ACUSON NX3 and NX3 Elite Features and Applications Reference Manual Ver 1.0 Nov 2015

ACUSON NX3, Product Version 1.0

CE Declaration

ACUSON NX3 Elite, Product Version 1.0

This product is provided with a CE marking in accordance with the regulations stated in Council Directive 93/42/EEC of June 14, 1993 concerning Medical Devices. The CE marking only applies to medical devices that have been put on the market according to the above referenced Council Directive.

Software Version VA10 ©2015 Siemens Medical Solutions USA, Inc. All Rights Reserved. November 2015 Printed in the Republic of Korea. 3-Scape, ACUSON NX3, Advanced SieClear, Axius, Cadence, Clarify, DTI, DTO, Dynamic TCE, eSie Touch, fourSight, MultiHertz, QuickSet, SieClear, SieScape, and TGO are trademarks of Siemens Medical Solutions USA, Inc., and syngo is a trademark of Siemens Healthcare AG. All other product names are references to third-party products and are trademarks of their respective companies. Siemens includes references to third-party products in the user documentation for informational purposes only. Siemens does not endorse third-party products referenced in the user documentation. Siemens does not assume responsibility for the performance of third-party products.

Unauthorized changes to this product are not covered by the CE marking and the related Declaration of Conformity. EU Authorized Representative Siemens AG Medical Solutions Henkestrasse 127 91052 Erlangen Germany

Siemens reserves the right to change system specifications at any time. Global Business Unit and Legal Manufacturer Siemens Medical Solutions USA, Inc. Ultrasound 685 East Middlefield Road Mountain View, CA 94043 U.S.A. Phone: +1-888-826-9702 www.siemens.com/healthcare

Siemens Global Headquarters Siemens AG Wittelsbacherplatz 2 80333 Muenchen Germany Global Siemens Healthcare Headquarters Siemens AG Healthcare Sector Henkestrasse 127 91052 Erlangen Germany Phone: +49 9131 84-0 www.siemens.com/healthcare

Contents Chapter A1

Imaging Functions Explanation of annotations, body markers (pictograms), and user-defined exam types (QuickSets).

Chapter A2

2D and M-Mode Imaging Functions Description of the imaging functions for 2D-mode and M-mode imaging. Includes an explanation of the following features and options:  DTO Dynamic Tissue Optimization technology  LVO (Left Ventricular Opacification) Contrast technology  THI (Tissue Harmonic Imaging)  TGO (Tissue Grayscale Optimization) technology  SieClear multi-view spatial compounding  Clarify vascular enhancement (VE) technology

Chapter A3

Color Flow Imaging Procedures for Color Flow imaging.

Chapter A4

Doppler Functions Procedures for Doppler functions.

Chapter A5

CINE Information on how to review CINE data, either frame by frame or as a continuous display.

Chapter A6

SieScape Imaging Explanation of the SieScape panoramic imaging feature.

Chapter A7

fourSight 4D Imaging and 3-Scape Imaging Explanation of the fourSight 4D Imaging option and the 3-Scape Real-Time 3D Imaging option.

Chapter A8

Reserved for Future Use

Chapter A9

Stress Echo Explanation of the Stress Echo feature.

Chapter A10

Contrast Agent Imaging Explanation of contrast agent imaging technology.

Chapter B1

Measurements and Calculations Description of the Measurement function with procedures for using all general measurements and calculations and the report feature.

Features and Applications Reference

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Chapter B2

Application-Specific Measurements and Calculations Description of the measurements and calculations specific to the following exams: Gynecology, Orthopedic, Fetal Echo, TCD (Transcranial Doppler), Thyroid. Note: All general measurements and calculations are available for the Abdominal, Musculoskeletal, Breast, Testicle, Renal, Pediatric, and Small Parts exam types.

Chapter B3

Obstetrical Measurements and Calculations Description of the measurements and calculations specific to the Obstetrical package, including fetal cardiac measurements.

Chapter B4

Urology Measurements and Calculations Description of the measurements and calculations specific to the Urology exam.

Chapter B5

Vascular Measurements and Calculations Description of the measurements and calculations specific to the Vascular exams: Cerebrovascular, Peripheral Vascular, Venous.

Chapter B6

Cardiac Measurements and Calculations Description of the measurements and calculations specific to the Cardiac exam.

Chapter B7

Emergency Medicine Measurements and Calculations Description of the measurements and calculations specific to the EM (Emergency Medicine) exam, including information for each report type.

Chapter C1

Patient Data Management Explanation of the integrated workstation, including storage and management of studies on the system and external storage media.

