scan TIC Aaprt lt 1 aprt a Non scan Aaprt gt 1 min of W 3 z4 JlrA 321 Z1 Zbp Zsp deqlZsp Associated Acoustic Parameter fe Dim of Aaprt He FE FE HE Gt PD PRF pr Pll max deq Pllmax Focal Length Other Information Ipa 3 Mlmax Control 1 Exam Type Control 2 Optimization Operating Control Conditions Control 3
135. e 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 Chapter 7 References 215 se uaJoJay General References x or S D Ratio x abs Velocity A Velocity B where A velocity cursor B velocity cursor x Acceleration Index ACC Zwiebel W J Introduction to Vascular Ultrasonography 4th ed W B Saunders Company 2000 52 ACC abs delta velocity delta time Elapsed Time ET ET time between velocity cursors in milliseconds Hip Angle d D Ratio Graf R Fundamentals of Sonographic Diagnosis of Infant Hip Dysplasia Journal of Pediatric Orthopedics Vol 4 No 6 735 740 1984 Morin C Harcke H MacEwen G The Infant Hip Real Time US Assessment of Acetabular Development Radiology 177 673 677 December 1985 Intima Media Thi
136. e output display standard acoustic power and intensity tables and other safety information A WARNING describes precautions necessary to prevent injury or loss of life A Caution describes precautions necessary to protect the products Ergonomic Safety WARNING To prevent musculoskeletal disorders follow the Healthy Scanning Guidelines on page 9 Electrical Safety Classification Class equipment Class Il equipment Type BF applied parts Type CF applied parts IPX 7 watertight equipment IPX 8 watertight equipment Non AP APG Ultrasound system powered from power supply or part of the Mobile Docking System Ultrasound system not connected to the power supply battery only Ultrasound transducers ECG module ECG leads Ultrasound transducers Footswitch Ultrasound system power supply Mobile Docking System and peripherals Equipment is not suitable for use in the presence of flammable anaesthetics Chapter 9 Safety 225 Ayayes Electrical Safety This system meets EN60601 1 Class l internally powered equipment requirements and Type BF isolated patient applied parts safety requirements This system complies with the applicable medical equipment requirements published in the Canadian Standards Association CSA European Norm Harmonized Standards and Underwriters Laboratories UL safety standards See Chapter 8 Specifications For maximum safety observe the following warnings and cautions
137. e sensitive 3 In Sonographer enter the user s initials to display the information in the patient header and the sonographer field in the Patient Information form Optional 4 InAdministration Access click the check box to allow users access to all administration privileges or leave unchecked to restrict access Optional 5 Select Save Modify User Information 1 In the User List select desired user name 2 Enter the new name 3 Enter the new password and confirm 4 Select Save Any change to the user name replaces the old name Delete User 1 Inthe User List select the desired user name 2 Select Delete A dialog box is displayed 3 Select Yes to delete or No to cancel Chapter 2 Getting Started 27 peueis 6Bunjo5 Export or Import User Accounts 28 Change User Password 1 Inthe User List select the desired user name 2 Enterthe new password and confirm 3 Select Save Done Select Done from the on screen menu to return to live imaging Note Export and import are used to configure multiple systems and to back up user account information Export User Account 1 Insert the CompactFlash card in the back slot of the system See Installing or Removing CompactFlash Card on page 12 2 Pressthe Setup key 3 Select Administration 4 Select Export from the on screen menu All user names and passwords are copied to the CompactFlash card 5 Remove the CompactFlash card Import User Account
138. e surface of the screen Chapter 6 Troubleshooting and Maintenance 187 Bunoouse qnoJ Clean and Disinfect System Surfaces 1 Turn off the system 2 Disconnect the system from the power supply or remove 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 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 188 To disinfect the transducer 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 3 Disinfectants Compatible with System and Transducers on page 193 WARNING Caution To avoid electrical shock before cleaning disconnect the transducer from the system To avoid injury always use protective eyewear and gloves when performing cleaning and disinfecting procedures To avoid infection if a pre mixed disinfection solution is used observe the solution expiration date and ensure that the date has not passed To avoid infection the level o
139. e system prompts you for a license key If you have not yet obtained a valid license key you can elect to use the software as long as the grace period time has not been fully consumed When a system is running in the grace period all system functions are available As you use the system the grace period is slowly consumed When the grace period has expired the system will not be usable until a valid license key has been entered Grace period time is not consumed while the system is powered off or when it is in sleep mode Whenever a system is running in the grace period the grace period time remaining is available on the license update screen Caution When the grace period expires all system functions except for licensing are unavailable until a valid license key is entered into the system Upgrading the System and Transducer Software As described in the About the System Software on page 8 software upgrades are provided on CompactFlash cards which are installed in the back CompactFlash slot on the right hand side of the system Upgrades provided may be required or optional Whenever you install a CompactFlash card containing a newer version of software into the system the system will determine the level of software prepare the system for the upgrade and then install the new software onto the system When a CompactFlash card contains new transducer software and the transducer that requires a software upgrade is connected the system p
140. e with the measurements displayed Doppler measurement from aorta 1 Onafrozen Doppler spectral trace press the Calcs key 2 Fromthe calculations menu select AV then select VTI See Velocity Time Integral VTI on page 127 3 Perform the measurement Select Set from the on screen menu 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed For information on using the automatic trace tool see Automatic Trace on page 87 Stroke Index SI Note This calculation requires a measurement taken in 2D and a measurement taken in Doppler It also requires the inclusion of the Body Surface Area BSA After the measurements are completed and saved the result is displayed in the patient report 1 Complete patient height and weight on the Patient Information page The BSA is calculated automatically 2 Perform the calculation for Stroke Volume SV See Stroke Volume SV on page 132 Chapter 4 Measurements and Calculations Heart Rate HR Note Heart Rate is available in all cardiac packages The Heart Rate is not calculated using the ECG trace 1 Ona frozen Doppler spectral trace press the Calcs key 2 From the calculations menu select HR A vertical caliper is d
141. eaning methods listed are recommended by SonoSite for compatibility with product materials not for biological effectiveness Refer to the disinfectant label instructions for guidance on disinfection efficacy and appropriate clinical uses The level of disinfection required for a device is dictated by the type of tissue it will contact during use To avoid infection ensure the disinfectant type is appropriate for the equipment For information see the disinfectant label instructions and the recommendations of the Association for Professionals in Infection Control and Epidemiology APIC and 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 Chapter 6 Troubleshooting and Maintenance 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 Cleaning and Disinfecting Ultrasound System The exterior surface of the ultrasound system and the accessories can be cleaned and disinfected using a recommended cleaner or disinfectant WARNING To avoid electrical shock before cleaning disconnect the system from the power supply or remove from the mini do
142. easurement Calculation Result Qp Qs TDI E A VMax and TRmax e and a 1 2 LVOT Din 2D D RVOT D in 2D VTI LVOT VTI VMax RVOT VTI SV Qp Os Wall e and a Vmax Wall e and a E e ratio Wall e and a Wall e and a On a frozen Doppler spectral trace press the Calcs key From the calculations menu select MV TV or TDI then select the desired measurement Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report For each cardiac measurement the system stores up to five individual measurements and their average If more than five measurements are made the most recently taken measurement replaces the fifth one If a saved measurement is deleted from the report the next measurement taken replaces the deleted one in the report The most recently saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Select the next measurement Repeat these steps until all measurements have been performed Select Save from the on screen menu to save the measurement to the patient report Chapter 4 Measurements and Calculations Velocity Time Integral VTI Note This calculation computes other result in addition to VTI s See Table 21 1 Onafrozen Doppler spectral trace press the Calcs key
143. echnical Support at the following numbers or addresses Technical Support International technical support Technical Support fax Technical Support e mail SonoSite website Table 1 Troubleshooting Symptom 1 877 657 8118 Contact your local representative or call 425 951 1330 1 425 951 6700 service sonosite com www sonosite com and select Support amp Service Solution System will not power on System image quality is poor No CPD image No Color image No OB measurement selections Check all power connections Perform the following sequence remove DC input connector and battery wait 10 seconds connect DC input or install battery press the power key Ensure the battery is charged Adjust the LCD screen to improve viewing angle Adjust the brightness as necessary to improve image quality Adjust the gain Adjust the gain Adjust the gain or the scale Select the OB exam type Chapter 6 Troubleshooting and Maintenance 175 Bunoouse qnoJ 176 Table 1 Troubleshooting Continued Symptom Solution Print does not work DVD VCR does not record External monitor does not work Unexpected labels using the function keys Inaccurate fetal age calculation System does not recognize the transducer Text cursor does not move when touchpad or arrows are selected A maintenance icon displays on the system screen Set the correct printer in system setup Check t
144. ecology 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 Chapter 7 References 213 so uaJoJay Growth Analysis Tables Abdominal Circumference AC Chitty Lyn S et al Charts of Fetal Size 3 Abdominal Measurements British Journal of Obstetrics and Gynaecology 101 February 1994 131 Appendix AC Derived Hadlock F et al Estimating Fetal Age Computer Assisted Analysis of Multiple Fetal Growth Parameters Radiology 152 1984 497 501 Jeanty P E Cousaert and F Cantraine Normal Growth of the Abdominal Perimeter American Journal of Perinatology 1 January 1984 129 135 Also published in Hansmann Hackeloer Staudach Wittman Ultrasound Diagnosis in Obstetrics and Gynecology Springer Verlag New York 1986 179 Table 7
145. ed 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 9 Safety Table 31 Transducer Model P17 5 1 Operating Mode CW TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 1 0 3 6 2 6 Pr3 Wo 120 60 121 23 B min of W 3 Z4 lzA 374 ua 5 2 ge sa I E Zsp 14 o deqlZsp 0 63 e F m me 2 00 2 00 2 00 Dim of Aaprt 0 85 0 85 0 85 1 3 1 3 1 3 PD 5 PRF E Pr Pll max Es deq Pllmax 50 Focal Length 9 lt 5 7 0 7 0 Ip 3 M max D_ Control 1 Exam Type Card Card Card E Control 2 Depth Any Any Any i C 5 o c Control 3 Zone Zones Qa amp 5 amp Zone 2 Zone 2 3 amp 4 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 9 Safety 269 Ayayes
146. ed 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 GA by LMP The GA Gestational Age by Last Menstrual Period is the fetal age calculated using the date of the Last Menstrual Period LMP GA by LMPd The GA Gestational Age by derived Last Menstrual Period is the fetal age calculated using the Last Menstrual Period LMPd derived from the Established Due Date LMP The LMP Last Menstrual Period is the first day of the Last Menstrual Period and is used to calculate gestational age and EDD LMPd The LMPd derived Last Menstrual Period is calculated from the user entered Established Due Date Estab DD UA The UA Ultrasound Age is calculated on the mean measurements taken for a particular fetal biometry Chapter 4 Measurements and Calculations 101 suone n je pue sjueulaJnseeIw 102 If you change the calculation author during the exam the common measurements are retained The following table shows the system defined measurements available for OB calculations by author For descriptions of the acronyms see Glossary on page 287 Table 10 System Defined OB Calculations and Table Authors Calculation Result Gestational OB Table Authors Measurements Gestational Age GS Hansmann See note 1 Nyberg Tokyo U CRL Hadlock Hansmann Osaka Tokyo U BPD Chitty Hadlock Hansmann Osaka Tokyo U OFD Hansmann HC
147. ee the SonoSite accessories user guide Electrostatic discharge ESD or static shock is a naturally occurring phenomenon ESD is common in conditions of low humidity which can be caused by heating or air conditioning Static shock is a discharge of the electrical energy from a charged body to a lesser or non charged body The degree of discharge can be significant enough to cause damage to a transducer or an ultrasound system The following precautions can help reduce ESD anti static spray on carpets anti static spray on linoleum and anti static mats Chapter 9 Safety 231 Ayayes Manufacturer s Declaration 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
148. eep state display off a completely discharged battery fully charges in 2 5 to 3 5 hours If the system is on and in the freeze state a completely discharged battery fully charges in 5 to 6 hours If the system is in the imaging state the battery is trickle charged at a very low rate and may take over 24 hours to charge To minimize recharging time turn off the system Chapter 2 Getting Started 13 pa1iejs buia The system can run on AC power and charge the battery in two ways Connected directly to the system Connected to a mini dock docking system See the Mini Dock User Guide MDS User Guide MDSe User Guide or MDS Lite User Guide WARNING The equipment shall be connected to a center tapped single phase supply circuit when users in the United States connect the equipment to a 240V supply system Caution Verify that the hospital supply voltage corresponds to the power supply voltage range See Electrical on page 222 Operate 1 Connect the DC power cable from the power supply to the connector on the System Using system See Figure 2 on page 7 AC power 2 Connect the AC power cord to the power supply and connect to a hospital grade electrical outlet Turning System On Off Caution Do not use the system if an error message appears on the display Note the error code and turn off the system Call SonoSite or your local representative Turn System 1 Locate the Power key on the top left side of the system
149. efore saving Chapter 3 Imaging 71 Print to Local Printer Ensure the printer is properly set up for operation with the system See Printer on page 33 for system setting and the applicable SonoSite accessory user guide for hardware setup Print Image Press the Print key Image and Clip Review The patient list displays all the patients who have images clips saved on the CompactFlash card Image clip review is comprised of two parts the patient list and the patient images The patient images display images clips for the current patient or the patient selected from the patient list Patient List v Archived Suspended Figure 8 Patient List Patient List Press the Review key If there is a current patient select List from the on screen menu The number of saved images and clips is displayed on the patient list Select All Select All from the on screen menu to highlight all the entries within Deselect the patient list Deselect removes the highlight from all the entries and highlights the previously selected patient Review is disabled when all entries in the list are selected Review Images Select Review from the on screen menu to review the images for the currently selected patient Archive Hal Note SiteLink and DICOM are optional features Select Archive from the on screen menu to send the selected patient exams to a PC using SiteLink or to a DICOM printer or archiver See Transfer Mode
150. elect the desired measurement Perform the measurement on the first follicle Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Select the next measurement Repeat these steps until all measurements are performed Chapter 4 Measurements and Calculations 99 suone n je pue sjueauloaJnseaIwy OB Calculations Note EFW is only calculated once appropriate measurements are completed If any one of these parameters results in a EDD greater than what the OB tables provide the EFW will not be displayed WARNING Make sure you have selected the OB exam type and the OB calcs author for the OB table you intend to use See Table 10 System Defined OB Calculations and Table Authors on page 102 In OB exams an accurate date and time are critical for accurate obstetrics calculations Verify that the date and time are accurate before each use of the system The system does not automatically adjust for daylight savings time changes Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 Prior to use verify OB custom ta
151. ent To perform the first trace move the caliper to the desired starting point and press the Select key to start the tracing function Use the Touchpad to trace the desired area If an error is made select Undo from the on screen menu to delete the previous position Complete the trace and select Set from the on screen menu Select Save from the on screen menu to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement Select the next measurement Perform the next trace Complete the trace and select Set from the on screen menu Select Save from the on screen menu to save the measurement to the patient report The percent area reduction result is displayed in the measurement and calculation data area and in the patient report Percent Diameter Reduction On a frozen 2D image press the Calcs key From the calculations menu select the desired measurement Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement Select the next measurement Perform the next measurement Select Save from the on screen menu to save the measurement to the patient report The percent diameter reduction result is displayed i
152. ent report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Repeat these steps until all measurements have been performed Chapter 4 Measurements and Calculations 93 suone n je pue sjueuloaJnseaIwy Volume Flow Calculation 94 WARNING Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 The following table shows the transducers and exam types that provide a volume flow calculation Table 4 Transducers and Exam Types for Volume Flow Transducer Exam Types Gate Sizes mm Clle Abdomen 1 2 3 C60e Abdomen 2 3 5 7 10 12 HFL38 Vascular 1 3 5 7 10 12 L25e Vascular 1 3 5 7 10 12 L38e Vascular 1 3 5 7 10 12 P17 Abdomen 2 3 5 7 10 12 P10 Vascular Abdomen 2 3 5 7 10 12 SLA Vascular 1 3 5 7 10 12 SLT Hepatic Abdomen 1 2 3 5 7 10 For definitions of acronyms see Glossary on page 287 Table 5 Volume Flow Calculation Measurement Calculation Result D 2D distance VF Volume Flow TAM Doppler auto trace Volume flow measurements are done in 2D and Doppler Both measurements are required for the volume flow calculation The Doppler sample volume should completel
153. entions 4 Symbols and Terms 4 Upgrades and User Guide Updates 4 Customer Comments 4 Contact Information 5 About the System 6 About the System Software 8 Getting Started 9 Healthy Scanning Guidelines 9 System Preparation 11 Installing or Removing Battery 11 Installing or Removing CompactFlash Card 12 Using AC Power Charging Battery 13 Turning System On Off 14 Connecting or Removing Transducer 15 System Controls 16 Screen Layout 19 General Interaction 20 Touchpad 20 On Screen Menus 21 Menu Controls 21 Annotation and Text 22 Forms 23 System Setup 24 Set Security Settings 25 Audio and Battery 31 Cardiac Calculations 32 Connectivity 33 Date and Time 35 Delta Key and Annotation 36 Display Information 38 IMT Calculations 39 OB Calculations Authors 40 OB Custom Measurements 42 OB Custom Tables 43 Presets 45 System Information 47 Network Status 48 Imaging 49 Patient Information 49 Transducer Exam Type and Imaging Mode 52 Transducer Preparation 55 General Use 56 Invasive or Surgical Use 56 Modes 57 2D Imaging 57 M Mode Imaging 61 Color Doppler Imaging 63 Pulsed Wave PW and Continuous Wave CW Doppler Imaging 65 Clips 68 Clip Acquisition Delay 69 Image and Clip Storage 70 Save to CompactFlash 70 Print to Local Printer 72 Image and Clip Review 72 Patient List 72 Patient Images and Clips 73 Annotations 74 ECG Monitoring 76 Footswitch 77 Bar Code Scanner 78 Needle Guidance 78 Measurements and Calculations 79
154. erence Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety Table 21 Transducer Model L38e 10 5 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 0 1 9 2 6 b Pr3 MPa 2 169 Wo mW 80 347 80 347 Y min of W 3 z4 lz 3 z4 mW o z 5 k cm 0 9 1 2 Sg sP 3 daz cm 0 4518 4i R MHZ 5 02 5 05 5 05 Dim of Aaprt X cm 1 86 1 86 Y cm 0 4 0 4 PD usec 1 27 S PRF H2 1562 5 E D Pllmax MPa 2 537 S deqGPllia cm 0 29 Focal Length FL cm 5 54 amp FLy cm 2 5 lpa 3 MImax W cm 201 36 Control 1 Exam Type Bre SmP Bre SmP Bre SmP o 2 Vas IMT Vas IMT Vas IMT E g Control 2 Sample Volume 1mm 3mm 3mm e S Control 3 PRF 1563 26250 26250 O O Control 4 Sample Volume Position Zone 0 Zone 7 Zone 7 top bottom bottom a This index is not required for this operating mode value is 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety
