HS50-HS60-XH50-XH60-v2-01-00-00-en-us

[Page 1] SAMSUNG MEDISON DIAGNOSTIC ULTRASOUND SYSTEM Version 2.01 HS50/HS60 XH50/XH60 English Copyright © 2018 By SAMSUNG MEDISON CO., LTD. All rights reserved.

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[Page 3] WARRANTY Samsung Medison provides the following warranty to the purchaser of this unit. This warranty is valid for a period of one year from the date of installation and covers all problems caused by faulty workmanship or faulty material. Samsung Medison will, as sole and exclusive remedy and at no charge, replace any such defective unit returned to Samsung Medison within the designated warranty period. The warranty does not cover damages and loss caused by outside factors including, but not limited to, fire, flood, storm, tidal wave, lightning, earthquake, theft, abnormal conditions of operation, and intentional destruction of the equipment. Damage caused by equipment relocation is not covered. The warranty is void in cases where the equipment has been damaged as a result of an accident, misuse, abuse, dropping, or when attempts to modify or alter any part or assembly of the equipment have taken place. Parts with cosmetic defects or deterioration will not be replaced. Replacement of batteries, training materials, and supplies are not covered. Samsung Medison will not be responsible for incidental or consequential damages of any kind arising from or connected with the use of the equipment. Samsung Medison will not be responsible for any loss, damage, or injury resulting from a delay in services rendered under the warranty This limited warranty is in lieu of all other warranties expressed or implied, including warranties of merchant ability or fitness for any particular use. No representative or other person is authorized to represent or assume for Samsung Medison any warranty liability beyond that set forth herein. Defective equipment shipped from you to Samsung Medison must be packed in the replacement cartons. Shipping and insurance costs are the responsibility of the customer. To return defective material to Samsung Medison contact the Samsung Medison Customer Service Department. Samsung Medison or a local distributor will make available, upon request, circuit diagrams, a component parts list, descriptions, calibration instructions and other information which will assist your appropriately qualified technical personnel to repair those parts of the equipment which are designed by Samsung Medison as repairable. Subject to the applicable laws of the relevant territory, Samsung Medison reserves the right to accommodate service requests by (1) replacing the product presented for repair with a refurbished product of the same model or (2) repairing the product with refurbished parts. The refurbished products and parts shall be subject to the same inspection, quality control procedures as for new products and parts. CAUTION: United State federal law restricts this device to sale by or on the order of physicians. MANUFACTURER : SAMSUNG MEDISON CO., LTD. 3366, Hanseo-ro, Nam-myeon, Hongcheon-gun, Gangwon-do 25108, REPUBLIC OF KOREA Customer Service Department : SAMSUNG MEDISON CO., LTD. Website: www.samsungmedison.com EC Representative : SAMSUNG ELECTRONICS (UK) LTD. Blackbushe Business Park, Saxony Way, Yateley, Hampshire, GU46 6GG, UNITED KINGDOM United States Agent : NEUROLOGICA CORPORATION 14 Electronics Avenue, Danvers, MA 01923 USA

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[Page 5] PROPRIETARY INFORMATION AND SOFTWARE LICENSE The Customer shall keep confidential all proprietary information furnished or disclosed to the Customer by Samsung Medison unless such information has become part of the public domain through no fault of the Customer. The Customer shall not use such proprietary information, without the prior written consent of Samsung Medison, for any purpose other than the maintenance, repair or operation of the goods. Samsung Medison systems contain Samsung Medison proprietary software in machine-readable form. Samsung Medison retains all its rights, title and interest in the software except that purchase of this product includes a license to use the machine-readable software contained in it. The Customer shall not copy, trace, disassemble or modify the software. Transfer of this product by the Customer shall constitute a transfer of this license that shall not be otherwise transferable. Upon cancellation or termination of this contract or return of the goods for reasons other than repair or modification, the Customer shall return to Samsung Medison all such proprietary information.

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[Page 7] Safety Standards „ „ Classifications X „ Type of protection against electrical shock: Class I X „ Degree of protection against electrical shock (when the patient is in physical contact): Type BF or Defibrillation-proof type CF applied part X „ Degree of protection against the ingress of harmful liquids: General equipment X „ Degree of safety of use in the presence of flammable anesthetic agent mixed with air, oxygen, or nitrous oxide: Not suitable for use near flammable anesthetic agent mixed with air, oxygen, or nitrous oxide X „ Mode of operation: Continuous operation „ „ Electromechanical Safety Standards Met X „ Medical Electrical Equipment, Part 1: General Requirements for Basic Safety and Essential Performance [IEC 60601-1] X „ Medical Electrical Equipment, Part 1: General Requirements for Basic Safety and Essential Performance [ANSI/AAMI ES60601-1] X „ Medical Electrical Equipment, Part 1: General Requirements for Basic Safety and Essential Performance [CAN/CSA-22.2 No. 60601-1] X „ Medical Electrical Equipment, Part 1-2: General Requirements for Basic Safety and Essential Performance – Collateral Standard: Electromagnetic Compatibility – Requirements and Tests [IEC 60601-1-2] X „ Medical Electrical Equipment, Part 1-6: General Requirements for Basic Safety and Essential Performance – Collateral Standard: Usability [IEC 60601-1-6] X „ Medical Electrical Equipment, Part 2-37: Particular Requirements for the Basic Safety and Essential Performance of Ultrasonic Medical Diagnostic and Monitoring Equipment [IEC 60601-2-37] X „ Medical Devices – Application of Risk Management to Medical Devices [ISO 14971] X „ Biological Evaluation of Medical Devices, Part 1: Evaluation and Testing within a Risk Management Process [ISO 10993-1]

[Page 8] „ „ Statements The Nemko-CCL mark with “C” and “US” identifiers indicates that the product is compliant with and certified to the applicable U.S. and Canadian standards. This mark certifies that the product conforms to applicable EEC standards and has been certified by the European certification agency. This mark certifies that the product conforms to applicable EEC standards. The GMP symbol indicates the Good Manufacturing Practice in accordance with the Korean quality management regulations.

[Page 9] Precautions for Use You should be familiar with all of these areas before attempting to use this manual or your ultrasound system. X „ Please keep this user guide close to the product as a reference when using the system. X „ For safe use of this product, you should read ‘Chapter 1. Safety’ and ‘Chapter 4. Maintenance’ in this manual, prior to starting to use this system. X „ This manual does not include diagnosis results or opinions. Also, check the measurement reference for each application’s result measurement before making the final diagnosis. X „ This product is an ultrasound scanner and cannot be used from a user’s PC. We are not responsible for errors that occur when the system software is run on a user’s PC. X „ Only medical doctors or persons supervised by medical doctors should use this system. Persons who are not qualified must not operate this product. X „ The manufacturer is not responsible for any damage to this product caused by carelessness and/or neglect by the user. X „ Please note that orders are based on the individually agreed specifications and may not contain all features listed in the user manual. X „ It might be possible that some features, options or probes are NOT available in some countries. X „ All references to standards/regulations and their revisions are valid for the time of publication of the user manual. X „ The figures in the user manual for illustrational purposes only and may be different from what you see on the screen or device. X „ Information contained in this user manual is subject to change without prior notice. X „ Products that are not manufactured by Samsung Medison are marked with the trademark of their respective copyright holders. X „ The headings below describe vitally important precautions necessary to prevent hazards.

[Page 10] DANGER: Disregarding this instruction may result in death, serious injury, or other dangerous situations. WARNING: Follow these instructions to prevent a serious accident or damage to property. CAUTION: Follow these instructions to prevent a minor accident or damage to property. NOTE: The accompanying information covers installation, operation, and maintenance procedures that require careful attention from the user but have little chance of directly leading to a dangerous situation.

[Page 11] Revision History The revision history of this manual is as follows. VERSION DATE NOTE v2.01.00-00 2018.10.16 Initial Release Product Upgrade and Manual Update Samsung Medison Ultrasound is committed to innovation and continued improvement. Upgrades may be announced that consist of hardware or software improvements. Updated manuals will accompany those system upgrades. Check if this version of the manual is correct for the system version. If not, please contact the Customer Service Department. If You Need Assistance If you need any assistance with the equipment, like the service manual, please contact the Samsung Medison Customer Service Department or one of their worldwide customer service representatives, immediately.

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[Page 13] Table of Contents Indications for Use 1-3 Contraindications 1-3 Safety Information 1-4 Safety Symbols 1-4 Symbols 1-6 Labels 1-6 Electrical Safety 1-7 Prevention of Electric Shocks 1-7 ECG-Related Information 1-9 ESD 1-9 EMI 1-10 EMC 1-10 Mechanical Safety 1-17 Moving the Equipment 1-17 Precautions on Ramps 1-18 Precautions for Use 1-18 Biological Safety 1-20 ALARA Principle 1-20 Protecting the Environment 1-36

[Page 14] Product Specifications 2-3 Product Configuration 2-7 Monitor 2-9 Control Panel 2-11 Console 2-18 Peripheral Devices 2-21 Probes 2-24 Accessories 2-25 Optional Functions 2-26 Setup 3-3 System 3-4 Imaging 3-18 Application 3-25 Measurement 3-27 Report 3-46 Annotation 3-50 BodyMarker 3-54 Customize 3-58 Peripherals 3-63 Connectivity 3-66 Service 3-88 Help 3-88 ECG (Option) 3-89 EzCompare (Option) 3-91

[Page 15] Stress Echo (Option) 3-92 Setting up a Protocol 3-92 Starting a Protocol and Acquiring Images 3-97 Reviewing an Image 3-101 Strain+ Image (Option) 3-106 Strain+ 3-107 Auto EF 3-114 TMAD 3-121 Operational Environment 4-3 Product Maintenance 4-4 Cleaning and Disinfection 4-4 Electrical Safety Check 4-9 Accuracy Check 4-9 Battery Pack Management 4-10 Replacing the Battery Pack 4-10 Recharging the Battery Pack 4-11 Disposing of the Battery Pack 4-11 Information Maintenance 4-12 User Setting Backup 4-12 Patient Information Backup 4-12 Software 4-12 Cybersecurity 4-13

[Page 16] Probes 5-3 Using Ultrasound Gel 5-25 Using Sheaths 5-27 Probe Safety Precautions 5-28 Using and Infection Control of the Probe 5-29 Risk of Electric Shock 5-30 Cleaning and Disinfecting Probes 5-31 MPTEE Probe 5-40 Biopsy 5-47 Biopsy Kit Components 5-48 Using Biopsy Kit 5-49 Assembling the Biopsy Kit 5-52 Cleaning and Disinfecting Biopsy Kits 5-57 System Power 6-3 Turning the Power On 6-3 Shutting Down the System 6-4 Probes and Applications 6-5 Selecting Probes and Applications 6-6 Creating UserPreset 6-6 Modifying UserPreset 6-6 Deleting UserPreset 6-6 Patient Information 6-7 Patient Information for Each Application 6-11 Searching Patient Information 6-18

[Page 17] Information 7-3 Types of Modes 7-3 Basic Use 7-5 Basic Mode 7-8 2D Mode 7-8 S-Detect 7-24 M Mode 7-34 Color Doppler Mode 7-37 Power Doppler Mode 7-42 PW Spectral Doppler Mode 7-44 CW Spectral Doppler Mode 7-50 TDI Mode 7-52 TDW Mode 7-53 ElastoScan Mode 7-54 Combined Mode 7-62 2D/C/PW Mode 7-62 2D/PD/PW Mode 7-62 2D/C/CW Mode 7-62 2D/C/M Mode 7-62 2D/TDI/TDW Mode 7-63 Dual Live Mode 7-63 Multi-Image Mode 7-64 Dual Mode 7-64 Quad Mode 7-65 3D/4D Mode 7-66 3D Stand By 7-74 3D View – MPR 7-78 Orientation Dot 7-88 Render Setup 7-88 VOCAL 7-92 3D XI 7-99 XI VOCAL 7-109

[Page 18] XI STIC 7-116 3D MXI 7-120 Realistic Vue 7-131 Crystal Vue 7-132 Chroma 7-134 Preset 7-135 5D NT 7-136 5D Follicle 7-139 5D Heart Color 7-142 Measurement Accuracy 8-3 Causes of Measurement Errors 8-3 Optimization of Measurement Accuracy 8-5 Measurement Accuracy Table 8-7 Basic Measurements 8-9 Distance Measurement 8-13 Circumference and Area Measurement 8-23 Volume Measurement 8-26 Measurements by Application 8-29 Things to Note 8-29 Common Measurement Methods 8-33 OB Measurements 8-37 Fetal Heart Measurements 8-46 Gynecology Measurements 8-49 Cardiac Measurements 8-52 Abdomen Measurements 8-66 Pediatric Hips Measurements 8-68 Urology Measurements 8-70 Small Parts Measurements 8-71 Musculoskeletal Measurements 8-75 Vascular Measurements 8-76

[Page 19] Reports 8-85 Viewing Reports 8-85 Report Preview 8-86 Editing Report (Worksheet) 8-89 Adding Comments 8-92 Print Reports 8-94 Saving Reports 8-94 Store SR 8-95 Images 8-95 OB Graph 8-97 Description 8-102 Closing Reports 8-104 Cine/Loop 9-3 Annotating Images 9-5 Annotation 9-5 BodyMarker 9-10 Saving, Playing and Transferring Images 9-12 Saving Images 9-12 Playing Images 9-13 Transferring Images 9-14 Printing Images 9-15 Printing Images 9-15 SonoView Mode 9-16 Exam List 9-17 Review – Exam Mode 9-19 Review – Compare Mode 9-23 DICOM Q/R 9-29 Reference Manual A Reference Manual (English) is supplied with this product.

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[Page 21] Chapter 1 Safety ‹ ‹ Indications for Use 1-3 Contraindications 1-3 ‹ ‹ Safety Information 1-4 Safety Symbols 1-4 Symbols 1-6 Labels 1-6 ‹ ‹ Electrical Safety 1-7 Prevention of Electric Shocks 1-7 ECG-Related Information 1-9 ESD 1-9 EMI 1-10 EMC 1-10 ‹ ‹ Mechanical Safety 1-17 Moving the Equipment 1-17 Precautions on Ramps 1-18 Precautions for Use 1-18 ‹ ‹ Biological Safety 1-20 ALARA Principle 1-20 ‹ ‹ Protecting the Environment 1-36

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[Page 23] Indications for Use The ultrasound diagnostic system and probes are designed to obtain ultrasound images and analyze body fluids. The clinical applications include: Fetal/Obstetrics, Abdominal, Gynecology, Pediatric, Small Organ, Neonatal Cephalic, Adult Cephalic, Trans-rectal, Trans-vaginal, Muscular-Skeletal (Conventional, Superficial), Urology, Cardiac Adult, Cardiac Pediatric and Peripheral vessel. NOTE: For detailed information on applications and presets, please refer to ‘Chapter 2. Introduction’ and ‘Chapter 5. Probes’ in this user manual. Contraindications This product must not be used for ophthalmological applications, or any other use that involves the ultrasound beam passing through the eye. X ‹ Federal law restricts this device to sale by or on the order of a physician. X ‹ The method of application or use of the device is described in the manual ‘Chapter 6. Starting Modes of Operation’ and ‘Chapter 7. Modes of Operation’. 1-3

[Page 24] Safety Information Please read the following safety information before using this product. It is relevant to the ultrasound system, the probes, the recording devices, and any of the optional equipment. This product is intended for use by, or by the order of, and under the supervision of, a licensed physician who is qualified for direct use of medical devices. Prolonged use of three-dimensional ultrasound (3D, 4D) by an unqualified individual, such as to produce a commemorative photograph or video of the fetus, may have an adverse effect on the fetus. Please use the 3D ultrasound diagnostic imaging system for appropriate purposes only, since using it for non-diagnostic purposes such as recording videos of the fetus may adversely affect the fetus. Safety Symbols The International Electro Technical Commission (IEC) has established a set of symbols for medical electronic equipment, which classify a connection or warn of potential hazards. The classifications and symbols are shown below. WARNING: Warnings to prevent a serious accident, or damage to Data Input/Output port property CAUTION: Precautions to prevent a minor accident or damage to Input port property Refer to the user manual. Output port Follow the user manual. Print remote output CAUTION: Risk of Electric Shock Foot Switch Port Type BF applied part (category of protection against electrical ECG port danger) 1-4

[Page 25] Defibrillation-proof type CF applied part (category of USB port protection against electrical danger) Power On/Off Network port Protected against vertically falling Power On water drops Protected against the effects of Power Off temporary immersion in water Protected against the effects of Power On for part of the product continuous immersion in water CAUTION: Electrostatic sensitive Power Off for part of the product devices (ESD) Alternating current voltage source Do not sit on the product. Direct current voltage source Do not push the product. Dangerous voltage (Indicates dangerous voltages over 1000V AC Do not lean against the product. or 1500V DC) Be mindful of the space. Do not Protective earth (ground) place a finger, and or any part of your body in the space. No access for people with active Equipotentiality implanted cardiac devices. DANGER: Do not place your Data output port fingers, hands, or any parts of your body in the space. 1-5

[Page 26] Do not place objects heavier than Data input port the weight specified next to the symbol. Do not place heavy objects on the Microphone Port monitor while the monitor mount is folded. Do not push down on the monitor Probe port while the monitor mount is folded. Symbols Authorized Representative In The Manufacturer European Community Labels Phrases containing the words ‘WARNING’ and/or ‘CAUTION’ are displayed on the product’s surface in order to protect it. 1-6

[Page 27] Electrical Safety This product is categorized as a Class I device. X ‹ As for US requirement, the LEAKAGE CURRENT might be measured from a center-tapped circuit when the equipment connects in the United States to 240V supply system. X ‹ To help assure grounding reliability, connect to a “hospital grade” or “hospital only” grounded power outlet. Prevention of Electric Shocks In a hospital environment, hazardous current can form due to potential differences between exposed conductive parts and connected devices. The solution to the problem is consistent equipotential bonding. Medical equipment is connected with connecting leads made up of sockets which are angled to the equipotential bonding network in medical rooms. [Figure 1.1 Equipotential Bonding] Additional equipment connected to medical electrical equipment must comply with the respective IEC standards (e.g. IEC 60950/EN 60950 for data processing equipment, IEC 60601-1/ EN 60601-1 for medical devices). Furthermore, all configurations shall comply with the requirements for medical electrical systems (see IEC 60601-1/EN 60601-1). Anybody connecting additional equipment to signal input and output ports of medical electrical equipment should make sure that the equipment complies with IEC 60601-1/EN 60601-1. 1-7

[Page 28] X ‹ Electric shock may result if this system, including all of its externally mounted recording and monitoring devices, is not properly grounded. X ‹ Never open the cover of the product. Hazardous voltages are present inside. All internal adjustments and replacements must be made by qualified Samsung Medison Customer Support Department personnel. X ‹ Always check the product’s housing, cables, cords, and plugs before using the product. Disconnect the power source and do not use the equipment if the housing is damaged such as cracked, and chipped, or if the cable is worn. X ‹ Always disconnect the system from the wall outlet prior to cleaning the system. X ‹ All patient contact devices, such as probes and ECG leads, must be removed from the patient prior to application of a high voltage defibrillation pulse. X ‹ The use of flammable anesthetic gas or oxidizing gases (N 2 O) should be avoided. There is a risk of explosion. X ‹ Avoid installing the system in such a way that it is difficult for the operator to disconnect it from the power source. X ‹ Do not use together with HF surgical equipment. HF surgical equipment may be damaged, which may result in fire. X ‹ The system must only be connected to a supply mains with protective earth to avoid risk of electric shock. X ‹ The system has been designed for 100-240VAC; you should select the input voltage of any connected printer and VCR. Prior to connecting a peripheral power cord, verify that the voltage indicated on the power cord matches the voltage rating of the peripheral device. X ‹ An isolation transformer protects the system from power surges. The isolation transformer continues to operate when the system is in standby. X ‹ Do not immerse the cable in liquids. Cables are not waterproof. X ‹ Make sure that the inside of the system is not exposed to or flooded with liquids. In such cases, fire, electric shock, injury, or damage to the product may occur. X ‹ The auxiliary socket outlets installed on this system are rated 100-240VAC with maximum total load of 150VA. Use these outlets only for supplying power to equipment that is intended to be part of the ultrasound system. Do not connect additional multiple-socket outlets or extension cords to the system. X ‹ Do not connect any peripheral devices that are not listed in this manual to the auxiliary socket outlet of the system. It may cause an electrical hazard. X ‹ Do not touch SIP/SOP and the patient simultaneously. There is a risk of electric shock from leakage current. 1-8

[Page 29] ECG-Related Information X ‹ This device is not intended to provide a primary ECG monitoring function, and therefore does not have means of indicating an inoperative electrocardiograph. X ‹ Do not use ECG electrodes with HF surgical equipment. HF surgical equipment may be damaged, which may result in fire. X ‹ Do not use ECG electrodes during cardiac pacemaker procedures or any procedures that involve other types of electrical stimulators. X ‹ Do not use ECG leads and electrodes in an operating room. ESD Electrostatic discharge (ESD), commonly referred to as a static shock, is a naturally occurring phenomenon. ESD is most prevalent during conditions of low humidity, which can be caused by heating or air conditioning. The static shock or ESD is a discharge of the electrical energy build- up from a charged individual to a less or non-charged individual or object. An ESD occurs when an individual with an electrical energy build-up comes into contact with conductive objects such as metal doorknobs, file cabinets, computer equipment, and even other individuals. X ‹ The level of electrical energy discharged from a system user or patient to an ultrasound system can be significant enough to cause damage to the system or probes. X ‹ Always perform the pre-ESD preventive procedures before using connectors marked with the ESD warning label. – Apply anti-static spray to carpets or linoleum. – Use anti-static mats. – Ground the product to the patient table or bed. X ‹ It is highly recommended that the user be given training on ESD-related warning symbols and preventive procedures. 1-9