Chapter D1

syngo Auto Left Heart Explanation of the syngo Auto Left Heart (Auto LH) module.

Chapter D2 Chapter D3

Reserved for Future Use Axius Edge-Assisted Ejection Fraction Explanation of the Axius Edge-Assisted Ejection Fraction feature and measurements.

Chapter D4

syngo Arterial Health Package Explanation of the syngo Arterial Health Package.

Note: Not all features and options described in this publication are available to all users. Please check with your Siemens representative to determine the current availability of features and options.

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Features and Applications Reference

About the User and Reference Manuals The user and reference manuals contain descriptions for the following ultrasound systems: 

ACUSON NX3 diagnostic ultrasound system



ACUSON NX3 Elite diagnostic ultrasound system

Features and options unique to an ultrasound system are identified in Chapter 1 and Appendix A of the Instructions for Use. The user and reference manuals consist of the following publications. Publication

Includes

Instructions for Use

 Intended Audience  Technical description of the ultrasound system  Safety and care information for the system and compatible transducers  Descriptions of all system controls  Procedures for system setup, examination fundamentals, and the biopsy function  Acoustic output data

Features and Applications Reference*

 Descriptions of image acquisition and optimization, including optional imaging features  General and exam-specific measurements and calculations  Data management  Explanation of the clinical software programs for use on the ultrasound system

System Reference*

 Description of customizable system settings  Information about DICOM connectivity, network capabilities, and external devices  Clinical references

Electromagnetic Emissions and Immunity: Guidance and Manufacturer's Declaration*

 Information regarding the electromagnetic compatibility (EMC) testing of this system

*Languages supported by the user interface include a translation of this publication.

Features and Applications Reference

iii

Conventions Take a moment to familiarize yourself with these conventions. Warnings, Cautions, and Notes

WARNING: Warnings are intended to alert you to the importance of following the correct operating procedures where risk of injury to the patient or system user exists. Caution: Cautions are intended to alert you to the importance of following correct operating procedures to prevent the risk of damage to the system. Note: Notes contain information concerning the proper use of the system and/or correct execution of a procedure.

Cross-References

Examples: See also: Biohazards, Safety and Care, Chapter 2, Instructions for Use See also: Documentation Devices, Chapter 2, System Reference See also: Alphanumeric Keyboard, p. 26

Customizable System Settings

System settings available for customization are depicted as shown. Example: Default Settings > Automatic Freeze Response

Keys and Controls

Keys and controls located on the control panel are identified by uppercase, boldface type. Example: Rotate the 2D control. Keys located on the keyboard are identified by boldface type. Example: Press the Exam key.

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Features and Applications Reference

On-screen Objects

On-screen objects such as menu selections, soft key selections, and buttons are identified by boldface type. Example: The system displays the Patient Registration form.

Selection of On-screen Objects

The SET key on the control panel functions as a point-and-select device (similar to a computer mouse) when used with the trackball. "Select" or "click" describes this action: Roll the trackball to position the pointer (cursor) on an on-screen object and then press the SET key. "Double-click" describes this action: Roll the trackball to position the pointer (cursor) on an on-screen object and then press the SET key twice. "Drag" describes this action: Roll the trackball to position the pointer (cursor) on an on-screen object and then press and hold the SET key. Roll the trackball to reposition the object and then release the SET key.

Touch Screen Controls

Tap the touch screen to make a soft key selection or to change a setting. Examples: Select 2D. Tap 2D. The touch screen has unlabeled controls located on the control panel. Press, rotate, or press and then rotate the controls to make a selection or change a setting. Within procedures in the user manual, the selection assigned to these controls are indicated in boldface type within brackets. Examples: Press and then rotate [Map] to select a color map.

Features and Applications Reference

v

Intended Audience The intended audience for the user and reference manuals includes the following users. User

Interaction with Ultrasound Equipment

Expected Experience and Other Characteristics

Sonographer

 Acquires diagnostic views of anatomy, blood flow, and related pathology

 Ranges from novices (for example, students) to advanced practitioners with certification in multiple subspecialties

 Performs measurements and analysis of the acquired images  Prepares exam data for review and interpretation by a qualified physician

Cardiologist

 Performs invasive and non-invasive ultrasound exams  Interprets exam data, including echocardiography exam data  Writes and assembles exam findings in a report

Maternal-fetal Medicine Obstetrician/ Perinatologist Radiologist and Internist

 Many sonographers have a Bachelor's degree; some have advanced degrees in related health care subjects  Medical doctor  Expert in diagnostic imaging, including computed tomography (CT), magnetic resonance imaging (MRI), X-ray, ultrasound, and nuclear medicine  Advanced training in imaging physics with typically four to six years of post-doctoral training in the field of cardiology