155. ers and Exam Type Transducer Exam Type HFL38 Small Parts L38e Small Parts Hip Angle 1 Onafrozen 2D image press the Calcs key 2 From the calculations menu select Right or Left 3 Select Baseline A baseline is displayed on the screen 4 Position the baseline and select Set from the on screen menu Line A alpha line is displayed on the screen 5 Position Line A and select Save from the on screen menu to save the measurement to the patient report Line B beta line is highlighted and active 6 Position Line B and select Save from the on screen menu to save the measurement to the patient report 7 If desired press the Save key to save the image with the measurements displayed d D Ratio On a frozen 2D image press the Calcs key From the calculations menu select Right or Left Under d D Ratio select Fem Hd femoral head Use the Touchpad to position the circle and press the Select key to change the circle size 5 Select Set from the on screen menu The baseline is automatically displayed with the left caliper active 6 Position the caliper and select Save from the on screen menu to save the measurement to the patient report 7 If desired press the Save key to save the image with the measurements displayed A U N 96 Chapter 4 Measurements and Calculations Gyn Calculations WARNING Verify that the patient information date and time settings are accurate Before starting a new calculation start a
156. ess the Backspace key to delete the previous position 7 Select Set from the on screen menu to complete the first trace line 8 Repeat steps 4 5 and 6 for the lumen intima boundary 9 Select Set from the on screen menu to complete the second trace line and display results 10 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report IMT Tool Sketch Sketch mode locates the IMT measurement between two user defined sketch lines that can be adjusted manually 1 Select Edit from the on screen menu 2 Select Manual from the on screen menu A single caliper is displayed on the screen and Sketch shows on screen next to the selected calculation 3 Position the caliper at the beginning of the desired adventitia media boundary and press the Select key 4 Use the Touchpad to move the caliper to the next desired point 5 Continue marking points by pressing the Select key If an error is made select Undo from the on screen menu or press the Backspace key to delete the previous position 6 Select Set from the on screen menu to complete the first trace line 7 Repeatsteps 3 4 and 5 for the lumen intima boundary 8 Select Set from the on screen menu to complete the second trace line and display results If necessary adjust the measurement by selecting Width or Edit from the on screen menu If you select Edit you can select Smooth Lumen or Adventitia from the on screen menu to make a
157. essories Use the cleaning recommendations in the peripheral manufacturer s instructions when cleaning or disinfecting your peripherals For more information about cleaning or disinfection solutions or ultrasound gels used with the transducer contact SonoSite or your local representative For information about a specific product contact the product manufacturer There is no recommended periodic or preventive maintenance required for the system transducer or accessories other than cleaning and disinfecting the transducer after every use See Cleaning and Disinfecting Transducers on page 188 There are no internal adjustments or alignments that require periodic testing or calibration All maintenance requirements are described in this chapter and in the MicroMaxx Ultrasound System Service Manual Performing maintenance activities not described in the user guide or Service Manual may void the product warranty Contact SonoSite Technical Support for any maintenance questions Recommended Disinfectant See the Table 3 Disinfectants Compatible with System and Transducers on page 193 See the SonoSite website for updated cleaning and disinfectant information www sonosite com Safety 186 Please observe the following warnings and cautions when using cleaners disinfectants and gels More specific warnings and cautions are included in the product literature and in the procedures later in this chapter WARNING Disinfectants and cl
158. et 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 283 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 acoustic output that is representative of Chapter 9 Safety 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 va
159. etting Started 39 pexeis 6Bunyo5 OB Calculations Authors Gestational Age GS Nyberg APTO None CRL Hadiock AC Hadtock BPD Hadlock FTA None OFD None FL Hadiock HC Hadiock EFW Hadtock TTD None Growth Analysis BPD Hadlock EFW Hadiock HC Hadiock HC AC Campbell AC Hadiock FL Hadlock Figure 18 Setup OB Calculations Gestational Age 1 Press the Setup key Growth Analysis 2 Select OB Calculations In Gestational Age or Growth Analysis lists select the desired OB authors Selecting an author places the measurement on the calculation menu Selecting None removes the measurement from the calculation menu More Select More to display the list of user defined custom measurements and to associate a custom table for the custom measurement This option is only available when a user defined custom table has been created for the custom measurement Insert a blank CompactFlash card in the back slot of the system Press the Setup key Select OB Calculations Select Export from the on screen menu All user defined tables and measurements are copied to the CompactFlash card Export A U N 40 Chapter 2 Getting Started Import Insert the CompactFlash card in the back slot of the system Press the Setup key Select OB Calculations Select Import from the on screen menu Select Yes to import data or No to cancel After all user defined ta
160. etwork Speed Not available in wireless connectivity 4 Selectthe Wireless check box 5 Select Next to display page 2 Chapter 5 Connectivity and Configuration E 2007Mar22 15 32 Profile Name Network Name SSID Security Policy Profile Profile Name PROFILE XXX Network Name SSID Security Policy SKA M Encryption WEP 128 bit 2 Key Index 4 Key 2 2 Next Symbols Cancel save Import Export Done Figure 3 SiteLink Wireless Locations Configuration Page 2 Configure 1 Enter information in the following fields SiteLink The information entered in these fields must match exactly the information Wireless entered in the router setup For information on installing and configuring the Location wireless router and wireless network card see MicroMaxx Wireless Installation page 2 Instructions Profile Name Name of profile set for this location Network Name SSID This name is provided by the network administrator Security Policy Security type that is used to authenticate with the network The security settings on the router may be set to Auto or Shared Key If Auto is selected either Open or SKA may be selected on the MicroMaxx If Shared Key is selected on the router setup then SKA must be selected on the MicroMaxx Encryption Encryption key type 64 bit or 128 bit Key Index WEP key index 1 4 Key WEP key value used to encrypt data 2 Select Save then select Done
161. etwork name for the ultrasound system Default is MicroMaxx Alias Name used to identify the network location of the MicroMaxx IP Address Unique identifier of the ultrasound system location Cannot be between 127 0 0 0 and 127 0 0 8 Subnet Mask Identifies a network subdivision The default value is 255 255 0 0 Default Gateway IP address where network connects to another network Cannot be between 127 0 0 0 and 127 0 0 8 Alternate Gateway Alternate location where network connects to another network Cannot be between 127 0 0 0 and 127 0 0 8 In the Network Speed list make the appropriate selection Select Save then select Done from the on screen menu A dialog box is displayed to restart the system Select SiteLink Location Press the Setup key then select Connectivity In the Location list select the desired location A dialog box is displayed to restart the system Delete Location Select the name of the location from the list of locations Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration information then select Done from the on screen menu A dialog box is displayed to restart the system Configuring SiteLink for Wireless Note Wireless connectivity for SiteLink is an optional feature Caution To avoid damage to the wireless card always turn off the ultrasound system before inserting or re
162. ey moves the tool several pixels to the left 2 Select Width from the on screen menu to adjust the IMT tool width e The top key increases the width by 1 mm The bottom key decreases the width by 1 mm IMT Tool Note The IMT lines may be adjusted for vertical position and smoothing Editing 1 Select Edit from the on screen menu 2 Select Smooth from the on screen menu to adjust the IMT line smoothing 3 Select Adven from the on screen menu to adjust the adventitia media line The top key moves the line upward on the screen The bottom key moves the line downward 4 Select Lumen from the on screen menu to adjust the lumen intima line The top key moves the line upward on the screen The bottom key moves the line downward Each of the two IMT lines can be adjusted independently Chapter 4 Measurements and Calculations IMT Tool Trace Trace mode defines the IMT measurement solely from the user defined location 1 Select Edit from the on screen menu 2 Select Manual from the on screen menu 3 Select Sketch from the on screen menu A single caliper is displayed on the screen and Trace shows on screen next to the selected calculation 4 Position the caliper at the beginning of the desired adventitia media boundary and press the Select key 5 Use the Touchpad to move the caliper to the next desired point 6 Continue marking points by pressing the Select key If an error is made select Undo from the on screen menu or pr
163. f disinfection required for a transducer is dictated by the type of tissue it contacts during use Ensure the solution strength and duration of contact are appropriate for the equipment SonoSite tests products for compatibility of materials 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 Transducers must be cleaned after every use Cleaning transducers is necessary prior to effective disinfection Ensure you follow the manufacturer s instructions when using disinfectants Do not use a surgeon s brush when cleaning transducers Even the use of soft brushes can damage a transducer Use a soft cloth Using a non recommended cleaning or disinfection solution incorrect solution strength or immersing a transducer deeper or for a longer period of time than recommended can damage or discolor the transducer and void the transducer warranty Chapter 6 Troubleshooting and Maintenance Caution Do not allow cleaning solution or disinfectant into the transducer connector Do not allow disinfectant to contact metal surfaces Use a soft cloth lightly dampened in a mild soap or compatible cleaning solution to remove any disinfectant that remains on metal surfaces Clean and 1 Disconnect the transducer from the system Disinfect 2 Remove any transducer sheath Transducer 3 C
164. formation in the following fields The information entered in these fields must match exactly the information entered in the router setup For information on installing configuring wireless router and wireless network card see MicroMaxx Wireless Installation Instructions Profile Name Name of profile set for this location Network Name SSID This name is provided by the network administrator Security Policy Security type that is used to authenticate with the network The security settings on the router may be set to Auto or Shared Key If Auto is selected either Open or SKA may be selected on the MicroMaxx If Shared Key is selected on the router setup then SKA must be selected on the MicroMaxx Encryption Encryption key type 64 bit or 128 bit Key Index WEP key index 1 4 Key WEP key value used to encrypt data 8 Select Save then select Done from the on screen menu Select DICOM 1 Service Class Provider SCP 3 N v A On the DICOM Location screen select the wireless location you just created Select a preconfigured SCP device type s Select Done from the on screen menu You are prompted to reboot the system Press the Setup key then select Connectivity Select DICOM Setup Select Verify The Status column shows whether verification passed or failed for each selected SCP Chapter 5 Connectivity and Configuration Verify Wireless 1 Verify that the connection icon with strength bars and ultraso
165. from the RA list If you change the RA from the default number 5 it affects the RVSP calculation in the report Chapter 4 Measurements and Calculations 127 suone n je pue sjuauleansea y 128 Pressure Half Time PHT in MV or AV Note On cardiac exams only PHT shows on the on screen menu It can be selected there instead of via the calculations menu 1 Ona frozen Doppler spectral trace press the Calcs key 2 From the calculations menu select MV or AV then select PHT 3 Position the first caliper at the peak and press the Select key A second caliper is displayed 4 Position the second caliper In MV position the caliper along the EF slope In AV position the caliper at end diastole 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Proximal Isovelocity Surface Area PISA Note This calculation requires a measurement taken in 2D a measurement taken in color and two measurements taken in spectral Doppler After all measurements are completed and saved the result is displayed in the patient report 2D measurement from Ann D 1 Onafrozen 2D image press the Calcs key 2 From the calculations menu locate PISA then select Ann D 3 Perform the
166. g box is displayed to restart the system Chapter 5 Connectivity and Configuration Configuring Worklist Servers 2 2005May03 09 52 Configure Worklist Servers p Alias Model IP Address Port AE Title Worklist Name ii O IP Address I8 B B Alias i O Port Hl AETle Ping 1 2 Next New Delete Symbols Cancel Save Import Export Done Figure 12 Worklist Configuration Page 1 Name Network host name for a worklist server Alias Personalized name for a worklist server AE Title Application Entity Title IP Address Unique identifier for the worklist server Port Device port number IP port 104 is normally assigned for DICOM Chapter 5 Connectivity and Configuration 161 A apuu 162 Z 2005May03 09 53 Configure Worklist Servers Alias Model IP Address Port AE Title Worklist Automatic Query FI This MicroMAXX Only cion Ng Occurs Every Start Time X 2 2 Next New Delete Cancel Save Import Export Done Figure 13 Worklist Configuration Page 2 Date Range Defines the date range for manual or automatic queries This MicroMAXX Only Restricts the query to patient procedures that are scheduled for the system based on its AE Title Automatic Query Turns automatic query on off Occurs Every Start Time An option for an automatic query to select the length of time between automatic updates An option for an automatic query to select the sta
167. g from the on screen menu In the Configure list select Worklist Servers In Automatic Query page 2 select On In the Occurs Every list select the desired length of time between automatic updates In the Start Time list select the start time for the automatic updates Select Done from the on screen menu A dialog box is displayed to restart the system Delete Worklist Server Select the name of the device from the worklist Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Configuring Procedures Procedures are automatically added to the procedure list when new exam types from the patient procedures are selected from the worklist E Configure 2005May03 09 53 Procedure List Y Add Delete Import Export Done Figure 14 Procedure Configuration 164 Chapter 5 Connectivity and Configuration Add New Procedure Ensure the system is set up for DICOM connectivity See System Configuration for DICOM on page 147 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu In the Configure list select Procedure List Type desired text Select Add Select Done from the on screen menu Delete Procedure Select the name of the procedure from the list of proce
168. ghout the exam The variables which affect the way the qualified ultrasound user implements the ALARA principle include patient body size location of the bone relative to the focal point attenuation in the body and ultrasound exposure time Exposure time is an especially useful variable because the qualified ultrasound user can control it The ability to limit the exposure over time supports the ALARA principle Applying ALARA The system imaging mode selected by the qualified ultrasound user is determined by the diagnostic information required 2D imaging provides 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
169. gin Administrator Login AU Ne Chapter 2 Getting Started 25 payers 6unyo5 26 Change Administrator Password 1 In User Information enter your new password in the Password field Enter the password again in the Confirm field To ensure passwords are secure it is recommended that passwords contain characters from the following categories Upper case characters A Z Lower case characters a z Numbers 0 9 The password is case sensitive In Password changes click on the check box to allow users access to change their password or leave unchecked to restrict access Optional Select Save User Login Setting Chapter 2 Getting Started In the User Login list select On or Off Selecting On restricts access to the system and requires the user to enter a user name and password Selecting Off allows access to the system and does not require the user to enter a user name and password After making changes in the Administration setup reboot the system to log off as administrator User Setup gt 2006Nov13 12 63 Figure 8 Setup User List Information Add New User 1 Select New 2 In User Information enter information in Name Password and Confirm fields To ensure passwords are secure it is recommended that passwords contain characters from the following categories Uppercase characters A Z Lower case characters a z Numbers 0 9 The name and password are cas
170. gital Imaging and Communications in Medicine DICOM configurations Chapter 1 Introduction Figure 2 System Back View Table 2 System Back Connectors Number Feature uon npoanu 1 DC input connector 2 I O connector 3 Battery 4 ECG connector Currently the system supports the following transducers C11e 8 5 MHz C60e 5 2 MHz D2 2 MHz HFL38 13 6 MHz ICT 8 5 MHz LAP 12 5 MHz L25e 13 6 MHz L38e 10 5 MHz P10 8 4 MHz P17 5 1 MHz SLA 13 6 MHz e SLT 10 5 MHz TEE 8 3 MHz Chapter 1 Introduction The ultrasound system may include one or more of the following docking systems Mobile Docking System enhanced MDSe e Mobile Docking System MDS MDS Lite See the applicable SonoSite accessory user guide See Chapter 8 Specifications for a complete list of all system accessories System peripherals include medical grade conforming to the requirements of EN60601 1 and non medical commercial grade products See Chapter 8 Specifications for a complete list of compatible peripherals System setup instructions for the use of peripherals are covered in System Setup on page 24 Manufacturer s instructions accompany each peripheral Instructions for the use of accessories and peripherals with the system are covered in the applicable SonoSite accessory user guide About the System Software The ultrasound system contains software that controls its operation A soft
171. h card is inserted into the back slot the CompactFlash icon and number of stored images and clips are not displayed If the CompactFlash card is storing images or clips the CompactFlash card animation is displayed While the CompactFlash card animation is being displayed Image review is not available Card should not be removed System should not be turned off Save Image Press the Save key to save an image to the CompactFlash card After the audible beep is heard the next image may be saved It may take a few seconds for the image to be stored During this time the CompactFlash card animation is displayed When an image is stored the image and clip counter increases by one Ensure there is sufficient memory available on the CompactFlash card before saving additional images A maximum of 200 images can be saved for an individual patient exam Save Clip Press the Save Clip key to save a clip to the Compact Flash card While the clip is being acquired the stored clips counter is highlighted After the audible beep is heard counter is no longer highlighted the next clip may be saved It takes several seconds for the clip to be stored during which time the CompactFlash card animation is displayed The longer the clip and the more frequently clips are saved the longer it takes to store all clips When a clip is stored the clip counter increases by one Ensure there is sufficient memory available on the CompactFlash card b
172. he printer connections Check the printer to ensure that it is turned on and set up properly See the printer manufacturer s instructions if necessary Check the DVD VCR connections Check the DVD VCR to ensure that it is turned on and set up properly See applicable SonoSite accessory user guide and the manufacturers instructions if necessary Check the monitor connections Check the monitor to ensure that it is turned on and set up properly See the monitor manufacturers instructions if necessary Ensure labels have been assigned to the function keys Ensure that the patient information date and time are set accurately Disconnect and reconnect the transducer Text cursor is constrained to one line This icon indicates that system maintenance may be required Record the number in parentheses on the C line and contact SonoSite or your SonoSite representative Chapter 6 Troubleshooting and Maintenance Software Licensing SonoSite software is controlled by a license key which is obtained from SonoSite or from its authorized representatives You must obtain one key for each system or transducer that will use the new software See Obtaining a License Key on page 184 The software may be installed and will operate for a short period of time without requiring a valid license key We refer to this period of time as the grace period The grace period is variable When you first install your software your SonoSit