[Page 30] EMI Although this system has been manufactured in compliance with existing EMI (ElectroMagnetic Interface) requirements, use of this system in the presence of an electromagnetic field can cause degradation of the ultrasound image or product damage. If this occurs often, Samsung Medison suggests a review of the environment in which the system is being used, to identify possible sources of radiated emissions. These emissions could be from other electrical devices used within the same room or an adjacent room. Communication devices such as cellular phones and pagers can cause these emissions. The existence of radios, TVs, or microwave transmission equipment nearby can also cause interference. CAUTION: In cases where EMI is causing disturbances, it may be necessary to relocate this system. EMC Testing of the EMC (Electromagnetic Compatibility) of this system has been performed according to the international standard for EMC with medical devices (IEC 60601-1-2). This IEC standard was adopted in Europe as the European norm (EN 60601-1-2).
Guidance and Manufacturer’s Declaration – Electromagnetic Emission This product is intended for use in the electromagnetic environment specified below. The customer or the user of this product should ensure that it is used in such an environment. Emission Test Compliance Electromagnetic Environment – Guidance The Ultrasound System uses RF energy only for its internal RF Emission functions. Therefore, its RF emissions are very low and are Group 1 CISPR 11 not likely to cause any interference in nearby electronic equipment. RF Emission Class A CISPR 11 The Ultrasound System is suitable for use in all Harmonic Emission establishments other than domestic and those directly Class A IEC 61000-3-2 connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. Flicker Emission Complies IEC 61000-3-3 1-10

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Approved Cables, Probes and Peripherals for EMC „ ‹ Cables Cables connected to this product may affect its emissions; use only the cable types and lengths listed in the table below. Cable Type Length VGA Shielded Normal USB Shielded Normal LAN (RJ45) Twisted pair Any S-Video Shielded Normal Foot Switch Shielded 2.99m Audio R.L Shielded Normal Parallel Shielded Normal HDMI Shielded Normal MIC Unshielded Any ECG 3-lead Shielded Normal „ ‹ Probes The image probe used with this product may affect its emission. The probe listed in ‘Chapter 5. Probes’ when used with this product, have been tested to comply with the group1 Class A emission as required by International Standard CISPR 11. „ ‹ Peripherals Peripherals used with this product may affect its emissions. CAUTION: When connecting other customer-supplied accessories to the system, it is the user’s responsibility to ensure the electromagnetic compatibility of the system. WARNING: The use of cables, probes, and peripherals other than those specified may result in increased emission or decreased Immunity of the Ultrasound System. 1-11

[Page 32] Electromagnetic Immunity Test IEC 60601 Test Level Compliance Level Environment – Guidance Floors should be wood, concrete or ceramic tile. Electrostatic ±6kV Contact ±6kV Contact If floors are covered with discharge (ESD) ±8kV Air ±8kV Air synthetic material, the IEC 61000-4-2 relative humidity should be at least 30%. ±2kV for power supply ±2kV for power supply Mains power quality Electrical fast lines lines should be that of a transient/burst ±1kV for input/ ±1kV for input/ typical commercial or IEC 61000-4-4 output lines output lines hospital environment. Mains power quality Surge ±1kV differential mode ±1kV differential mode should be that of a IEC 61000-4-5 ±2kV common mode ±2kV common mode typical commercial or hospital environment. Mains power quality should be that of a Voltage <5% U т for 0.5 cycles <5% U т for 0.5 cycles typical commercial or dips, short (>95% dip in U т) (>95% dip in U т) hospital environment. If interruptions 40% U т for 5 cycles 40% U т for 5 cycles the user of this product and voltage (60% dip in U т) (60% dip in U т) requires continued variations on 70% U т for 25 cycles 70% U т for 25 cycles operation during power power supply (30% dip in U т) (30% dip in U т) mains interruptions, it is input lines recommended that this <5% U т for 5 s <5% U т for 5 s IEC 61000-4-11 (<95% dip in U т) (<95% dip in U т) product be powered from an uninterruptible power supply or a battery. Power frequency Power frequency magnetic fields should (50/60Hz) be at levels characteristic 3 A/m 3 A/m magnetic field of a typical location in IEC 61000-4-8 a typical commercial or hospital environment. NOTE: U т is the AC mains voltage prior to application of the test level. 1-12

[Page 33] Immunity IEC 60601 Compliance Electromagnetic Environment – Guidance Test Test Level Level Conducted RF 3 Vrms 3V Portable and mobile RF communications IEC 61000-4-6 150 kHz – equipment should be used no closer to any part of 80 MHz the Ultrasound System, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended Separation Distance 1.2 1.2 80MHz – 800MHz 2.3 800MHz – 2.5GHz Radiated RF 3 V/m 3 V/m Where P is the maximum output power rating IEC 61000-4-3 80 MHz – of the transmitter in watts (W) according to 2.5 GHz the transmitter manufacturer and d is the recommended separation distance in meters (m). Field strengths from fixed RF transmitters a , as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range b . Interference may occur in the vicinity of equipment marked with the following symbol: NOTE 1: At 80MHz and 800MHz, the higher frequency range applies. NOTE 2: 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 Ultrasound System is used exceeds the applicable RF compliance level above, the 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 Ultrasound System, or using a shielded location with a higher RF shielding effectiveness and filter attenuation. b Over the frequency range 150kHz to 80MHz, field strengths should be less than 3V/m. 1-13

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Recommended Distance Between Wireless Communication Device and this Product This product is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of this product can help to prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and this product as recommended below, according to the maximum output power of the communications equipment. Separation Distance According to Frequency of Transmitter [m] Rated Maximum Output Power of Transmitter 150kHz – 80MHz 80MHz – 800MHz 800MHz – 2.5GHz [W] 1.2 1.2 0.01 0.12 0.12 0.23 0.1 0.38 0.38 0.73 1 1.2 1.2 2.3 10 3.8 3.8 7.3 100 12 12 23 For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where p is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. NOTE 1: At 80MHz and 800MHz, the separation distance for the higher frequency range applies. NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
Electromagnetic Environment – Guidance It is recommended to use ultrasound systems in shielded locations offering RF shielding effectiveness, with shielded cables. Field strengths outside the shielded location from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than 3V/m. It is essential that the actual shielding effectiveness and filter attenuation of the shielded location be verified to ensure that they meet the minimum specification. CAUTION: If the system is connected to other customer-supplied equipment, such as a local area network (LAN), Samsung Medison cannot guarantee that the remote equipment will work correctly in the presence of electromagnetic emission phenomena. 1-14

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Avoiding Electromagnetic Interference Typical interference on Ultrasound Imaging Systems varies depending on Electromagnetic phenomena. Please refer to the following table: Imaging Mode ESD 1 RF 2 Power Line 3 For sector imaging probes, white radial bands or flashes in the centerlines of White dots, dashes, the image. diagonal lines, or diagonal 2D For linear imaging lines near the center of the probes, white vertical image. bands, sometimes more pronounced on the sides of Change of operating the image. mode, system settings, or system Increase in the image White dots, dashes, M reset. Brief flashes background noise or white diagonal lines, or increase in the displayed or M mode lines. in image background noise recorded image. Color flashes, radial or Color flashes, dots, dashes, vertical bands, increase Color or changes in the color in background noise, or noise level. changes in color image. Horizontal lines in the Vertical lines in the spectral display or tones, spectral display, popping Doppler abnormal noise in the type noise in the audio, or audio, or both. both. 1. ESD caused by discharging of electric charge build-up on insulated surfaces or persons. 2. RF energy from RF transmitting equipment such as portable phones, hand-held radios, wireless devices, commercial radio and TV, and so on. 3. Conducted interference on powerlines or connected cables caused by other equipment, such as switching power supplies, electrical controls, and natural phenomena such as lightning. 1-15

[Page 36] A medical device can either generate or receive electromagnetic interference. The EMC standards describe tests for both emitted and received interference. Samsung Medison’s ultrasound products do not generate electromagnetic interference in excess of standard levels established for such devices. An Ultrasound System is designed to receive signals at radio frequency and is therefore susceptible to interference generated by RF energy sources. Examples of other sources of interference are medical devices, information technology products, and radio and television transmission towers. Tracing the source of radiated interference can be a difficult task. Customers should consider the following in an attempt to locate the source: X ‹ Is the interference intermittent or constant? X ‹ Does the interference show up only with one transducer operating at the same frequency or with several transducers? X ‹ Do two different transducers operating at the same frequency have the same problem? X ‹ Is the interference present if the system is moved to a different location in the facility? The answers to these questions will help determine if the problem resides with the system or the scanning environment. After you answer the questions, contact the Samsung Medison Customer Support Department. 1-16

[Page 37] Mechanical Safety Moving the Equipment WARNING: Special caution should be taken during movement. Careless transportation of the product may result in product damage or personal injury. X ‹ Before transporting the product, check that the brakes on the wheels are unlocked. Also, make sure to retract the monitor arm completely so that it is secured in a stationary position. X ‹ Always use the handles at the back of the console and move the product slowly. This product is designed to resist shocks. However, excessive shock, for example, if the product falls over, may cause serious damage. If the system operates abnormally after repositioning, please contact the Samsung Medison Customer Support Department.
Foot Lock You can use the brakes to control the movement of the product. The brake pedal is located at the center of the console pedal and when pressed brakes all the wheels simultaneously. To lock the brakes, press the front part of the brake pedal with your foot. To unlock the brakes, press the back of the pedal. We recommend that you lock the brakes when using the product. 1-17

[Page 38] Precautions on Ramps Always make sure that the control panel is facing the direction of movement. WARNING: Be aware of the castors, especially when moving the system. Samsung Medison recommends that you exercise caution when moving the product up or down ramps. If you leave the product on an inclined surface, the product may fall over even if the brakes are engaged. Do not rest the product on a ramp. Precautions for Use X ‹ Do not press the control panel excessively. X ‹ Never attempt to modify the product in any way. X ‹ Check the operational safety when using the product after a prolonged break in service. X ‹ Make sure that other objects, such as metal pieces, do not enter the system. X ‹ Do not block the ventilation slots. X ‹ Do not pull on the power cord to unplug the product. Doing so might damage the cord and cause the product to short-circuit, or the cord itself to break. Unplug the cord by pulling on the plug itself. X ‹ Excessive bending or twisting of cables on patient-applied parts may cause failure or intermittent operation of the system. X ‹ Improper cleaning or sterilization of a patient-applied part may cause permanent damage. X ‹ Servicing the product, including repairs and replacement of parts, must be done by qualified Samsung Medison service personnel. Assuming that the product is used in accordance with the guidelines contained in this manual and maintained by qualified service personnel, the expected service life of the product is approximately 7 years. Please refer to ‘Chapter 4. Maintenance’ for detailed information on protection, cleaning, and disinfecting the equipment. 1-18

[Page 39]
Caution for Using Monitor When adjusting the height or position of the monitor, be careful of the space in the middle of the monitor arm. Catching your fingers or other body parts in it may result in injury. [Figure 1.2 Safety Note for Monitor]
Caution for Using Control Panel X ‹ Do not push the control panel with excessive force or lean on it. X ‹ Do not sit on the control panel or exert excessive force on it. X ‹ Do not lift the product using the handles on the control panel. When adjusting the height or position of the control panel, pay attention to the space between the control panel and the lift. Catching your fingers or other body parts in it may result in injury. [Figure 1.3 Safety Note for Control Panel] 1-19

[Page 40] Biological Safety For safety instructions concerning probes and biopsies, refer to “Chapter 5. Probes“. X ‹ Ultrasound waves may have damaging effects on cells and, therefore, may be harmful to the patient. If there is no medical benefit, minimize the exposure time and maintain the ultrasound wave output level at low. Please refer to the ALARA principle. X ‹ Do not use the system if an error message appears on the video display indicating that a hazardous condition exists. Note the error code, turn off the power to the system, and call Samsung Medison customer service department. X ‹ Do not use a system that exhibits erratic or inconsistent functioning. Discontinuities in the scanning sequence are indicative of a hardware failure that should be corrected before use. X ‹ The system limits the maximum contact temperature to 43 degrees Celsius, and the ultrasonic wave output observes American FDA regulations. ALARA Principle Guidance for the use of diagnostic ultrasound is defined by the “ A s L ow A s R easonably A chievable“ (ALARA) principle. The decision as to what is reasonable has been left to the judgment and insight of qualified personnel. No set of rules can be formulated that would be sufficiently complete to dictate the correct response to every circumstance. By keeping ultrasound exposure as low as possible, while obtaining diagnostic images, users can minimize ultrasonic bioeffects. Since the threshold for diagnostic ultrasound bioeffects is undetermined, it is the sonographer’s responsibility to control the total energy transmitted into the patient. The sonographer must reconcile exposure time with diagnostic image quality. To ensure diagnostic image quality and limit exposure time, the Ultrasound System provides controls that can be manipulated during the exam to optimize the results. The ability of the user to abide by the ALARA principle is important. Advances in diagnostic ultrasound, not only in the technology but also in its applications, have resulted in the need for increased and improved information to guide the user. The output indices are designed to provide that important information. There are a number of variables, which affect the way in which the output display indices can be used to implement the ALARA principle. These variables include mass, 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 user controls it. The ability to limit the index values over time supports the ALARA principle. 1-20

[Page 41]
Applying ALARA The system imaging mode used depends upon the information needed. 2D mode and M mode imaging provide anatomical information, while Doppler, Power, and Color imaging provide information about blood flow. Scanned modes, like 2D mode, Power, or Color, disperse or scatter the ultrasonic energy over an area, while an unscanned mode, like M mode or Doppler, concentrate the ultrasonic energy. Understanding the nature of the imaging mode being used allows the sonographer to apply the ALARA principle with informed judgment. The probe frequency, system set-up values, scanning techniques, and operator experience aid the sonographer in meeting the ALARA principle. The decision as to the amount of acoustic output is, in the final analysis, up to the system operator. This decision must be based on the following factors: type of patient, type of exam, patient history, ease or difficulty of obtaining diagnostically useful information, and the potential localized heating of the patient due to probe surface temperatures. Prudent use of the system occurs when patient exposure is limited to the lowest index reading for the shortest amount of time necessary to achieve acceptable diagnostic results. Although a high index reading does not mean that a biological effect is actually occurring, it should be taken seriously. Every effort should be made to reduce the possible effects of a high index reading. Limiting exposure time is an effective way to accomplish this goal. There are several system controls that the operator can use to adjust the image quality and limit the acoustic intensity. These controls are related to the techniques that an operator might use to implement ALARA and can be divided into three categories: direct, indirect, and receiver control.
Direct Controls Application selection and the output intensity control directly affect acoustic intensity. There are different ranges of allowable intensity or output depending on your selection. Selecting the correct range of acoustic intensity for the application is one of the first things required during any exam. For example, peripheral vascular intensity levels are not recommended for fetal exams. Some systems automatically select the proper range for a particular procedure, while others require manual selection. Ultimately, the user bears the responsibility for proper clinical use. Samsung Medison systems provide both automatic and user-definable settings. Output has direct impact on acoustic intensity. Once the application has been established, the output control can be used to increase or decrease the output intensity. The output control allows you to select intensity levels less than the defined maximum. Prudent use dictates that you select the lowest output intensity consistent with good image quality. 1-21

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Indirect Controls The indirect controls are those that have an indirect effect on the acoustic intensity. These controls affect the imaging mode, pulse repetition frequency, focus depth, pulse length, and probe selection. The choice of imaging mode determines the nature of the ultrasound beam. 2D mode is a scanning mode, Doppler is a stationary or unscanned mode. A stationary ultrasound beam concentrates energy on a single location. A moving or scanned ultrasound beam disperses the energy over a wide area and the beam is only concentrated on a given area for a fraction of the time necessary in unscanned mode. The pulse repetition frequency or rate refers to the number of ultrasound bursts of energy over a specific period of time. The higher the pulse repetition frequency, the more pulses of energy in a given period of time. Several controls affect pulse repetition frequency: focal depth, display depth, sample volume depth, color sensitivity, number of focal zones, and sector width controls. The focus of the ultrasound beam affects the image resolution. To maintain or increase resolution at a different focus requires a variation of output over the focal zone. This variation of output is a function of system optimization. Different exams require different focal depths. Setting the focus to the proper depth improves the resolution of the structure of interest. Pulse length is the time during which the ultrasonic burst is turned on. The longer the pulse, the greater the time-average intensity value. The greater the time-average intensity, the greater the likelihood of temperature increase and cavitations. Pulse length, burst length or pulse duration is the output pulse duration in Pulsed Doppler. Increasing the Doppler sample volume, increases the pulse length. Probe selection affects intensity indirectly. Tissue attenuation changes with frequency. The higher the probe operating frequency, the greater the attenuation of the ultrasonic energy. Higher probe operating frequencies require higher output intensity to scan at an increased depth. To scan deeper at the same output intensity, a lower probe frequency is required. Using more gain and output beyond a point, without corresponding increases in image quality, can mean that a lower frequency probe is needed. „ ‹ Receiver Controls Receiver controls are used by the operator to improve image quality. These controls have no effect on output. Receiver controls only affect how the ultrasound echo is received. These controls include gain, TGC, dynamic range, and image processing. The important thing to remember, relative to output, is that receiver controls should be optimized before increasing output. For example; before increasing output, optimize gain to improve image quality. 1-22

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Additional Considerations Ensure that scanning time is kept to a minimum, and ensure that only medically required scanning is performed. Never compromise quality by rushing through an exam. A poor exam will require a follow-up, which ultimately increases the scanning time. Diagnostic ultrasound is an important tool in medicine, and, like any tool, should be used efficiently and effectively.
Output Display Features The system output display comprises two basic indices: a mechanical index and a thermal index. The thermal index consists of the following indices: soft tissue (TIs), bone (TIb) and cranial bone (TIc). One of these three thermal indices will be displayed at all times. The thermal index to be displayed is determined by the system preset or user choice, depending upon the application. The mechanical index is continuously displayed over the range of 0.0 to 1.9, in increments of 0.1. The thermal index consists of the three indices, and only one of these is displayed all the time. Each diagnostic probe application has a default selection. The TIb or TIs is continuously displayed over its range of 0.0 to maximum output, based on the probe and application, in increments of 0.1. The default setting of the application-specific nature is also an important factor of index selection. A default setting is a system control state which is preset by the manufacturer or the operator. The system has default index settings for the probe application. The default settings are applied automatically by the ultrasound system when the power is turned on, new patient data is entered into the system database, or a change of application takes place. The decision as to which of the three thermal indices to display should be based on the following criteria: Appropriate index for the application: TIs is used for imaging soft tissue, and TIb for a focus at or near a bone. Some factors might create artificially high or low thermal index readings (e.g. presence of fluid or bone, or the flow of blood). A highly attenuating tissue path, for example, may cause the potential for local zone heating to be lower than the thermal index indicates. The selection of scanned modes or unscanned modes of operation also affect the thermal index. For scanned modes, heating tends to be near the surface; for unscanned modes, the potential for heating tends to be deeper in the focal zone. Always limit ultrasound exposure time. Do not rush the scanning. Ensure that the indices are kept to a minimum, and that exposure time is limited without compromising diagnostic sensitivity. 1-23

[Page 44] „ ‹ Mechanical Index (MI) Display Mechanical bioeffects are threshold phenomena that occur when a certain level of output is exceeded. The threshold level varies, however, with the type of tissue. The potential for mechanical biological effects varies with peak pressure and ultrasound frequency. The MI accounts for these two factors. The higher the MI value, the greater the likelihood of mechanical bioeffects occurring. However, there is no specific MI value that means that a mechanical bioeffect will actually occur. The MI should be used as a guide for implementing the ALARA principle. „ ‹ Thermal Index (TI) Display The TI informs the user of potential temperature increase occurring on the body surface, within body tissue, or at the point of focus of the ultrasound beam on bone. The TI is an estimate of the temperature increase in specific body tissues. The actual amount of any temperature rise is influenced by factors such as tissue type, vascularity, and modes of operation. The TI should be used as a guide for implementing the ALARA principle. The bone thermal index (TIb) informs the user about potential heating at or near the focus after the ultrasound beam has passed through soft tissue or fluid, such as the skeletal structure of a 2-3 month old fetus. The cranial bone thermal index (TIc) informs the user about the potential heating of bone at or near the surface, for example, the cranial bone. The soft tissue thermal index (TIs) informs the user about the potential for heating within soft homogeneous tissue. TIc is displayed when you select a trans-cranial application. You can select the TI to display at Setup > Imaging > Application/Preset > Thermal Index Type. „ ‹ Mechanical and Thermal Indices Display Precision and Accuracy The Mechanical and Thermal Indices on the system are precise to 0.1 units. The MI and TI display accuracy estimates for the system are given in the manual‘s Acoustic Output Tables. These accuracy estimates are based on the variability ranges of probes and systems, inherent acoustic output modeling errors, and the measurement variability, as described below. The displayed values should be interpreted as relative information to help the system operator achieve the ALARA principle through prudent use of the system. The values should not be interpreted as actual physical values of investigated tissue or organs. The initial data that is used to support the output display is derived from laboratory measurements based on the AIUM measurement standard. The measurements are then put into algorithms to calculate the displayed output values. 1-24

[Page 45] Many of the assumptions used in the process of measurement and calculation are conservative in nature. Over-estimation of actual in situ exposure, for the vast majority of tissue paths, is built into the measurement and calculation process. For example, the acoustic output values measured underwater are derated using a conservative, industry standard, attenuation coefficient of 0.3dB/cm-MHz. Conservative values for tissue characteristics were selected for use in the TI models. Conservative values for tissue or bone absorption rates, blood perfusion rates, blood heat capacity, and tissue thermal conductivity were selected. A steady state temperature rise is assumed in the industry standard TI models, and the assumption is made that the ultrasound probe is held steady in one position long enough for a steady state to be reached. A number of factors are considered when estimating the accuracy of display values: Hardware deviation, algorithm accuracy, and measurement deviation. Deviation among probes and systems in particular is an important factor. Probe deviation results from piezoelectric crystal efficiencies, process-related impedance differences, and sensitive lens focusing parameter variations. Differences in the system pulse voltage control and efficiencies are also a contributor to variability. There are inherent uncertainties in the algorithms use d for estimating acoustic output values over the range of possible system operating conditions and pulse voltages. Inaccuracies in laboratory measurements are related to differences in hydrophone calibration and performance, positioning, alignment and digitization tolerances, and variability among test operators. The conservative assumptions of the output estimation algorithms of linear propagation, at all depths, through a 0.3dB/cm-MHz attenuated medium are not taken into account in the calculation of the accuracy estimate displayed. Neither linear propagation nor uniform attenuation at the 0.3dB/cm-MHz rate occurs in underwater measurements, or in most tissue paths in the body. In the body, different tissues and organs have dissimilar attenuation characteristics. In water, there is almost no attenuation. In the body, and particularly in underwater measurements, non-linear propagation and saturation losses occur as pulse voltages increase. The display accuracy estimates take into account the variability ranges of probes and systems, inherent acoustic output modeling errors, and the measurement variability. Display accuracy estimates are measured according to AIUM measurement standards but not based on errors caused during the measurement or inherent errors. They are also independent of the effects of non-linear loss on the measured values. 1-25