 Performs ultrasound exams

 Medical doctor

 Interprets exam data

 Manages high-risk obstetrical patients for the safe and successful delivery of the fetus

 Writes and assembles exam findings in a report

 Skilled in interpreting ultrasound exam data

 Performs ultrasound exams

 Medical doctors

 Interprets exam data

 Expert in diagnostic imaging, including CT, MRI, X-ray, ultrasound, and nuclear medicine

 Writes and assembles exam findings in a report

System Administrator and Customer Service Engineer

 Educated in anatomy, physiology, patient care, and identification of pathology in ultrasound images

 Configures the ultrasound system for use in a networked environment

 Advanced training in imaging physics with typically two to six years of post-doctoral training in the field of radiology  A System Administrator is an individual within your organization who is designated to set up system parameters to connect the ultrasound system or workstation to a picture archiving and communication system (PACS).  Customer Service Engineers are Siemens representatives who configure the ultrasound system or workstation during software installation and support troubleshooting activities.

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Features and Applications Reference

A1 Imaging Functions Annotations and Pictograms ... 3 Adding Annotations ... 3 Inserting User-Defined Text ... 5 Inserting Directional Arrows ... 6 Inserting Pictograms ... 7 Deleting Annotations, Arrows, and Pictograms... 8 QuickSet Feature ... 9 Working with QuickSets ... 9 Specifying the Default Exam Type or QuickSet for a Transducer ... 11 Information Stored in QuickSets ... 12 Mode QuickSets ... 12

Features and Applications Reference

A1 - 1

A1 Imaging Functions

A1 - 2

Features and Applications Reference

A1 Imaging Functions

Annotations and Pictograms You can use any of these methods to annotate an image: 

Direct text entry using the keyboard



Predefined labels for positions and anatomical structures



Arrow keys



Pictograms of anatomical structures

You can program the system to automatically delete on-screen annotations each time you unfreeze the image. Use the system presets to specify whether all text or all pictograms are deleted at unfreeze. General 2 > Common Mode > Delete Pictogram on Unfreeze General 2 > Common Mode > Delete Text on Unfreeze

Adding Annotations Note: You can also insert text without activating the annotation function.

Use the system presets to specify the size of annotation text and to set up the display of predefined labels. General 2 > Common Mode > Font Size Text Annotation > Text Annotation Text Annotation > List Order Text Annotation > Auto-Complete

To activate the annotation function: Press Text on the keyboard.



The system displays the list of Text A, Text B, Library, and User Defined annotations on the touch screen. To

Do This

Access another page of annotations

 Tap the arrows on the lower right of the touch screen to display the next or previous page. Or, drag your finger across ("swipe") the selection on the touch screen.

Define the default position for the annotation cursor

1. Roll the trackball to position the annotation cursor at the required location on the image screen. 2. Tap Set Home Position. Or, press Home Set on the keyboard.

Return to the defined default position during imaging

 Tap Home Position. Or, press Home on the keyboard.

Features and Applications Reference

A1 - 3

A1 Imaging Functions

To

Do This

Enter annotation text

1. To reposition the text cursor, roll the trackball. 2. Use the keyboard to enter text. When you begin typing annotation text, the system displays a predefined label that matches the first characters entered. 3. To confirm the predefined text, press Enter on the keyboard. Or, press SET twice. Note: If you move the trackball or press SET once before confirming the predefined label, the text displayed to the right of the cursor is deleted. Note: The predefined label is confirmed when the image is stored to a disk.

Insert a predefined or user-defined annotation label

Note: Each exam type has annotation labels for anatomical structures, imaging views, and body positions. The system displays the list of annotations for the active exam.  To reposition the text cursor, roll the trackball and then tap the required label.

Reposition an annotation

1. Click the required annotation. 2. Roll the trackball to the new location and then press SET to confirm the change. The system places the cursor at the end of the annotation with a space.

Edit an annotation

1. Double-click the required annotation. 2. Use the keyboard to edit the annotation.

Cycle through confirmed annotations

 Press UPDATE. Or, press Tab on the keyboard.

Temporarily hide annotations

1. Tap Hide Text. Or, press Hide Text on the keyboard. 2. To redisplay annotations, tap Show Text. Or, press Hide Text again.

Insert or overwrite text

 Press INS/OVR on the keyboard.

Exit the annotation function

 Press Text.

Exit the annotation function and delete all text

 Press ESC.