173. he text cursor To reset the home position reposition the cursor and select Home Set from the on screen menu Home Press the Text key 2 Select Home from the on screen menu to move the cursor to the original home position upper left The home position can be set to a new location To change the home position see Home Set on page 74 The factory default home position is different depending on the imaging screen layout Label Press the Text key 2 Use the Touchpad to set the cursor on the desired location on the image 3 Select Label from the on screen menu Select the desired label group 1 x to insert the appropriate label There are three label groups See Annotations on page 36 Predefined labels can be inserted on the following imaging layouts full screen 2D full screen trace dual or duplex Symbols Select Symbols from the on screen menu to enter special characters See Symbols on page 23 Delete Word Select Delete Word from the on screen menu repeatedly to clear the screen of text a word at a time Words are deleted in sequence right to left and bottom to top Delete Press the Delete key to clear the screen of all text at once Preset delete options to save or delete text when unfreezing an image See Unfreeze on page 37 for information on presetting options when unfreezing an image Arrow 1 Press the Arrow key Use the arrow as a pointer to bring attention to a specific part of the image
174. ic Output Measurement 243 In Situ Derated and Water Value Intensities 243 Tissue Models and Equipment Survey 244 About the Acoustic Output Table 245 Acoustic Output Tables 246 Acoustic Measurement Precision and Uncertainty 283 Labeling Symbols 283 Glossary 287 Terms 287 Acronyms 289 vii viii Chapter 1 Introduction Please read the information in this user guide before using the SonoSite MicroMaxx ultrasound system It applies to the ultrasound system and transducers About the User Guide The MicroMaxx Ultrasound System User Guide provides information on preparing and using the ultrasound system on upgrading the system and transducers and on cleaning and disinfecting the system and transducers It also provides references for calculations system specifications and additional safety and acoustic output information The MicroMaxx Quick Start Cards located in the back of the user guide provide an overview of basic system functions The user guide is designed for a reader familiar with ultrasound techniques it does not provide training in sonography or clinical practices Before using the system you must have ultrasound training See the applicable SonoSite accessory user guide for information on using accessories and peripherals See the manufacturers instructions for specific information about peripherals Intended Uses The intended uses for each exam type are contained here See the intended transducer fo
175. ics and direction of the acoustic beam For example C15 C60e A menu item used to adjust the depth of the display A constant speed of sound of 1538 5 meters second is assumed in the calculation of echo position in the image In the natural or original position Glossary 287 K esso 5 linear array transducer M Mode mechanical index MI MI TI NTSC PAL phased array pulsed wave PW Doppler mode skinline SonoMB SonoRES Tissue Doppler Imaging TDI thermal index TI Glossary 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 Motion Mode showing the phasic motions of the cardiac structures A single beam of ultrasound is transmitted and reflected signals are displayed as dots of varying intensities which create lines across the screen An indication of the likelihood of mechanical bioeffects occurring the higher the MI the greater the likelihood of mechanical bioeffects See Chapter 9 Safety for a more complete description of MI See mechanical index and thermal index National Television Standards Committee A video format setting See also PAL Phase Alternating Line A video format setting See also NTSC A transducer designed primarily for cardiac scanning Fo
176. ion Phantom 0 01 cm sec of full scale 550 cm sec Frequency cursor lt 2 plus 1 Acquisition Phantom 0 01kHz 20 8 kHz of full scale Time lt 2 plus 1 Acquisition Phantom 0 01 10 sec of full scales a SonoSite special test equipment was used b Full scale for frequency or velocity implies the total frequency or velocity magnitude displayed on the scrolling graphic image c Full scale for time implies the total time displayed on the scrolling graphic image Sources of Measurement Errors In general two types of errors can be introduced into the measurement acquisition error and algorithmic error Acquisition Error Acquisition error includes errors introduced by the ultrasound system electronics relating to signal acquisition signal conversion and signal processing for display Additionally computational and display errors are introduced by the generation of the pixel scale factor application of that factor to the caliper positions on the screen and the measurement display Algorithmic Error Algorithmic error is the error introduced by measurements which are input to higher order calculations This error is associated with floating point versus integer type math which is subject to errors introduced by rounding versus truncating results for display of a given level of significant digit in the calculation Terminology and Measurement Publications Terminology and measurements comply with AIUM publi
177. ired peripheral If PCis selected the system allows report data to be sent as ASCII text from the system to a PC Special third party software must be on the PC to acquire view or format the data into a report Check the compatibility of your software with SonoSite Technical Support Chapter 2 Getting Started 33 peueis 6unjo5 34 Transfer Mode 1 Press the Setup key 2 Select Connectivity 3 Inthe Transfer Mode list select DICOM or SiteLink 4 Select DICOM Setup or SiteLink Setup as appropriate Ifthe transfer mode is changed a dialog box is displayed to restart the system For more information on setting up DICOM or SiteLink see Chapter 5 Connectivity and Configuration Thesettings for SiteLink Image Manager and system configurations must correspond See the SiteLink Image Manager User Guide Location 1 Press the Setup key 2 Select Connectivity 3 Inthe Locations list select the desired DICOM or SiteLink location If the Location is changed a dialog box is displayed to restart the system See Chapter 5 Connectivity and Configuration for configuring locations in DICOM or SiteLink CF Capacity Alert 1 Press the Setup key 2 Select Connectivity 3 Select CF Capacity Alert When CF Capacity Alert is selected the system alerts the user if the Compact Flash card is near capacity at End Exam then deletes archived patient exams if desired Reset Select Reset from the on screen menu to return setting
178. is only available with the Save Clip option Select Delay from the on screen menu Line m Select the desired position of the delay line on the ECG trace The delay line indicates where the clip acquisition is triggered Gain Select the desired gain from the on screen menu to increase or decrease ECG gain 0 20 Save Saves the current position of the delay line on the ECG trace You can change the position of the delay line temporarily Entering a new patient or cycling the system power will revert the delay line to the most recently saved position Chapter 3 Imaging 69 Image and Clip Storage Save to CompactFlash 70 Images and clips are saved to the CompactFlash card The images clips in the patient list are organized alphabetically by the patient name and ID If a name is not entered in the patient name field a patient exam is created and identified as No Name If an ID number is not entered in the ID field the ID number is identified as No ID Toreview saved images clips see Image and Clip Review on page 72 The images clips saved on the CompactFlash card cannot be opened and viewed on a PC Images may be archived from the ultrasound system using DICOM Image Transfer or to a PC using SiteLink Image Manager See Connectivity and Configuration on page 141 or the SiteLink Image Manager User Guide The number of images clips saved to the CompactFlash card varies depending on the storage capacity of the card
179. is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Chapter 4 Measurements and Calculations Aortic Valve Area AVA continued Doppler measurement from aorta 1 Ona frozen Doppler spectral trace press the Calcs key 2 From the calculations menu select AV then select VTI or Vmax 3 Perform the measurement See E A VMax and TRmax e and a on page 126 or Velocity Time Integral VTI on page 127 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Qp Qs Qp Qs continued Note This calculation requires two measurements taken in 2D and two measurements taken in Doppler After the measurements are completed and saved the result is displayed in the patient report 2D measurement from LVOT D and RVOT D 1 Onafrozen 2D image press the Calcs key 2 From the calculations menu locate Qp Qs then select LVOT D 3 Perform the measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement 5 Select RVOT D Perfor
180. is 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 9 Safety 273 Ayayes Table 36 Transducer Model SLT 10 5 Operating Mode 2D TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 0 a a Pr3 2 475 Wo B min of W 3 Z4 lza 374 ua 5 Z ge e SS 5 s QU OQ 2 deg Zsp _ i fc 4 39 E Z Dim of Aaprt n PD 0 50 S PRF 6633 E pr Pll max 2 871 amp deg Pllmax E Focal Length E B O lpa 3 Mlmax 253 3 m Control 1 Exam Type Any g Control 2 Optimization Pen TO a3 c Control 3 Depth 4 5 cm O o 274 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 9 Safety Table 37 Transducer Model SLT 10 5 Opera
181. isplayed on the screen 3 Use the Touchpad to position the first vertical caliper at the peak of the heart beat 4 Press the Select key A second vertical caliper is displayed on the screen The active caliper is highlighted green 5 Use the Touchpad to position the second vertical caliper at the peak of the next heart beat 6 Select Save from the on screen menu to save the heart rate measurement to the patient report This overwrites the previous heart rate value entered under exam patient information If desired press the Save key to save the image with the measurements displayed Cardiac Output CO Note This calculation requires a stroke volume and a heart rate After the measurements are completed and saved the result is displayed in the patient report 1 Perform the calculation for SV See Stroke Volume SV on page 132 2 Perform the calculation for HR See Heart Rate HR on page 133 Cardiac Index CI Note This calculation requires a stroke volume a heart rate and body surface area BSA 1 Complete patient height and weight in the Patient Information page The BSA is calculated automatically 2 Perform the Calculation for Cardiac Output CO See Cardiac Output CO on page 133 Chapter 4 Measurements and Calculations 133 suone n je pue sjuauleansea y 134 Tissue Doppler Imaging TDI N Ensure TDI is turned on See Tissue Doppler Imaging TDI on page 66 On a frozen Dopple
182. ivity and Configuration Verify Images and Clips Sent Press the Review key The Patient List indicates the status of image and clip transfer See Figure 18 on page 170 Patient exams that are checked are archived Patient exams that are not checked are pending archive Patient exams that are identified with an asterisk are suspended Transfer of images and clips is suspended when the system executes the number of Attempts and Interval configured in the configuration setup These exams need to be manually archived Manually Archive or Print Images Patient Information Verify that the ultrasound system is turned on and the correct location is selected With the system on check the LAN link light green LED next to the mini dock connector to verify physical connection to LAN The network connection icon in the system status area is animated during DICOM network activity when images are transferred Press the Review key on the ultrasound system or If there is a current patient select List from the on screen menu Select an individual patient exam or Select All from the on screen menu Select Archive from the on screen menu Any check marks or asterisks are removed Once archived a check mark reappears to the left of the selected patient s name The patient information form is used to enter patient data into the system See Patient Information on page 49 for information on completing fields on the fo
183. key 1 Contact SonoSite at 1 877 657 8118 www sonosite com service sonosite com 2 Supply the following a Your name b Transducer part c Transducer bundle version 20 80 200 001 R d Transducer serial 033K59 3 Enter license key Figure 11 Transducer License Screen At this point the software upgrade process is complete but the software is not yet licensed The following section Obtaining a License Key explains how to license your system and transducer software Note If you are upgrading additional transducers it is recommended to upgrade all items before calling SonoSite Technical Support for your license keys To postpone obtaining a license key press Cancel from the on screen menu Upgrading Triple Transducer Connect TTC Upgrade TTC If the TTC requires an upgrade for the MicroMaxx system the following message is displayed Do you want to upgrade the Triple Transducer Connect now If this message is displayed perform the upgrade Select Yes to accept and No to cancel the upgrade e If you select Yes the system presents you with the license update screen so that you may license the software See Obtaining a License Key on page 184to license your software If you select No the system restarts Chapter 6 Troubleshooting and Maintenance 183 BuljooysajqnosL Obtaining a License Key A license key is required to update your system It may be obtained by contacting SonoSite Inc Technical Supp
184. l Length E B o lpa 3 Mlmax 427 5 m Control 1 Exam Type Any X g g Control 2 Optimization Pen 5 so EG c Control 3 Depth 38cm O v 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 256 Chapter 9 Safety Table 19 Transducer Model L38e 10 5 Operating Mode M Mode TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 4 a 1 3 b Pr3 2 382 Wo 21 29 B min of W 3 Z4 lzA 374 wn 5 2 Z ES SEE I E Zsp 14 14 o S deql sp 0 149 lt fe 5 14 5 14 Dim of Aaprt 0 66 0 4 PD 0 322 S PRF 1600 8 pr Pll max 3 05 S deq Pllmax 0 148 em Focal Length xx a O lpa 3 Mlmax 385 13 D_ Control 1 Exam Type Any Any 5 g Control 2 Optimization Pen Pen Lr TO amp e 5 Control 3 Depth 38cm 38cm 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 c
185. l 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 9 Safety 251 Ayayes Table 14 Transducer Model HFL38 13 6 Operating Mode PW Doppler TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a 1 2 2 2 b Pr3 MPa Wo mW 46 55 46 55 2 min of W 3 z Mla 3 Z1 mW 5 z cm cm 555 S mj amp 1 1 S deq sp cm 0 33 lt fe MH 5 33 5 33 Dim of Aaprt X cm 1 04 1 04 Y cm 0 4 0 4 PD usec PRF H z pr Pll max MP deq Pllmax cm 0 46 Focal Length FL cm 3 72 e9 lt 5 FL cm 2 5 IpA 3 M max W cm o 2 Control 1 Exam Type Vas Vas E g Control 2 Sample Volume 12mm 12mm 5 Control 3 PRF 10417 10417 O Control 4 Sample Volume Position Zone 7 Zone 7 252 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 Va
186. lation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Repeat these steps until all measurements have been performed Chapter 4 Measurements and Calculations 109 suone n je pue sjuauleansea y IMT Calculations 110 WARNING To ensure high quality images all patient images must be obtained by qualified and trained individuals To avoid patient injury IMT results should not be used as a sole diagnostic tool All IMT results should be interpreted in conjunction with other clinical information or risk factors To avoid measurement errors all measurements must be of the common carotid artery CCA This tool is not intended for measuring the bulb or the internal carotid artery ICA Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 2005MayO4 07 10 Ant F Mean 0 702mm Max 0 91 1mm Width 10 0mm Smooth Figure 11 IMT The following table shows the transducers and exam types that provide intima media thickness IMT calculations Table 14 Transducer and Exam Types for IMT Transducer Exam Types L25e IMT L38e IMT HFL38 IMT Chapter 4 Measurements and Calculations 2D IMT Calculations The following table shows the available IMT labels A maximum of eight l
187. lation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Chapter 4 Measurements and Calculations 83 suone n je pue sjuauleansea y 84 Heart Rate HR 1 Onafrozen M Mode trace press the Caliper key for HR or press the Calcs Fetal Heart Rate key for FHR OB exam only FHR The following on screen menu options are available Eg Heart rate HR Delete Wd Save 2 Select HR from the on screen menu or select FHR from the calculation menu A vertical caliper is displayed on the screen 3 Use the Touchpad to position the first vertical caliper at the peak of the heart beat 4 Press the Select key Asecond vertical caliper is displayed on the screen The active caliper is highlighted green 5 Use the Touchpad to position the second vertical caliper at the peak of the next heart beat 6 Select Save from the on screen menu to save the HR measurement to the patient report This overwrites the previous heart rate value entered under exam patient information 7 If desired press the Save key to save the image with the measurements displayed Delete Select Delete from the on screen menu Measurement This removes the HR measurement from the screen Chapter 4 Measurements and Calculations Doppler Measurements Inspect the auto trace to confirm that the system generated boundar
188. lculations for example mean Select 1 x from the on screen menu to view additional pages of the patient report Thelast page of the patient report contains patient information In the OB report pages a signature space is available for signing printed reports Press the Save key to save the current page of the patient report Select Done from the on screen menu to exit patient report and return to the previous imaging state Chapter 4 Measurements and Calculations 135 suone n je pue sjuauleansea y 136 Vascular Report O At the end of a vascular exam press the Report key Select 1 x from the on screen menu to view additional pages of the patient report Select Details or Summary from the on screen menu to view report information in detail or summary form The mean of the detail entries is used in the summary report To delete a measurement go to the Details page use the Touchpad to select the desired measurement The selected measurement is highlighted green Measurements can only be deleted from the Details page Select Delete from the on screen menu Deleting some measurements also deletes related measurements When a measurement is deleted it is no longer included in the summary information In the Ratio list select the desired measurements for the ICA CCA ratio for both the right and left sides Cardiac Report Li At the end of a cardiac exam press the Report key Se
189. lean the surface using a soft cloth lightly dampened in a mild soap or eiu Ae detergent cleaning solution to remove any particulate matter or body fluids etho Apply the solution to the cloth rather than the surface 4 Rinse with water or wipe with water dampened cloth then wipe with a dry cloth 5 Mixthe disinfectant solution compatible with the transducer following disinfectant label instructions for solution strengths and disinfectant contact duration 6 Wipe surfaces with the disinfectant solution 7 Air dry or towel dry with a clean cloth 8 Examine the transducer and cable for damage such as cracks splitting or fluid leaks If damage is evident discontinue use of the transducer and contact SonoSite or your local representative Chapter 6 Troubleshooting and Maintenance 189 Bunoouse qnoJ Clean and Disinfect Transducer Using Immersion Method Disconnect the transducer from the system Remove any transducer sheath 3 Clean the surface using a soft cloth lightly dampened in a mild soap or compatible cleaning solution to remove any particulate matter or body fluids Apply the solution to the cloth rather than the surface 4 Rinse with water or a wipe with water dampened cloth then wipe with a dry cloth 5 Mix the disinfectant solution compatible with the transducer following disinfectant label instructions for solution strengths and disinfectant contact duration 6 Immerse the transducer into the disinfection
190. lect 1 x from the on screen menu to view additional pages of the patient report Select Details or Summary from the on screen menu to view report information in detail or summary form The mean of the detail entries is used in the summary report To delete a measurement go to the Details page use the Touchpad to select the desired measurement The selected measurement is highlighted green Measurements can only be deleted from the Details page Select Delete from the on screen menu Deleting some measurements also deletes related measurements When a measurement is deleted it is no longer included in the summary information Chapter 4 Measurements and Calculations Transcranial Report OB Twins Report Individual O At the end of a transcranial Doppler exam press the Report key Select Next Page 1 x from the on screen menu to view additional pages of the patient report Select Details or Summary from the on screen menu to view report information in detail or summary form The maximum values for the TAP calculation are displayed on the summary page To delete a measurement go to the Details page use the Touchpad to select the desired TAP measurement The selected measurement is highlighted green Select Delete from the on screen menu Deleting a TAP measurement deletes the entire row of measurements When a measurement is deleted it is no longer included in the summary information At