[Page 46]
Control Effects – Controls Affecting the Indices As various system controls are adjusted, the TI and MI values may change. This will be most apparent as the Power control is adjusted; however, other system controls will also affect the on-screen output values. „ ‹ Power Power controls the system acoustic output. Two real-time output values are on the screen: a TI and a MI. They change as the system responds to Power adjustments. In combined modes, such as simultaneous Color, 2D mode, and Pulsed Doppler, the total TI is the sum of TIs of the individual modes. Each mode is a vital contributor to this total; the displayed MI will be from the mode with the largest peak pressure.
2D Mode Controls „ ‹ 2D Mode Size Narrowing the sector angle may increase the frame rate. This will increase the TI. Pulse voltage may be automatically adjusted down with software controls to keep the TI below the system maximum. A decrease in pulse voltage will decrease MI. „ ‹ Zoom Increasing the zoom magnification may increase frame rate. This will increase the TI. The number of focal zones may also increase automatically to improve the resolution. This action may change the MI, since the peak intensity can occur at a different depth. „ ‹ Number of Focal Zones Increasing the number of focal zones may change both the TI and MI by automatically changing the frame rate or focal depth. Lower frame rates decrease the TI. The MI displayed will correspond to the focal zone with the largest peak intensity. „ ‹ Focus In general, higher MI values will occur when the focal depth is near the natural focus of the probe (transducer). 1-26

[Page 47]
Color and Power Controls „ ‹ Color Sensitivity Increasing the color sensitivity may increase the TI. More time is required for the scanning of color images. Color pulses are the dominant pulse type in this mode. „ ‹ Color Sector Width Narrower color sector width will increase the color frame rate, and so the TI will increase. The system may automatically decrease the pulse voltage to stay below the system maximum. A decrease in pulse voltage will decrease the MI. If Pulsed Doppler is also enabled, then Pulsed Doppler will remain the dominant mode and the TI change will be small. „ ‹ Color Sector Depth Deeper color sector depth may automatically decrease color frame rate, or select a new color focal zone or color pulse length. The TI will change due to the combination of these effects. Generally, the TI will decrease with increased color sector depth. MI will correspond to the peak intensity of the dominant pulse type, which is a color pulse. However, if Pulsed Doppler is also enabled, then Pulsed Doppler will remain the dominant mode and the TI change will be small. „ ‹ Scale Using the Scale control to increase the color velocity range may increase the TI. The system will automatically adjust the pulse voltage to stay below the system maximum. A decrease in pulse voltage will also decrease MI. „ ‹ 2D Mode Size A narrower 2D mode sector width in Color imaging will increase color frame rate. The TI will increase. MI will not change. If Pulsed Doppler is also enabled, then Pulsed Doppler will remain the dominant mode and the TI change will be small. 1-27

[Page 48]
M Mode and Doppler Controls „ ‹ Simultaneous and Update Methods Use of combination modes affects both the TI and MI through the combination of pulse types. During Simultaneous mode, the TI is an ancillary element. During auto-update and duplex, the TI will display the dominant pulse type. The displayed MI will be from the mode with the largest peak pressure. „ ‹ Sample Volume Depth When Doppler sample volume depth is increased, the Doppler PRF may automatically decrease. A decrease in PRF will decrease the TI. The system may also decrease the pulse voltage to remain below the system maximum. A decrease in pulse voltage will decrease MI.
Doppler, CW, M Mode, and Color Imaging Controls When a new imaging mode is selected, both the TI and the MI will change to their default settings. Each mode has a corresponding pulse repetition frequency and maximum intensity point. In combined or simultaneous modes, the TI is the sum of the contribution from the modes enabled, and the MI is the value for the focal zone of the mode with the largest derated intensity. If a mode is turned off and then reselected, the system will return to the previously selected settings. „ ‹ Probe Each probe model available has unique specifications for the contact area, beam shape, and center frequency. Defaults are initialized when you select a probe. Samsung Medison‘s factory defaults vary according to the probe, application, and mode. Defaults have been chosen below the FDA limits for intended use. „ ‹ Depth An increase in the 2D mode depth will automatically decrease the 2D mode frame rate. This would decrease the TI. The system may also automatically choose a deeper 2D mode focal depth. A change of focal depth may change the MI. The MI displayed is that of the zone with the largest peak intensity. „ ‹ Application Acoustic output defaults are set when you select an application. Factory defaults vary with probe, application, and mode. Defaults have been chosen below the FDA limits for intended use. 1-28

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Related Guidance Documents For more information about ultrasonic bioeffects and related topics, refer to the following; X ‹ Medical Ultrasound Safety (AIUM, 2014). X ‹ AIUM Consensus Report on Potential Bioeffects of Diagnostic Ultrasound: Executive Summary, J. Ultrasound in Medicine, 2008, Vol. 27, Num. 4. X ‹ WFUMB. Symposium on Safety of Ultrasound in Medicine: Conclusions and Recommendations on Thermal and Non-thermal Mechanisms for Biological Effects. Ultrasound in Med. & Biol; 1998, 24: Supplement 1. X ‹ Bioeffects and Safety of Diagnostic Ultrasound (AIUM, 1993) X ‹ Guidelines for the safe use of diagnostic ultrasound equipment. (BMUS, 2009) X ‹ Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers (U.S. FDA - 2008) X ‹ Particular requirements for the basic safety and essential performance of ultrasonic medical diagnostic and monitoring equipment. (IEC, 2007) X ‹ Acoustic Output Labeling Standard for Diagnostic Ultrasound Equipment (AIUM, 2008) X ‹ Standard Means for the Reporting of the Acoustic Output of Medical Diagnostic Ultrasonic Equipment. (IEC, 2007) X ‹ Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices On Diagnostic Ultrasound Equipment (AIUM/NEMA, 2004) X ‹ Ultrasonics - Field characterization - Test methods for the determination of thermal and mechanical indices related to medical diagnostic ultrasonic fields (IEC, 2005) X ‹ Measurement and Characterization of Medical Ultrasonic Fields up to 40 MHz. (IEC, 2007) X ‹ Ultrasonics - Power Measurements - Radiation Force Balances and Performance Requirements. (IEC, 2006) X ‹ Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment. (AIUM/NEMA, 2004) 1-29

[Page 50]
Acoustic Output and Measurement Since the first usage of diagnostic ultrasound, the possible human biological effects (bioeffects) of 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 (Bioeffect 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 up to date information. In addition, periodically updated reports on biological effects, results, and guidelines on safe usage have been published by groups such as the WFUMB (World Federation of Ultrasound in Medicine and Biology), AIUM, and BMUS. The Acoustic output for this system has been measured and calculated in accordance with the Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices On Diagnostic Ultrasound Equipment (AIUM/NEMA, 2004) and Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment (AIUM/NEMA, 2004). 1-30

[Page 51]
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 the largest possible value. Biological tissue absorbs acoustic energy. The true value of the intensity at any point depends on the amount and type of tissue, and the frequency of the ultrasound that passes through the tissue. The intensity value in the tissue, In Situ , has been estimated using the following formula: - (0.23 alf ) In Situ = Water [ e ] Where: In Situ = In Situ Intensity Value Water = Water Value Intensity e = 2.7183 a = Attenuation Factor Tissue a (dB/cm-MHz) Brain 0.53 Heart 0.66 Kidney 0.79 Liver 0.43 Muscle 0.55 l = Skin line to measurement depth (cm) f = Center frequency of the transducer/system/mode combination (MHz) Since the ultrasonic path during an examination is likely to pass through varying lengths and types of tissue, it is difficult to estimate the true In Situ intensity. An attenuation factor of 0.3 is used for general reporting purposes; therefore, the In Situ value is commonly reported using this formula: - (0.069 lf ) In Situ (derated) = Water [ e ] Since this value is not the true In situ intensity, the term “derated“ is used. The maximum derated and maximum water values do not always occur under the same operating conditions. Therefore, the reported maximum water and derated values may not be related to the In Situ (derated) formula. For example, a multi-zone array transducer has the greatest water value intensities at its deepest zone. The same transducer may have its largest derated intensity at one of its shallowest focal zones. 1-31

[Page 52]
Terms and Symbols Related to Acoustic Output and Measurement The terms and symbols used in the acoustic output tables are defined in the following paragraphs. f awf ACOUSTIC WORKING FREQUENCY is the frequency of an acoustic signal based on the observation of the output of a hydrophone placed in an acoustic field at the position corresponding to the spatial-peak temporal-peak acoustic pressure. (unit: MHz) I pa,α at z pii,α The ATTENUATED PULSE-AVERAGE INTENSITY at the depth of maximum ATTENUATED SPATIAL-PEAK TEMPORAL-AVERAGE INTENSITY. (unit: Watts per square centimeter) I ta (z) The TEMPORAL-AVERAGE INTENSITY at axial distance z. (unit: Milliwatts per square centimeter) I ta, α (z) The ATTENUATED TEMPORAL-AVERAGE INTENSITY at axial distance z. (unit: Milliwatts per square centimeter) MI MECHANICAL INDEX is a displayed parameter representing potential cavitation bioeffects (unit: N/A) n pps The number of acoustic pulses travelling along a particular ULTRASONIC SCAN LINE. P OUTPUT POWER is time-average ultrasonic power emitted by an ultrasonic transducer into an approximately free field under specified conditions in a specified medium, preferably water. (unit: mW) P 1x1 Maximum value of the time average acoustic output power emitted from any one-centimetre square region of the active area of the transducer, the one- centimetre square region having 1 cm dimensions in the x- and y-directions. P r at z pii The PEAK-RAREFACTIONAL ACOUSTIC PRESSURE at the depth of maximum SPATIAL-PEAK TEMPORAL-AVERAGE INTENSITY. (unit: Megapascals) P r,α at z MI The ATTENUATED PEAK-RAREFACTIONAL ACOUSTIC PRESSURE associated with the transmit pattern giving rise to the reported value of MI. (unit: Megapascals) pii Time integral of the instantaneous intensity at a particular point in an acoustic field integated over the acoustic pulse waveform. (unit: Watts per square centimeter) 1-32

[Page 53] pii α (Z) Value of the pulse-intensity integral after attenuation, at a specified distance from the external transducer aperture. (unit: Watts per square centimeter) prr PULSE REPETITION RATE is reciprocal of time interval between equivalent points on successive pulses or tone-bursts. (unit: Hz) srr SCAN REPETITION RATE is reciprocal of time interval between identical points on two successive frames, sectors or scans, applying to automatic scanning systems with a periodic scan sequence only.(unit: Pulses per second or Hz) TIB BONE THERMAL INDEX is a themal index for applications such as foetal (second and third trimester), in which the ultrasound beam passes through soft tissue and a focal region is in the immediate vicinity of bone. (unit: N/A) TIC CRANIAL BONE THERMAL INDEX is a thermal index for applications, in which the ultrasound beam passes through bone near the beam entrance into the body, such as paediatric and adult cranial or neonatal cephalic applications. (unit: N/A) TIS SOFTT TISSUE THERMAL INDEX is a thermal index related to soft tissues. (unit: N/A) z b,ns DEPTH FOR BONE THERMAL INDEX for non-scanning modes, the distance along the beam axis from the external transducer aperture to the plane where the product of attenuated output power and attenuated spatial-peak temporal-average intensity is a maximum over the distance range equal to, or greater than, the break-point depth, z bp . (unit: cm) z MI Depth on the BEAM-AXIS from the EXTERNAL TRANSDUCER APERTURE to the plane of maximum ATTENUATED PULSE INTENSITY INTEGRAL (pii,α). (unit: cm) z s,ns DEPTH FOR SOFT-TISSUE THERMAL INDEX for non-scanning modes, the distance along the beam axis from the external transducer aperture to the plane at which the lower value of the attenuated output power and the product of the attenuated spatial-peak temporal-average intensity and 1 cm is maximized over the distance range equal to, or greater than, the break-point depth, z bp . (unit: cm) z pii,α Position of maximum ATTENUATED SPATIAL-PEAK TEMPORAL-AVERAGE INTENSITY for NONSCANNING MODE components, determined beyond the BREAK-POINT DEPTH, z bp , on the BEAM-AXIS. (unit: cm) 1-33

[Page 54]
Acoustic Measurement Precision and Uncertainty The Acoustic Measurement Precision and Acoustic Measurement Uncertainty are described below. Quantity Precision Total Uncertainty pii α (attenuated pulse intensity integral) 3.2% +21% to -24% P (acoustic power) 6.2% ±19% P r,α (attenuated rarefaction pressure) 5.4% ±15% f awf (acoustic working frequency) < 1% ±4.5% „ ‹ Systematic Uncertainties For the pulse intensity integral, derated rarefaction pressure Pr.3, center frequency, and pulse duration, the analysis includes considerations of the effects on accuracy of: Hydrophone calibration drift or errors. Hydrophone/Amp frequency response. Spatial averaging. Alignment errors. Voltage measurement accuracy, including. X ‹ Oscilloscope vertical accuracy. X ‹ Oscilloscope offset accuracy. X ‹ Oscilloscope clock accuracy. X ‹ Oscilloscope Digitization rates. X ‹ Noise. The acoustic power is measured using a Radiation Force for systematic uncertainties through the use of calibrated NIST acoustic power sources. We also refer to a September 1993 analysis conducted by the working group of the IEC technical committee 87 and prepared by K. Beissner, as a first supplement to IEC publication 1161. 1-34

[Page 55] The document includes analysis and discussion of the sources of error/measurement effects due to: X ‹ Balance system calibration. X ‹ Absorbing (or reflecting) target suspension mechanisms. X ‹ Linearity of the balance system. X ‹ Extrapolation to the moment of switching the ultrasonic transducer (compensation for ringing and thermal drift). X ‹ Target imperfections. X ‹ Absorbing (reflecting) target geometry and finite target size. X ‹ Target misalignment. X ‹ Ultrasonic transducer misalignment. X ‹ Water temperature. X ‹ Ultrasonic attenuation and acoustic streaming. X ‹ Coupling or shielding foil properties. X ‹ Plane-wave assumption. X ‹ Environmental influences. X ‹ Excitation voltage measurement. X ‹ Ultrasonic transducer temperature. X ‹ Effects due to nonlinear propagation and saturation loss.
Training The users of this ultrasound system must familiarize themselves with the ultrasound system to optimize the performance of the device and to detect possible malfunctions. It is recommended that all users receive proper training before using the device. You can receive training on the use of the product from the Samsung Medison service department, or any of the customer support centers worldwide. 1-35

[Page 56] Protecting the Environment X ‹ For disposal of the system or accessories that have come to the end of their service lives, contact the vendor or follow appropriate disposal procedures. X ‹ Waste must be disposed of in compliance with local regulations. X ‹ The lithium ion battery used in the product must be replaced by a Samsung Medison service engineer or an authorized dealer.
EU WEEE Directive Correct Disposal of This Product (Waste Electrical & Electronic Equipment) This marking on the product, accessories or literature indicates that the product and its electronic accessories (e.g. charger, headset, USB cable) should not be disposed of with other household waste at the end of their working life. To prevent possible harm to the environment or human health from uncontrolled waste disposal, please separate these items from other types of waste and recycle them responsibly to promote the sustainable reuse of material resources. Household users should contact either the retailer where they purchased this product, or their local government office, for details of where and how they can take these items for environmentally safe recycling. Business users should contact their supplier and check the terms and conditions of the purchase contract. This product and its electronic accessories should not be mixed with other commercial wastes for disposal. 1-36

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EU REACH Regulation For information on Samsung’s environmental commitments and product specific regulatory obligations e.g. REACH visit: Samsung.com/uk/aboutsamsung/samsungelectronics/corporatecitizenship/data_corner.html
State of California Proposition 65 Warning (US Only) WARNING: This product contains chemicals known to the State of California to cause cancer, birth defects or other reproductive harm. 1-37

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[Page 59] Chapter 2 Introduction ‹ ‹ Product Specifications 2-3 ‹ ‹ Product Configuration 2-7 Monitor 2-9 Control Panel 2-11 Console 2-18 Peripheral Devices 2-21 Probes 2-24 Accessories 2-25 Optional Functions 2-26

[Page 60]

[Page 61] Product Specifications Height: 1,344 mm (with Monitor) Width: 529 mm Physical Dimensions Depth: 767 mm (with Keyboard) Weight: 79.8 kg (without accessories) Weight: Approx. 98 kg (with Safe Working Load) 2D Mode M Mode Color M Mode Anatomical Mode Color Doppler Mode Pulsed Wave (PW) Spectral Doppler Mode Continuous Wave (CW) Doppler Mode Tissue Doppler Imaging (TDI) Mode Imaging Modes Tissue Doppler Wave (TDW) Mode Power Doppler (PD) Mode ElastoScan Mode 3D/4D/XI STIC imaging Mode Dual Mode Quad Mode Combined Mode Simultaneous Mode Zoom Mode Gray Scale 256 (8 bits) Transmit focusing, maximum of eight points (four points simultaneously Focusing selectable) Digital dynamic receive focusing (continuous) 2-3

[Page 62] HS50/XH50 Linear Array LA3-14AD, LA3-16A Curved Array CA1-7AD, CA2-9AD, CA2-6BM, CF4-9 Endo Cavity ER4-9, EVN4-9 Phased Array PA3-8B, PE2-4, PA4-12B 3D CV1-8AD, V5-9 CW CW6.0, DP2B TEE MMPT3-7 HS60/XH60 Probes Linear Array (Type BF/IPX7) LA3-14AD, LA2-9A, LA3-16AI, LA4-18BD, LA3-16A Curved Array CA1-7AD, CA2-9AD, CA2-6BM, CF4-9, CA3-10A Endo Cavity EA2-11B, VR5-9, EA2-11AR Phased Array PA1-5A, PA3-8B, PA4-12B 3D CV1-8AD, V5-9 CW CW6.0, DP2B, DP8B TEE MMPT3-7 X ‹ Probe CA2-6BM is not supported in the US and Canada. X ‹ CW6.0 Probe is not supported for XH50 and XH60. 2-4

[Page 63] 3 Probe Connectors, 4 Probe Connectors for option HS50/XH50 HS60/XH60 Probe Connections 3 PORT O X 4 PORT O (Option) O CW Probe Connector Main Monitor Number of Pixel: 1,920 x 1,080 21.5 inch LCD Monitor (LED Backlight unit, hereafter referred to as “LCD monitor”) Touchscreen Monitor Number of Pixel: 1,280 x 800 10.1 inch LCD Monitor (LED Backlight unit, hereafter referred to as “LCD monitor”) ECG USB Type (Defibrillation-proof type CF) Audio Output Port (Right/Left) Rear Panel VGA monitor Input/Output LAN Connections USB Port HDMI output Maximum 45,000 frames for Cine memory Image Storage Maximum 14,000 Lines for Loop memory Image filing system Obstetrics, Gynecology, Urology, Abdomen, Cardiac, Vascular, Small Parts, TCD, Application MSK, Pediatric 100-240VAC, 800VA, 50/60Hz Electrical Parameters Battery: 14.4VDC, 6900mAh Abdomen, Obstetrics, Gynecology, MSK, Pediatric, Small Parts, Urology, Measurement Vascular, Cardiac, Fetal Heart Packages * Refer to the ‘Chapter 8. Measurements’ for additional information. Acoustic Power Control Signal Processing Dynamic Aperture Control (Pre-Processing) Dynamic Apodization Control Dynamic LPF Control 2-5

[Page 64] Digital TGC Control Slider TGC Control Mode-Independent Gain Control Black Hole/Noise Spike Filtering 1D Lateral/Axial Filtering Signal Processing 2D Edge/Blurring Filtering (Post-Processing) Frame average M/D Mode Sweep Speed Control Zoom Image View Area Control Image Orientation (left/right and up/down) Trackball operation of multiple cursors X ‹ 2D Mode: Linear measurements and area measurements using elliptical approximation or trace Measurement X ‹ M Mode: Continuous readout of distance, time, and slope rate X ‹ Doppler Mode: Velocity and trace DVD Multi-Drive Digital B/W Video Printer Digital Color Video Printer USB Printer DVD Recorder Auxiliary Foot switch (IPX8) USB Flash Memory Media USB HDD USB ECG User Interface English, German, French, Spanish, Italian, Portuguese, Russian, Chinese Operating: 700 – 1060hPa Pressure Limits Storage: 700 – 1060hPa Operating: 30 – 75% Humidity Limits Storage & Shipping: 20 – 90% Operating: 10 – 35°C Temperature Limits Storage & Shipping: -25 – 60°C 2-6

[Page 65] Product Configuration This product consists of monitor, control panel, console, peripheral devices and probes. 1 Monitor 2 Monitor arm 3 Keyboard 1 2 4 Control panel 5 Lift 6 Probe holder 7 DVD drive 8 USB port 9 Speaker 0 Probe port ! Wheel 3 @ Location of ID Label # Brake $ Gel warmer % Internal peripheral devices outlet 0 @ [Figure 2.1 Front of the Product] 2-7

[Page 66] 1 Handle 2 Storage compartments 3 Ventilation 4 Rear panel 5 Power connection part 6 ID label [Figure 2.2 Back of the Product] 2-8

[Page 67] Ultrasound images and other information are displayed on the color LCD monitor.
Screen Layout The monitor displays ultrasound images, operation menus and a variety of other information. [Figure 2.3 Monitor Display] 1 Title Area Displays patient information, hospital name, application, frame rate, depth, probe information, acoustic output information, and the current date and time. 2 Image Area Displays ultrasound images. Image information, annotation, and measurement information are also displayed. 3 Thumbnail Area Images saved by pressing the preset Store button are shown in the thumbnails. When you save Single screens, up to 4 images are shown in a list; for Quad screens, up to 12 images are shown. Click it with the pointer to enlarge the preview image. 4 User Information and Status Information Area Information that is useful to the user, such as current system status, image information, selectable items, etc., is displayed. 2-9