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Features and Applications Reference

A1 Imaging Functions

Inserting User-Defined Text You can insert user-defined text on the image screen with the Text A and Text B keys on the keyboard or the user-defined keys on the control panel. Use the system presets to create the user-defined text and assign the text to the Text A or Text B keys. You can also assign the Text A and Text B function to the user-defined keys on the control panel, Text Annotation > Text Annotation Text Annotation > Key Function To

Do This

Insert user-defined text using the keyboard

 Press Text A or Text B.

Insert user-defined text using user-defined keys

 Press the assigned user-defined keys on the control panel.

The system cycles through the user-defined text. The system cycles through the user-defined text.

Features and Applications Reference

A1 - 5

A1 Imaging Functions

Inserting Directional Arrows Use the system presets to select the type and the size of the arrow. You can place multiple types of arrows on the image screen. General 2 > Arrow Size

To place an arrow on the image screen: Press Arrow on the keyboard. Or, tap Arrow.



The system displays an arrow on the image screen. To

Do This

Place multiple arrows on the image screen

1. Roll the trackball to position an arrow. 2. Press SET. Or, tap New. The system confirms the activated arrow and displays a new arrow on the screen.

Reposition the selected arrow

 Roll the trackball to the new location.

Change the direction of the arrow

 Rotate SELECT. Or, rotate [Rotate].

Change the size of the active arrow

 Rotate [Arrow Size].

Confirm the position and direction of the selected arrow

 Press SELECT. Or press SET.

Activate a confirmed arrow

 Position the cursor on the arrow and then press SET.

Cycle through arrows on the image screen

 Press UPDATE. Or, tap Select Arrow.

Cancel placement of the selected arrow

 Press Arrow on the keyboard.

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Features and Applications Reference

A1 Imaging Functions

Inserting Pictograms Pictograms are graphics that display on-screen to indicate the anatomical structure under evaluation and to indicate the orientation of the transducer to the structure. One pictogram can display on an image. In Dual-mode and 4B-mode, you can display one pictogram for each image. Use the system presets to customize the pictograms assigned to an exam type, to change the location of the pictogram on the image, and to delete the pictogram when the image is unfrozen. Use the system presets to automatically display pictograms when you freeze the image. Pictogram List General 2 > Common Mode > Pictogram Location General 2 > Common Mode > Delete Pictogram on Unfreeze

To activate the pictogram function: 

Press Pictogram on the keyboard. The system displays the available pictograms for the active exam type and includes a transducer orientation indicator. Note: The system displays the pictogram in white and the transducer marker in green.

To

Do This

Position the transducer orientation indicator

 Before confirming the pictogram, roll the trackball to move the indicator to the required position.

Rotate the transducer orientation indicator

 Rotate SELECT. Or, rotate [Rotate].

Display the next pictogram

 Press UPDATE.

Confirm the displayed pictogram and exit the pictogram function

 Press Pictogram again. Or, press SELECT or SET.

Features and Applications Reference

A1 - 7

A1 Imaging Functions

Deleting Annotations, Arrows, and Pictograms Use the system presets to automatically delete all text, arrows, and/or all pictograms when you unfreeze the image. General 2 > Delete Text on Unfreeze General 2 > Delete Pictogram on Unfreeze To

Do This

Delete all annotations, arrows, and pictograms

 Tap Clear Screen. Or, press Clear Screen on the keyboard. Note: To delete annotations and arrows during the annotation function without removing the pictogram from the screen, press ESC.

Delete a single annotation

 Select the annotation and then tap Delete Word. Or, press Delete Word on the keyboard.

Delete a line of annotations

 Click anywhere in the annotation line and then tap Delete Line.

Delete an arrow

 Select the arrow and then tap Delete.

Delete all arrows

 Tap Delete all.

Delete a pictogram

 Select the pictogram and then tap Delete.

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Features and Applications Reference

A1 Imaging Functions

QuickSet Feature The QuickSet feature allows you to capture an optimized configuration of imaging parameter settings for a specific transducer and exam. When a QuickSet is selected as the current exam type, the system activates the associated transducer and resets all imaging functions according to the stored configuration. A QuickSet can be saved for a particular physician or user. You can have a maximum of 128 QuickSets on the system at one time. If you attempt to create a new QuickSet or load a saved QuickSet from disk after the maximum is reached, the system requires you to delete one or more existing QuickSets before you can add new ones.