191. lected group Add a label to a group by selecting the group then entering the label name in the Text field and selecting Add Rename an existing label by highlighting it typing the new name in the Text field and selecting Rename Move a label within a group by highlighting it and selecting the up or down arrow Delete a label from a group by highlighting it and selecting Delete Symbols can be used when naming labels For more information on using symbols see Symbols on page 23 Unfreeze Preset options for saving text when an image is unfrozen or when image layout changes 1 Press the Setup key 1 Select Delta Key Annotations 2 Inthe Unfreeze list select the desired text state Keep All Text Keep Home Text or Clear All Text Home text runs to the right of the home cursor position For more information on setting the home cursor position see Home Set on page 74 The default is Keep All Text Import Imports and replaces all predefined label groups for all exams with those from the CF card Export Saves and exports all predefined label groups for all exams to the CF card Reset Select Reset from the on screen menu to return settings for this setup page to factory default Chapter 2 Getting Started 37 pares bunya Display Information 38 d 20060ct19 13 07 Patient Header F Patient name F Institution F Patient ID F Date and Time F Sonographer Mode Data F20 F Doppler F Color F M Mode Network Stat
192. ll image Near and far correspond to the time gain compensation TGC controls found on other ultrasound systems Freeze 1 Press the Freeze key 2 Pressthe Freeze key again to return to live imaging Thecine icon is removed from the system status area of the screen and live imaging resumes On the frozen M Mode image press the M Mode key to display the associated frozen 2D image with the M line or press the Update key to display the 2D live image with the M line Cine Buffer amm On a frozen image press the Cine keys to view the trace at different points in time 2D Imaging Chapter 3 Imaging Press the 2D key to return to 2D imaging Color Doppler Imaging Note Color power Doppler CPD and color Doppler Color are optional features and depend on transducer and exam type The following instructions cover CPD and Color imaging Figure 5 Color Image CPD or Color 1 Press the Color key for CPD or Color A ROI box is displayed in the center of the 2D image l 2 Select CPD or Color from the on screen menu Thecurrent setting is displayed in the upper left corner of the screen and in the on screen menu In Color or CPD mode the Color indicator bar is displayed in the upper left corner of the screen The Color bar displays velocity in cm s in Color mode only ROI Box 1 Use the Touchpad to position or change the size of the ROI box While moving or changing the size of the ROI box a green outline
193. lly as the cine key is pressed The total number of frames in the buffer is displayed in the system status under the freeze icon M Mode Imaging The following instructions cover Motion mode M Mode imaging See 2D Imaging on page 57 for instructions about depth and optimization M Mode M Line 2005May18 12 45 Figure 3 M Mode M Line 1 Press the M Mode key for the M line If M Mode does not come on make sure the system is in live imaging M Line Use the Touchpad to position the M line over the area of interest on the image Depth changes are not available in M Mode trace Adjust the depth prior to activating the M Mode trace Chapter 3 Imaging 61 M Mode Trace 62 2005Apr25 11 21 Figure 4 M Mode Trace Image M Mode Trace 1 Press the M Mode key again to acquire the M Mode trace The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals 2 Pressthe Update key to toggle between the M line and trace 3 In duplex press the M Mode key to return to the full screen M line You can choose from one of three layouts For duplex imaging see Duplex on page 45 Sweep Speed Select the desired sweep speed from the on screen menu slow med fast Gain Turn the Near Far or Gain knobs on the lower left side of the control panel to increase or decrease the amount of gain applied to the near field far field orthe overa
194. lmax Focal Length Other Information lpa 3 Mlmax Control 1 Exam Type Control 2 Optimization Control 3 Depth Operating Control Conditions 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 9 Safety 261 Ayayes Table 24 Transducer Model P10 8 4 Operating Mode CPD Color TIS TIB Index Label M Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a 1 3 b Pr3 Wo 60 98 E min of W 5 z4 lz 3 z4 gt Z ge E S Z a Sm SP o j deqlZsp 4 t 4 30 2 Dim of Aaprt X 0 992 Y 0 7 PD S PRF 8 p GPlli a S deq Pllmax Focal Length FL 5 06 E FL 5 0 Ip 3 MImax W cm o 2 Control 1 Mode Color E 2 Control 2 Exam Type Any gS Control 3 Optimization Depth Low 6 8 cm O Control 4 Color Box Size Narrow 262 a This index is not required for this operating mode value is lt 1 b This transduce
195. lor box position and size floating cursor and more The arrow keys control much of the same functionality as the touchpad 20 Chapter 2 Getting Started On Screen Menus The on screen menus located at the bottom of the screen provide controls that can be adjusted based on the system state For example in 2D the following options may be available Table 3 On Screen Menus Icon Description Values Types EA Gen Controls 2D image optimization Res Gen Pen Cycle E Dynamic Adjusts the image by varying the range 43 3 Up Down Range of displayed grays m Dual Displays side by side images On Off U L Flips the image up left D L Flips the image down left Cycle D R Flips the image down right y U R Flips the image up right Ea Brightness Controls display brightness 1 10 Up Down Menu Controls The menu controls consist of six sets of 2 button groups at the top of the control panel They adjust the values of each control displayed in the on screen menu The buttons function in one of four ways depending on context Table 4 Menu Control Options Control Description Cycle Moves through a list of values then begins again when the bottom or top of the list is reached Up Down Stops at the top and bottom of a value list not allowing user to go from the first to last or last to first value in one button press On Off Turns available features on or off depending on their current state Action Performs some action related to a
196. lt fc M 4 18 Dim of Aaprt X _ Y PD usec 1 80 S PRF 2471 8 Pr Pllmax M 3 05 9 deq Pllmax Focal Length FL cm E 5 FL Ipa 3 MI max W cm 354 5 Control 1 Exam Type Any Control 2 Optimization Any 2 Control 3 Depth 4 5 cm Be Control 4 PRF 401 Hz a9 S Control 5 Color Box Position Size Default O position Default width 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 276 Chapter 9 Safety Table 39 Transducer Model SLT 10 5 Operating Mode PW TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value a 1 2 2 1 b Pra MPa Wo mW 61 20 38 51 Y min of W 5 z4 lza 3 z4 mW 5 o z cm t Zp cm 9 E 5 cm 14 So SP o z deqlZsp cm 0 24 lt fe MH 4 18 4 18 Dim of Aaprt X cm 1 646 m 0 329 Y cm 0 55 0 55 PD usec PRF H E pr Pll max MP S deq P Imax cm 0 24 Focal Length FL cm 6 46 E FLy cm Em 3 0 Ip 3
197. lue line Data are not applicable for this transducer mode Chapter 9 Safety Table 15 Transducer Model ICT 8 5 Operating Mode CPD Color TIS TIB Index Label M Non scan Non TIC Scan AaprtS1 Aaprt gt 1 scan Global Maximum Index Value a 1 0 a a 1 5 Pr3 Wo 49 66 49 66 E min of W 3 z lA 34 5 Z m 95 iim SB mw 9 deq z p lt fe 4 36 4 36 Dim of Aaprt X 0 28 0 28 Y 0 5 0 5 PD PRF E Pr PIl max amp deq Pllmax Focal Length FL 1 2 1 2 0 r FL e 2 5 2 5 IpA 3 MI max W cm Control 1 Mode CPD CPD Control 2 Exam Type Any Any a Control 3 Optimization Med Med se 5 Control 4 Color Box Position Size Max S ez depth acs Max depth M o ax J Max width Min height No g Min height 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 9 Safety 253 Ayayes Table 16 Transducer Model ICT 8 5 Operating Mode PW Doppler
198. m the measurement 7 Select Save from the on screen menu to save the measurement to the patient report Doppler measurement from LVOT VTI and RVOT VTI 1 Ona frozen Doppler spectral trace press the Calcs key 2 From the calculations menu select Qp Qs then select LVOT VTI 3 Trace the waveform and select the Set key from the on screen menu 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report Select RVOT VTI Trace the waveform and select the Set key from the on screen menu 7 Select Save from the on screen menu to save the measurement to the patient report Ov Ui For information on using the automatic trace tool see Automatic Trace on page 87 Chapter 4 Measurements and Calculations 131 suone n je pue sjuauleansea y 132 Stroke Volume SV Note This calculation requires a measurement taken in 2D and one measurement taken in Doppler After the measurements are completed and saved the result is displayed in the patient report 2D measurement from LVOT 1 Ona frozen 2D image press the Calcs key 2 Fromthe calculations menu select LVOT D 3 Perform the measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the imag
199. ment General Requirements for Safety Collateral Standard Electromagnetic Compatibility Requirements and Tests CISPR11 2004 International Electrotechnical Commission International Special Committee on Radio Interference Industrial Scientific and Medical ISM Radio Frequency Equipment Electromagnetic Disturbance Characteristics Limits and Methods of Measurement The Classification for the SonoSite system SiteStand accessories and peripherals when configured together is Group 1 Class A Airborne Equipment Standards RTCA DO 160E 2004 Radio Technical Commission for Aeronautics Environmental Conditions and Test Procedures for Airborne Equipment Section 21 0 Emission of Radio Frequency Energy Category B DICOM Standard NEMA PS 3 15 2000 Digital Imaging and Communications in Medicine DICOM Part 15 Security Profiles HIPAA Standard The Health Insurance and Portability and Accountability Act Pub L No 104 191 1996 45 CFR 160 General Administrative Requirements 45 CFR 164 Security and Privacy Chapter 8 Specifications 223 suone yi oedsg 224 Chapter 8 Specifications Chapter 9 Safety Read this information before using the ultrasound system The information in this guide applies to the ultrasound system transducer accessories and peripherals This chapter contains information required by various regulatory agencies including information about the ALARA as low as reasonably achievable principle th
200. menu or press the Enter key This saves the new measurement to the patient report and overwrites the previously saved measurement From the calculations menu select the desired measurement Select Delete from the on screen menu This removes the last saved measurement from the patient report Some measurements can be deleted from the report pages See Patient Report on page 135 Chapter 4 Measurements and Calculations 89 suone n je pue sjueauloaJnseaIwy Percent Reduction Calculations WARNING Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 Percent reduction calculations may be performed and saved to the patient report The following table shows the transducers and exam types that provide vascular percent reduction calculations Table 2 Transducer and Exam Types for Percent Reduction Transducer Exam Types Clle Abdomen C60e Abdomen HFL38 IMT Small Parts Vascular L25e Vascular Muscle L38e IMT Small Parts Vascular P17 Abdomen P10 Vascular Abdomen SLA Vascular Muscle SLT Hepatic Abdomen 7 A 0 39cm Area Red 42 6 Figure 4 Percent Area Reduction Measurement 90 Chapter 4 Measurements and Calculations Percent Area Reduction On a frozen 2D image press the Calcs key From the calculations menu select the desired measurem
201. meter 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 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
202. mference and trace measurements can be performed at the same time Thenumber of measurements available depends on the order and types of measurements See Area Circumference Measurement on page 81 and Manual Trace on page 82 for more information Select Switch from the on screen menu to move between caliper sets To save the highlighted measurement to a calculation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Chapter 4 Measurements and Calculations Area Circumference Measurement N On a frozen 2D image press the Caliper key Select Ellipse from the on screen menu Press the Select key to activate the calipers and use the Touchpad to adjust the size and position of the ellipse The active caliper is highlighted green Theresult is displayed in the measurement and calculation data area and is updated as the caliper moves The measurement is complete when you finish moving the calipers Press the Caliper key to activate additional caliper sets A combination of distance area circumference and trace measurements can be performed at the same time Thenumber of measurements available depends on the order and types of measurements If you exceed the allowed combination of measurements for an image Ellipse is not shown on the on screen menu Select Switch f
203. moving the wireless card Chapter 5 Connectivity and Configuration 143 yAn euuo 144 2 2007Feb22 09 33 Alias DHCP IP Address Subnet Mask Default Gateway Not connected EJ Alias 01 255 255 0 0 g Location Host Name MicroMAXX Alias Alias_02 IP Address 172 20 33 46 Iv Subnet Mask 255 255 0 0 Default Gateway HH Alternate Gateway i Network Speed Auto Negotiate gt 1 2 Next New Delete Symbols Cancel Save Import Export Done Figure 2 SiteLink Wireless Locations Configuration Page 1 Configure Note Only Symbol LA 4137 802 11b wireless CompactFlash cards are compatible SiteLink with the MicroMaxx ultrasound system Use only wireless cards supplied by SonoSite Wireless 1 Turn system off insert the wireless network card in back slot and then turn Location system on page 1 2 Pressthe Setup key select Connectivity then select SiteLink Setup 3 Select New and enter information in the following fields Host Name MicroMaxx should be auto filled in this field Alias Enter a unique name to identify the location information IP Address Enter a unique address using numbers from the first three fields of the router IP address and creating a unique number in the last field to identify this MicroMaxx system in the wireless network Subnet Mask 255 255 0 0 should be auto filled in this field Default Gateway Optional Alternate Gateway Optional N
204. n 157 A apuu EZ 2005MayO3 09 52 Configure Printers Y Alias Model IP Address Port AE Title Printer FimSize Attempts Film Type gg Interval sec m Destination mH Copies m Format mx Priority hm Orientation x 2 3 Next New Delete Cancel Save Import Export Done Figure 10 Printers Configuration Page 2 Film Size Film sizes supported by the printer Film Type Film medium supported by the printer Destination Location film is placed after it is printed Format Number of columns and rows in the image printout Orientation Film layout Attempts Number of times the system tries to resend a failed image transfer Interval Amount of time between attempts Copies Number of copies to print for each image Priority Importance of the print job 158 Chapter 5 Connectivity and Configuration 2 2005May03 09 52 Configure Printers Alias Model IP Address Port AE Title Printer Density Settings 0 m Max mmm Magnification Hn Min Configure Border Empty EE 3 3 Next New Delete Cancel Save Import Export Done Figure 11 Printers Configuration Page 3 Max Density Min Density Border Density Empty Density Settings Magnification Configure Maximum density of the black value Minimum density of the white value Density of the areas surrounding and between film images Empty image density Defines how images are sent to
205. n object on the screen Chapter 2 Getting Started 21 pares bunje5 Annotation and Text Keyboard Controls ER EN ES ES ENESESESESESERI E KB EA EN EN ENEENERNEESESES o Em Wa ER ER EB KB EB ER F3 NC 7D 10 11 EB EE ES EZ EE EE EBESFE EN ER ES a 8773 5 6 7 8 9 Figure 5 Keyboard Controls Table 5 Keyboard Controls Number Key Description 1 Tab Moves cursor among fields in the forms and tabs between text position in dual screens 2 Caps Locks keyboard in caps mode 3 Shift Allows entry of capitalized characters and international characters 4 Text Turns the keyboard on and off for text entry 5 Picto Turns pictographs on and off 6 Arrow Displays an arrow that can be moved and rotated within the image area 7 Spacebar Turns the keyboard on for text entry or adds a space with access to additional on screen menus symbols delete line and done 8 Delete Removes all text from the screen during text entry and when in non measurement modes 9 Arrow keys Moves highlighted selection in calculations menus moves cursor one space when entering text moves caliper position and moves among pages in image review and reports 10 Backspace Removes one character to the left of the cursor in text entry mode 11 Enter Moves cursor among fields in forms and saves calculations to report 22 Chapter 2 Getting Started Symbols Note Not all of the symbols special chara
206. n the measurement and calculation data area and in the patient report Chapter 4 Measurements and Calculations 91 suone n je pue sjueuloaJnseaeIw Volume Calculation 92 WARNING Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 The following table shows the transducers and exam types that provide a volume calculation Table 3 Transducers and Exam Types for Volume Transducer Exam Types Clle Abdomen Nerve C60e Gyn Abdomen HFL38 Breast Nerve Small Parts Vascular ICT Gyn L25e Nerve Vascular Superficial Muscle L38e Breast Nerve Small Parts Vascular P17 Abdomen P10 Vascular Neonatal Abdomen Nerve SLA Vascular Superficial Muscle Nerve SLT Hepatic Abdomen The following measurements D D D 2D distance are required to complete the volume calculation Volume measurements are performed in 2D mode Chapter 4 Measurements and Calculations Figure 5 gt D 6 03cemVol 125 8cm 2D Image with Volume Calculation Volume Note D D2 and D are required to complete a volume calculation 1 2 3 4 On a frozen 2D image press the Calcs key From the calculations menu select the desired measurement Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the pati
207. ndocardial Epi Epicardial EPSS E Point Septal Separation Estab DD Established Due Date ET Elapsed Time FH Femoral Head FHR Fetal Heart Rate 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 HC Head Circumference HR Heart Rate ICA Internal Carotid Artery IMT Intima Media Thickness IVRT Iso Volumic Relaxation Time IVS Interventricular Septum Glossary Table 1 Acronyms Continued Acronym Description IVSd Interventricular Septum Diastolic IVSFT Interventricular Septum Fractional Shortening IVSs Interventricular Septum Systolic LA Left Atrium LA Ao Left Atrium Aorta Ratio LAT F Lateral Far LAT N Lateral Near LMP Last Menstrual Period LMPd derived Last Menstrual Period LVO Left Ventricular Opacification LV Left Ventricular LV Area Left Ventricular Area LV mass Left Ventricular mass LV Volume Left Ventricular Volume Vd Left Ventricular diastolic LVD Left Ventricular Dimension LVDd Left Ventricular Dimension Diastolic LVDFS Left Ventricular Dimension Fractional Shortening LVDs Left Ventricular Dimension Systolic LVEDV Left Ventricular End Diastolic Volume LVESV Left Ventricular End Systolic Volume LVET Left Ventricular Ejection Time LVOT Left Ventricular Outflow Tract LVOT Are
208. ng System enhanced MDSe Mini Dock Power supply Reference Guide SiteLink Image Manager SonoCalc IMT System User Guide Triple Transducer Connect Ultrasound gel 220 Chapter 8 Specifications Cables ECG cable 6 ft 1 8 m System AC power cord 10 ft 3 1 m Peripherals See the manufacturer s specifications for the following peripherals Medical Grade Black and white printer Recommended sources for printer paper Contact Sony at 1 800 686 7669 or www sony com professional to order supplies or to obtain the name and number of the local distributor Color printer DVD recorder Video cassette recorder Non Medical Grade Kensington Security Cable Temperature and Humidity Limits Note The temperature pressure and humidity limits apply only to the ultrasound system and transducers Operating Limits System 10 40 C 50 104 F 15 95 R H 700 to 1060hPa 0 7 to 1 05 ATM Shipping Storage Limits System without Battery 35 65 C 31 149 F 15 95 R H 500 to 1060hPa 0 5 to 1 05 ATM Operating Limits Battery 10 40 C 50 104 F 15 95 R H Shipping Storage Limits Battery 20 60 C 4 140 F 0 95 R H 500 to 1060hPa 0 5 to 1 05 ATM For storage longer than 30 days store at or below room temperature Chapter 8 Specifications 221 suone yi edsg Operating Limits Transducer 10 40 C 50 104 F 15 95 R H Shipping Storage Limits Transducer 35 65 C 31 149 F 15 95 R H
209. ning Footswitch 192 Cleaning and Disinfecting ECG Cables 192 References 201 Display Size 201 Caliper Placement 201 2D Measurements 201 Sources of Measurement Errors 203 Acquisition Error 203 Algorithmic Error 203 Terminology and Measurement Publications 203 Cardiac References 204 Obstetrical References 210 Gestational Age Tables 211 vi Growth Analysis Tables 214 Ratio Calculations 215 General References 216 Specifications 219 System Dimensions 219 Display Dimensions 219 Transducers 219 Imaging Modes 220 Image Storage 220 Accessories 220 Hardware Software and Documentation 220 Cables 221 Peripherals 221 Temperature and Humidity Limits 221 Electrical 222 Battery 222 Electromechanical Safety Standards 222 EMC Standards Classification 223 Airborne Equipment Standards 223 DICOM Standard 223 HIPAA Standard 223 Safety 225 Ergonomic Safety 225 Electrical Safety Classification 225 Electrical Safety 226 Equipment Safety 228 Battery Safety 228 Biological Safety 230 Electromagnetic Compatibility EMC 230 Manufacturer s Declaration 232 The ALARA Principle 235 Applying ALARA 235 Direct Controls 236 Indirect Controls 236 Receiver Controls 236 Acoustic Artifacts 236 Guidelines for Reducing MI and TI 237 Output Display 239 Mechanical and Thermal Indices Output Display Accuracy 240 Factors that Contribute to Display Uncertainty 240 Related Guidance Documents 241 Transducer Surface Temperature Rise 242 Acoust