[Page 68] Battery Assist X ‹ Batteries are attached to the product so you can move it while scanning patients without turning it off. X ‹ Please check the battery capacity before use. Battery in use Battery not in use 5 User Key (User Defined Key) Area Settings for User Defined Keys, including the positions of Set and Exit buttons, are displayed. You can change the setting of each button in Setup > Customize > Buttons. NOTE: For information on User Key Setup, please refer to ‘Chapter 3. Utilities’. Principles of Operation of the Diagnostic Ultrasound System Medical ultrasound images are created by digital memory and computer when they convert the high-frequency wave signals that are transmitted and received by the probe. As ultrasound waves propagate through the human body, they generate reflected signals whenever they encounter a change in density. For example, reflected signals are generated when signals pass from fatty tissues to muscle tissues. Reflected signals return to the probe, where they are converted into electronic signals. The reflected signals are amplified and processed by analog and digital circuits that have filters for various frequencies and response time options. Then they are again converted into high-frequency electronic signals, and saved as a series of digital image signals. The monitor displays the image signals stored on the storage device in real time. The entire process of transmitting, receiving, and processing signals is controlled by the computer. 2-10

[Page 69] Control Panel The system can be controlled by using the control panel. [Figure 2.4 Control Panel] The control panel consists of a keyboard, soft menus, buttons, dials, dial-buttons, a slider, and a trackball. The dial-button can be used both as a dial and a button. 2-11

[Page 70]
Functions of the Control Panel The following are the descriptions and instructions for the controls on the control panel. For more information on controls with multiple functions, see Chapter 3 and later in this manual. Button Turns the system on/off. On/Off Finishes the exam of the currently selected patient and resets the related data. End Exam Button Displays the screen for viewing and managing stored images. SonoView Displays the Report screen that shows the measurement results of the current application and other information. Report When you press the dial-button, the menu items that are available in the current scan mode are shown on screen. Rotating the Menu dial- Dial-button button to the right selects the menu one row above the current menu selected, and rotating it to the left selects the menu one row below. X ‹ Marker: Allows the user to enter a BodyMarker over an image. Dial-button X ‹ Ref: Moves the reference slice horizontally in 3D View. Adjusts the angle of the sample volume in Spectral Doppler mode. Dial-button It is also used to adjust the Arrow’s angle or the probe angle for a BodyMarker. Button In this mode, only the image is displayed on the screen. Button Compares four independent images. Compares two independent images. The active image mode is on the left. Compares two independent images. The active image mode is on the right. Switch Adjusts the scanning depth of the image. Switch Moves the focus to the target area for observation. 2-12

[Page 71] Makes the Zoom Box appear. Dial-button In order to close the Zoom mode, press the Exit button. Press this button to turn the Quick Scan function on. The ‘Q Scan’ mark Button will appear at the top of an image. It can be used in applications of all probes. Button Pauses/resumes scanning. Stands for User Key; functions can be assigned to these buttons as Button desired. The function for each button can be assigned in Setup > Customize > Buttons > User Key. Start or end M Mode. Rotate this dial-button to adjust Gain. Also, Dial-button turning this dial-button when in 3D View rotates the image along the x-axis. Press this button to start/stop PW Spectral Doppler mode. Rotate this Dial-button dial-button to adjust Gain. Also, turning this dial-button, when in 3D View rotates the image along the y-axis. Press this button to start/stop Color Doppler mode. Rotate this dial- Dial-button button to adjust Gain. Also, turning this dial-button when in 3D View rotates the image along the z-axis. Button Press this button to start/stop Power Doppler mode. Press this button to start/stop CW Spectral Doppler mode. Available only with the phased array probe. Press this button to start 2D mode. Rotate this dial-button to adjust Dial-button Gain. Button Press this button to turn 3D/4D Mode on/off. Set or Exit function may be assigned to this button. The function for each button can be assigned in Setup > Customize > Set/Exit Key. X ‹ Set: Select an item or value using the trackball. Also used to change the function of the trackball. Set/Exit X ‹ Exit: Exits the function currently being used and returns to the previous state. 2-13

[Page 72] Deletes text, Arrow, BodyMarker, measurement results, etc. displayed on an image. Clear When this is pressed, an arrow marker appears to point to parts of the displayed image. Pointer Button Changes the current trackball function. Change Button Allows the user to place text on an image. Button Starts measurements by application. Calculator Trackball Moves the cursor on the screen. Also scrolls through Cine images. Trackball 2-14

[Page 73] „ ‹ Keyboard The keyboard is used to type in text. [Figure 2.5 Keyboard] Help Displays the Help Manual on the screen. Patient Displays the General Information on the screen. Patient Info. Shows or hides the patient information on the screen. Image Info. Shows or hides the Image Parameters on the screen DICOM Spooler Displays the DICOM Spooler on the screen. Arrow Initiates Arrow mode. Home Moves the cursor to the Home position in Annotation mode. Set Home Specifies the Home position in Annotation mode. Delete Word Deletes the last text entered in Annotation mode. Delete All Deletes all the text that has been entered in Annotation mode. Setup This displays the Setup screen. Insert Select an input method. Delete Deletes text. Turns up the speaker volume. Turns down the speaker volume. 2-15

[Page 74]
Touchscreen The touchscreen is an operating tool that can be touched by the user to input data. The functions that are available in the current mode are shown in the form of buttons or a dial- button. „ ‹ Touchscreen Layout [Figure 2.6 Touchscreen Display] 1 These buttons are always displayed on the touchscreen. Buttons that are in use are shown in blue and buttons that cannot be used are deactivated. The Patient Information screen will appear, where you can select a Patient Patient ID in the list or enter new patient information. It displays the Probe Selection screen where you can select and modify Probe the probe and application. Quick Preset 1–4 It shows up to 4 Preset buttons configured at Setup. The general system settings that do not have a direct bearing on imaging Setup are explained below. NOTE: For further details about setting up Quick Preset, please refer to ‘Setup > System > Quick Preset’ in ‘Chapter 3. Utilities’. 2-16

[Page 75] 2 Displays the mode that is currently used. 3 This is the TGC area. Adjust TGC Slide when TGC Curve is activated on the touchscreen. Move the slider to the right to increase Gain and brighten the image. TGC stands for Time Gain Compensation. CAUTION: Too great a difference in the gain value settings of adjacent TGC sliders may cause stripes in an image. 4 Menu Area: The menu items that are available in the current input mode are shown in the form of buttons. The user can access the desired menu item by pressing the corresponding button. The menu currently in use is shown in blue. To change the values in the menu, use the ◁ and ▷ buttons. 5 Soft Menu Area: The Soft Menu items that are available in the current input mode are shown. Press or rotate the dial-buttons right below each menu. When there are Two Soft Menus When there are two menus available – upper and lower, both menus can be adjusted with the corresponding dial-button. Or tap the button for the menu you want to use on the touchscreen and then use the dial-button.
Adjusting the Control Panel X ‹ Do not apply excessive force to the control panel. X ‹ Use the handle at the back of the product when moving it. „ ‹ Adjusting to the Right and Left Hold the control panel handle and move it carefully to the right or left. „ ‹ Adjusting the Height Press the lever on the handle of the control panel and move it carefully up or down. 2-17

[Page 76] Console The console consists of two parts – the inner and outer units. The interior of the console mainly contains devices that produce ultrasound images. On the exterior of the console are various connectors, probe holders, storage compartments, handles, and wheels, etc.
Rear Panel A monitor and other peripheral devices, like a printer, are connected via the rear panel at the back of the system. 1 HDMI Port (Output): Outputs digital signals to the monitor. (Input: Not supported.) 3 2 USB Port: Used to connect to peripheral USB devices. 3 Audio Port (Output): Outputs audio signal. (Input: Not supported.) 5 4 Network Port: Connect to a network. You can transfer patient information to another server via DICOM network. 5 R.G.B Port (Output): Provides analog signal output to be displayed on the monitor. 7 6 S-VHS Port (Output): Provides an S-VHS connection for a VCR. [Figure 2.7 Rear Panel] 7 Microphone Port (Input): Connects a microphone. 2-18

[Page 77]
Power Connection Part The power connection part is located at the bottom on the rear panel. [Figure 2.8 Power Connection Part] 1 Power switch/breaker: Turns on the power of the product, and cuts off power if overcurrent or overvoltage occurs. 2 Power inlet: Accepts the power cord, which connects to an external power supply. 3 Equipotential Terminal: This should be connected to the equipotential connection part in the exam room. 2-19

[Page 78]
Probe Holder Probe holders are mounted at the left and right-hand sides of the control panel. The holder can be separated for easy cleaning. The six probe holders on the control panel can be attached and removed. Hold the marked area at the top Pull the holder up th detach it. of the holder and pull it in the direction shown by the arrow. [Figure 2.9 Removing the Probe Holder] Hockey Stick Probe Holder Insert the Hockey stick probe holder into the probe holder to mount. It is provided as an option. 2-20

[Page 79] Peripheral Devices Peripheral devices can be connected to their corresponding ports on the left/right or rear sides of the console, as needed. X ‹ Do not install peripheral devices that are not listed in this user manual in the patient environment. If you install an unlisted device in the patient environment, it may cause an electrical hazard. X ‹ Do not connect additional external peripheral devices to the auxiliary socket outlet. Doing so may decrease safety level. 1.5m 1.5m 1.5m [Figure 2.10 Patient Environment] NOTE: Refer to the user manual of the peripheral device for its operating information. 2-21

[Page 80] „ ‹ DVD-Multi DVD±R, DVD±RW, DVD-RAM, CD-R, CD-RW „ ‹ Solid State Device SSD 512G CAUTION: When using a peripheral device via a USB port, always turn the power off before connecting/disconnecting the device. Connection/disconnection of USB devices while the power is on may lead to malfunction of the system and the USB devices. NOTE: The console’s USB ports are located on the rear panels of both the control panel and the console. We recommend that you connect USB storage devices (flash memory media, etc.) to the ports on the control panel, and other USB peripheral devices to the rear panel for convenience. The following products are recommended: „ ‹ Digital Video Printer X ‹ Black and White: Sony UP-D897 (UP-897MD, UP-X898MD, UP-D898MD), Mitsubishi P95DE (P95DW, P95D, P95DE) X ‹ Color: Sony UP-D25MD, Mitsubishi CP30DW „ ‹ USB Printer HP Officejet 4500, Samsung CLP-620NDK, Samsung ML-2950 Series 2-22

[Page 81] „ ‹ DVD Recorder Sony DVO-1000MD X ‹ You must install a printer and driver compatible with the English version of Microsoft Windows 7. Contact Samsung Medison customer support division for inquiries about printer driver installation. X ‹ When connecting the printer, ensure that the printer is configured under Microsoft Windows or system setup and has been chosen as the default printer. X ‹ Please check the port that the printer uses before connecting. Printers should be connected to the printer port while the USB printer should be connected to the USB port. „ ‹ Foot Switch X ‹ 3 Pedals HID Type To configure the foot switch function, go to Setup > Customize > Buttons > Foot Switch. You can select Exit , Freeze , U1 , U2 , U3 , U4 , U5 , U6 , Update , Single , or Quad . „ ‹ Misc. Flash Memory Media X ‹ The system cannot recognize USB 1.1 flash memory. Remove the flash memory from the console and equip again with an appropriate device. X ‹ Regarding file formats that are not ordinarily saved: Please check first to see if it is possible to save the file format on a desktop PC before trying to save the file on flash memory. X ‹ Do not use flash memory media which contain anti-virus programs or are defective. Otherwise, the product may fail to work properly. 2-23

[Page 82] Probes Probes are devices that generate ultrasound waves and process reflected wave data for the purpose of image formation. NOTE: For information on probes, refer to ‘Chapter 5. Probes’ and the Reference Manual.
Connecting Probes Be sure to connect or disconnect probes when the power is off to ensure the safety of the system and the probes. 1. Connect probes to the probe connectors on the front panel of the system. Up to four (options inclusive) (five including CW) probes may be connected. 2. Turn the connector-locking handle clockwise. [Figure 2.11 Probe Connector] NOTE: If the probe does not connect properly, try reconnecting it after removing any foreign objects. 2-24

[Page 83] Accessories An accessory box containing the items below is supplied with the product. SONO GEL GROUND CABLE MANUAL USER GUIDE [Figure 2.12 Accessories] NOTE: Supplied accessories may vary by region. 2-25

[Page 84] Optional Functions HS50 and HS60 products have the following options based on the version: Option HS50/XH50 HS60/XH60 4D O O 3DXI O O DICOM O O EZ-Exam+ O O MultiVision O Basic option 5D NT O O CW Function O O Cardiac Measurement O O Strain+ O O Auto IMT+ O O ElastoScan O O E-Strain O O Panoramic O O XI STIC O O SEE Stream (RU region only) O O NeedleMate+ O O CEUS+ X O Realistic Vue O O HDVI X O Mobile Export O O 5D Follicle O O Stress Echo O / X O / X 2D NT O O 5D Heart Color X O Crystal Vue X O 2-26

[Page 85] Option HS50/XH50 HS60/XH60 S-Detect for Breast X O 3D MXI X O HQ-Vision X O For further information about optional functions, please refer to the relevant chapters in this manual. NOTE: XH50 and XH60 do not support ‘Stress Echo’. 2-27

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[Page 87] Chapter 3 Utilities ‹ ‹ Setup 3-3 System 3-4 Imaging 3-18 Application 3-25 Measurement 3-27 Report 3-46 Annotation 3-50 BodyMarker 3-54 Customize 3-58 Peripherals 3-63 Connectivity 3-66 Service 3-88 Help 3-88 ‹ ‹ ECG (Option) 3-89 ‹ ‹ EzCompare (Option) 3-91 ‹ ‹ Stress Echo (Option) 3-92 Setting up a Protocol 3-92 Starting a Protocol and Acquiring Images 3-97 Reviewing an Image 3-101 ‹ ‹ Strain+ Image (Option) 3-106 Strain+ 3-107 Auto EF 3-114 TMAD 3-121

[Page 88]

[Page 89] Setup General system settings that do not have direct bearing on imaging are explained. The setup can be modified depending on your specific needs or preferences. 1. Tap button on the touchscreen or press Setup button on the keyboard. 2. Setup screen will appear on the monitor and the touchscreen. Select a tab that contains items you want to specify. Selecting a Tab You can select the tab you want in either one of two ways. Select the method that suits you. X ‹ Use the trackball and the Set button to select a tab. X ‹ Tap the corresponding button on the touchscreen. 3. Specify the settings for each item. 4. Save settings and exit. Click Exit on the monitor screen, or tap Exit on the touchscreen, or press the Exit button on the control panel to switch to Scan Mode. [Figure 3.1 Setup – Touchscreen] 3-3

[Page 90] System In the Setup screen, select System tab. Or tap System on the touchscreen. From this tab, you can configure the general system settings. General In the Setup screen, select General tab in the System category. [Figure 3.2 Setup – System – General]
Location You can specify the information that is displayed in the title area on the screen. „ ‹ Institute Enter the name of the hospital/institution where the product is installed. Special characters can be entered. „ ‹ Language Select the system language. (Supported languages: English, German, French, Spanish, Italian, Simplified Chinese, Russian, Portuguese (Brazilian)) 3-4

[Page 91]
Date and Time Set the date and time for use in the system. X ‹ Before starting diagnosis, please confirm the time, date and time zone and modify the settings if necessary. X ‹ Make sure to set the date and time to the time zone in which the system is installed. If it is not set, the date and time can be automatically synchronized to the time zone of the country of the manufacturer. X ‹ You cannot change the date and time when a patient ID has been registered. To change the date and time, you should finish the current diagnosis by pressing the End Exam button on the control panel. X ‹ When the system time and date are changed, the change is not reflected in the time and date indicated in previous diagnosis results. „ ‹ Date Format Specify the date format. Select a date format using the combo button. The date format that you specify will be applied to various date fields in Patient Information . „ ‹ Time Format Specify the time format. Press the combo button to select the preferred display format (12 Hour or 24 Hour). „ ‹ Date and Time Select settings for date and time. When you press this button, the Date and Time screen appears. 1. Set the date and time by using the trackball and the Set button on the control panel. 2. Press Save to apply the settings. Tap Cancel or press Exit button on the control panel to cancel. 3-5

[Page 92] „ ‹ Time Zone Specify the local time zone where the system is used. When you press this button, the Time Zone Settings screen appears. 1. Press Time Zone . 2. Specify the time zone by using the trackball and the Set button for the combo button. 3. Press OK to apply the settings. Tap Cancel to cancel.
Temperature „ ‹ Temperature Unit Set the temperature unit.
Trackball Speed „ ‹ Scan Mode Specify the trackball speed in Scanning Mode as Slow, Normal, or Fast. „ ‹ Measurement Used to specify the trackball’s speed during measurement. Select Slow, Normal, or Fast. Slower speeds allow for more precise measurements.
Video „ ‹ Format Choose between NTSC or PAL. 3-6

[Page 93]
Beep Sound „ ‹ Touchscreen Set the sound level when using the touchscreen. Turn it on or off by using the trackball. „ ‹ Control Panel Set the sound level of sound when using buttons and dial-buttons in the control panel. You can turn it on or off by using the trackball. In particular, for Set/Exit , Freeze , Save , and Other buttons and dial-buttons, you can turn them on or off.
Account Register a user ID and password. „ ‹ User Account Manager This is the exclusive administrator function for approval and management of accounts. X ‹ User Login: You can enable the user account (login) function. When turned on, this applies to the following cases: – Screen Saver – System startup X ‹ Password Expiry Period (Days): Set the password expiration period to None, 30, 60, or 90. X ‹ Login Attempts for Account Lockout (times): Set the number of failed login attempts that are allowed before an account is locked out to None or 5. X ‹ User Account List: You can manage user accounts. X ‹ Create: Fill out the User ID, Password, Name, and Authority fields. Then, press the OK button to create a new ID. You can specify the Grade (i.e., Admin or User) of the created account. When you create a User Grade account, you can restrict the following functions: – Export (SonoView, Report, External Storage) – Backup & Restore (SonoView) – Delete (Patient, SonoView) – Connectivity (Setup) 3-7

[Page 94] X ‹ Modify: Save the changes. X ‹ Delete: Delete the selected ID. X ‹ Close: Close Settings. Emergency This is an Emergency Login function provided in case of an emergency. You can use this function on the User Login screen. When you log in using Emergency Login, the existing function for using patient information is disabled. „ ‹ Login You can set a User Account ID after logging in to the Admin account. Please contact the service engineer to learn how to reset user account information including the Admin account. X ‹ The Admin account can be configured when you run ‘User Account Manager’ at Setup for the first time. X ‹ The Admin account cannot be deleted. X ‹ Once the user account function is activated, you cannot load exams without logging in. X ‹ The password must be 8 to 16 characters and composed of at least three of the following: – English alphabet upper case – English alphabet lower case – Numbers – Special characters X ‹ If you exceed the maximum number of invalid password attempts, you cannot login for a certain period of time. „ ‹ Logout Close the account. 3-8

[Page 95] Display In the Setup screen, select Display tab in the System category. Configure the settings for displaying images. [Figure 3.3 Setup – System – Display] 3-9

[Page 96]
Display „ ‹ System Logo Choose one of SAMSUNG or HS50/HS60/XH50/XH60. „ ‹ Direction Marker Set the Direction Marker. Among SAMSUNG HS50/HS60/XH50/XH60, HS50/HS60/XH50/ XH60, and S Marker, select a desirable shape. „ ‹ Screen Saver Select the wait time (in minutes) for the screen saver. „ ‹ System Power Button X ‹ Ask me what to do: Set a message to recheck the Off status when it is shut down. X ‹ Shut Down: The power will turn off. „ ‹ Option X ‹ Auto Freeze: Automatically switch to freeze state. Set the Freeze time by clicking the – and + buttons. X ‹ Prompt for Save on Exit: Use the checkbox to select whether to save or not. – Check On: Set a message to recheck whether to save the changes when closing the setup. – Check Off: Set it to automatically save changes when closing the setup. X ‹ Boot up Caps Lock On: When the checkbox is selected, Caps Lock is turned on after completing the system booting. „ ‹ Touchscreen Brightness By using the trackball, adjust brightness of the touchscreen from 0 to 100 in the units of 10. Adjust it by pressing – and + buttons. 3-10

[Page 97] Patient In the Setup screen, select the Patient tab in the System category. [Figure 3.4 Setup – System – Patient]
Patient Data „ ‹ Name Display X ‹ Last, First Middle: Display the name of the patient in the order of last name, first name, then middle name. X ‹ First Last Middle: Display the name of the patient in the order of first name, last name, then middle name. „ ‹ Title Display Show or hide patient information in the Title area of the screen. X ‹ None: Patient information is not displayed. X ‹ Date of Birth: Displays the patient's date of birth. X ‹ Age: Displays the patient's age. X ‹ Gender: Select this checkbox to display the patient's gender. Note that the patient's gender can only be displayed if their date of birth or age is also displayed. 3-11

[Page 98] „ ‹ Title LMP/GA/EDD Display X ‹ LMP/GA: The last menstruation date and estimated gestation weeks are shown on the screen. X ‹ EDD/GA: The expected delivery date and estimated gestation weeks are shown on the screen. „ ‹ Save Patient Page as First Image If On is checked, Patient information is saved as the first image. „ ‹ Other ID When a Patient record is created, a GUI for text input is displayed for you to enter the Other ID. X ‹ Other ID Format: Any, Numbers, Letters and Numbers, and NHS Numbers are available. Except Any, inputs in each format type can only be entered as text.
User Defined List You may enter information related to studies beforehand, so that you can assign the information easily when entering patient information. X ‹ Keep Last Physician/Operator Name: Decide whether or not the last name entered should also be used for the next patient. Use the Change , Delete All , Delete , Up , and Down buttons to add, edit, or delete information; you may create a list of up to 20 for each item. X ‹ Operator: You can save the name of the operator who scanned the patient. X ‹ Diag. Physician: The name of the physician who diagnosed the patient can be saved. X ‹ Ref. Physician: You can save the name of the referring physician. X ‹ Indication: You can save information about the patient's medical history. X ‹ Description: You can save up to 20 diagnostic memos per application. 3-12

[Page 99] Quick Preset In the Setup screen, select Quick Preset tab in the System category. [Figure 3.5 Setup – System – Quick Preset]
Quick Preset After selecting the Probe, Application, and Preset connected to the port, save them to Quick Preset. Up to 4 sets can be saved. By using Preview, you can preview the saved preset. X ‹ In the Operation modes, the saved Probe and Preset are shown as a button on the touchscreen. 3-13

[Page 100] EZ‑Exam+ In the Setup screen, select the EZ‑Exam+ tab in the System category. EZ - Exam+ is a macro function that saves your frequently used exams as a protocol and runs them together. This feature streamlines the diagnosis process. 9 6 [Figure 3.6 Setup – System – EZ - Exam+] 3-14