Working with QuickSets To

Do This

Create a QuickSet

1. Adjust the image parameter settings as required. 2. Press QuickSet on the keyboard. Or, press EXAM on the control panel and then click QuickSet>>. 3. Enter up to 10 characters in the QuickSet Name field for the name of the QuickSet. 4. To add a comment for the new QuickSet, enter up to 30 characters in the Description field. 5. To use the QuickSet when the transducer is selected, select Yes next to Active QuickSet when transducer is selected. The system automatically activates the QuickSet in the Exam/QuickSet list when you select the associated transducer. 6. Click New. The system adds the new name to the list of the QuickSets. 7. Click Close. The system displays the image screen and activates the QuickSet you created.

Overwrite an existing QuickSet with the current image parameter settings

1. Adjust the image parameter settings as required. 2. Press QuickSet on the keyboard. Or, press EXAM on the control panel and then click QuickSet>>. 3. Enter the name of the QuickSet and then click Overwrite. The system displays a message to confirm overwriting the QuickSet. 4. To assign the new QuickSet configuration to the existing name, click OK. 5. To display the image screen, click Close.

Features and Applications Reference

A1 - 9

A1 Imaging Functions

To

Do This

Rename an existing QuickSet with the current image parameter settings

1. Adjust the image parameter settings as required. 2. Press QuickSet on the keyboard. Or, press EXAM on the control panel and then click QuickSet>>. 3. Select an existing QuickSet. 4. Enter a new name in the QuickSet Name field. 5. To add a comment, enter text in the Description field. 6. Click Rename. 7. Click Close. The system displays the image screen with the renamed QuickSet activated.

Delete an existing QuickSet

Note: QuickSets currently in use cannot be deleted. 1. Press QuickSet on the keyboard. Or, press EXAM on the control panel and then click QuickSet>>. 2. Select an existing QuickSet and then click Delete. The system removes the highlighted name from the list of QuickSets. 3. Click Close.

Activate a QuickSet

1. Press QuickSet on the keyboard. Or, press EXAM on the control panel and then click QuickSet>>. The system displays the list of exams and QuickSets. 2. Click the required QuickSet.

Display all QuickSets

1. Press QuickSet on the keyboard. Or, press EXAM on the control panel. 2. Click All QuickSets. Note: Click the name of the connected transducer to display the list of exams and QuickSets associated with the transducer.

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Features and Applications Reference

A1 Imaging Functions

Specifying the Default Exam Type or QuickSet for a Transducer Note: To display the specified default exam type or QuickSet during patient registration, re-select the related transducer from the Transducer drop-down list.

To specify the default exam type or QuickSet for a connected transducer: 1.

Press QuickSet on the keyboard. Or, press EXAM on the control panel and then click QuickSet>>.

2.

Click the required transducer button. The system displays the exams supported by the selected transducer.

3. 4.

Select the required exam type or QuickSet. Click Set as Default. The system displays an asterisk next to the exam type or QuickSet.

5. 6.

To activate an exam or a QuickSet, click <<Exam and then click the required exam type or QuickSet. To close the dialog box without changing the active exam or QuickSet, click Close.

Features and Applications Reference

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A1 Imaging Functions

Information Stored in QuickSets QuickSets contain all settings controlled by the control panel, including pictograms and annotations, the current setting (on or off) for Tissue Harmonic Imaging (THI), and the following mode-specific parameters.

Mode QuickSets 2D-mode

M-mode

Color Flow

Power Mode

Doppler

Gain

Transmit Frequency

Color Map

Transmit Frequency

Transmit Frequency

Persistence

Sweep Speed

Baseline

Gain

Gate Size

Gray Map

Dynamic Range

Scale

Scale

Baseline

Dynamic Range

Edge Enhancement

Transmit Frequency

Filter

Scale

Edge Enhancement

Map

Persistence

Persistence

Tint

Tint

Gain

Resolution/Speed

Power map

Sweep Speed

2D FOV

Transmit Power

Smooth

Smooth

Doppler Gain

Transmit Power

Tint

Gain

Color Priority

Map

Depth

Filter

Resolution/Speed

Angle

Focal Zones

Color Priority

Flow State

Update Rate

Transmit Frequency

Invert

Directional Power

Filter

Flip (U/D)

Flow State

Volume

Flip (L/R)

Color DTI

Gain

Resolution/Speed

Color DTE

Dynamic Range

THI Trapezoid

Time/Frequency Resolution

Display Format

Spectral DTI

SieClear/Advanced SieClear

Sensitivity

Auto Stat

LVO Contrast Clarify VE TGO Gain DTO Offset DTCE CAI1 Image Presets 1

QuickSets for contrast agent imaging include settings for on/off, capture duration, balance, frame rate control, and burst duration.

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Features and Applications Reference