210. noJ When the upgrade is completed the system displays the following message Figure 5 System Software Step 2 Restart 6 Select Restart When the operating software has been replaced the system presents you with the license update screen so that you may license the software If upgrading a transducer press Cancel from the on screen menu 7 2005MayO3 10 11 Please enter a new license key or cancel System this operation To obtain a license key 1 Contact SonoSite at 1 877 657 8118 www sonosite com service sonosite com 2 Supply the following a Your name b System serial c ARM version 30 40 300 019 R d PCBA serial 000000 e Previous license update 161428413005 3 Enter license key i Figure 6 System Software License Key At this point the software upgrade process is complete but the software is not yet licensed See Obtaining a License Key on page 184 Note If you are upgrading a system and one or more transducers it is recommended to upgrade all items before calling SonoSite Technical Support for your license keys To postpone obtaining a license key press Cancel from the on screen menu Caution To avoid damage to the ultrasound system or transducer do not remove the upgrade card during the upgrade process 180 Chapter 6 Troubleshooting and Maintenance Upgrade Note Connect the transducer directly to the ultrasound system Do not upgrade using Transducer the Triple Transducer Connect Do not
211. nt label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Automatic On a frozen Doppler spectral trace press the Caliper key Trace Select Auto from the on screen menu A vertical caliper is displayed Use the Touchpad to position the first caliper at the beginning of the wave form Press the Select key A second vertical caliper is displayed e If calipers are not placed in the correct position the calculation is not performed accurately Use the Touchpad to position the second caliper at the end of the wave form Select Set from the on screen menu to complete the trace and to display the results To save the highlighted measurement to a calculation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Chapter 4 Measurements and Calculations 87 suone n je pue sjuauleansea y The following table shows the auto trace results displayed by exam type Table 1 Auto Trace Results by Exam Type Auto Trace Results Cardiac TCD Orb Vascular OB Gyn Abdomen Neo Velocity Time Integral VTI Peak Velocity Vmax Mean Pressure Gradient PGmean Mean Velocity on Peak Trace Vmean Pressure Gradient PGmax Cardiac Output CO Peak Systolic Velocity PSV Time Average Mean TAM
212. nt to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Aortic Valve Area AVA Aortic Valve Area AVA continued Note This calculation requires a measurement taken in 2D and two measurements taken in Doppler After the three measurements are completed and saved the result is displayed in the patient report 2D measurement from LVOT 1 Onafrozen 2D image press the Calcs key 2 Fromthe calculations menu select LVOT D 3 Perform the measurement 4 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Doppler measurement from LVOT 1 Onafrozen Doppler spectral trace press the Calcs key 2 From the calculations menu select AV 3 Locate LVOT then select Vmax or VTI 4 Perform the measurement See E A VMax and TRmax e and a on page 126 or Velocity Time Integral VTI on page 127 5 Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark
213. ntially 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 MSDs f a Magnavita N L Bevilacqua P Mirk A Fileni and N Castellino Work related Musculoskeletal Complaints in Sonologists Occupational Environmental Medicine 41 11 1999 981 988 b Craig M Sonography An Occupational Hazard Journal of Diagnostic Medical Sonography 3 1985 121 125 C Smith C S G W Wolf G Y Xie and M D Smith Musculoskeletal Pain in Cardiac Ultrasonographers Results of a Random Survey Journal of American Society of Echocardiography May1997 357 362 d Wihlidal L M and S Kumar An Injury Profile of Practicing Diagnostic Medical Sonographers in Alberta International Journal of Industrial Ergonomics 19 1997 205 216 e Habes DJ and S Baron Health Hazard Report 99 0093 2749 University of Medicine and Dentistry of New Jersey 1999 f
214. ntricular mass LV mass 123 left ventricular outflow tract diameter LVOT D 121 Index left ventricular systolic LVs 121 left ventricular volume LV volume 122 license key 184 185 live trace 45 67 login 25 26 30 LVO Left Ventricular Opacification 58 M M mode M line 61 trace 62 maintenance 186 manual trace 82 87 measurement area circumference 81 delete 82 distance 80 83 follicle 99 heart rate 84 terminology publications 203 vascular 108 measurement accuracy 2D measurements 201 caliper placement 201 display size 201 measurement and calcs data 19 measurements and calculations cardiac Doppler calculations 124 mechanical index MI 240 288 menu controls 21 mitral valve aortic valve MV AV 122 M line M Mode 61 mode data 19 38 modes 18 near description 17 network log 166 new patient 49 NTSC definition 288 O OB calculations 100 105 Doppler calculations 107 graphs 139 table set up 43 obstetrical references 210 obstetrical intended uses 2 on screen controls 17 on screen menu 19 21 optimize 57 orbital 117 orientation marker 19 output display 240 P PAL definition 288 pan 60 password 26 28 30 patient header 20 38 patient images delete 73 next or previous 73 patient list 73 turn on 73 patient information DICOM 171 new patient 49 patient list archive 72 delete 73 print all images 73 review images 72 turn on 72 patient report cardiac 136 general 135 OB twins 137 tran
215. nu select the desired view and phase Position the caliper at the medial mitral annulus and press the Select key to start the tracing function Use the Touchpad to trace the left ventricular LV cavity If an error is made select Undo from the on screen menu to delete the previous position Complete the trace and select Set from the on screen menu Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Select the next measurement Repeat these steps until all measurements have been performed MV AV Area No On a frozen 2D image press the Calcs key From the calculations menu locate Area then select MV or AV Position the caliper at the trace start point and press the Select key to start the tracing function Use the Touchpad to trace the desired area If an error is made select Undo from the on screen menu to delete the previous position Complete the trace and select Set from the on screen menu Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the
216. o Trace remove the caliper points Use the Touchpad to backtrack caliper over caliper points Press the Backspace key Select Undo from the on screen menu The following table shows the measurements required to complete the desired cardiac calculation The cardiac measurements are done in PW Doppler and CW Doppler mode For definitions of acronyms see Glossary on page 287 Table 21 Cardiac Calculations in Doppler Description Cardiac Measurement Calculation Result MV E E A EPG A APG E A PHT deceleration time PHT MVA Decel time VTI VTI Vmax PGmax Vmean PGmean IVRT IVRT dP dT 100 cm sec dP dT 300 cm sec PISA Radius in Color PISA Area MR VTI ERO Ann D in 2D MV Rate MV VTI Regurgitant Volume 124 Chapter 4 Measurements and Calculations Regurgitant Fraction Table 21 Cardiac Calculations in Doppler Continued Description Cardiac Measurement Calculation Result AV Vmax Vmax PGmax VTI VTI Vmax PGmax Vmean PGmean LVOT D in 2D AVA VTI or Vmax from LVOT VTI or Vmax from AV VTI SV LVOT D in 2D VTI CO HR LVOT D in 2D LVOT Vmax Vmax PGmax VTI VTI Vmax PGmax Vmean PGmean Al PHT slope Al PHT Al slope TV TRmax TRmax PGmax RA pressure RVSP PV Vmax Vmax PGmax VTI VTI Vmax PGmax Vmean PGmean Chapter 4 Measurements and Calculations 125 suone n je pue sjuauleansea y Doppler Cardiac Calculations 126 Table 21 Cardiac Calculations in Doppler Continued Description Cardiac M
217. o maintain or transmit health information are required by the Health Insurance Portability and Accountability Act HIPAA of 1996 and the European Union Data Protection Directive 95 46 EC to implement appropriate procedures to ensure the integrity and confidentiality of information to protect against any reasonably anticipated threats or hazards to the security or integrity of the information or unauthorized uses or disclosures of the information SonoSite provides a comprehensive set of tools on the system that allows its customers to meet the applicable security requirements listed in the HIPAA standard SonoSite s customers are ultimately responsible for ensuring the security and protection of all electronic protected health information collected stored reviewed and transmitted on the system Setup Pages Setup Pages Administrator Login User Login On To access administrative settings enter User List your administrator user name and password and then click Login New Delete Name Administrator User Information Password 3 7 Name Administrator Login Password Confirm To reset your password contact SonoSite at 1 877 657 8118 F Password changes Save j Cancel Figure 7 Setup Administration and Administrator Information Press the Setup key Select Administration In Administrator Login type Administrator in the Name field Call SonoSite for the password 1 877 657 8118 USA and Canada only 5 Select Lo
218. of acronyms see Glossary on page 287 Table 19 Cardiac Calculations in 2D Description Cardiac Measurement Calculation Result LV RVWd CO RVDd EF IVSd SV LVDd LVESV LVPWd LVEDV RVWs IVSFT RVDs LVPWFT IVSs LVDFS LVDs CI LVPWs SI HR needed for CO amp CI Ao Ao LA Ao LA LA LA Ao AAo AAo LVOT D LVOT D LVOT area Area AV AV Area MV MV Area LV Vol A4Cd LV Vol A4Cs LV Area A2Cd EF A2Cs CO Biplane SV CI SI LV mass Epi LV Mass Endo Epi Area Apical Endo Area D Apical 118 Chapter 4 Measurements and Calculations Table 19 Cardiac Calculations in 2D Continued Description Cardiac Measurement Calculation Result PISA Ann D PISA Area Radius in Color ERO MR VTI in Doppler MV Rate MV VTI in Doppler Regurgitant Volume Regurgitant Fraction Qp Qs LVOT D D RVOT D VTI LVOT VTI in Doppler VMax RVOT VTI in Doppler PGmax Vmean PGmean SV Qp Qs Chapter 4 Measurements and Calculations 119 suone n je pue sjueulaJnseeIw 120 Table 20 Cardiac Calculations in M Mode Description Cardiac Measurement Calculation Result LV RVWd CO RVDd EF IVSd SV LVDd LVESV LVPWd LVEDV RVWs IVSFT RVDs LVPWFT IVSs LVDFS LVDs CI LVPWs SI HR in M Mode or Doppler LV Mass Ao Ao LA Ao LA LA LA Ao ACS ACS LVET LVET EF SLOPE EF SLOPE EPSS EPSS Chapter 4 Measurements and Calculations gt AACE 36 2cm 141 0ml EF 77 Figure 13 Cardiac M Mode and LV Volume LVd and LVs 2D and
219. olic waveform Press the Select key and position the second caliper at end diastole on the waveform OR Manual Trace If S D RI Pl is selected the manual trace function is activated Position the caliper at the beginning of the desired waveform and press the Select key Use the Touchpad to trace the desired area e Complete the trace and select Set from the on screen menu If calipers are not placed in the correct position the calculation is not performed accurately Select Save from the on screen menu or press the Enter key to save the measurements to the patient report The results are displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Only one calculation S D RI or S D RI Pl can be saved Repeat these steps until all measurements are performed Chapter 4 Measurements and Calculations 107 suone n je pue sjuauleansea y Vascular Calculations WARNING Verify that the patient information date and time settings are accurate Before starting a new calculation start a new patient exam to delete the previous measurements See New Patient on page 49 Vascular Measurements The following table shows the transducers and exam types that provide vascular measurements Table 12 Transducer and Exam Types for Vascular Transducer Exam Types HFL38 Vascular L25e Vascular L
220. on 288 small parts calculations 96 software DICOM 148 license 177 upgrade 178 SonoMB 59 288 SonoRES 58 288 special characters 23 specifications 219 spectral trace 67 standards airborne equipment 223 DICOM 223 electromechanical 222 EMC classification 223 steering CPD 64 Doppler 66 sterilizable transducers 190 storage specifications equipment 221 stroke index SI 132 stroke volume SV 132 superficial intended uses 3 symbols 23 symbols labeling 283 system clean and disinfect 187 software 8 specifications 221 storage and shipping 221 turn on off 14 upgrade software 177 wake up 14 Index system control AC power indicator 17 alphanumeric 16 annotation 16 caliper calcs 17 depth 17 far 17 forms 18 freeze 18 gain 17 modes 18 near 17 on screen controls 17 power 16 print 17 save 17 select 17 THI 16 touchpad 17 update 18 video recording 18 zoom 17 system dimensions 219 system setup annotations 36 beep alert 31 cardiac calculation 32 date 35 delta key 36 description 24 DICOM 148 Doppler scale 45 duplex images 45 export OB tables 40 footswitch 46 gestational age 40 growth analysis 40 import OB tables 41 IMT calculations 39 key click 31 live trace 45 mode data 38 OB custom measurement 42 patient header 38 power delay 31 printer 33 save key 46 security 25 serial port 33 sleep delay 31 system information 47 system status 38 48 thermal index 45 time 35 transfer mode 34 video mode 33 sys
221. ondition 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 9 Safety 257 Ayayes Table 20 Transducer Model L38e 10 5 Operating Mode CPD Color TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 5 1 2 b Pr3 MPa 3 364 Wo mW 50 35 min of W 3 zi lrA 3 z1 Jl mW 5 Z cm 7 Zpp cm E S Zsp cm 1 1 a o dizi cm lt fe MHz 5 03 5 03 Dim of Aaprt X cm 0 42 Y cm 0 4 PD usec 1 69 S PRF Hz 4963 8 D Pll max MPa 3 28 S deq Pllmax cm Focal Length FL cm 1 5 9 Ear E FL cm 2 5 Ipa 3 MImax W cm 473 11 Control 1 Mode CPD Color Control 2 Exam Type Bre Any IMT Vas o 2 Control 3 Optimization Depth PRF Low 3 1 Low SoS cm NA 2 0 cm PET 1453 o e v S Control 4 Color Box Position Size Max depth Default or max width Any Default height 258 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 Ref
222. oppler 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 2 Chapter 1 Introduction 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 obtain ultrasound images The pediatric abdominal pelvic and cardiac anatomy pediatric hips neonatal head and surrounding anatomical structures can be assessed for the presence 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 p
223. oppler imaging definition 287 D d D ratio 96 date 35 default settings change to 47 delta key 36 delta pressure delta time dP dT 130 depth adjust 59 definition 287 description 17 depth marker 20 deselect patient list 72 DICOM archive image 170 backup 147 configuration 147 connectivity 34 location 149 manual archive image 171 patient information 171 patient query 173 print image 170 select archiver 168 select location 168 select printer 168 select worklist server 168 sort worklist 173 standard 223 system setup 148 usage 167 verify archiver status 168 verify image transfer 171 verify printer status 168 verify worklist server status 168 worklist 173 DICOM wireless 152 disinfectants compatibility table 193 198 safety 186 disinfecting battery 192 ECG cable 192 system 187 transducer cables 190 transducers 188 distance measurement 2D 80 M mode 83 D line PW Doppler 65 Doppler color 63 CW 65 Doppler amplitude mode See CPD imaging Doppler gate depth 66 Doppler scale 45 PW 65 dual images 58 duplex images 45 DVD problem 176 setup 33 E E A and VMax TRmax 126 e 126 e anda 126 ECG monitoring 76 turn on 59 elapsed time ET measurement 86 electrical safety 226 specifications 222 electromagnetic compatibility 230 electromechanical safety standards 222 EMC classification standards 223 EMED Worksheets 140 end exam 51 energy mode See CPD imaging enter text 74 equipment safety 228 ergonomic s
224. ormation and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 Connectivity and Configuration 165 yAn euuo Reviewing the Network Log 166 The Network Log function is accessible on any DICOM configuration page The log collects network errors and events typically to support diagnostics and can be exported to a CompactFlash card and read by a CompactFlash reader The log contents are saved when the system is turned off The log has a finite amount of space and writes over existing information when it is full Z 2005May03 09 58 Network Log Export Clear Done Figure 15 Network Log Clear Deletes all entries from the log Export Copies the contents of the log to the CompactFlash card back slot The log file is named log txt on the CompactFlash card Done Returns to the previous page Export Log Note The Event log and the DICOM network log have the same filename log txt When you export either one to the same CompactFlash card it will overwrite the existing log txt file 1 Insert the CompactFlash card in the back slot of the system 2 Press the Setup key select Connectivity then select DICOM Setup 3 Select Log and then Export from the on screen menu 4 View the files on a CompactFlash reader The log is a text file that can be opened by a text file application for example Microsoft Word or Notepad The log file is named log txt Chapter 5 Connectivit
225. ort Department Technical Support 1 877 657 8118 International technical support Contact your local representative or call 425 951 1330 Technical Support fax 1 425 951 6700 Technical Support e mail service sonosite com SonoSite website www sonosite com and select Support amp Service To receive your license key you will need to provide the following information which is displayed on the system information screen of your system Table 2 Software License Key Information System Software Transducer Software Name of the person installing the upgrade Name of the person installing the upgrade Serial number located on the bottom of your Serial number system ARM version REF number PCBA serial number SH database version 184 Chapter 6 Troubleshooting and Maintenance Installing a License Key When you have obtained a license key for your software you must enter it into the system Once a valid license key has been entered the system remains licensed until the next time the system software is upgraded Install 1 Turnon the system License Key If the software is not yet licensed the license update screen displays The license update screen displays the following information how to contact SonoSite the required information to obtain the license key and the grace period time remaining on your system 2 2005May03 10 12 Please enter a new license key or cancel System Please enter a new license key or cancel Transduce
226. p 0 85 o 2 deqlZsp lt fe 6 45 Dim of Aaprt x PD 0 274 S PRF 14336 E pr Pll max 2 991 S deq Pllmax Focal Length O lpa 3 Mlmax 331 4 HME Control 1 Exam Type Any T Control 2 Optimization Pen a3 E Control 3 Depth 1 9 cm O o a This index is not required for this operating mode value is lt 1 b This transducer is not intended for transcranial or neonatal cephalic uses No data are reported for this operating condition since the global maximum index value is not reported for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety 271 Ayayes Table 34 Transducer Model SLA 13 6 Operating Mode CPD Color TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Value 1 04 b Pr3 M 2 547 Wo m S min of W 3 z1 la 3 z1 m Bos 5 Z c y l SE c z S S p c 0 7 m a o deq Zsp c lt fe MH 6 0 a _ Dim of Aaprt X c Y c PD usec 1 89 S PRF H 2340 E pr Pllmax M 2 675 amp deg Pllmax c Focal Length FL cm E ne 9 Ea 5 FLy cm E IpA 3 MI max W cm2 308 1 Control 1 Exam Type Mus or Sup P Control 2 Optimization Low 2s 6
227. r Press the Setup key select Connectivity then select DICOM Setup From the Device list select the desired device or devices Select Done from the on screen menu A dialog box is displayed to restart the system Press the Setup key select Connectivity then select DICOM Setup Select Verify to confirm that a printer archiver or worklist server is connected The connection status of the device is identified in the Device list If the verify button is disabled restart the system Chapter 5 Connectivity and Configuration Ez 2005May03 09 58 DICOM Location Mobile AE Title Type Device Status g Verify Log Config Done Figure 17 DICOM Main Screen Post Verify Failed DICOM communication with the selected device was unsuccessful Success DICOM communication with the selected device was accomplished Unknown DICOM device does not support the C ECHO for example verify query command DICOM Image Archive and Print Images and clips are sent from the ultrasound system to a PACS server or printer using an Ethernet connection The images and clips are automatically sent when the system detects an Ethernet connection E This icon is present and animated when the ultrasound system is connected and images and clips are archiving Chapter 5 Connectivity and Configuration 169 yAn2euuo 170 F 05Jun01 20 00 oF Patient ID Date Time n m Archived pey PATIENT 1 12345 6789 2005Jun01 1