[Page 101]
Protocol List Provides a protocol list for the application. EZ-Exam+ in the Default List cannot be deleted or edited. Adding a new EZ-Exam+ is not allowed. X ‹ Show EZ-Exam+ Guide Image: On the Protocol List, liver-related guide protocols will show a guide image appropriate for the task at the bottom left side. 1 Category: A list of available applications is shown. 2 If previously configured EZ Exams are available, they will be shown in the Preset Lists when an application is selected. 3 New Protocol: An EZ-Exam+ Creator window is created; upon opening the window, a new protocol is created automatically. 4 Edit: Edits any protocol selected in the protocol list. 5 Rename: Modifies the name of the protocol selected from the protocol list. 6 Delete: Deletes a protocol selected from the protocol list. 7 Import: Imports the protocol data. 8 Export: Exports the protocol selected from the protocol list. 9 Move Up Button: Moves the protocol selected from the protocol list up one row. 0 Move Down Button: Moves the protocol selected from the protocol list down one row. ! Task List: Provides a task list which belongs to the protocol selected from the protocol list. 3-15

[Page 102]
EZ‑Exam+ Creator [Figure 3.7 Setup – System – EZ - Exam+ Creator] 1 Options in Function Window X ‹ New: Creates a new protocol. X ‹ Open: Loads an existing protocol. X ‹ Save: Saves the current protocol. It is activated at any time even when there is no change of data. X ‹ Save As: Saves the current protocol with a different name. X ‹ Undo/Redo: Undoes the last performed function, or restores the last undone function. (Up to 50 Undo/Redo actions can be done; this function will be inactive if it cannot be performed.) X ‹ Format Painter: Applies the format settings from one protocol to another. 2 View Preview: Shows a preview automatically when a task is performed. 3-16

[Page 103] [Figure 3.8 Setup – System – EZ-Exam+ New Protocol] X ‹ Add Task( ↑ ): Creates a new task on the row above the task selected from the task list. X ‹ Add Task( ↓ ): Creates a new task on the row below the task selected from the task list. X ‹ Copy: Copies a task selected from the task list. X ‹ Cut: Cuts a task selected from the task list. X ‹ Paste: Pastes a task below the task selected from the task list. X ‹ Delete: Deletes a task selected from the task list. X ‹ Move Up: Moves a task selected from the task list up one row. X ‹ Move Down: Moves a task selected from the task list down one row. X ‹ Task List: Provides the task list which belongs to the protocol. X ‹ Task Parameter: Provides a parameter which belongs to the protocol selected from the protocol list. 3-17

[Page 104] Imaging In the Setup screen, select the Imaging tab. Or tap Imaging on the touchscreen. Configure the settings for displaying images. Common Common settings apply to all applications. You can select multiple items. Use the trackball and Set button to select items and set the checkbox. [Figure 3.9 Setup – Imaging – Common]
General Settings „ ‹ HPRF In PW Spectral Doppler Mode, this detects blood flow velocity that exceeds the maximum speed at the depth you want to obtain the Sample Volume from. „ ‹ Color Map Auto Invert (on Linear) Turns the Color Map’s Invert function on or off when Steer is changed. 3-18

[Page 105] „ ‹ Write Zoom Rearrangement Enable this to align the Write Zoom image with the center. When disabled, the Write Zoom image is displayed in the same shape as the observed position. „ ‹ Update 2D in Cursor Moving Enable this so that in PW Only Mode, moving the SV stops tracing and changes the mode to 2D Live, while stopping the SV resumes tracing. „ ‹ Relative Focal Position Enable this so that when adjusting the 2D Depth value, a similar pre-modification ratio of depth to focus position can be maintained. „ ‹ Enable MultiVision in Dual Live Mode Enable this so that in Dual Live, MultiVision is applied to the left image regardless of the configuration of the right image. Note that in B/BC Dual Live Mode, MultiVision will be applied to both images regardless of this setting. „ ‹ Enable ClearVision in Dual Live Mode Enable this so that in Dual Live, ClearVision is applied to the left image regardless of the configuration of the right image. Note that in B/BC Dual Live Mode, ClearVision will be applied to both images regardless of this setting. „ ‹ Preferred Probe Port Select the Probe Port that takes the highest priority when the system starts or when you select a probe. „ ‹ Color Velocity Unit Select the units of velocity in Color Mode. „ ‹ Doppler Scale Unit Select the units of measurement for the axis scale in Spectral Doppler Mode. 3-19

[Page 106]
Strain+ Apical View Order: Provides each view in the order of LAX, A2C, A4C or A2C, A4C, and LAX.
Display Settings „ ‹ Show Image Info Show or hide the image information. If the image information intrudes too much on the screen, when it is turned off, it hides the image information. „ ‹ Show Horizontal Scale Bar Show or hide the Horizontal Scale Bar in the Scan UI. „ ‹ Display Tx Frequency Specify how to display the Tx Frequency for each probe. If checked, the current state will be indicated in MHz; if unchecked, the state will be indicated as PEN, GEN, or RES. „ ‹ Display Linear Full Image in Single Mode Show the full image of the Linear (including virtual convex) probe in Single Mode. When the sides of an ultrasound image are not visible at a low depth, use this function to view the entire image. „ ‹ Display Linear Full Image in Dual Mode Show the full image of the Linear (including Virtual Convex) probe in Dual (or Dual Live) Mode. When the sides of an ultrasound image are not visible at a low depth, use this function to view the entire image. „ ‹ Live Scan Display at EzCompare When EzCompare is executed, you can locate the live images to the left or right. „ ‹ TGC Window Auto Close (sec) Specify how much time must elapse before the TGC Control Window on the touchscreen automatically closes because of a lack of user input. You can select among Off, 3, 5, 10, 15, or 20 seconds. If Off is ticked, it does not automatically close. You must press the Close button. 3-20

[Page 107] „ ‹ TGC Curve Display Specify how long the TGC Curve is displayed for in Scan UI (On: Always displayed, Off: Never displayed, Auto: Displayed for a specific length of time and then disappears). „ ‹ Biopsy Guideline Type Select the type of Biopsy Guide Line displayed. Select one from Center Line Only, Outer Line Only, or Both. „ ‹ Wide Dual View Wide screen is provided. Select one from Dual, Dual Live, CEUS+, or ElastoScan. „ ‹ Quad: Active Window Sequence Set the Window Change Order in Quad Mode to Zigzag or Clockwise. X ‹ Zigzag: Set in the order of 1 → 2 → 3 → 4 . X ‹ Clockwise: Set in the order of 1 → 2 → 4 → 3 . 3-21

[Page 108] Application/Preset These settings specifically apply to the selected application. You can select multiple items. Use the trackball and the Set button to select and check or uncheck items. [Figure 3.10 Setup – Imaging – Application/Preset]
Application Settings „ ‹ Select Application Set up the measurement application. „ ‹ Seamless Dual Mode Select whether or not to use Seamless Dual Mode in Dual Mode. When checked, no space will be shown between the left and right images in the Dual Mode, while when unchecked, a space will be shown between the left and right images. „ ‹ Enable Doppler Cursor Mode Select whether or not to enter Cursor Mode before Doppler Mode. 3-22

[Page 109] „ ‹ Enable M Cursor Mode Select whether or not to enter Cursor Mode before M Mode. „ ‹ Activated Mode When Image is Frozen Select which mode will activate upon freezing an image. Choose one of the following: Cine, Measurement, Annotation, BodyMarker, or Arrow. X ‹ When you select Measurement, the D or M Mode Only button is enabled; If you tick it, Measurement is enabled in D or M Mode only.
Preset Settings „ ‹ Select Preset Check the Probe, Application, and Preset. „ ‹ ECG Enable or disable ECG for each Preset. „ ‹ Thermal Index Type Set the TIs shown on the screen from among TIs (Soft tissue thermal Index), TIb (Bone thermal index), TIc (Cranial bone thermal index). You can specify indices by Preset. 3-23

[Page 110] S ‑ Detect On the Setup screen, select the S ‑ Detect tab. Enable or disable the settings for Breast. [Figure 3.11 Setup – Imaging – S-Detect]
S ‑ Detect for Breast „ ‹ Description Select On or Off to display the BIRADS to use. Turn this option Off to hide the call text from the screen. „ ‹ Sensitivity Setting Select High Sensitivity, High Accuracy, or High Specificity. „ ‹ Classification Select the classification to use: BIRADS2003 or BIRADS2013. 3-24

[Page 111] Application In the Setup screen, select the Application tab. Or tap Application on the touchscreen. General [Figure 3.12 Setup – Application – General]
Probe Select a probe.
Application Select an application.
Preset Select the Preset that is supported by the selected application. 3-25

[Page 112]
Select Library „ ‹ Annotation Setup a text library. „ ‹ BodyMarker Setup a BodyMarker library. „ ‹ Measurement X ‹ Application: Setup the measurement application. X ‹ Package: Setup a package for the measurement application. 3-26

[Page 113] Measurement Specify various setup options for measurements. The setup can be modified depending on your specific needs or preferences. 1. Press Setup on the touchscreen or keyboard. When the Setup screen appears, select the Measurement tab. 2. When the Measurement screen appears, select the tab that contains the items you wish to configure. 3. Specify the settings for each item. 4. Press the Save button to save the settings and finish. You can click Exit on the monitor screen or tap Exit on the touchscreen to exit the Setup screen and switch to Scan Mode. General In the Setup screen, select the General tab in the Measurement category. You can specify basic measurement options. [Figure 3.13 Setup – Measurement – General] 3-27

[Page 114]
Menu „ ‹ Directions Select the Direction Type to be applied to the measurement target in the initial system status. The options are Left and Right. „ ‹ Location Select the Location Type to be applied to the measurement target in the initial system status. The options are Prox, Mid, and Dist. „ ‹ Hide the menu on Unfreeze Hide or show the Measurement menu on the screen after taking measurements. Show the Scan Mode (On) or hide the Measurement menu (Off).
Display „ ‹ 2D Line Type Select the type of line to use for measurement in 2D mode (Solid: Solid line, Dot: Dotted line, None: Start and end points). „ ‹ Ellipse Cross Line Show (On) or hide (Off) the long axis and the short axis of an ellipse while taking Ellipse measurements. „ ‹ Clear Measurement(s) on Unfreeze Show or hide measurement results on the screen when switching to Scan Mode after taking measurements. Select this checkbox to show measurement results in 2D or M/D Mode. „ ‹ Zoom Window Generate an enlarged image centered around the marker. You can select On or Off. 3-28

[Page 115]
Result Select how measurement results are displayed. „ ‹ Position on 2D Mode Reposition the measurement results when 2D Mode is selected. X ‹ Left-Top: Measurement results are displayed in the top left corner of the screen. X ‹ Left-Bottom: Measurement results are displayed in the bottom left corner of the screen. X ‹ Right-Bottom: Measurement results are displayed in the bottom right corner of the screen. X ‹ Right-Top: Measurement results are displayed in the top right-hand corner of the screen. X ‹ Custom: Measurement results are displayed in a location selected by the user. „ ‹ Position on M/D Mode Move the measurement results. X ‹ Left-Top: Measurement results are moved towards the top left corner of the screen. X ‹ Left-Bottom: Measurement results are moved towards the bottom left corner of the screen. X ‹ Right-Bottom: Measurement results are moved towards the bottom right corner of the screen. X ‹ Right-Top: Measurement results are moved towards the top right corner of the screen. X ‹ Custom: Measurement results are moved to a location selected by the user. „ ‹ Font Size Select the size of the font used for the measurement results. „ ‹ Show Background Turn the background of the measurement results transparent (On) or opaque (Off). 3-29

[Page 116]
Key „ ‹ Trackball Operation Set the motion of the trackball when using Caliper or Measure. X ‹ Marker: Stand-by and ready to measure; display the basic marker on the measurement screen. X ‹ Cine: Ready to select a Cine frame by using the trackball. „ ‹ Set Measurement on Store Turn the function on or off that automatically completes measurements when the Store key on the control pad is pressed while a measurement is being taken. „ ‹ Set Measurement on Unfreeze Turn on or off the function that completes measurements when the image is unfreezed by using Freeze Key while a measurement is being taken.
Cursor „ ‹ Cursor Type Select the shape of the default caliper cursor displayed on the screen. Select between ‘Cross’ shape (+) and ‘X’. „ ‹ Arrow Head Marker Show or hide the Head Marker when measuring a small area. „ ‹ Size Select the size of the default caliper cursor displayed on the screen. Select Small, Medium, or Large. 3-30

[Page 117] Library In the Setup screen, select the Library tab in the Measurement category. [Figure 3.14 Setup – Measurement – Library]
Measure Library in the Measure category is shown. Latest, Average, Max, or Min may be selected for each item. „ ‹ Application Select an application. „ ‹ Create Group Create a USERGROUP other than default group. „ ‹ Create Label Enter a preferred Name for the created group. NOTE: ‘Create Label’ can be edited. „ ‹ Delete Delete a newly created name or group in ‘Create Label’ or ‘Create Group’, respectively. 3-31

[Page 118]
Caliper Specify whether additional information will be shown along with the basic measurement values when basic measurements are taken by pressing the control panel’s Caliper button. If this option is selected, the additional information will be saved as an output along with the measurement results. Setting ‘Application’ to General will change the items in ‘D Trace’. Setting ‘Application’ to Cardiac will change the items in ‘D Trace’ and ‘D Velocity’. NOTE: ‘Cardiac’ setting is activated when the probe setting is Cardiac. Select the default tool that functions in the measurement cursor state for each Image mode. Distance, Trace, Trace Length, Ellipse, Open Spline, Closed Spline, Distance Stenosis, Trace Length Stenosis, Open Spline Stenosis, Ellipse Stenosis, Trace Stenosis, Closed 2D Mode Spline Stenosis, Ellipse Trace Stenosis, 2 Lines Angle, 3 Point Angle, 1 Dist Volume, 2 Dist Volume, 3 Dist Volume, Ellipse Volume, Ellipse + Dist Vol, Disk Volume Velocity, Velocity (Cardiac), Accel, Time(D), HR(D), RI, Auto Trace, Limited Trace, Manual Trace, Auto Trace(Cardiac), Limited Trace(Cardiac), Manual Trace(Cardiac), Dist Volume Flow, Trace Length Volume Flow, Open Spline Volume Flow, Ellipse Volume Flow, Trace Volume Flow, Closed Spline Volume Flow, S/D Ratio, D/S Ratio, V1/V2 Ratio, D Mode Velocity(F), Velocity(F) (Cardiac), Auto Trace(F), Limited Trace(F), Manual Trace(F), Auto Trace(F) (Cardiac), Limited Trace(F) (Cardiac), Manual Trace(F) (Cardiac), Dist Volume Flow(F), Trace Length Volume Flow(F), Open Spline Volume Flow(F), Ellipse Volume Flow(F), Trace Volume Flow(F), Closed Spline Volume Flow(F), S/D Ratio(F), D/S Ratio(F), V1/V2 Ratio(F) M Mode Distance, Slope, Time(M), HR(M) 3-32

[Page 119] Menu In the Setup screen, select the Menu tab in the Measurement category. [Figure 3.15 Setup – Measurement – Menu]
Library Measurement items provided for each application are shown in a list. 3-33

[Page 120]
Menu „ ‹ Package Select the Packages that are supported by each application. „ ‹ Image Mode View the Menu and the Touch Menu for each Image mode. „ ‹ Group View Group View lists the groups shown in the Menu. When Group View is activated, you can delete any of the groups shown, and change the layout of the groups shown in the Menu and the Touch Menu. „ ‹ Label View Label View lists the items shown in the Menu. When Item View is activated, you can delete any of the items shown and change the layout of the items shown in the Menu and the Touch Menu. „ ‹ Auto Sequence It is activated when the Auto Sequence box is checked. It provides a function for executing selected items in a group in sequential order. It also supports the sequential measurement function for measuring AFI and Volume in OB. „ ‹ Up, Down Adjust the order of the groups or items in Label View. „ ‹ Remove Delete a group or item selected in Group View or Item View. 3-34

[Page 121] „ ‹ Touch A Group or an Item can be placed on the touchscreen or shown in the Group View or Item View. X ‹ Click the Touch button to display a dialog box that shows the touch button. X ‹ Clear All: Delete all groups and items. X ‹ Add Page: Add a page. X ‹ Remove Page: Delete a page. X ‹ Click the touch button to display the groups and items that may be assigned to the button. X ‹ Select Empty in the groups and items shown to delete the groups and items currently assigned to the touch button. X ‹ Deleted groups and items from the Touch will be removed from the Group View or Item View when closing the dialogue box by clicking the Save button. „ ‹ Reset Defaults Press the Reset Defaults button and then select OK to go to the initial state. 3-35

[Page 122] Applications In the Setup screen, select the Applications tab in the Measurement category. [Figure 3.16 Setup – Measurement – Applications]
Caliper „ ‹ Caliper then Assign After taking a Basic Measurement, the measurement result may be set as a Label. You can enable or disable each Image Mode by selecting On or Off. „ ‹ Default Tool You can set up a maximum of three default tools for each Image Mode, which can function when the measurement cursor is active. X ‹ 2D Mode: Distance, Trace, Trace Length, Ellipse, Open Spline, Closed Spline, %Stenosis(D), %Stenosis(A), 2 Lines Angle, 3 Points Angle,1 Dist Volume, 2 Dist Volume, 3 Dist Volume, Ellipse Volume, Ellipse Dist Vol, Disk Volume X ‹ D Mode: Velocity, Accel, Time(D), HR(D), RI, Limited Trace, Manual Trace, Volume Flow(D), Volume Flow(A), S/D Ratio, D/S Ratio, V1/V2 Ratio X ‹ M Mode: Distance, Slope, Time(M), HR(M) 3-36

[Page 123] „ ‹ Default Tool Category Select the default tool for each measurement category. X ‹ %Stenosis(D): Distance Stenosis, Trace Length Stenosis, Open Spline Stenosis X ‹ %Stenosis(A): Ellipse Trace Stenosis, Ellipse Stenosis, Trace Stenosis, Closed Spline Stenosis X ‹ Volume Flow(D): Dist Volume Flow, Trace Length Volume Flow, Open Spline Volume Flow X ‹ Volume Flow(A): Ellipse Volume Flow, Trace Volume Flow, Closed Spline Volume Flow
Menu X ‹ Caliper then Calc: Clicking the Calculator button switches the mode back and forth from Caliper to Calc. X ‹ Calc. then Caliper: Clicking the Calculator button switches the mode back and forth from Cal. to Caliper. X ‹ Caliper Only: Clicking the Calculator button switches the mode to Calc. X ‹ Calc. Only: Clicking the Calculator button switches the mode to Caliper. When the Menu Type is set to Caliper Only or Calc. Only, pressing the Measurement Key on the control panel during measurements will exit the user.
Doppler „ ‹ Display Absolute Value The doppler measurement is displayed as an absolute value. „ ‹ Heart Rate X ‹ Cycle: Select the number of heart rate (HR) cycles. X ‹ Manual: Enter the heart rate manually when conducting a measurement. X ‹ Automatic: Heart rate is entered automatically by the ECG while conducting a measurement. 3-37

[Page 124] Additional Options In the Setup screen, select the Additional Options tab in the Measurement category. [Figure 3.17 Setup – Measurement – Additional Options] 3-38

[Page 125]
Application Select an application. „ ‹ Cardiac X ‹ RAP Default Value: Configure the default value of RAP. You may select 0, 5, 10, 15, 20, or 25mmHg. X ‹ LV Volume Method: Specify how the volume of the left ventricle is measured. Select Teichholz, Gibson, or Cubed. For more information on calculation formulae, please refer to the reference manual. X ‹ LV Study On Straight Line: The measurement direction can be set for each LV measurement. If it is On, the initial measurement direction is fixed. If it is Off, measurement can be conducted in any desirable direction. „ ‹ OB X ‹ SD/Percentile Type: Select None, SD, or Percentile. X ‹ NT Marker: Select the indicator symbol for measuring NT. You can select either Cross or Line type. X ‹ Clear Measurement(s) on Unfreeze: You can set whether to delete the results at Unfreeze. Select either of 2D or M/D or both of them. – 2D: Set whether to delete the values shown in the 2D image. – M/D: Set whether to delete the values shown in the Trace image. X ‹ Biometry Assist: Select a measurement item amongst BPD , HC , AC , and FL to display the selected item on the screen. The measurement standard for the BPD Method can be set to either Outer ‑ Inner or Outer ‑ Outer . „ ‹ Vascular ICA/CCA Ratio: Select a measurement item to use to calculate the ICA/CCA ratio. You can select Max, Prox, Mid, or Dist as PS and ED for ICA and CCA, individually. NOTE: You may select this when the application is OB, GYN, Vascular, or Cardiac. 3-39

[Page 126] AutoCalc. In the Setup screen, select the AutoCalc. tab in the Measurement category. AutoCalc. is a Spectral Doppler Mode feature that automatically performs specific calculations based on measured values. NOTE: The specified items will only appear on the screen when the AutoCalc. button on the touchscreen is tapped in Power Doppler Mode. [Figure 3.18 Setup – Measurement – AutoCalc.]
AutoCalc. Setting Add and remove automatic calculations by using the check boxes. When the Peak Systolic Velocity and End Diastolic Velocity values are 0, not all results for the items will be displayed on the screen. 3-40

[Page 127] Tables In the Setup screen, select the Tables tab in the Measurement category. View and edit the Tables and Equations to be used in each measurement item of OB. [Figure 3.19 Setup – Measurement – Tables] „ ‹ Select Category Select a category from Fetal Age, Fetal Growth, and EFW (Estimated Fetal Weight) to view and edit tables and charts for that category. „ ‹ Select Label Select a Label in the list box; that Label’s Author List will be copied into the combo box and the first Author’s data will be displayed on screen. „ ‹ Select Author Select Author in the combo box and the Author’s data will be displayed on screen. „ ‹ Create Create new Author data. „ ‹ Copy Copy the currently selected Author’s data to create new Author data. 3-41

[Page 128] „ ‹ Edit Modify the currently selected Author data. „ ‹ Delete Delete the currently selected Author data. NOTE: Only the Author data created by the user may be deleted. „ ‹ Author Name Indicates the currently selected Author’s name. The Author’s name may be entered when creating new Author data. NOTE: When creating new Author data, you cannot save the data without entering the Author’s name. „ ‹ Author Data Label Indicates the Label that the currently selected Author data belongs to. The Label may be changed when creating new Author data. „ ‹ Author Data Type Represents the currently selected Author data type. NOTE: Author data type may be changed when creating new Author data by using the New button. Note that Table type data cannot be created for EFW. „ ‹ Age Unit Indicates the Fetal Age unit for the currently selected Author data. The age unit may be changed when creating new Author data. „ ‹ Valid GA Range Indicates the valid range of the Gestational Age (GA) for the currently selected Author data. The valid GA range may be changed when creating new Author data. 3-42

[Page 129] „ ‹ Label Unit Indicates the Label unit for the currently selected Author data. The Label unit may be changed when creating new Author data. „ ‹ Valid Label Value Range Represents the valid range of the Label value for the currently selected Author data. The valid Label value range may be changed when creating new Author data. „ ‹ Table Type Indicates the deviation type of the Fetal Age Table for the currently selected Author data. The deviation type of the Table may be changed when creating new Author data. „ ‹ SD Type Indicates the deviation type of the Fetal Growth Table for the currently selected Author data. The deviation type of the Table may be changed when creating new Author data. „ ‹ EFW Unit Indicates the EFW unit of the currently selected Author data. The EFW unit may be changed when creating new Author data. „ ‹ Equation Indicates the currently selected Author Equation data. The equation may be changed using the Input Parameter list box or the Calculator buttons when creating new Author data. X ‹ If the Equation contains a formulaic error, the data cannot be saved. X ‹ If you enter a Label that is not found in the Input Parameter list box, the data cannot be saved. „ ‹ Table Indicates the table for the currently selected Author data. The table may be changed using the Insert Row , Delete Row , and Clear Table buttons when creating new Author data. NOTE: At least one row of data must be entered into the Table before data can be saved. 3-43

[Page 130] Author In the Setup screen, select the Author tab in the Measurement category. [Figure 3.20 Setup – Measurement – Author]
Fetal Age Specify the Fetal Age Author for each Label.
Fetal Growth Specify the Fetal Growth Author for each Label.
Estimated Fetal Weight Specify the EFW or EFW percentile Author. Each label is displayed sequentially in EFW Sequential Measurement upon setting each item. 3-44

[Page 131]
Composite GA Author Specify the Author to use for Composite GA. „ ‹ Set Authors To This enables the user to set all applicable measurement values at a time as selected in the applicable list box. 3-45

[Page 132] Report In the Setup screen, select the Report tab. Or tap Report on the touchscreen. Here you can set items related to the measurement report. [Figure 3.21 Setup – Report – Report Order] Report Order In the Setup screen, select the Report Order tab in the Report category.
Library Application ComboBox: It provides a list of labels for each application.
Report Order You can add items from the library to the Report Order list. X ‹ Reset Defaults: Restores the default settings for Report Order. X ‹ Up/Down: Change the order (up/down) of the selected items in Report Order. X ‹ Delete: Removes the items from the library when they’ve been moved by the user. (Original items in the Application cannot be deleted.) 3-46

[Page 133] Comment In the Setup screen, select the Comment tab in the Report category. [Figure 3.22 Setup – Report – Comments]
Select Application Display all diagnostic measurement information and select the measurement information to show in Report.
Comment The user can enter comments manually. „ ‹ Clear Delete saved comments. When executing Unfreeze, any annotation is deleted. 3-47

[Page 134] Description In the Setup screen, select the Description tab in the Report category. [Figure 3.23 Setup – Report – Description] „ ‹ Application Select an available application. Preset items exist for this application, but for other applications, only user-added items are available. „ ‹ Create Create a user item. Enter a name and category, then tap the OK button to create, or tap the Cancel button to reset all values to the defaults. 3-48

[Page 135]
Available Items This is a category or item list that can be added to the Anatomy page.
Selected Items This is a category or item list that has been added to the Anatomy page.
Selection Menu This is a list of the lower-tier items belonging to an item you have selected that has been added to the Anatomy page. X ‹ Edit: Items added by the user can be edited. X ‹ Delete: Items added by the user can be deleted. X ‹ On the Setup – Report – Description screen, users can tap the 1 buttons to add or remove a selected item. X ‹ On the Setup – Report – Description screen, users can tap the 2 buttons to change the order of a selected item. 3-49

[Page 136] Annotation In the Setup screen, select Annotation . Or tap Annotation on the touchscreen. Set up options for entering an opinion or a diagnosis. Library In the Setup screen, select the Library tab in the Annotation category. You can create, edit, or delete an Annotation library. [Figure 3.24 Setup – Annotation – Library] 3-50

[Page 137]
Library Select an application type.
User Defined Library The user can enter or delete text. „ ‹ Create Create text. „ ‹ Delete Delete text. „ ‹ Reset Defaults Revert to default settings.
Touchscreen Page 1 Specify the items that will be displayed on the first page of the touchscreen.
Touchscreen Page 2 Specify the items that will be displayed on the second page of the touchscreen.
Replacement Words Select and edit the text you wish to modify and then save it by tapping the Save button. Up to four different preset text entries can be added for one text button.
Copy From Existing Select and set up items provided by the system. 3-51

[Page 138] Annotation In the Setup screen, select the Annotation tab in the Annotation category. Select whether or not to discard annotations from the screen when in Scan Mode or when the probe or application is changed. [Figure 3.25 Setup – Annotation – Annotation]
Common „ ‹ Erase When the Image is Unfrozen When executing Unfreeze, the annotation is deleted. „ ‹ Erase When the Probe or Application is Changed Select whether or not to erase annotations when the probe or application is changed. „ ‹ Erase When the Mode is Changed Select whether or not to erase annotations when the Operation mode is changed. „ ‹ Display Annotation on Thumbnail Images Select whether or not to display annotations on thumbnail images. 3-52

[Page 139]
Annotation „ ‹ Font Size Select the font size to use. „ ‹ Text Color Select the font color to use.
Arrow „ ‹ Arrow Size Select the size of the arrow. „ ‹ Arrow Type Select the shape of the arrow. „ ‹ Arrow Angle Select the angle of the arrow. 3-53

[Page 140] BodyMarker In the Setup screen, select the BodyMarker tab. Library In the Setup screen, select the Library tab in the BodyMarker category. You can create, edit, or delete a library in the BodyMarker category. 1. On Touchscreen Page 1 or Touchscreen Page 2, use the trackball to select the location you want; the touch button will be selected. 2. In Copy From Existing, select the BodyMarker you want; the new BodyMarker will be created at the location marked in blue. 3. On Touchscreen Page 1 or Touchscreen Page 2, use the trackball to select a BodyMarker to display it in blue; tap Erase to delete the BodyMarker. [Figure 3.26 Setup – BodyMarker – Library] 3-54

[Page 141]
Library Select an application.
User Defined Library The user can create or delete a Library. „ ‹ Create Create a new Library. „ ‹ Delete Delete a BodyMarker. „ ‹ Reset Defaults Revert to default settings.
Touchscreen Page 1 Specify the items that will be displayed on the first page of the touchscreen.
Touchscreen Page 2 Specify the items that will be displayed on the second page of the touchscreen.
Copy From Existing Select and set up the BodyMarker provided by the system. 3-55

[Page 142] BodyMarker In the Setup screen, select the BodyMarker tab in the BodyMarker category. [Figure 3.27 Setup – BodyMarker – BodyMarker] 3-56

[Page 143]
Common „ ‹ Activate when dual/quad mode on Show or hide BodyMarker when Dual or Quad Mode is active. „ ‹ Erase when the image is unfrozen Choose whether or not pressing the Freeze button on the control panel to switch to Scan Mode automatically deletes the BodyMarker. „ ‹ Erase when the preset is changed Select whether or not to erase the BodyMarker when the Preset is changed. „ ‹ Copy to active area when dual/quad mode on Select whether or not to copy the BodyMarker to the active area when Dual or Quad Mode is activated.
BodyMarker „ ‹ Home Position You can save the position of a BodyMarker. Select a desired position. 3-57

[Page 144] Customize Select the Customize tab on the Setup screen. Alternatively, tap Customize on the touchscreen. General In the Setup screen, select the General tab in the Customize category. You can set the functions of the keys and buttons on the product. [Figure 3.28 Setup – Customize – General] 3-58

[Page 145]
Common „ ‹ Set/Exit Key Select the functions to assign to the buttons on the left and right sides of the trackball on the control panel. X ‹ Set/Set: Both the left and the right buttons are set to the Set function. X ‹ Set/Exit: The left button is set to Set and the right button is set to Exit . X ‹ Exit/Set: The left button is set to Exit and the right button is set to Set . „ ‹ Pointer Select Pointer or Arrow. „ ‹ End Exam X ‹ End Exam + Patient: Switches the screen to the Patient Information screen. X ‹ End Exam Only: Switches the screen to the B Mode Scan screen as soon as an exam ends. X ‹ Reset Preset: Preset is saved to default settings. „ ‹ Foot Switch Assign functions to the Foot Switch’s left, middle, and right pedals. The functions you can assign are as follows: X ‹ Exit, Freeze, U1, U2, U3, U4, U5, U6, Update, Single, and Quad.
Clip Store „ ‹ Clip Store Type X ‹ Retrospective: When saving images, images before pressing the save button are saved. X ‹ Prospective: When saving images, images after pressing the save button are saved. 3-59

[Page 146]
Clip Store Method „ ‹ Clip Length (sec) Specify the length of the image to save. Select a desired Sec value using the button. „ ‹ Number of Heart Cycles Specify the number of Heart Cycles to be included in the image. „ ‹ Time before Heart Cycle (ms) Specify the time to be included before a Heart Cycle begins. „ ‹ Time after Heart Cycle (ms) Specify the time to be included before a Heart Cycle completes. 3-60

[Page 147] Buttons On the Setup screen, select the Buttons tab in the Customize category. Configure User Keys. [Figure 3.29 Setup – Customize – Buttons] Assign functions to the U1 , U2 , U3 , U4 , U5 , and U6 buttons on the control panel. The functions you can assign are as follows: U1, U2, U3, U4, U5, U6 Patient Quad Arrow Exit Biopsy Pointer TGC Simultaneous Probe Change Q scan Caliper TDI Harmonic Calculation TDW Single EFW Measure Store/Send/Print Dual EFW Result Steer Invert Dual Live Auto IMT+ None When you select Store/Send/Print, you can additionally configure the Store (e.g., Single, Clip, 3D Image Save, or Volume Save), Send (e.g., DICOM Storage Service), and Print-related settings. When you select External Storage, you can configure the settings such as the external storage that you use to export images (e.g., USB/Network Drive), directory, file type, image quality, and display of patient information. 3-61

[Page 148] Touch Menu In the Setup screen, select the Touch Menu tab in the Customize category. [Figure 3.30 Setup – Customize – Touch Menu]
Mode Type You can configure the 2D Live, 2D Freeze, C/PD Live, C/PD Freeze, TDI/S-Flow Live, TDI/S-Flow Freeze, PW /TDW Live, PW/TDW Freeze, CW Live, CW Freeze, M Live, M Freeze, ECG Live, ECG Freeze, SEE Stream Live, SEE Stream Freeze, Panoramic Ready, Panoramic Review, ElastoScan Live, ElastoScan Freeze, CEUS+ Live, CEUS+ Freeze, Lithotripsy, Stress Echo, and Stress Echo Review settings. * SEE Stream Live and SEE Stream Freeze are only available in Russia. „ ‹ Touch Panel Specify items to be included on the touchscreen and their positions. „ ‹ Toggle Control Specify the dial-button activated items to be included in the bottom menu on the touchscreen and their positions. „ ‹ Reset Defaults Revert to default settings. 3-62

[Page 149] Peripherals In the Setup screen, select the Peripherals tab. Or tap Peripherals on the touchscreen. You can configure keys, buttons, and the peripheral devices connected to the product. Peripherals In the Setup screen, select the Peripherals tab in the Peripherals category. You can configure peripheral devices connected to the product. [Figure 3.31 Setup – Peripherals – Peripherals] 3-63

[Page 150]
Printer „ ‹ Printer Settings Select the printer to use by using the combo button. To remove a printer that is no longer used, select the printer and press the Remove button. „ ‹ Printing Image Adjustment Choose a printer you wish to use from Printer Settings. You can configure the Gamma, Brightness, and Contrast settings in 2D Mode and 3D Mode separately. Press the Reset button to reset it to the default settings. „ ‹ Print Queue Choose whether or not to cancel a printer job while an image is being printed. Use the combo button to select a printer that is printing an image. Press the Clear Print Queue button to cancel the print job. X ‹ Select All Printer: Select this checkbox to cancel all print jobs for the connected printer. NOTE: A print job can be canceled only if the image data to print has not been completely sent to the printer. „ ‹ Local Printing Area Select the area that will be printed. X ‹ Full Screen: Prints everything shown on the monitor screen. X ‹ Video Out: Prints only a certain area of the screen, including the Image area. X ‹ Image Only: Print out the image area only. „ ‹ Hide Patient Data Select whether or not to display the patient information.
Export Image Compensation When transferring external images, the user can configure the monitor settings according to their environment. You can change the Gamma, Brightness, and Contrast settings, and click the Reset button to restore the default settings. 3-64

[Page 151] Device In the Setup screen, select the Device tab in the Peripherals category. Press the Eject/Remove button to eject or remove the disk from the device. Press the Format Media button to erase the CD/DVD. [Figure 3.32 Setup – Peripherals – Device]
Map Network Drive Connect to a network. 1. Press Map Network Drive button. 2. Select a Drive Name. 3. Enter a Network Folder Path. 4. Enter User ID and password and then press the Connect button. 5. Select a Drive Name and press the Disconnect button to close it. 3-65

[Page 152] Connectivity Tap Connectivity on the touchscreen. You can perform DICOM administration tasks or manage DICOM server settings and network information for your system. DICOM In the Setup screen, select the DICOM tab in the Connectivity category. Configure DICOM (Digital Imaging and Communication in Medicine) operation and DICOM server. NOTE: For more information, please refer to the server’s user manual or the DICOM Conformance Statement. [Figure 3.33 Setup – Connectivity – DICOM] 3-66

[Page 153]
System Configuration Information about the DICOM server used by the system is displayed. You can change the information, or add or delete a server. The server information is used to identify the DICOM for the system within a network. It is also used to transfer data to other DICOM servers. NOTE: For the ‘IP Address’, ‘AE Title’, and ‘Port No’ settings, contact your organization’s network administrator. „ ‹ Station Name Enter the name of the system. Along with AE Title, it is often used to identify the system in the DICOM network. „ ‹ Port No. Enter the port number of the server being used. „ ‹ AE Title Enter the name of the DICOM AE (Application Entity). Used for identifying the equipment that uses DICOM on the network. „ ‹ Use TLS Choose whether or not to use DICOM TLS when receiving data. X ‹ Verify Client Certificate: You can check whether the certificate of the counterpart that tries to send data using the Trusted Authority Certificates saved on the device is valid. 3-67

[Page 154] „ ‹ DICOM TLS Select a certificate required for DICOM communication encryption. For encrypted DICOM communication, the device must have a certificate; if not, you must register a new certificate. X ‹ Import: Register a certificate for the device. Select the certificate and private key file that you have. Fields marked in red are required fields. X ‹ Create: A certificate is self-generated for the device. Fields marked in red are required fields. X ‹ Delete: Delete a certificate from the device. X ‹ Export: Copy a device’s certificate to a USB drive. If you have created a certificate yourself on the device, the other’s server that you will access later may need to verify the certificate for the device. X ‹ Trusted Autority Certificates: When using the DICOM function, register the certificate for the certification authority which will verify the certificate of the counterpart you will access. Press Import under Trusted Authority Certificates and then select a certificate file.
General Configuration „ ‹ SR Format Select a format to be used to save SR among General Report and ViewPoint. „ ‹ Store SR at End of Exam Select whether or not to store the SR at the end of the exam. When you select this checkbox, the SR is automatically stored at the end of the exam. Otherwise, it is not stored. „ ‹ Create New Series by Pressing Continue Exam Even if patients are not examined continuously, the exam results are provided together, and not separated. 3-68

[Page 155]
Adding DICOM Services Click Add on the screen. A screen is displayed where you can enter a DICOM service to add. After adding a service, click Apply to save the information. Tap Cancel to cancel. „ ‹ DICOM Services Select the type of service to use via DICOM. The supported DICOM servers are Storage, SC, Worklist, Print, PPS, STORAGE SR, and QR. „ ‹ Alias Enter the name of the DICOM server. „ ‹ AE Title Enter the AE title of the DICOM server. Consult your network administrator before specifying this option. „ ‹ Host Enter the IP address of the server being used. Consult your network administrator before specifying this option. „ ‹ Port No. Enter the port number of the server being used. Consult your network administrator before specifying this option. „ ‹ Connect Timeout The connection will time out if there is no response from the DICOM server within the configured time period. You can specify this time period in seconds. „ ‹ Read Timeout Specify the Read Timeout time limit for the server you are adding. „ ‹ Retry Interval Specify how many seconds the system will wait before it retries a failed transmission. You can specify this time period in seconds. 3-69

[Page 156] „ ‹ Maximum Retries Specify how many times a failed transmission will be retried. „ ‹ Packet Size Specify the size of the transfer packet. „ ‹ Use TLS Choose whether or not to use DICOM TLS when sending data. X ‹ Verify Server Certificate: You can check whether the certificate of the server that tries to receive data using the Trusted Authority Certificates saved on the device is valid. Storage Server Information Select ‘Storage’ as the DICOM Service Options item. Configure the Image Storage Service using DICOM. [Figure 3.34 DICOM Service Options – Storage] „ ‹ Transfer Mode Select a transfer method: X ‹ Send After Acquisition: Send an image whenever you press the Store button to save it. X ‹ Send on End Exam: Send all saved images when you press the End Exam button. 3-70

[Page 157] „ ‹ Transfer Types X ‹ Include Multi Frame: Select this checkbox to transfer Cine Loops. X ‹ Include 3D Volume: Select whether or not to send 3D volume data together with the 3D images. NOTE: Only select this option if you use a storage service that supports the 3D volume data format used by Samsung Medison. „ ‹ Convert to Grayscale Select the grayscale conversion type for the image you want to apply the DICOM service to. X ‹ No Conversion: Send the original image without converting it. X ‹ All Images: Convert all images to grayscale before sending them. X ‹ B/W Image only: Only the images that do not have color are converted to grayscale before being sent. „ ‹ Support Include Pixel Spacing: In addition to the area information used in ultrasonography, the area information used in CT or radiography is also included. You can take measurements in a PACS system that does not support ultrasound area information. NOTE: However, only 2D and 2D Color Mode images are supported. In Dual and Quad Mode, the depths of the included images must be identical. „ ‹ DICOM Compression Select whether or not to compress the images for the DICOM service. Use the combo button to select the image type and the compression type (Uncompressed or JPEG Baseline). When you select Uncompressed, the images are saved without compression. X ‹ Single Frame: Specify the compression type for still images. X ‹ Multi Frame: Specify the compression type for Cine images. X ‹ For JPEG Baseline type, choose either Lossless, Low, Medium, or High. You can prioritize either the quality or the compression ratio. You can specify the compression type, compression ratio, and frame rate. You can select Full, 10, or 20 as the frame rate for Multi Frame. 3-71

[Page 158] „ ‹ VOI LUT Setup Configure the VOI LUT (Value Of Interest Look Up Table). Adjust the brightness and contrast of a DICOM image when saving it. The saved image can be viewed with any PACS device that has DICOM VOI LUT implemented. X ‹ Window Center: Enter a value for the DICOM Tag (0028, 1050) setting. The setting value indicates the brightness of an image that is displayed by the storage service. The image will get darker if the value is set to 128 or higher. Note that this function can be used only when it is supported by the storage service. X ‹ Window Width: Enter a value for the DICOM Tag (0028, 1051) setting. The setting value indicates the contrast of the image displayed by the storage service. Values set to higher than 256 will result in lower contrast. Note that this function is available only when it is supported by the storage service. SC Server Information Select ‘SC’ (Storage Commitment) as the DICOM Service Options item. Configure the Storage Commitment Service using DICOM. The Storage Commitment Service is used after a diagnosis is finished and all saved images and reports are sent. [Figure 3.35 DICOM Service Options – SC] „ ‹ Associated Storage Server Select an Image Storage server to connect to. 3-72

[Page 159] Worklist Server Information Select ‘Worklist’ as the DICOM Service Options item. Set Modality Worklist service by using DICOM. [Figure 3.36 DICOM Service Options – Worklist] „ ‹ Query Setting Select the type of Modality to retrieve when updating the worklist. X ‹ Modality: Select either ultrasound images (US) or all images (All). After setting up the Worklist service, press the Patient button on the control panel to go to the Worklist page. „ ‹ Update Method Specify the method of updating worklist. X ‹ Only on User Request: Updates the Worklist only upon user request. To update the Worklist, set Search Source to Worklist in the Search tab on the Patient Information screen, and then press Search . X ‹ When Worklist Page Opens: Updates the Worklist every time it is opened. 3-73

[Page 160] X ‹ On Startup and Every: Updates the Worklist when the system starts, and then updates it automatically at specified intervals. „ ‹ Exam Description You can specify which sections of the DICOM file you will import information for the Exam Description from. Print Server Information Select ‘Print’ as the DICOM Service Options item. Configure the Print Service using DICOM. [Figure 3.37 DICOM Service Options – Print] X ‹ You can only configure printers connected to the DICOM network. X ‹ Depending on the printer, some of the following functions may not be available. Before configuring a printer, please refer to the printer’s user manual, or the DICOM Conformance Statement. 3-74