228. r this operation th s operation To obtain a license key To obtain a license key 1 Contact SonoSite at 1 877 667 8118 1 Contact SonoSite at 1 877 657 8118 www sonosite com www_sonosite com service sonosite com service sonosite com 2 Supply the following a Your name 2 Supply the following a Your name b System serial b Transducer part c ARM version c Transducer bundle version 30 40 300 019 20 80 200 001 R d PCBA serial te d Transducer serial 000000 033K59 e Previous license update 161428413005 3 Enter license key EE 3 Enter license key zen ZT 31 1 NEM EE 7 7 7 NM Figure 12 System and Transducer License Screens 2 Enter your license key in the license number field 3 Select Done from the on screen menu to install the license key and license your software If you have entered a valid license key and you cannot complete the licensing procedure verify that the license key has been entered correctly If after confirming correct entry of the license key you are still unable to license your system call SonoSite Technical Support Chapter 6 Troubleshooting and Maintenance 185 Bunoouse qnoJ Maintenance This section is intended to assist in effective cleaning and disinfection It is also intended to protect the system and transducers against damage during cleaning or disinfection Use the recommendations in this section when cleaning or disinfecting your ultrasound system transducer and acc
229. r exam type in Table 2 Transducer Exam Type and Imaging Mode on page 53 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 patient s electrocardiogram ECG may be obtained and is used for timing of diastolic and systolic function WARNING The ECG is not used to diagnose cardiac arrhythmias and is not designed for long term cardiac rhythm monitoring Chapter 1 Introduction 1 uon npoanu Gynecology and Infertility Imaging Applications This system transmits ultrasound energy in the pelvis and lower abdomen using 2D M Mode color power Doppler
230. r 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 9 Safety Table 25 Transducer Model P10 8 4 Operating Mode PW TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value 1 05 1 4 2 7 b Pr3 MPa 2 196 Wo mW 66 76 47 32 Y min of W 5 z4 lza 3 z4 mW o Z E S mn cm 0 8 0 8 Sg P oy HER cm 0 295 lt fe MHz 4 37 4 36 4 36 Dim of Aaprt X cm 0 992 m 0 384 Y cm 0 7 0 7 PD usec 1 31 S PRF Hz 1562 E P Pllmax MPa 2 48 S deqGPllia cm 0 267 Focal Length FL cm 6 77 E FL cm 5 0 lpa 3 M max W cm 186 99 4 Control 1 Exam Type Card Vas Neo Vas Neo 2s S Abd Abd o E E Control 2 Sample Volume 1mm 10 mm 12mm amp S S Control 3 PRF 1563 gt 5208 15625 Control 4 Sample Volume Position Zone 1 Zone 7 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 repor
231. r spectral trace press the Calcs key From the calculations menu select TDI then select the desired measurement Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Perform the next measurement Repeat these steps until all measurements are performed Chapter 4 Measurements and Calculations Patient Report Vascular Prox cm s Mid cm s Dist cm s s d s d s d 698 281 6e 310 698 339 698 262 68 368 620 359 60 1 107 679 174 6805 165 Area Red Vol Flow 20065Dec05 20 51 Cardiac Mean Values HR 67bpm 1 4 a 50 2cm s vm 18 6cm 1 01mmHg Vmax 75 7cm s 40 6cm s PGmax 2 29mmHg 0 66mmHg Vmean 58 0cm s 1 24 PGmean 1 36mmHg 52 2ms 180 0ms TV 421cm 2650 0cm s 11 0cm 25 0mmHg 52 0cm s 1 08mmHg 31 1cms 0 39mmHg 65 0ms Dia Red Figure 14 Vascular and Cardiac Patient Reports Patient Reports 1 Press the Report key The pound symbol is displayed on the patient report when an entry is out of range for example too large or small The value for a calculation is displayed only when the calculation has been performed e Calculation values that are out of range are not included in derived ca
232. r to verify physical connection to LAN 2 2007Feb22 12 54 Locations Alias DHCP IP Address Subnet Mask Default Gateway Alias 01 255 255 0 0 E Location Host Name MicroMAXX I DHCP Alias Alias 02 IPAddress AE Title oo0000_scu Subnet Mask 255 255 o o Default Gateway m RES Alternate Gateway Next 42 Next New Delete Symbols Cancel Save Import Export Done Figure 4 DICOM Locations Configuration Page 1 148 Chapter 5 Connectivity and Configuration Configure DICOM Location Page 1 ma BW N Ensure the system is set up for DICOM connectivity See System Connectivity Setup on page 141 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu Select New See Figure 4 on page 148 Select DHCP to enable DHCP Dynamic Host Configuration Protocol if desired When DHCP is selected the IP Address Subnet Mask Default Gateway and Alternate Gateway fields are inactive Enter network information in the following fields Host Name Unique network name for the ultrasound system Default is MicroMaxx Alias Name used to identify the network location of the MicroMaxx AE Title DICOM Application Entity Title Wireless If you are setting up SiteLink for wireless use select the Wireless check box IP Address Unique identifier of the ultrasound system location Cannot be between 127 0 0
233. ranseptic USA Cleaner Alcohol N U N N N N Tristel GBR Liquid Chlorine Dioxide A A A A A A Tristel Wipes GBR Wipe Chlorine Dioxide N A N A N A Vesphene II 4 USA Liquid Sodium A U A A A A o Phenylphenate Virex Il 256 USA Liquid Ammonium Chloride A U A A A Virex TB 4 USA Liquid Quat Ammonia A U N N Wavicide 01 2 4 USA Liquid Gluteraldehyde U N N N N 5 Bunoouse qnoJ 86L e xueuajureyy pue bunoouse qnoJ 9 4a3deyD Table 3 Disinfectants Compatible with System and Transducers Continued Vs C60e ICT Disinfectionand JCoMmpe uec Active Ingredient L38e P10 D2 HFL38 SLT e ur System Cleaning Solutions of Origin L25e Surfaces P17 SLA Wavicide 06 4 USA Liquid Gluteraldehyde A U A A A N Wex Cide 4 USA Liquid O phenylphenol A U A A A A 1 Compatible but no EPA Registration 2 Has FDA 510 k 3 Has CE Mark 4 EPA Registered 5 FDA 510 k cleared liquid sterilant or high level disinfectant A Acceptable for use with system or transducer cable N No do not use U Untested do not use Caution To avoid damaging the transducer follow the disinfectant manufacturer s instructions Soaking times exceeding values in the table below and or inadequate rinsing may reduce transducer life time or cause damages See the TEE Transducer User Guide for important transducer care and cleaning instructions Table 4 Disinfectants Compatible with TEE Transducers Disinfectant Active Ingredient TEE zi w
234. rd 60950 Information Technology Equipment ITE Do not use the system if an error message appears on the image display note the error code call SonoSite or your local representative turn off the system by pressing and holding the power key until the system powers down To avoid increasing the system and transducer connector temperature do not block the airflow to the ventilation holes on the side of the system Chapter 9 Safety 227 Ayayes Equipment Safety To protect your ultrasound system transducer and accessories follow these precautions Caution Excessive bending or twisting of cables can cause a failure or intermittent operation Improper cleaning or disinfecting of any part of the system can cause permanent damage For cleaning and disinfecting instructions see Chapter 6 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 The battery has a safety device Do not disassemble or alter the ba
235. re is calculated when values are entered NST non stress test is optional Chapter 4 Measurements and Calculations Figure 16 OB Graphs R OB C 111 BPO Hadlock 12 10 OB Graphs Note OB Graphs may only be viewed when LMP or Estab DD is entered in the patient information screen 1 At the end of an OB exam press the Report key 2 Select Graphs from the on screen menu 3 Inthe Graphs list select the desired measurement author The graph for the selected measurement is displayed If desired select another measurement author or select 1 x from the on screen menu If desired press the Save key to save the current graph page 4 Select Report from the on screen menu to return to the previous report page or Done to return to live imaging For twins both measurement sets are plotted on the same graph Chapter 4 Measurements and Calculations 139 suone n je pue sjuauleansea y 2007Feb27 13 37 Iliac Right iliac Left Sagitta Figure 17 EMED Worksheet EMED This feature is optional Worksheets 1 At the end of an exam press the Report key 2 Select EMED from the on screen menu 3 Select the desired worksheet AAA FAST Gallbladder GB Kidney 140 Chapter 4 Measurements and Calculations Chapter 5 Connectivity and Configuration SiteLink Image Manager and DICOM are easy and effective methods of transferring data and images when using the ultrasound system This chapter contains
236. rements of acoustic output made in water Currently available models may be limited in their accuracy because of varying tissue paths during diagnostic ultrasound exposures and uncertainties in the acoustic properties of soft tissues No single tissue model is adequate for predicting exposures in all situations from measurements made in water and continued improvement and verification of these models is necessary for making exposure assessments for specific exam types A homogeneous tissue model with attenuation coefficient of 0 3 dB cm MHz throughout the beam path is commonly used when estimating exposure levels The model is conservative in that it overestimates the n 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 n Situ acoustic exposure The amount of underestimation depends upon each specific situation Fixed path tissue models in which soft tissue thickness is held constant sometimes are used to estimate n Situ acoustic exposures when the beam path is longer than 3 cm and consists largely of fluid When this model is used to estimate maximum exposure to the fetus during transabdominal scans a value of 1 dB cm MHz may be used during all trimesters Existing tissue models that are based on linear propagation may
237. remove the transducer from the system until the Software license page is displayed on the system 1 Turn the system off and remove the CompactFlash card from the back slot Connect the transducer for the upgrade 2 3 Turnthe system on 4 Waitapproximately 10 seconds and then insert the upgrade CompactFlash card incompatible transducer To use the active transducer please insert the upgrade CF card into the back slot Figure 7 Incompatible Transducer Update This screen is not displayed for compatible transducers Figure 8 Upgrade Transducer Software Chapter 6 Troubleshooting and Maintenance 181 Bunoouse qnoJ Select Upgrade to accept or Cancel to cancel the upgrade When you accept the transducer software upgrade the system loads the new software and displays the following message Please wait transducer upgrade in progress Figure 9 Transducer Software Loading When the upgrade is completed the system displays the following message Figure 10 Transducer Software Installation 6 Select Restart When the transducer software has been replaced the system presents you with the license update screen so that you may license the software for your transducer Upgrade all transducers before obtaining license keys Repeat all steps in Upgrade Transducer Software 182 Chapter 6 Troubleshooting and Maintenance Please enter a new license key or cancel Transducer th s operation To obtain a license
238. riability 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 Medical Ultrasound Safety American Institute of Ultrasound in Medicine AIUM 1994 A copy is included with each system Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment NEMA UD2 2004 Acoustic Output Measurement and Labeling Standard for Diagnostic Ultrasound Equipment American Institute of Ultrasound in Medicine 1993 Standard for Real Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment NEMA UD3 2004 Guidance on the interpretation of Tl and MI to be used to inform the operator Annex HH BS EN 60601 2 37 reprinted at P05699 Chapter 9 Safety 241 Ayayes Transducer Surface Tempera
239. rm The options listed below are only available in DICOM Worklist New Patient H 1 Press the Patient key Select New from the on screen menu This ends the current patient procedure Selecting new patient erases any previously entered information including any calculations and report pages e To save this information save the screen for each item for example report pages patient information calculations and graphs 3 Enter information into appropriate fields Procedure Type Select the procedure type only available when DICOM Worklist feature is licensed and configured Procedure ID Enter desired identification information The field is editable when performing a manual patient query Chapter 5 Connectivity and Configuration 171 yAn euuo Query The Query on screen menu is displayed when the following is set up Data is entered in the following fields Patient Last First Middle Patient ID Accession Procedure ID System is connected to a LAN Worklist server is active See Manual Patient Query on page 173 Worklist 1 Press the Patient key 2 Select Worklist from the on screen menu to view all scheduled patient procedures that have been queried by the system DICOM Worklists DICOM worklist provides the ability to import patient data from the Hospital Information System or Radiology Information System The patient information form also provides the ability to enter specific patient dat
240. rm Definition Ispra 3 Derated spatial peak temporal average intensity in units of milliwatts cm Tl type Applicable thermal index for the transducer imaging mode and exam type TI value Thermal index value for the transducer imaging mode and exam type MI Mechanical index Ipa 3 MImax Derated pulse average intensity at the maximum MI in units of W cm TIS Soft tissue thermal index is a thermal index related to soft tissues TIS scan is the soft tissue thermal index in an auto scanning mode TIS non scan is the soft tissue thermal index in the non autoscanning mode TIB Bone thermal index is a thermal index for applications in which the ultrasound beam passes through soft tissue and a focal region is in the immediate vicinity of bone TIB non scan is the bone thermal index in the non autoscanning mode TIC Cranial bone thermal index is the thermal index for applications in which the ultrasound beam passes through bone near the beam entrance into the body Aaprt Area of the active aperture measured in cm Pr3 Derated peak rarefactional pressure associated with the transmit pattern giving rise to the value reported under MI Megapascals Wo Ultrasonic power except for TIS 3 in which case it is the ultrasonic power passing through a one centimeter window in units of milliwatts W 3 z1 Derated ultrasonic power at axial distance z in units of milliwatts Ispta 3 Z1 Derated spatial peak temporal average intensity at axial
241. rm Toggle between full and side by side 2D images 2D only 9g y g y Clips Display the clips menu optional feature Biopsy Display biopsy guidelines 2D only dependent on transducer type Orientation ry Select image orientation Up Right Up Left Down Left and Down Right Brightness E Adjust display brightness 0 10 SonoRES El Select S to turn on SonoRES SonoMB MB is on when SonoMB is available When both 2D image enhancements are available SonoRES and SonoMB share the same on screen menu Sweep Speed Select desired M Mode sweep speed slow med fast ECG j Display the ECG trace optional feature Color Doppler Imaging 1 Press Color key for color power Doppler CPD or color imaging dependent on transducer and exam type 2 Select Color or CPD 3 Use the Touchpad to position the region of interest ROI box On screen menu items for this mode Control Description Color or CPD Select Color or CPD Flow zm Select flow sensitivity low medium or high Sensitivity PRF Scale Select pulse repetition frequency Wall Filter VF Select wall filter setting low med or high Steering iw Select correct steering angle for pulsed wave PW Doppler 15 0 or 15 degrees L38e and HFL38 transducers only Variance Turn variance option on and off cardiac only Invert Select to switch the displayed direction of flow 4 See MicroMaxx Ultrasound System User Guide for more information MicroMaxx Quick Start Cards PW
242. rms a sector image by electronically steering the beam direction and focus A Doppler recording of blood flow velocities in a range specific area along the length of the beam A depth on the display that corresponds to the skin transducer interface A subset of the 2D imaging mode where 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 subset of 2D imaging mode where 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 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 9 Safety for a more complete description of TI TIB bone thermal index TIC cranial bone thermal index TIS soft tissue thermal index Tissue Harmonic Imaging transducer variance Acronyms 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
243. rom the on screen menu to move between measurements To save the highlighted measurement to a calculation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Chapter 4 Measurements and Calculations 81 suone n je pue sjueuloaJnseaIwy 82 Manual Trace U AUN On a frozen 2D image press the Caliper key Select Manual from the on screen menu Use the Touchpad to position the caliper at the trace start point Press the Select key to start the tracing function Use the Touchpad to complete the trace and select Set from the on screen menu The result is displayed in the measurement and calculation data area Press the Caliper key to activate additional caliper sets A combination of distance area circumference and trace measurements can be performed at the same time The number of measurements available depends on the order and types of measurements If you exceed the allowed combination of measurements for an image Manual is not shown on the on screen menu Select Switch from the on screen menu to move between measurements To save the highlighted measurement to a calculation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it
244. rompts the user that the transducer requires the upgrade Caution To avoid damage to the ultrasound system or transducer do not remove the upgrade card during the upgrade process Chapter 6 Troubleshooting and Maintenance 177 Bunoouse qnoJ Upgrade 1 Remove any transducer or Triple Transducer Connect from the system System 2 Connect the system directly to the power supply or through the mini dock Software docking system See the SonoSite accessories user guide 3 Insert the CompactFlash card into the back slot The system displays the following message Figure 1 Upgrade System Software 4 Select Yes to accept or No to cancel the upgrade When you accept the system software upgrade the system begins to load the new software and prepare for the upgrade and displays the following message Figure 2 System Software Loading 178 Chapter 6 Troubleshooting and Maintenance When the software upgrade has prepared the system for upgrade the system displays the following message 2003Jun17 23 04 1 SH Renten IM bese DNUS DO NOT turn off the system oc remove the CompactFlash card Restart 1 Figure 3 System Software Step 1 Restart 5 Select Restart After restart there is a short delay before the system goes into the upgrade process Do not turn the system off The system displays the following message Figure 4 System Software Installation Chapter 6 Troubleshooting and Maintenance 179 Bunoouse q
245. rostate 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 Transcranial Imaging Applications This system transmits ultrasound energy into the cranium using 2D color Doppler Color color power Doppler CPD and pulsed wave PW Doppler to obtain ultrasound images The anatomical structures and vascular anatomy of the brain can be assessed for presence or absence of pathology Two exam types support transcranial imaging TCD and Orb Imaging can be used temporally trans occipitally or trans orbitally WARNING To avoid injury to the patient use only an orbital exam type Orb when performing imaging through the eye The FDA has established lower acoustic energy limits for opthalmic use The system will not exceed these limits only if the Orb exam type is selected Vascular Imaging Applications This system transmits ultrasound energ
246. rovals The specifications for recommended peripherals can be found in the manufacturers instructions System Dimensions 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 C60e transducer and battery installed Display Dimensions Length 8 4 in 21 34 cm Height 6 3 in 16 cm Diagonal 10 4 in 26 4 cm Transducers C11e 8 5 MHz 6ft 1 8m C60e 5 2 MHz 5 5 ft 1 7 m D2 2 MHz 5 5 ft 1 7m HFL38 13 6 MHz 5 6 ft 1 7 m ICT 8 5 MHz 5 5 ft 1 7 m LAP 12 5 MHz 8 2 ft 2 5 m L25e 13 6 MHz 7 5ft 2 3m L38e 10 5 MHz 5 5 ft 1 7 m P10 8 4 MHz 6 ft 1 8 m P17 5 1 MHz 6 ft 1 8 m SLA 13 6 MHz 7 5 ft 2 3 m SLT 10 5 MHz 8 1 ft 2 5 m TEE 8 3 MHz 7 2 ft 2 2 m Chapter 8 Specifications 219 suone yi edsg Imaging Modes 2D 256 gray shades Color power Doppler CPD 256 colors Color Doppler Color 256 colors M Mode Pulsed wave PW Doppler Continuous Wave CW Doppler Tissue Doppler Imaging TDI Tissue Harmonic Imaging THI Image Storage The number of images saved to the CompactFlash card vary depending on the card storage capacity Cine buffer Accessories Hardware Software and Documentation American Institute of Ultrasound Medicine Medical Safety Guidance Battery Biopsy Guide Carry case External display Footswitch BS EN 60601 2 37 2001 Annex HH Mobile Docking System Lite MDS Lite Mobile Docki
247. rrect functioning If this occurs survey the site to determine the source of disruption and take the following actions to eliminate the source s Turn equipment in the vicinity off and on to isolate disruptive equipment Relocate or re orient interfering equipment Increase distance between interfering equipment and your ultrasound system Manage use of frequencies close to ultrasound system frequencies Remove devices that are highly susceptible to EMI Lower power from internal sources within facility control such as paging systems Label devices susceptible to EMI Educate clinical staff to recognize potential EMI related problems Eliminate or reduce EMI with technical solutions such as shielding Restrict use of personal communicators cell phones computers in areas with devices susceptible to EMI Share relevant EMI information with others particularly when evaluating new equipment purchases which may generate EMI Purchase medical devices that comply with IEC 60601 1 2 EMC Standards To avoid the risk of increased electromagnetic emissions or decreased immunity use only accessories and peripherals recommended by SonoSite Connection of accessories and peripherals not recommended by SonoSite could result in malfunctioning of your ultrasound system or other medical electrical devices in the area Contact SonoSite or your local representative for a list of accessories and peripherals available from or recommended by SonoSite S