[Page 161] „ ‹ Transfer Mode Select a printing method: X ‹ Print After Acquisition: Print an image whenever you press the Store button to save it. X ‹ Print on End Exam: Print all saved images when you press the End Exam button. „ ‹ Layout Setting Specify the paper layout. For the rows from 1 to 6, the columns from 1 to 4 may be selected. „ ‹ Printer Setup X ‹ Color: Specify whether to use colors. Select Grayscale or RGB. X ‹ Orientation: Specify the paper orientation. Select either Landscape or Portrait. X ‹ Magnification: Specify the interpolation when resizing an image to print. Select from Replicate, Bilinear, Cubic, or None. X ‹ Border Density: Specify the border color of the image to be printed. Select Black or White. X ‹ Priority: Specify a priority for the print command. Select High, Med, or Low. X ‹ Destination: Specify the paper pathway. Select Magazine or Processor. X ‹ Medium Type: Specify the material type for the printout. Select from Paper, Clear Film, Blue Film, Mammo Clear Film, or Mammo Blue Film. X ‹ Copies (1–99): Enter the number of copies to print, using a value from 1 to 99. X ‹ Film Size: Select a paper size from 8×10 inches, 8.5×11 inches, 10×12 inches, 10×14 inches, 11×14 inches, 11×17 inches, 14×14 inches, 14×17 inches, 24×24 cm, 24×30 cm, A4, or A3. X ‹ Smoothing Type: This option is available only when Magnification is set to CUBIC. Enter the value for the printer which is specified in the DICOM Conformance Statement. X ‹ Empty Density: Specify the background color of an image to print. Select Black or White. X ‹ Min Density: Specify the minimum brightness of an image to print. If this option is not specified, the default value is applied. X ‹ Max Density: Specify the maximum brightness of an image to print. If this option is not specified, the default value is applied. X ‹ Configuration Info: Specify the unique value for a printer. Please refer to the DICOM Conformance Statement for the printer. 3-75

[Page 162] PPS Server Information Select DICOM Service Options as the ‘PPS’ (Performed Procedure Step). Configure the Modality Performed Procedure Step Service using DICOM. [Figure 3.38 DICOM Service Options – PPS] „ ‹ Always Complete Exams When you check this checkbox, exams are always reported in their final state. If you press the End Exam button without selecting a checkbox, the cancellation message that was selected after you selected the cancellation message for End Exam will be sent to the RIS server. 3-76

[Page 163] Storage SR Server Information Select ‘Storage SR’ (Storage Structured Report) as the DICOM Service Options item. Configure the Report Storage Service using DICOM. [Figure 3.39 DICOM Service Options – Storage SR] „ ‹ Transfer Mode Select a printing method: X ‹ Send After Acquisition: Whenever you press the Store button, the measurement data in the report is transferred. X ‹ Send on End Exam: Whenever the End Exam button is pressed, the measurement data in the report will be sent. 3-77

[Page 164] QR Server Information Set DICOM Service Options to ‘QR (Query & Retrieve)’. Configure the Query & Retrieve Service settings using DICOM. [Figure 3.40 DICOM Service Options – QR] 3-78

[Page 165]
Modifying DICOM Information Select a service and click Modify on the screen. The information on the selected service will appear. After changing the information, click Apply to save the changes. Tap Cancel to cancel.
Deleting DICOM Services Select a service and click Delete on the screen.
Testing DICOM Servers Select a service and click Verify on the screen. The connection with the selected service is tested and the results are shown under Verify. If the result is Success, the connection is normal. 3-79

[Page 166] HL7 Include the Measurement Data PDF in the HL7 Message and send it to the HL7 Repository server. Select the HL7 tab and click the HL7 Manager button on the screen. [Figure 3.41 DICOM HL7 – HL7 Manager] 3-80

[Page 167] „ ‹ Repository Register, edit, and delete a report repository server to send reports to. X ‹ Add Repository: Add a repository to send an HL7 message. – Alias: Refers to a name of the HL7 repository server to send an HL7 message to. – IP Address: Enter an IP address for the HL7 repository server. – Port No: Enter the port number of the HL7 repository server. (a value from 0 to 65535) – Connect Timeout: Select a time for transfer standby in seconds. (a value from 120 to 300) – Read Timeout: Set the standby time for transmission in seconds. (a value from 120 to 300) [Figure 3.42 DICOM HL7 – HL7 Manager] X ‹ Edit Repository: Edit the repository server information. X ‹ Delete Repository: Delete the repository server information. X ‹ Active/Inactive Repository: Select whether or not to use the repository server by selecting the Active checkbox for the registered repository. 3-81

[Page 168] „ ‹ Show Job Status Shows the information regarding the transfer of the HL7 report into an HL7 message. X ‹ Columns: The user can select columns to check. X ‹ Retry: The user can select and retry the failed jobs. X ‹ Delete: The user can delete a job, whether the status is ‘SUCCESS’ or ‘FAIL’. X ‹ Show All: Shows all jobs. X ‹ Delete Archived Job Status after (days): Delete archived jobs for the selected dates. [Figure 3.43 DICOM HL7 – HL7 Manager] 3-82

[Page 169] „ ‹ HL7 Export If there is an Active repository server registered to the HL7 Manager, the user can export the report by selecting the HL7 button after taking at least one measurement on the Report screen. (However, patient information must exist and a warning message asking for a valid patient ID will appear if the information has not been entered.) [Figure 3.44 Report – HL7 Export] 3-83

[Page 170] Network In the Setup screen, select the Network tab in the Connectivity category. Or tap Connectivity on the touchscreen. You can manage the network information for the current equipment. [Figure 3.45 Setup – Connectivity – Network]
Network Configuration Set up the network information for the current equipment. „ ‹ Automatic Configuration (DHCP) If the checkbox is selected, the IP information will be configured automatically. „ ‹ Static Configuration If the checkbox is empty (Automatic Configuration), you can enter a static IP address. Specify the IP Address, Subnet Mask, Gateway, and DNS information. „ ‹ Revert Clear the currently entered information and revert to the default settings. „ ‹ Apply Use the information entered currently to set up the IP. 3-84

[Page 171]
Wireless „ ‹ Wireless LAN Use a USB adapter to connect the system to a wireless network. NOTE: The Wireless Network Settings window is enabled only when the system is connected to a wireless USB adapter. X ‹ SSID: Displays the name of the connected wireless network. SSID stands for Service Set IDentifier. X ‹ Authentication: Displays the authentication method for the wireless network. X ‹ Encryption: Displays the data encryption method for communicating with the wireless network. X ‹ Password: Enter the password for the network. Connecting to a Wireless Network 1. Use the trackball and the Set button to press the Scan button. 2. Select an available wireless network and then press the Select button. 3. Press the Connect button to connect the system to the wireless network. 4. Press the Disconnect button to disconnect the system from the wireless network. 5. Press the Close button to finish the setup. 3-85

[Page 172] Profile Manager This function allows the user to backup and restore the Connectivity Setup data. [Figure 3.46 Setup – Connectivity – Profile Manager] „ ‹ Add Save the current DICOM Service list, HL7 Repository list, and Local Network Setting information. „ ‹ Modify Edit the Institute and Department information of the saved Profile (other information cannot be edited). „ ‹ Refresh Update the saved Profile List and display it on the screen. „ ‹ Import Import Profile settings from an external storage device (USB drive). (You can only execute one import at a time; the target profile names are displayed in the Import UI.) 3-86

[Page 173] „ ‹ Export Export the Profile settings to an external storage device (USB drive). „ ‹ Delete/Delete All Delete the selected Profile or all Profiles. „ ‹ Apply Restore the Profile settings to the selected values and then shut down the system. X ‹ A maximum of 30 Profiles can be registered. X ‹ When adding a Profile, you can enter up to 30 alphabetical characters into the Profile Name, Institute, and Department fields (Profile Name is a mandatory field; Institution and Department are optional fields). X ‹ If there is no User Data setting for the DICOM Service and HL7 Repository, the checkbox will be disabled. X ‹ If there is no additional User Data setting in the Local Network Setting, the Profile List will be disabled. X ‹ Other settings for DICOM and HL7 (e.g., System and General Configuration) are excluded from the Import, Export, and Apply actions. 3-87

[Page 174] Service X ‹ Users should not attempt to perform anything on their own. They must contact the customer service department of Samsung Medison who can perform this service for them. X ‹ Enable or disable optional software or hardware. – Option: Show the types of optional software that can be installed on the product. – Status: Show the current status of optional software. Registered means that the software can be used until the date specified by the Expiration Date is reached. Unregistered means that the software cannot be used now. X ‹ Displays the software version of the product. Help Press the Help button on the keyboard. The electronic manual will appear on the monitor’s screen. Press the button one more time or Exit to close it. 3-88

[Page 175] ECG (Option) If an ECG is installed, the ECG tab will be displayed on the touchscreen. In a Multi Image Mode such as Dual or Quad, ECG Cine can be used for each image. NOTE: You can set each Preset to show or hide the ECG on the screen by going to Setup > Application/Preset > Preset Setting.
Starting and Terminating an ECG Tap the ECG button on the touchscreen menu to turn the function on or off.
ECG Setup „ ‹ Sweep Speed Tap the Sweep Speed button in the touchscreen menu to select the ECG display speed. You can select 15mm/s, 29mm/s, 44mm/s,59mm/s, 88mm/s, or 117mm/s. „ ‹ Invert Tap the Invert button on the touchscreen menu to turn ECG Invert on or off. „ ‹ Gain Adjust the amplitude of the ECG. Rotate the Soft Menu dial-button 1 to adjust the gain from 0 to 100. „ ‹ Position Rotating the Soft Menu dial-button 2 changes the display position of the ECG signal. You may select a position from 0 to 10; selecting a higher value will position the ECG higher on the screen. „ ‹ Clip Rotate the Soft Menu dial-button 3 to select the interval for saving the clip. You can select either Time or Beat. 3-89

[Page 176] „ ‹ Trigger Tap the Trigger button on the touchscreen menu to set up Trigger. You can rotate the Soft Menu dial-button 4 to select a number of ECG Triggers from 1 to 7. „ ‹ Trigger Delay Select the time delay between the R-wave and the frame containing the trigger, which will be applied to the Trigger function. Rotate the dial-button 4 to select a value from 0 to 3,000msec. „ ‹ Dual Trigger Tap the Dual Trigger button on the touchscreen menu to turn Dual Trigger on or off. „ ‹ Dual Trigger Delay Select the time delay between the frame containing the first trigger and the frame containing the second trigger, which will be applied to the Dual Trigger function. Rotate the dial-button 4 to select a value from 6 to 3,000 msec. X ‹ If the ECG is less than 30 Hz, the Heart Rate (HR) might not be displayed. X ‹ In CW Mode, when the ECG is active, the error ratio of the Heart Rate (HR) should be within 2%. 3-90

[Page 177] EzCompare (Option) EzCompare is a function that automatically sets and displays the exam list of a previously saved patient and the current scanning images in the same setting values on the screen to help diagnosis. However, Live scan is available only when the same probe preset is selected as that of the saved image or scan. X ‹ Tap the Patient button on the touchscreen. Select an exam list to analyze using the trackball and the Set button. (Multiple selection of lists allowed.) X ‹ Tap the EzCompare button. X ‹ The saved screen is provided in the Thumbnail field and Date tab appears. X ‹ Double click an image of desirable screen to show the selected exam image in the right or left-hand of the screen and the live scan is shown in the opposite side with the same setting values as that of the exam image. X ‹ When saved in the EzCompare screen, it is saved in the Current Exam tab under the thumbnail field. NOTE: Go to Setup > Imaging > Display Settings and specify the position of live images to the left or right. 3-91

[Page 178] Stress Echo (Option) Stress Echo is a function that is used to observe changes in the heart and make a diagnosis after placing an added burden on the heart through exercise or drugs. X ‹ Stress Echo is an optional feature of this product. X ‹ It is not supported for XH50/XH60. X ‹ You can use it only when the application is cardiac. The procedure for using Stress Echo is as follows: X ‹ When setting up and using a new protocol: Register a patient ID → Set up a protocol → Select a protocol and start → Acquire and specify images → Review the images and make a diagnosis → Create a Stress Echo report. X ‹ When selecting and using an existing protocol: Register a patient ID → Select a protocol and start → Acquire and specify images → Review the images and make a diagnosis → Create a Stress Echo report. This manual provides instructions for using Stress Echo by setting up a new protocol. For instructions on registering patient IDs, please refer to ‘Chapter 6. Starting Modes of Operation.’ For information on Stress Echo reports, please refer to ‘Chapter 8. Measurements.’ Setting up a Protocol After registering a patient ID, press the Stress Echo button on the touchscreen followed by the Template Editor button. The Protocol Template Editor screen will be displayed. You may edit an existing protocol or set up a new protocol. „ ‹ Creating a New Protocol Template Press the New button. „ ‹ Editing an Existing Protocol Template Press the combo button in the upper left corner of the screen, and select a protocol to use from the protocol list. 3-92

[Page 179]
The Protocol Template Editor Screen The Protocol Template Editor screen consists of the following items. Use these items to set a protocol. [Figure 3.47 Protocol Template Editor] „ ‹ Protocol When you press the combo button, a list of the default protocols and other existing protocols appears. 3-93

[Page 180] Default Protocols This product offers the following five protocols by default: The default protocols cannot be deleted or transferred to external storage media. In addition, once the default protocol is revised, it cannot be save with the same name. Protocol View Stage Two Stage PLAX, PSAX, A4C, A2C Rest, Peak Exercise Stress Three Stage PLAX, PSAX, A4C, A2C Rest, Peak, Post Bicycle Stress Four Stage Pharmacological PLAX, PSAX, A4C, A2C Stage 1–4 Stress (TBD) MV-PW, TDI, LVOT-PW, TR, Baseline, Legs UP, 25W, 50W, Diastolic Stress PSAX-BASE, PSAX-Mid, PSAX- 75W, 100W, 125W, REC2, REC5, APEX, 4CH, 2CH, MR REC10 PLAX, PSAX, 4CH, APLAX, 2CH, Baseline, 5, 10, 20, 30, 40, Dobutamin Stress MV-PW, TDI, LVOT-PW, TR-CW atropine, recovery „ ‹ Stage Set the stage. Use this button to add or delete a stage. To select one of the default Stages, use the Combo button. To enter it manually, use the keyboard. NOTE: You must create at least two stages, and you can add up to 10 stages. „ ‹ View Set the view. Use this button to add or delete a view. To select one of the default Views, use the Combo button. To enter it manually, use the keyboard. NOTE: You must create at least two views, and you can add up to 10 views. 3-94

[Page 181] „ ‹ Capture Unit Select a method for image acquisition by pressing the Save button on the control panel. X ‹ Beats: Acquires images by the number of heartbeats. X ‹ Time: Acquires images by the unit of seconds. „ ‹ Cycle/Time Select the image acquisition interval by pressing the Save button on the control panel. For the Capture Unit, you can select a Beats value from 1 to 4 or a Time value from 2 to 4. „ ‹ Auto Assign Once images are acquired, they are automatically assigned to each stage and view. „ ‹ Show Reference Displays the reference image in Dual Mode when a stage image is acquired. This can only be used if the ‘Auto Assign’ checkbox is ticked. When this is enabled, the previous stage automatically becomes the reference image. Tick each stage’s checkbox to acquire images for each stage using the same settings as the reference image. „ ‹ Auto Next Stage When an image is assigned to the last view of the current stage, the system automatically proceeds to the next stage. „ ‹ Capture Method Select the video acquisition range for images by pressing the Save button on the control panel. X ‹ Prospective: Saves images acquired after the button is pressed. X ‹ Retrospective: Saves images acquired before the button is pressed. 3-95

[Page 182] „ ‹ Timer Set the onscreen timer display settings. X ‹ Show Protocol Timer (T1): Displays the protocol’s recorded time (T1) on the screen. X ‹ Show Stage Timer (T2): Displays the current stage’s time record (T2) on the screen. „ ‹ New Template Press the New Template button on the touchscreen to create a new protocol. „ ‹ Save Press the Save button on the touchscreen to save the newly created protocol. This cannot be used when a default protocol has been changed. „ ‹ Save As Press the Save As button on the touchscreen to save a set protocol under a different name. „ ‹ Delete Template Press the Delete Template button on the touchscreen to delete the currently selected protocol and open a new protocol template. This cannot be used when a default protocol is selected. „ ‹ Apply & Exit Press the Apply & Exit button on the touchscreen to apply any changes made in the Protocol Template Editor and exit the screen. „ ‹ Exit Press the Exit button on the touchscreen to exit the Protocol Template Editor screen. 3-96

[Page 183] Starting a Protocol and Acquiring Images After registering a patient ID, press the Stress Echo button on the touchscreen. The Protocol Screen will appear. Select a protocol to start an examination, and review the acquired Stress Echo images. „ ‹ Selecting a Protocol Press the combo button at the top of the screen, and select the protocol to use from the protocol list. „ ‹ Starting a Protocol Press Begin/Continue . The screen will switch to Modes of Operation. „ ‹ Capturing Stress Echo Images Press the Save button on the control panel to acquire images for each view and stage. A matrix that indicates a Stress Echo image acquisition is displayed on the left-hand side of the screen. [Figure 3.48 Matrix] X ‹ To return to the Protocol Screen while acquiring an image, press the Stress Echo button on the touchscreen. X ‹ To change a stage and acquire images, use one of the following methods: 1. Press the Pointer button on the control panel. Use the pointer to select the next stage. 2. While using Stress Echo , press Next Stage . 3-97

[Page 184] Auto Assign and Auto Next Stage If either Auto Assign or Auto Next Stage is enabled, images will be automatically assigned when you acquire Stress Echo images. The matrix will be displayed as shown below: [Figure 3.49 Matrix – Auto Assign, Auto Next Stage] Show Reference If you have selected Show Reference from the Protocol Template Editor screen, images will be scanned by comparing them against the reference image on the Protocol Screen . Show Reference is a feature that sets the first stage as the reference image and compares subsequent scans under identical conditions. This feature can only be used if the Auto Assign checkbox has been selected. Enabling this feature activates Dual mode. The reference image is shown on the left. The current image is shown on the right-hand side of the screen and can be acquired under the same conditions as the reference image. Applied reference image conditions are as follows: X ‹ Image Depth X ‹ Width X ‹ Dynamic Range X ‹ 2D Mode (Harmonic, etc.), Color Mode X ‹ ClearVision Index X ‹ Post-Processing (Gray map) X ‹ Gain (2D, C) X ‹ Read Zoom 3-98

[Page 185]
Protocol Screen The Protocol Screen consists of the following items: 1 Protocol: Press the combo button to display the protocol list. Select the protocol that you want to use. NOTE: Once a protocol has started, you cannot change it. 2 Stage: Press the combo button to display the stage list. Select the stage to use. The thumbnail list shows the images saved for the selected stage. Tips! The area of the stage that is currently acquiring images is highlighted. 3 Stress Echo Image Area: Displays Stress Echo images by aligning them with View on the horizontal axis and Stage on the vertical axis. The currently selected Stress Echo image is highlighted with a blue border. 4 Thumbnail List: Displays the acquired Stress Echo images by stage. Images that have already been assigned to the Stress Echo image area are not displayed in the thumbnail list. 5 Stress Echo Information Area: Displays the Stress Echo settings. „ ‹ Pause Protocol Pauses a protocol. The Pause Protocol button disappears, and the Begin/Continue Protocol button appears. „ ‹ Begin/Continue Starts a protocol. Closes the Protocol Screen. „ ‹ Review Switches the screen to the Stress Echo Review screen. 3-99

[Page 186] „ ‹ Assign The stage selected in Stage is highlighted with a blue border. The Stress Echo images in the thumbnail list are assigned as appropriate to each view and stage. This cannot be used after the protocol has ended. „ ‹ Change View If Auto Assign has been enabled, this changes the Acquisition Focus View. When you move the Change View knob on the Protocol window, the blue border also moves to the left or right in the direction of View. This will not be displayed if Auto Assign or Auto Next Stage has not been enabled. „ ‹ Next Stage The stage will change to the next one. The stage that is currently being acquired is displayed with a green outline in the Stage area on the left-hand side of the screen. „ ‹ Thumb Scroll This will only be displayed if there are four or more acquired images. It changes the page of the thumbnail list. 3-100

[Page 187] Reviewing an Image Select a Stress Echo image on the Protocol Screen and press Review . The Stress Echo Review screen appears. Here you can review the selected image and perform measurements and other tasks.
Stress Echo Review Screen 1 Stress Echo Image Area: The Stress Echo images selected on the Protocol Screen are displayed. You can review up to four Stress Echo images on one screen. At the top of each image, the stage and view names, as well as the Protocol Timer (T1) and Stage Timer (T2), are displayed. You can review up to four Stress Echo images on one screen. 2 Image Information Area: The probe type, application, frame rate, depth, frequency, TI, image saving time, matrix, etc. are displayed. 3 WMS Diagram Area: Four of the seven WMS diagrams are displayed. WMS stands for Wall Motion Scoring. At the top of each diagram, there is a combo button that can be used to select a stage. At the bottom of each diagram, the WMSI value and the current value selected from the score menu are displayed. NOTE: You can perform measurements using the Caliper and Calculator buttons. Pressing the Calculator button displays the heart measurement menu, and the current stage is displayed in the menu subject line. 3-101

[Page 188]
WMS Four of the seven WMS diagrams are displayed. Enter WMS information after selecting a stage. 1. PLAX: Parasternal Long Axis 2. PSAX-Mid 3. A4C: Apical Four Chamber 4. A2C: Apical Two Chamber 5. APLAX 6. PASX-Base 7. PASX-Apex [Figure 3.50 WMS Diagram] 3-102

[Page 189] Left Ventricular Segment Area Number Basal Anterior Septum 1 Basal Anterior 2 Basal Lateral 3 Basal Posterior 4 Basal Inferior 5 Basal Septum 6 Mid Anterior Septum 7 Mid Anterior 8 Mid Lateral 9 Mid Posterior 10 Mid Inferior 11 Mid Septum 12 Apical Septum 13 Apical Anterior 14 Apical Lateral 15 Apical Inferior 16 [Table 3.1 Segments and Area Numbers] „ ‹ Entering WMS 1. Select a segment that you want to enter a WMS into by using the trackball and the Set button. The Score menu will appear. 2. Select a value from the menu. It will be displayed in the segment’s number and color. 3. Select a desired value on the Score menu at the bottom of the screen. 4. Place the pointer in the segment that you want to enter a value into, and press the Set button. The segment color will change and the WMS will be displayed. When a WMS is entered into a segment, the same score is applied to all segments that have the same area number. 3-103

[Page 190] „ ‹ Deleting a WMS To delete an entered value, select the applicable segment and then ‘N-Not Scored’. The color of the selected segment will be reset. Tips! Press Delete WMS to delete all WMS data entered for the current stage. „ ‹ Delete WMS Deletes all WMS data entered for the current stage. „ ‹ Cine Play You can play or stop playing all Cine images shown in the Stress Echo Image Area simultaneously. „ ‹ Strain+ You can use the Strain+ Image function. This is displayed only if the conditions for using the Strain+ Image function are met. „ ‹ Change Sync Select Normal, Short, Long, or End to End as the synchronization method for Cine images. X ‹ Normal: Indicates the general Cine image play status. X ‹ Short: Plays the shortest of the four Cine images. X ‹ Long: Plays the longest of the four Cine images. X ‹ End to End: Synchronizes the beginning and the end of the four Cine images and plays them. 3-104