248. rt time for the automatic update displayed in 24 hour time Chapter 5 Connectivity and Configuration The following table identifies the parameters used for worklist queries Table 1 Manual and Automatic Query Parameters ten ide UPdate rom ta Worklist Patient data X Date Range X X X This MicroMAXX Only X X Automatic Query On Off X Occurs Every X Start Time X Configure New Worklist Server 1 An AUN Ensure the system is setup for DICOM connectivity See System Configuration for DICOM on page 147 Press the Setup key select Connectivity then select DICOM Setup Select Config from the on screen menu In the Configure list select Worklist Servers Select New Enter information in the fields pages 1 and 2 Name Cannot contain special characters Alias and AE Title May contain special characters IP Address and Port Must be entered before the information is saved To use special characters select Symbols See Enter Symbol Special Character on page 23 Use the spacebar on the keyboard to enter the underscore symbol Select Cancel to undo last change Select Save Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 Connectivity and Configuration 163 yAn euuo Set Up Automatic Query Update U AUN Oo Press the Setup key select Connectivity then select DICOM Setup Select Confi
249. ry The battery comprises six lithium ion cells plus electronics a temperature sensor and battery contacts 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 conduct a safe system shutdown always keep a battery in the system Locking levers Figure 1 Insert Battery into System Chapter 2 Getting Started 11 pares bunje5 Install Battery 1 Disconnect the power supply from the ultrasound system 2 Turn the system upside down 3 Place the battery into the battery compartment at a slight angle See Figure 1 on page 11 4 Slide the battery forward until it locks into place 5 Push down on the two locking levers to secure the battery Remove 1 Push up on the two locking levers Battery 2 Slidethe battery back 3 Lift the battery from the compartment Installing or Removing CompactFlash Card 12 Images and clips are saved to a CompactFlash card and are organized in a patient list The images and clips in the patient list are organized alphabetically by the patient name and ID Images and clips are archived from the ultrasound system to a PC using a USB Ethernet connection wireless or CompactFlash card Images and clips on the CompactFlash card cannot be viewed directly from a CompactFlash reader Install 1 CompactFlash 2 Card Verify the ejector pin is pushed in completely
250. s for this setup Chapter 2 Getting Started page to factory default Date and Time Date and Time Date 2006 10 37 YYYY MM DD Time 18 hr 19 min Figure 14 Setup Date and Time WARNING An accurate date and time are critical for accurate obstetrics calculations Verify that the date and time are accurate before each use of the system The system does not automatically adjust for daylight savings time changes Date 1 Press the Setup key 2 Select Date and Time 3 Inthe Date field enter the current date year month and day Time 1 Press the Setup key 2 Select Date and Time 3 Inthe Time field enter the current time in 24 hour format hours and minutes Reset Select Reset from the on screen menu to return settings for this setup page to factory default Chapter 2 Getting Started 35 payeis 6Bunyo5 Delta Key and Annotation 36 4 20060ct19 13 07 IPPI E z Unfreeze Keep All Text Figure 15 Setup Delta Key Annotations Delta Key Press the Setup key Select Delta Key Annotations In the Delta Key list select desired functionality for the Delta key The Delta key now controls this function Annotations Chapter 2 Getting Started BRWN Press the Setup key Select Delta Key Annotations In the Exam list select the desired exam type Select the Group A B or C for the predefined labels you want associated with that exam The preset labels show for the se
251. s in gm 206 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 Chapter 7 References Left Ventricular Volume Biplane Method in ml Schiller N B P M Shah M Crawford et al Recommendations for Quantitation of the Left Ventricle by Two Dimensional Echocardiography Journal of American Society of Echocardiography September October 1989 2 362 v x se i l where V Volume in ml a Diameter b Diameter n Number of segments n 20 L Length i Segment Left Ventricular Volume Single Plane Method in ml Schiller N B P M Shah M Crawford et al Recommendations for Quantitation of the Left Ventricle by Two Dimensional Echocardiography Journal of American Society of Echocardiography September October 1989 2 362 ve ra i l where V Volume a Diameter n Number of segments n 20 L Length i Segment Left Ventricular Dimension LVD Fractional Shortening percent Oh J K J B Seward A J Tajik The Echo Manual Boston Little Brown and Company 1994 43 44 LVDFS LVDD LVDS LVDD 100 where LVDD Left Ventricle Dimension at Diastole LVDS Left Ventricle Dimension at Systole Left
252. s used exceeds the applicable RF compliance level above the SonoSite ultrasound system should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the SonoSite ultrasound system b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m 234 Chapter 9 Safety The ALARA Principle ALARA is the guiding principle for the use of diagnostic ultrasound Sonographers and other qualified ultrasound users using good judgment and insight determine the 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 throu
253. scranial 137 vascular 136 PC setup 33 peak velocity VMax 126 pediatric intended uses 3 percent area reduction 91 percent diameter reduction 91 percent reduction calculation 90 peripherals 221 pictograph 19 76 power 16 precision acoustic measurement 283 pressure half time PHT 128 pressure limits 221 PRF setting 67 print all images 73 print image 17 72 printer DICOM configuration 157 problem 176 setup 33 probe See transducer procedure configuration 164 prostate intended uses 3 proximal isovelocity surface area PISA 119 pulsed wave Doppler PW D line 65 spectral trace 67 Q Qp Qs 119 R recording problem 176 references cardiac 204 general 216 obstetrical 210 reports patient 135 resistive index RI measurement 86 review images 72 right ventricular systolic pressure RVSP 127 ROI box 63 S safety battery 228 biological 230 disinfectants 186 electrical 226 electromagnetic compatibility 230 equipment 228 ergonomic 9 save clip 71 save image 17 71 save key 46 scale 67 scanhead See transducer screen layout calcs menu 19 depth marker 20 measurement and calcs data 19 mode data 19 Index 303 xepu on screen menu 19 orientation marker 19 patient header 20 picto 19 system status 20 text 19 security setup 25 select 17 select all patient list 72 serial port 33 shipping specifications 221 Simpson s Rule 122 SiteLink configuration 141 connectivity 34 wireless 144 skin line definiti
254. shed standards Chapter 7 References 203 so uaJoJay Cardiac References Acceleration ACC in cm s2 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 A2 Ay ii V4 V5 where A Ao valve area A LVOT area V4 LVOT velocity V Ao valve velocity LVOT Left Ventricular Outflow Tract AVA PV yor PVAo CSA yo AVA VTliyor VTlAo CSAiyor Body Surface Area BSA in m Grossman W Cardiac Catheterization and Angiography Philadelphia Lea and Febiger 1980 90 BSA 0 007184 Weight 5 Height 725 Weight kilograms Height centimeters Cardiac Index CI in I min m Oh J K J B Seward A J Tajik The Echo Manual 2nd Edition Boston Little Brown and Company 1999 59 Cl CO BSA where CO Cardiac Output BSA Body Surface Area Cardiac Output CO in l min Oh J K J B Seward A J Tajik The Echo Manual 2nd ed Lippincott Williams and Wilkins 1999 59 CO SV HR 1000 where CO Cardiac Output SV Stroke Volume HR Heart Rate Chapter 7 Referen
255. solution not more than 12 18 inches 31 46 cm from the point where the cable enters the transducer Follow the instructions on the disinfectant label for the duration of the transducer immersion 7 Usingthe instructions on the disinfectant label rinse to the point of the previous immersion and then air dry or towel dry with a clean cloth 8 Examinethe 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 Sterilizing Transducers Surgical transducers can be sterilized using STERIS SYSTEM 1 or STERRAD See the Surgical Transducer User Guide and the LAP Transducer User Guide for more information Cleaning and Disinfecting Transducer Cables 190 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 Caution To avoid infection if a pre mixed disinfection solution is used observe the solution expiration date and ensure that the date has not passed Attempting to disinfect a transducer cable using a method other than the one included here can damage the transducer and void the warranty Chapter 6 Troubleshooting and Maintenance Clean and Disconnect the transducer from the system Disinfect Remove any transducer sheath Transducer Clean the
256. sound 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 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 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
257. stem has advanced image optimization technology that greatly simplifies user controls To achieve the best possible image quality it is important to properly adjust the display brightness gain depth settings and exam type It is also important to select an optimization setting that best matches your needs The system has a high performance liquid crystal display LCD To optimize image quality adjust the display for viewing angle and brightness Each time you turn the system on the 2D image is displayed It displays echoes in two dimensions on the display by assigning a brightness level based on the echo signal amplitude This is the system s default imaging mode When imaging in another mode you may return to 2D imaging by pressing the 2D key If the system does not return to 2D imaging after pressing the 2D key ensure the system is in live imaging 2006May17 15 52 Figure 2 2D Image Optimize Select the desired optimization setting from the on screen menu Res provides the best possible resolution Gen provides a balance between resolution and penetration Pen provides the best possible penetration Some of the parameters that are optimized to provide the best image include focal zones aperture size frequency center and bandwidth and waveform They cannot be adjusted by the user Dynamic m Select the desired dynamic range setting from the on screen menu to Range adjust grayscale range 3 2 1 0 1 2 3
258. t and Left Vertebral Artery VA BA Right and Left Dist Mid Prox AL Right and Left Extracranial Vertebral Artery ECVA Chapter 4 Measurements and Calculations TAP PSV EDV Pl RI S D Gate Size TAP PSV EDV Pl RI S D Gate Size TAP PSV EDV PI RI S D Gate Size TAP PSV EDV PI RI S D Gate Size 115 suone n je pue sjuauleansea y 116 2008Jan19 10 10 TAP 47 6cm s PSV 65 3cm s EDV 34 5cm s PI 0 65 RI 0 47 S D 1 89 Gate Depth 6 94cm Figure 12 Transcranial Doppler TCD Transcranial Doppler 1 TCD 2 On a frozen Doppler spectral trace press the Calcs key From the calculations menu select Left or Right then select the desired measurement Use the Touchpad to position the caliper Complete the trace and select Set from the on screen menu Select Save from the on screen menu or press the Enter key to save the measurement to the patient report Select the next measurement Repeat these steps until all measurements have been performed For information on using the automatic trace tool see Automatic Trace on page 87 WARNING To avoid injury to the patient use only an orbital exam type Orb when performing imaging through the eye The FDA has established lower acoustic energy limits for opthalmic use The system will not exceed these limits only if the Orb exam type is selected Chapter 4 Measurements and Calculations Transorbit
259. t from the on screen menu The information is displayed on the Patient Information form In the Type list edit the desired procedure type if required Select More to enter information on page 2 Select Done from the on screen to return to previous page Manual Worklist Update N Press the Patient key Select Worklist from the on screen menu then select Update from the on screen menu Automatic Worklist Update Ensure system is turned on and connected to the LAN See Configure DICOM Location Page 1 on page 149 Ensure system is set up for an automatic worklist query See Set Up Automatic Query Update on page 164 The worklist is automatically updated Verify the current system date and time Sort Worklist Press the Patient key Select Worklist from the on screen menu Select the desired column heading Name ID Accession Procedure or Date The worklist is sorted in ascending order Chapter 5 Connectivity and Configuration 173 yAn euuo 174 Chapter 5 Connectivity and Configuration Chapter 6 Troubleshooting and Maintenance This chapter contains information to help you correct problems with system operation and provides instructions on the proper care of the system transducer and accessories Troubleshooting If you encounter difficulty with the system use the information in this chapter to help correct the problem If the problem is not covered here contact SonoSite T
260. talc which can cause allergic reactions in some individuals Refer to 21 CFR 801 437 User labeling for devices that contain natural rubber Perform ultrasound procedures prudently Use the ALARA as low as reasonably achievable principle and follow the prudent use information concerning MI and TI SonoSite does not currently recommend a specific brand of acoustic standoff If an acoustic standoff is used it must have a minimum attentuation of 3dB cm MHz Some SonoSite transducers are approved for intraoperative applications if a market cleared sheath is used Electromagnetic Compatibility EMC 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 230 Chapter 9 Safety Caution Medical electrical equipment requires special precautions regarding EMC and must be installed and operated according to these instructions It is possible that high levels of radiated or conducted radio frequency electromagnetic interference EMI from portable and mobile RF communications equipment or other strong or nearby radio frequency sources could result in performance disruption of the ultrasound system Evidence of disruption may include image degradation or distortion erratic readings equipment ceasing to operate or other inco
261. tational Age tables for a custom OB measurement See OB Custom Tables on page 43 42 Chapter 2 Getting Started OB Custom Tables Table G Gestational Age Measurement CRL lt 1 6 Table Gestational Age Measurement BPO 1 4 C Growth Analysis Author Hadiock Growth Analysis Author Chatty B O70 Gnad Onde ie 170g Swidil Owed 1450 230 Ze 319 ie 50 Sse 44S 900 B OST Sued ovis He 100 sdf sa e 1555 265 Si 356 iy SO 45 49 35 EN OOIDO LT 1 1 T M Figure 20 Setup OB Custom Table Gestational Age Table Measurements The system provides gestational age measurements by selected authors for the age table measurements listed in Table 6 Growth Analysis Table Measurements The system provides growth graphs or curves for the growth table measurements listed in Table 6 Table 6 OB Custom Table Measurements GS CRL BPD OFD HC TTD AC FTA FL 5 additional custom measurement labels Gestational Age Table Measurements Growth Analysis Table Measurements BPD HC AC FL EFW WARNING Prior to use verify custom table data entries are correct The system does not confirm the accuracy of the custom table data entered by the user View OB Tables Press the Setup key Select OB Custom Meas or OB Calculations Select Tables from the on screen menu Select the desired table Age or Growth and measurement author AU NN Chapter 2 Getting Started 43 peueis 6Bunjo5 44
262. te 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 Chapter 7 References 211 so uaJoJay University of Tokyo Shinozuka N FJSUM et al Standard Values of Ultrasonographic Fetal Biometry Japanese Journal of Medical Ultrasonics 23 12 1996 885 WARNING The gestational age calculated by your SonoSite system does not match the age in the aforementioned reference at the 20 0 cm and 30 0 cm abdominal circumference AC measurements The implemented algorithm extrapolates the gestational age from the slope of the curve of all table measurements rather than decreasing the gestational age for a larger AC measurement indicated in the referenced table This results in the gestational age always increasing with an increase in AC Anteroposterior Trunk Dia
263. ted for the reason listed Reference Global Maximum Index Value line Data are not applicable for this transducer mode Chapter 9 Safety 263 Ayayes Table 26 Transducer Model P10 8 4 Operating Mode CW TIS TIB Index Label M I Non scan TIC Scan Non scan Aaprt lt 1 Aaprt gt 1 Global Maximum Index Value a a 2 1 b Pr3 Wo 40 82 B min of W 3 Z4 lza 34 wn 5 Z FE E S Zsp 0 7 QU OQ 8 deq Zsp 0 34 lt x fe 4 00 Dim of Aaprt 0 32 0 7 PD 5 PRF E pr GPlli ax S deq Pllmax 0 27 E Focal Length O lpa 3 Mlmax o Z2 Control 1 Exam Type Card 00 5 Control 2 Zone Jog Zone 1 2U 5 O o 264 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 9 Safety Table 27 Transducer Model P17 5 1 Operating Mode 2D TIS TIB Index Label M Non scan TIC Scan Non scan AaprtS1 Aaprt gt 1 Global Maximum Index Valu
264. tem status 20 38 T temperature limits 221 text description 19 enter 74 entry problems 176 thermal index TI 45 240 288 THI description 16 turn on off 59 time 35 tissue Doppler imaging TDI 66 134 tissue models 244 touchpad 17 20 trace calculations automatic 87 manual 87 transcranial Doppler TCD 116 transcranial intended uses 3 transducer cables clean and disinfect 190 clean and disinfect 188 connect 15 curved array 287 definition 289 disinfect 188 exam type 53 90 92 94 97 100 108 110 114 117 general use 56 imaging modes 53 invasive or surgical use 56 linear array 288 preparation 55 problems 176 remove 15 sheath 56 specifications 219 222 sterilizable 190 storage and shipping 222 upgrade software 177 transorbital TO 117 tricuspid regurgitation TRmax 126 troubleshooting 175 U ultrasound terminology 287 unfreeze text 37 update 18 upgrade system software 177 upgrade transducer software 177 user account 28 user guide conventions used 4 user login 26 user add 27 uses intended 1 3 V variance 64 vascular calculations 108 intended uses 3 VCR problem 176 setup 33 velocity measurement 86 velocity time integral VTI 127 video mode 33 video recording 18 volume adjust Doppler volume 67 calculation 92 93 volume flow 94 WwW wall filter 64 67 warnings definition 225 wireless DICOM 152 SiteLink 144 worklist servers configuration 161 worksheets 140 Z zoom
265. ternal Carotid Artery PGr Pressure Gradient PGmax Maximum Pressure Gradient PGmean Mean Pressure Gradient PHT Pressure Half Time PI Pulsatility Index PICA Proximal Internal Carotid Artery PISA Proximal Isovelocity Surface Area Plaq 1 Plaque Plaq 2 POSTF Posterior Far POSTN Posterior Near Prox Proximal PSV Peak Systolic Velocity PV Pulmonic Valve PW Pulsed Wave Doppler Qp Qs Pulmonary blood flow divided by systemic blood flow RA Right Atrial pressure Glossary 295 Aiessoj5 Table 1 Acronyms Continued Acronym Description RI Resistive Index RVD Right Ventricular Dimension RVDd Right Ventricular Dimension Diastolic RVDs Right Ventricular Dimension Systolic RVOT D Right Ventricular Outflow Tract Diameter RVOT VTI Right Ventricular Outflow Tract Velocity Time Integral RVSP Right Ventricular Systolic Pressure RVW Right Ventricular Free Wall RVWd Right Ventricular Free Wall Diastolic RVWs Right Ventricular Free Wall Systolic S SonoRES S D Systolic Diastolic Ratio SI Stroke Index Siphon Siphon internal carotid artery SM Submandibular SO Suboccipital SV Stroke Volume TAM Time Average Mean TAP Time Average Peak TDI Tissue Doppler Imaging TEE Transesophageal Echocardiogram THI Tissue Harmonic Imaging TI Thermal Index TICA Terminal Internal Carotid Artery TO Transorbital 296 Glossary Table 1 Acronyms Continued Acronym Description TRmax Tricuspid Regurgitation peak velocity TT Tr
266. the printer either as Color RGB or Monochrome images Type of interpolation used during printing Printer specific configuration value If using generic printer settings no configuration strings are available In hundredths of optical density OD Chapter 5 Connectivity and Configuration 159 yAn2euuo 160 Configure New 1 Ensure the system is set up for DICOM connectivity See System Configuration Printer for DICOM on page 147 2 Pressthe Setup key select Connectivity then select DICOM Setup 3 Select Config from the on screen menu 4 Inthe Configure list select Printers 5 Select New 6 Enter information in the fields pages 1 2 and 3 Name Cannot contain special characters Alias and AE Title May contain special characters IP Address and Port Must be entered before the information is saved To use special characters select Symbols See Enter Symbol Special Character on page 23 Use the spacebar on the keyboard to enter the underscore symbol Select Cancel to undo last change 7 Select Save 8 Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Delete Printer 1 Select the name of the device from the list of printers 2 Select Delete A dialog box is displayed 3 Select Yes to delete and No to cancel 4 Complete all configuration information and then select Done from the on screen menu A dialo
267. thout using the power supply To avoid the risk of electrical shock do not connect the system s power supply or a docking system to an MPSO or extension cord To avoid the risk of electrical shock before using the transducer inspect the transducer face housing and cable Do not use the transducer if the transducer or cable is damaged To avoid the risk of electrical shock always disconnect the power supply from the system before cleaning the system 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 6 Troubleshooting and Maintenance Chapter 9 Safety WARNING Caution To avoid the risk of electrical shock and fire hazard inspect the power supply AC power cord and plug on a regular basis Ensure they are not damaged To avoid the risk of electrical shock 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 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
268. ting 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 1 4 a Pr3 2 475 Wo 24 86 B min of W 3 Z4 lzA 374 ua 5 2 Se E SE 2 Zsp 1 8 1 7 Sg g deg Zsp 0 200 lt fe 4 39 4 39 Dim of Aaprt m m 0 658 0 55 PD 0 50 S PRF 1600 E pr Pll max 2 871 S deq Pllmax 0 1952 em Focal Length Em mm 3 E O lpa 3 Mlmax 253 3 D_ Control 1 Exam Type Any Any T Control 2 Optimization Pen Pen amp e E Control 3 Depth 4 5 cm AA JO 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 9 Safety 275 Ayayes Table 38 Transducer Model SLT 10 5 Operating Mode CPD Color TIS TIB Index Label M Non scan Non TIC Scan AaprtS1 Aaprt gt 1 scan Global Maximum Index Value 1 2 b Pr3 M 2 386 Wo Y min of W 5 z4 lz 3 z4 o Z BE a E Sow P 8 a dao Z
269. to enter the underscore symbol Select Cancel to undo last change Select Save Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Delete Archiver 1 2 Select the name of the device from the list of archivers Select Delete A dialog box is displayed Select Yes to delete and No to cancel Complete all configuration information and then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 Connectivity and Configuration Configuring Printers 2 2005May03 09 52 Configure Printers Alias Model IP Address Port AE Title List of printers r Printer Name IP Address i s r B Alias Port Printer specific information Model Agfa_DS2000 M AE Title Ping 143 Next New Delete Symbols Cancel Save Import Export Done Figure 9 Printers Configuration Page 1 Name Network host name for a printer Alias Personalized name for a printer Model List of Agfa Codonics and Kodak printer models If a specific model is not listed choose one of the generic models at the end of the list IP Address Unique identifier for the printer Port Device port number IP port 104 is normally assigned for DICOM AE Title Printer DICOM Application Entity Title Ping Utility to determine whether a specific IP address is accessible Chapter 5 Connectivity and Configuratio
270. transducer cable using a soft cloth lightly dampened in a mild soap Cable Using or detergent cleaning solution to remove any particulate matter or body fluids MipeMethon Apply the solution to the cloth rather than the surface Rinse with water or wipe with water dampened cloth then wipe with a dry cloth Mix the disinfectant solution compatible with the transducer cable following disinfectant label instructions for solution strengths and disinfectant contact duration Wipe surfaces with the disinfectant solution Air dry or towel dry with a clean cloth Examine the transducer and cable for damage such as cracks splitting or fluid leaks If damage is evident discontinue use of the transducer and contact SonoSite or your local representative Clean and Disconnect the transducer from the system Disinfect Remove any transducer sheath Transducer Clean the transducer cable using a soft cloth lightly dampened in a mild soap Cable Using or compatible cleaning solution to remove any particulate matter or body Immersion fluids Method 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
271. triCide 14 2 4 USA Liquid Gluteraldehyde A U A A A 5 MetriCide 28 2 4 USA Liquid Gluteraldehyde A U A A A A 5 MetriZyme USA Cleaner Propylene Glycol A U A A A A Mikrobak forte DEU Liquid Ammonium Chloride A U A A A A Mikrozid Wipes 3 DEU Wipe Ethanol Propanol A U A A A A Nuclean FRA Spray Alcohol Biguanide A U A A A N Precise 4 USA Spray O phenylphenol N U N N N N Ruthless USA Spray Quat Ammonia A U A A N A Sagrosept Wipe DEU Wipe Propanol A U A A A N Salvanios pH 7 FRA Liquid Quat Ammonia A U A A A A Sani Cloth HB USA Wipe Quat Ammonia A U A A N N Sani Cloth Plus USA Wipe Quat Ammonia A U A A A N Sklar 4 USA Liquid Isopropanol A U A A N N Sporicidin 2 4 USA Liquid Phenol A N A A A N Sporicidin Wipes 2 USA Wipe Phenol A U A A A N 4 e ueuajurey pue 6unoousa qnoJ 9 4a3deyD Table 3 Disinfectants Compatible with System and Transducers Continued Disinfection and Country tyne active ingredient laseiy Da Hrs sro CUSO Seem P17 SLA Staphene 4 USA Spray Ethanol A U N A A N Steranios FRA Liquid Gluteraldehyde A U A A A A Super Sani Cloth USA Wipe Isopropyl Alcohol N U N A N N T Spray USA Spray Quat Ammonia A U A A N N T Spray Il USA Spray Alkyl Chloride A U A A A A TASK 105 USA Spray Quat Ammonia A U A A A A TBO 4 USA Liquid Alkyl A U A A A N Theracide Plus USA Liquid Quat Ammonia A U A A A N Theracide Plus USA Wipe Quat Ammonia A U A N A A Wipes Tor 4 USA Liquid Quat Ammonia A U A A N N T
272. tromagnetic Immunity Continued Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Radiated RF 3 Vim 3 V m d 1 2 P d 2 3 JP 800 MHz to 2 5 GHz Where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in meters m Radiated RF Field strengths from fixed RF IEC 61000 4 3 transmitters as determined by an continued electromagnetic Site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol IEC 60417 No 417 IEC 5140 Source of non ionizing radiation Note Uristhe AC mains voltage prior to application of the test level Note At80 MHz and 800 MHz the higher frequency range applies Note These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 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 i
273. ttery 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 over 60 C 140 F Keep it away from fire and other heat sources Do not charge the battery near a heat source such as a fire or heater Do not leave the battery in direct sunlight Do not pierce the battery with a sharp object hit it or step on it Do not use a damaged battery Do not solder a battery The polarity of the battery terminals are fixed and cannot be switched or reversed Do not force the battery into the system Do not connect the battery to an electrical power outlet 228 Chapter 9 Safety 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 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 stor
274. ture Rise Table 6 and Table 7 list the measured surface temperature rise from ambient of transducers used on the MicroMaxx 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 3 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 6 Transducer Surface Temperature Rise EN 60601 2 37 External Use Test C11e C60e D2 HFL38 L25e L38e P10 P17 1 9 2 C 9 0 C 3 1 C 9 5 C 9 5 C 8 7 C 8 0 C 8 5 C 2 19 7 C 20 5 C 9 1 C 24 5 C 18 2 C 21 7 C 19 7 C 25 6 C Table 7 Transducer Surface Temperature Rise IEC 60601 2 37 Internal Use Test ICT LAP SLA SLT TEE 3 5 5 C 5 4 C 5 4 C 5 5 C 3 5 C 2 23 3 C 11 7 C 20 8 C 16 5 C 17 8 C 242 Chapter 9 Safety Acoustic Output Measurement Since the initial use of diagnostic ultra
275. ual measurements and their average If more than three measurements are made the oldest measurement is deleted The average measurement and ultrasound age are displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Select the next measurement Repeat these steps until all measurements have been performed Chapter 4 Measurements and Calculations 105 suone n je pue sjuauleansea y 106 The following table lists the ratios available for OB Doppler calculations Table 11 OB Doppler Calculations Measurement Description S D RI PI MCA Middle Cerebral Artery X X X Umb A Umbilical Artery X X X Calculation requires a trace o Color THI lt 1623Hz d 3 21 emis S D 24 0 RI 0 96 Pt 1 7 Figure 9 OB Doppler Calculation Chapter 4 Measurements and Calculations OB Doppler MCA Middle Cerebral Artery UmbA Umbilical Artery Note The system does not provide an MCA UmbA ratio from the PI Pulsatility Index 1 A Select OB exam type and select LMP or Estab DD in the patient information form On a frozen Doppler spectral trace press the Calcs key From the calculations menu select the desired measurement Perform the measurement Caliper Function If S D RI is selected the caliper function is activated e Position the first caliper at the peak syst
276. und connected Connection icon are displayed in system status on the ultrasound system 2 Send test data sample to verify wireless connection is set up and configured properly Delete 1 Select the name of the location from the list of locations Location 2 Select Delete A dialog box is displayed 3 Select Yes to delete and No to cancel 4 Complete all configuration information then select Done from the on screen menu A dialog box is displayed to restart the system Chapter 5 Connectivity and Configuration 153 KyAn euuo Configuring Archivers E 2006Nov02 13 09 Archivers M Alias Model IP Address Port AE Title List of archivers Archiver Archiver specific Mame New Name Address a 3 LES E information Alias Alias _01 Port 104 AE Title New AE Title Ping 1 2 Next KEN Delete Symbols Cancel Save Import Export Done Figure 7 Archivers Configuration Page 1 Name Network host name for an archiver Alias Personalized name for an archiver IP Address Unique identifier for the archiver Port Device port number IP port 104 is normally assigned for DICOM AE Title Archiver DICOM Application Entity Title Ping Utility to determine whether a specific IP address is accessible 154 Chapter 5 Connectivity and Configuration A 20060ct16 12 44 Configure Archivers v Alias Model IP Address Port AE Title Archiver Images RGB Uncompressed M Attempts 3 X Image typ
277. 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 elevations given here are for a fixed path tissue model and are for devices having Ispra values greater than 500 mW cm The temperature elevations for fetal bone and tissue were computed based on calculation procedures given in Sections 4 3 2 1 4 3 2 6 in Bioeffects and Safety of Diagnostic Ultrasound AIUM 1993 Chapter 9 Safety About the Acoustic Output Table Table 8 Acoustic Output Terms and Definitions Te
278. us F Power and Battery F VCR record F image memory F Connectivity EMT A F Deta Key F Cine loop F Printer Figure 16 Setup Display Information Patient Header Press the Setup key Select Display Information 3 Select the desired check boxes to display information in the patient header Mode Data Press the Setup key Select Display Information 3 Select the desired check boxes to display imaging information on the screen System Status Reset Press the Setup key Select Display Information 3 Select the desired check boxes to display the system status on the screen Select Reset from the on screen menu to return settings for this setup page to factory default Chapter 2 Getting Started IMT Calculations E 2006O0ct19 13 07 Setup Pages IMT Calculations inf interior near v PUAnteniorfer LL lat N Laterainear wie x Post N Posterior near Post F Posterior far gt Ulli IMT2 Region width mm 10 1 20 EN Tp quoc C Figure 17 Setup IMT Calculations IMT Calculations 4 Press the Setup key Select IMT Calculations In the IMT Calculations list select the desired labels Selecting a label places the measurement on the Calculation menu and into the report Selecting None removes a label Enter the desired Region width Reset Select Reset from the on screen menu to return settings for this setup page to factory default Chapter 2 G
279. ut WN 123 456 789 erat 9 2005Apr21 gt D 2 88cmVYol 50 6cm Figure 4 Screen Layout Table 2 Screen Layout X Delete Save Number Item Description 1 Mode Data Displays current imaging mode information for example Gen Res THI and PW 2 Orientation Provides indication for image orientation In dual and duplex Marker images the orientation marker is green on the active screen 3 Text Displays text entered using keyboard 4 Picto Displays pictograph to indicate anatomy and transducer position Opens pictograph on screen menu allowing anatomy and screen location selection 5 Calcs Menu Displays available calculations 6 Image Displays ultrasound image 7 Measurement Displays current measurement and calculation data and Calcs Data 8 On screen Menu Access to controls for each system state Chapter 2 Getting Started 19 pares bunje5 Table 2 Screen Layout Continued Number Item Description 9 Patient Header Displays current patient name ID number institution user and date time 10 System Status Displays information related to system status for example exam type transducer AC connected battery charging and CompactFlash card 11 Depth Marker Displays marks in 5 cm 1 cm and 5 cm increments depending on the depth General Interaction Touchpad The touchpad is used to select adjust and move objects on the screen For example it controls the caliper position CPD Co
280. ve then select Done from the on screen menu Chapter 5 Connectivity and Configuration Configure DICOM for Wireless Note Wireless connectivity for DICOM is an optional feature Caution To avoid damage to the wireless card always turn off the ultrasound system before inserting or removing the wireless card A 2007Mar22 15 34 Locations s Profile Name Network Name SSID Security Policy Profile Profile Name PROFILE_XXX Network Name SSID Security Policy SA Encryption WEP 128bit F Key Index 1 Key 3 3 Next Symbols Cancel Save Log Import Export Done Figure 6 DICOM Locations Wireless Configuration Page 3 Chapter 5 Connectivity and Configuration 151 yAn oeuuo 152 Configure Note Only Symbol LA 4137 802 116 wireless CompactFlash cards are compatible DICOM with the MicroMaxx ultrasound system Use only wireless cards supplied by SonoSite Wireless 1 Turn system off insert the wireless network card in back slot and then turn Locations system on Page 3 2 Pressthe Setup key select Connectivity then select DICOM Setup If the Transfer Mode is changed a dialog box is displayed to restart the system 3 Perform steps in Configure DICOM Location Page 1 on page 149 4 Select the Wireless check box 5 Select Next to display page 2 then perform steps in Configure DICOM Location Page 2 on page 150 6 Select Next to display page 3 See Figure 6 on page 151 7 Enter in
281. ware upgrade may be required SonoSite provides you with a CompactFlash card containing the software Typically new software provides new capabilities A single CompactFlash card can be used to update one or more systems Software upgrades use the back CompactFlash slot on the right hand side of the system CompactFlash cards installed in the front CompactFlash slot do not upgrade the system 8 Chapter 1 Introduction Chapter 2 Getting Started This chapter contains information on healthy scanning practices basic operation and changing system settings Healthy Scanning Guidelines These guidelines are intended to assist you in the comfort and effective use of your ultrasound system WARNING Use of an ultrasound system may be linked to musculoskeletal disorders Use of an ultrasound system is defined as the physical interaction between the operator the ultrasound system and the transducer When using an ultrasound system as with many similar physical activities you may experience occasional discomfort in your hands fingers arms shoulders eyes back or other parts of your body However if you experience symptoms such as constant or recurring discomfort pain throbbing aching tingling numbness burning sensation or stiffness do not ignore these warning signs Promptly see a qualified health professional Symptoms such as these can be linked with musculoskeletal disorders MSDs MSDs can be painful and may result in pote
282. which supplies buildings used for domestic purposes Harmonic emissions Class A IEC 61000 3 2 Voltage fluctuations Complies flicker emissions IEC 61000 3 3 The system is intended for use in the electromagnetic environment specified below Table 2 Manufacturer s Declaration Electromagnetic Immunity Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Electrostatic 2 0KV 4 0KV 6 0KV 2 0KV 4 0KV 6 0KV Discharge ESD contact contact IEC 61000 4 2 2 0KV 4 0KV 8 0KV air 2 0KV 4 0KV 8 0KV air Electrical fast 2KV on the mains 2KV on the mains Transient burst 1KV on signal lines 1KV on signal lines IEC 61000 4 4 232 Chapter 9 Safety Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 3096 Mains power quality should be that of a typical commercial or hospital environment Table 2 Manufacturer s Declaration Electromagnetic Immunity Continued Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Surge 0 5KV 1 0KV 2 0KV on 0 5KV 1 0KV 2 0KV Mains power quality should be that of a IEC 61000 4 5 AC power lines to on AC power lines typical commercial or hospital ground to ground environment 0 5KV 1 0KV on AC 0 5KV 1 0KV on AC power lines to lines power lines to lines Voltage dips 2596 Ur gt 5 Ur Mains power quality should be that of a short 295
283. y and Configuration Clear Log 1 Press the Setup key select Connectivity then select DICOM Setup Select Log from the on screen menu 3 Select Clear from the on screen menu to delete all text A dialog box is displayed Select Yes to delete or No to cancel 5 Select Done to return to the previous menu DICOM Usage The system can be connected through a LAN to send images and clips from single or multiple network locations to single or multiple devices printers archivers or worklists The system can be configured to recognize a maximum of 16 printers 16 archivers and 16 worklist servers From each location you may select a maximum of two printers four archivers and one worklist server Each device selected will receive the files that you transfer Based on your connectivity needs DICOM can be configured in the following ways Stationary system location transferring to a single device or to multiple devices Mobile system locations user selects between multiple locations within the facility transferring to a single device or to multiple devices 2 2005MayO3 09 58 DICOM Location Mobile AE Title Type Device Status Verify Log Config Done Figure 16 DICOM Main Screen Location Geographical location which identifies the network where the system is connected Network and DICOM device settings can be independently configured for each defined location Chapter 5 Connectivity and Configuration 167
284. y insonate the vessel The following factors should be considered when acquiring volume flow measurements Users should follow current medical practice for volume flow calculation applications The accuracy of the volume flow calculation is largely dependent on the user The factors identified in the literature that affect the accuracy are Using the diameter method for 2D area Difficulty ensuring uniform insonation of the vessel The system is limited to the sample volume sizes listed in Table 4 Precision in placing the caliper Accuracy in angle correction Chapter 4 Measurements and Calculations 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 Volume Flow 2D measurement 1 2 3 4 On a frozen full screen 2D image or duplex image press the Calcs key From the calculations menu under Volume Flow select D distance Perform the measurement Select Save from the on screen menu or press the Enter key to save the measurement to the patient report The saved measurement is displayed at the bottom of the calculation menu and a check mark is put in front of the measurement If desired press the Save key to save the image with the measurements displayed Doppler measurement 1 2 3 4 On a frozen Doppler spectral trace or
285. y 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 Chapter 1 Introduction 3 uon npoanu Conventions These conventions are used in this user guide A WARNING describes precautions necessary to prevent injury or loss of life A Caution describes precautions necessary to protect the products Numbered steps in the procedures must be performed in a specific order Bulleted lists present information in list format but do not imply a sequence The system handle is on the front of the system and the battery compartment is on the back of the system Symbols and Terms Symbols and terms used on the system and transducer are explained in Chapter 2 Getting Started Chapter 5 Connectivity and Configuration Glossary on page 287 and Chapter 9 Safety Upgrades and User Guide Updates SonoSite may offer software upgrades new features and improvements to the system performance User guide updates accompany the upgrade software and provide detailed information on the enhancements Customer Comments Questions and comments are encouraged SonoSite is interested in your feedba
286. y is correct If you are not satisfied with the auto trace obtain a high quality Doppler trace or use the manual measurement tool 2006May11 20 16 Crd m m Ma a I Pir i Figure 3 Doppler Trace with Two Velocity Measurements Velocity cm s Note The Doppler scale must be set to cm s for the following measurements Pressure Gradient See System Setup on page 24 1 Ona frozen Doppler spectral trace press the Caliper key A single caliper is displayed on the screen with the following on screen menu options ifl PHT cardiac exam only Manual trace By Auto Delete 2 Use the Touchpad to position the active green caliper to a peak systolic wave form This is a single caliper from the baseline 3 If desired press the Save key to save the image with the measurements displayed 4 Tosave the highlighted measurement to a calculation press the Calcs key select the appropriate measurement label then select Save from the on screen menu The measurement is saved to the patient report only if a label can be applied to it Chapter 4 Measurements and Calculations 85 suone n je pue sjuauleansea y 86 Velocities Elapsed Time x Ratio Resistive Index RI Acceleration On a frozen Doppler spectral trace press the Caliper key A single caliper is displayed on screen with the following menu options Manual trace Em Auto Delete Use the Touchpad to position the first caliper to a peak systolic w

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