[Page 191] „ ‹ Protocol Screen After closing the Stress Echo Review screen, it switches to the Protocol Screen . NOTE: For information on Stress Echo reports, please refer to ‘Chapter 8. Measurements.’ Pressing the Report button after finishing the WMSI drawing on the Stress Echo Review screen will open the Stress Echo Report. X ‹ The Stress Echo Report cannot be edited. 3-105

[Page 192] Strain+ Image (Option) Strain+ Image provides a feature that supports cardiovascular system applications. It uses a motion vector to see the heart movement. NOTE: Strain+ is an option of this product. NOTE: The Strain+ Image function can only be used when the following conditions are met: X ‹ Application: Cardiac X ‹ Operation mode: 2D (Freeze state) X ‹ ECG: On; two or more ECG trigger points; ECG HR: 30–240 Range „ ‹ Quantification You may select Strain+, Auto EF, and TMAD. NOTE: When the image selection is not appropriate, it does not go to Quantification screen. 3-106

[Page 193] Strain+ Tap Strain+ button on the touchscreen. It goes to Strain+ screen. Strain+ is executed in the following order: Select an image → Set up the contour line → Calculate Strain data → Analyze the result
Select an Image Select the image and chamber information. The Strain+ screen is composed as follows: 1 Thumbnail List: Saved images will be displayed as thumbnails. 2 Image Area: The images selected from the Thumbnail list are displayed. 3 Operation Guide: Displays the methods of selecting an image and retrieving it from the thumbnail list. 3-107

[Page 194] „ ‹ Select Images Select from one to three desired images from the thumbnail list. Use the trackball and the Set button on the control panel to select an image. The following two options are available: 1 When you double-click a desired image, the image will be displayed in the image area. 2 When you select a desired image and click the pointer in the image area, the image will appear. X ‹ If the conditions for using the Strain+ Image function (i.e., Cardiac, 2D Mode, ECG On (HR: 30-240 Range)) are not met, the relevant items will be displayed in red in the upper left corner of the image. X ‹ Each image cannot be used repeatedly. „ ‹ Selecting Cine Position Set up the Cine for each image displayed in the image area. Select an image by referring to the following: X ‹ Select an image that shows the entire wall of the heart. X ‹ There should be an R-Peak before/after the selected image, and there should be more than 70 Cine frames between the previous R-Peak and the last image. „ ‹ Selecting Chamber Information Select Apical View or Short Axis View using the radio button on the left or the View button on the touchscreen. NOTE: If the previously saved Strain+ data differs from the current Chamber information, a warning window will appear. 3-108

[Page 195]
Contour Line Setup and Calculations Tap the Next button on the Strain+ screen. The screen will switch to the Contour Setup screen. In the Contour Setup screen, a contour line will be drawn on the image and the calculations based on it will be carried out. The Next button is enabled only when the three displayed images are different from one another. [Figure 3.51 Strain+ Screen] „ ‹ Step 1: Setting an Image View Method Set an image view method, and select three images. X ‹ Apical View: Displays each view in order of LAX, A2C, and A4C. X ‹ Short Axis View: Displays views in order of Basal, Mid, and Apical. 3-109

[Page 196] „ ‹ Steps 2, 3 and 4: Drawing and Generating an Endocardial Contour Line Provides the same endocardial contour line for each view selected in Step 1. 1. Use the trackball and the Set button on the control panel to specify three points. Select three points that match the guide. While specifying three points, if you wish to edit any of the selected points, press the Undo button. Select Calculate when completed. X ‹ Clear: Resets all images that have been set. X ‹ Frame: You can explore the Cine Frame. X ‹ Thickness: Once a contour is drawn automatically based on the three points, the thickness between the Epicardial Line and Contour Line is adjusted. 3-110

[Page 197] 2. When you bring the cursor near the point you want to correct, the point will be marked by yellow borders. Press the Set button on the control panel and then use the trackball to reposition the point. Press the Set button again to update the contour line according to the changed point. 3. A checkbox is provided on the left of the values displayed for each segment. Inaccurate segment results can be disabled by unticking the relevant checkboxes, and the AVO and AVC values can be adjusted using the provided buttons. 4. To repeat, select the Reset or Edit button; when completed, select Calculate . X ‹ Direction: Subcategories are determined by View. 5. In Apical View, EF values are provided for A4C and A2C, but not for LAX. The Short Axis method does not provide EF values. Please review the result. 3-111

[Page 198] „ ‹ Step 5: Calculating Strain+ Data The final results for the three images are provided based on the image view method. 6. Step 5 begins. 7. You can check the Bull’s Eye and comprehensive results. X ‹ Frame , Cine Play , Cine Speed : Enabled when Display is set to Bull’s Eye + Images. X ‹ Display: Subcategories include Bull’s Eye (Default), Bull’s Eye + Images, and Bull’s Eye + Graph. X ‹ Save as AVI: When selected, images are saved as .AVI files. To use the Screen Capture function, press the Save button on the control panel. 3-112

[Page 199]
Strain+ Result The Strain+ result screen is composed as follows: [Figure 3.52 Strain+ Touch Panel] X ‹ Direction: For Apical View, the direction setting can be changed to Longitudinal or Radial, while for Short Axis View, it can be changed to Circumferential or Radial. X ‹ Segment: The default value is set to 18 Segment, and it can be changed to 17 Segment. X ‹ Save Strain Data: Saves strain data. If you are retrieving a saved image, the used exam will be automatically loaded, and Step 5 will begin. X ‹ Assign to Report: Saves the Strain+ analysis result to the report. X ‹ Export to Excel: Saves the results and the representative image in an Excel file. This is available only if a USB flash memory drive is connected. X ‹ Export to AVI: Saves the result in an .AVI file. This is available only if a USB flash memory drive is connected. X ‹ Strain: Displays the Strain value and relevant Parametric image on the screen. X ‹ Strain Rate: Displays the Strain Rate value and relevant Parametric image on the screen. X ‹ Time to Peak Strain: Displays the Strain’s Time to Peak value and relevant Parametric image on the screen in Step 5 only. After finishing reporting in the Strain+ Analysis screen, pressing the Report button on the control panel opens the Strain Report. X ‹ The Strain report cannot be edited. 3-113

[Page 200] Auto EF Press the Auto EF button on the touchscreen. X ‹ The Auto EF function can only be used when the following conditions are met. – Operation mode: 2D (Freeze state) – Screen Mode: Single Mode X ‹ The Auto EF function is not an auto-finishing option and the user needs to set the points to draw a contour line. [Figure 3.53 Auto EF Screen] 3-114

[Page 201]
Select Images Select a View. A4C is selected by default. „ ‹ Automatically Calculate X ‹ When enabled: After selecting three points, the user is moved to the Result screen. X ‹ When disabled: Modifications can be made after selecting three points. When the user selects the Calculate button manually, they are moved to the Result screen. „ ‹ Calculate Go to the Result screen. This is enabled after 3 points are selected. „ ‹ Clear You can reset and start over. 3-115

[Page 202]
Contour Line Setup and Calculations „ ‹ Drawing Contour Lines Use the trackball and the Set button on the control panel to specify three points. Select three points that match the guide. While specifying three points, if you wish to edit any of the selected points, press the Undo button. Select the Calculate button when completed. 3-116

[Page 203] „ ‹ Calculating Auto EF Data Press Calculate . The screen will switch to the Result screen. Pressing the Reset button will reset the data and switch to the screen where a three-point contour line can be drawn. 3-117

[Page 204]
Auto EF Result The Auto EF Result screen consists of the following items: 1 End Diastolic: Displays the related information in yellow. 2 End Systolic: Displays the related information in orange. 3 Calculation Results: Displays the Stroke Volume (SV) and Ejection Fraction (EF) values. If the position of the Cine frame is changed, the calculation results will be changed accordingly. To reposition the frame, use Diastolic or Systolic . To reset the frame’s changed position, use Reset Systolic or Reset Diastolic on the touchscreen. [Figure 3.54 Auto EF Touch Panel] 3-118

[Page 205] „ ‹ Display Subcategories include Dual View + Graph and Quad View Layout. X ‹ Frame , Cine Play , Cine Speed : Enabled when Display is set to Quad View. „ ‹ Assign to Report Relevant information will be saved in the report. „ ‹ Frame Move the current Frame. „ ‹ Cine Speed Select the playback speed for Cine images. „ ‹ Cine Play Stop or resume the playback of the image. 3-119

[Page 206] X ‹ Based on the Endocardial contour set by the user, it traces the endocardium in other images within the set Beat and finds its border. X ‹ Using the endocardial border calculated from all images of cardiac cycle and Simpson’s Rule, it measures the volume. X ‹ Among all volumes of the heart intervals, use the smallest value (ES: End Systolic) and the biggest value (ED: End Diastolic) to calculate the Stroke Volume (SV) and the Ejection Fraction (EF). X ‹ The user checks ED and ES. Simpson’s Rule Find the position of the Apex, followed by the length component of the longest axis. Based on this information, measure the volume assuming that there are multiple disks. Stroke Volume SV = EDV – ESV EF (Ejection Fraction) EF(%) = SV / EDV * 100 (Terminology) EDV: End-Diastolic Volume ESV: End-Systolic Volume 3-120

[Page 207] TMAD In the Cardiac Preset, execute Freeze and then press the TMAD button. TMAD stands for Tissue Motion Annulus Displacement, which studies the function of the heart by analyzing the displacement of the motion of the annulus. NOTE: TMAD function can only be used when the following conditions are met: X ‹ Application: Cardiac X ‹ Operation mode: 2D (Freeze state) X ‹ Screen Mode: Single Mode X ‹ ECG: On [Figure 3.55 TMAD Screen]
Select Images Select a View. A4C is selected by default. „ ‹ Automatically Calculate X ‹ When enabled: After selecting three points, the user is moved to the Result screen. X ‹ When disabled: Modifications can be made after selecting three points. When the user selects the Calculate button manually, they are moved to the Result screen. 3-121

[Page 208] „ ‹ Calculate Go to the Result screen. This is enabled after 3 points are selected. „ ‹ Clear You can reset and start over.
Contour Line Setup and Calculations „ ‹ Drawing Contour Lines 1. A4C is selected as the default screen. Use the trackball and the Set button on the control panel to specify three points. First, select a point in the direction of Septal, then a point in the Lateral, and finally one in the Apex. After specifying the points, a line connecting each point will be displayed. 2. Press Calculate . The screen will switch to the Result screen. Pressing the Reset button will reset the data and switch to the screen where a three-point contour line can be drawn. 3-122

[Page 209]
TMAD Result TMAD result screen is configured as below: 1. Measurement result and menu: The result of the measurement as well as the menu for adjusting or saving the Cine are displayed. 2. Image area: The image with the specified points is displayed. 3. Graph: The ECG and the graph of displacement by time are displayed. [Figure 3.56 TMAD Touch Panel] 3-123

[Page 210] „ ‹ Measurement Result The displacement and gradient of TMAD points and median are displayed. The color used for displaying the measurement result corresponds to the color of each point in the image. „ ‹ Position X ‹ Mid Point: Adjust the location of Apex point. X ‹ TMAD Point: Adjust the location of two Annuli. „ ‹ Export to Excel Save the result and the representative image as an Excel file. This is only available if a USB flash memory drive is connected. „ ‹ Export to AVI Save the result as an AVI file. This is only available if a USB flash memory drive is connected. „ ‹ Displacement Line Display the displacement line on the image. „ ‹ Displacement Graph Display the displacement by time. The graph line to be studied can be selected from the check box on the right-hand side. The color used for the graph line corresponds to the color of each point in the image. The vertical dotted line indicates the current position. „ ‹ Frame Move the current Frame. „ ‹ Cine Speed Select the playback speed for Cine images. „ ‹ Cine Play Stop or resume the playback of the image. 3-124

[Page 211] Chapter 4 Maintenance ‹ ‹ Operational Environment 4-3 ‹ ‹ Product Maintenance 4-4 Cleaning and Disinfection 4-4 Electrical Safety Check 4-9 Accuracy Check 4-9 ‹ ‹ Battery Pack Management 4-10 Replacing the Battery Pack 4-10 Recharging the Battery Pack 4-11 Disposing of the Battery Pack 4-11 ‹ ‹ Information Maintenance 4-12 User Setting Backup 4-12 Patient Information Backup 4-12 Software 4-12 Cybersecurity 4-13

[Page 212]

[Page 213] Operational Environment When installing the product, please pay attention to the following: CAUTION: Placing the system near generators, X-ray machines or broadcast cables may result in screen noise and abnormal visual images. Sharing the power source with other electrical devices may also induce noise. X ‹ For the system to function correctly, the temperature should be maintained from 10 to 35℃ and humidity from 30 to 75%. X ‹ Avoid excess humidity. X ‹ Avoid direct sunlight. X ‹ Avoid excessive fluctuations in temperature. X ‹ Avoid installing the product near a heating appliance. X ‹ Avoid dusty and/or poorly ventilated locations. X ‹ Avoid locations that are subject to vibration. X ‹ Avoid locations where chemical substances or harmful gases are present. X ‹ Avoid using this product close to or on top of another device as it may cause malfunctions. X ‹ Do not block the vents on the system, peripheral devices, and accessories. 4-3

[Page 214] Product Maintenance Cleaning and Disinfection Using an inappropriate cleaner or disinfectant may damage the product. Please read the following carefully. Clean and disinfect the product every day or after each test. X ‹ Turn off the system and disconnect the power cord from the wall outlet before cleaning and disinfecting, Otherwise, there is a risk of electric shock or fire. X ‹ Do not clean the electrical contacts or connectors. X ‹ Always wear a protective face mask and gloves when cleaning and disinfecting the product.
Cleaning X ‹ When you use a detergent, comply with the recommendations of the detergent manufacturer. X ‹ Do not spray detergent directly onto the product’s exterior. Doing so may discolor or crack the surface. X ‹ When using a spray-on product, do not spray it directly onto the product to prevent liquid from entering the product. X ‹ Do not use chemicals such as wax, benzene, alcohol, paint thinner, insecticide, air freshener, or lubricant. X ‹ Do not use liquid products (including cosmetics) containing glycol components such as Propylene glycol, Butylene glycol, Polyethylene glycol, etc. on the surface of the product. Doing so may discolor or crack the instruments on the exterior of the product. NOTE: For information on cleaning and disinfecting probes, please refer to ‘Chapter 5. Probes’ in this User Manual. 4-4

[Page 215] „ ‹ Console Use a soft cloth lightly dampened with a neutral soap solution or clean water to clean the exterior surface of the product. NOTE: Neutral soap solution: Since it does not contain strong chemical ingredients, it will not irritate the skin. The solution must not contain any fragrances, oil, or alcohol. „ ‹ Cleaning the Monitor Wipe the LCD surface carefully with a soft dry cloth. NOTE: Do not use glass cleaners or products containing bleach. „ ‹ Touchscreen Wipe the LCD surface carefully with a soft dry cloth. X ‹ Make sure that the touchscreen is not contaminated by an electrically conductive substance. X ‹ Contamination of the LCD screen by ultrasound gel or other substances may degrade the sensitivity of the touchscreen and cause malfunctions. This phenomenon is caused by the contact between the capacitive touchscreen and the conductive substance. If you find foreign substances on the screen, clean it with a dry cloth, and then restart the system. X ‹ Do not use glass cleaners or products containing bleach. 4-5

[Page 216] „ ‹ Trackball CAUTION: Make sure that liquids or other objects do not enter the product while cleaning the trackball. 1. Turn the trackball rim counterclockwise to remove it from the control panel. 2. Wipe the trackball with a soft cloth and reassemble in reverse order of disassembly. Rim [Figure 4.1 Removing the Trackball] X ‹ For information on cleaning and disinfecting probes, please refer to ‘Chapter 5. Probes’ in this User Manual. X ‹ This image may differ from the actual system. 4-6

[Page 217] „ ‹ Air Filter The air filter minimizes the amount of dust that ends up inside the product. When the air filter is clogged with dust, it may cause the product to overheat and generate noise. It may also reduce the reliability and the system performance. Clean the filter once a month to maintain the system in optimal condition. CAUTION: Be sure to lock the brakes on the front wheels before removing or installing the air filter. Otherwise, unexpected movement of the product may result in injury. [Figure 4.2 Removing the Air Filter] 1. Pull out the filter under the front part of the console to remove it from the product. 2. Remove dust using a brush or a vacuum cleaner. 3. Slide the filter back into the product and finish installation. NOTE: If you install the filter while it is wet, it may cause the system to malfunction. Allow the wet filter to dry thoroughly before installation. „ ‹ Peripheral Devices (Printer, etc.) Clean peripheral devices according to the manufacturer’s instructions. 4-7

[Page 218]
Disinfection In general, an ultrasound system has an irregular surface and disinfection of the entire surface of the product is not recommended. Therefore, the user should determine the areas to be disinfected and the disinfection cycle by taking into account different environments in which the ultrasound system and its accessories are used. X ‹ When using a disinfectant, comply with the recommendations of the disinfectant manufacturer. X ‹ When disinfecting the surface, be sure to use the disinfectants recommended by Samsung Medison. NOTE: For information on cleaning and disinfecting probes, please refer to ‘Chapter 5. Probes’ in this User Manual. A disinfectant qualified by the FDA 510 (k) process is recommended. 1. Turn off the system and disconnect the power cord from the wall outlet. 2. Dilute the disinfectant solution to the strength specified on the instruction label. 3. Wipe the system’s surfaces with the disinfectant solution, following the disinfectant’s instructions. 4. Air dry or towel dry with a soft cloth according to the instructions on the disinfectant product label. 4-8

[Page 219] Electrical Safety Check NOTE: Users may request safety inspections as required, but only trained persons are allowed to perform the safety inspection. The product’s maintenance status may affect the electrical safety of the product. The product should be maintained in an electrical safety state for the safety of the people. Accuracy Check NOTE: In case of doubt in the measurements, please contact your local Samsung Medison Service Department for an accuracy test. The product’s maintenance status may affect the measurements obtained using the product. The product should be maintained in an optimal state to ensure reliable measurements. The equations and table related to measurement accuracy are included in ‘Chapter 8. Measurements’ in this User Manual. 4-9

[Page 220] Battery Pack Management The battery pack is a consumable, and will lose performance over time. If the battery life becomes less than half of what it was when first purchased, it is time for a replacement. X ‹ The warranty period for battery packs is six months. X ‹ Samsung Medison recommends that you replace the battery pack once a year. NOTE: To purchase a battery pack, please contact Samsung Medison Service Department. Replacing the Battery Pack To replace a battery pack, please contact Samsung Medison Service Department. WARNING: Disconnect the power cord if you are not planning to use the product. Leaving the product unused and not plugged in to a power outlet for an extended period of time may deplete the battery completely, making it impossible to recharge the batteries. In addition, allowing the battery pack to become completely depleted may cause communication problems for the product. 4-10

[Page 221] Recharging the Battery Pack Connecting the AC adapter automatically begins to recharge the battery pack. The battery pack must be charged and discharged within the following temperature ranges:
Battery Model State Ambient Temperature Charging 5 – 35°C Discharging 10 – 35°C CAUTION: The ideal charging temperature is from 10 to 35°C. The battery pack can overheat if the ambient temperature is too high, or can take much longer than normal to recharge if the temperature is too low. Disposing of the Battery Pack A service representative of Samsung Medison or an authorized dealer must replace and dispose of the battery. WARNING: Do not dispose of the battery pack carelessly. Do not incinerate the battery, as this may cause an explosion or a fire. 4-11

[Page 222] Information Maintenance CAUTION: You may lose stored data due to external shocks or internal errors. Therefore, backup data on a regular basis. User Setting Backup Always keep a backup copy of all information related to the user settings in case of data loss. Users should not attempt to back up user settings on their own. Staff at Samsung Medison’s Customer Service Department should perform backup upon client’s request. Patient Information Backup The SonoView program can be used to backup patients’ basic information and scanned images. The data is saved in the system by default, and the user can also choose to save the data to a specific location. If the system needs to be reinstalled due to a defect in the product, staff at Samsung Medison’s Customer Service Department will restore the saved basic patient information and images. For more information, please refer to ‘Chapter 9. Image Management.’ Software The software may be changed to improve the product’s performance. Users should not attempt to modify the software by themselves; please contact staff at Samsung Medison’s Customer Service Department for help. CAUTION: Minor software updates may be carried out without prior notice from the manufacturer. If errors occur in the operating system (Windows 7) or a system upgrade is required, please follow the instructions of the operating system manufacturer. NOTE: This product uses the Windows firewall to prevent any hacker or malicious software from accessing the system through the internet or network. 4-12

[Page 223] Cybersecurity Threats against cybersecurity have intensified gradually in recent years. Threats manifest in a variety of forms, including a system breakdown caused by virus infections or a leak of patient data stored on the system, and unfortunately, no security measure can totally (100%) prevent such threats. Therefore, please comply with the following to prepare for cyber threats. X ‹ Do not connect the product to an unsecured public wired or wireless network, and under no circumstances do you connect to the Internet via this product. X ‹ Place this product in an area where it cannot be operated or tampered with physically by non- designated persons, and shut off power when it is not in use. X ‹ Only external devices (e.g., USB drive) that have been scanned for viruses and malwares should be connected to the product. X ‹ If you suspect that the product is infected, stop using it immediately, shut off power, and make sure that you contact the Security Manager (Technical Support). X ‹ If a new security patch has been released, adjust the schedule with the Service Team to apply the patch promptly. X ‹ Samsung Medison shall provide support until the product becomes discontinued, so that you can respond to publicly known cybersecurity vulnerabilities. 4-13

[Page 224]

[Page 225] Chapter 5 Probes ‹ ‹ Probes 5-3 Using Ultrasound Gel 5-25 Using Sheaths 5-27 Probe Safety Precautions 5-28 Using and Infection Control of the Probe 5-29 Risk of Electric Shock 5-30 Cleaning and Disinfecting Probes 5-31 MPTEE Probe 5-40 ‹ ‹ Biopsy 5-47 Biopsy Kit Components 5-48 Using Biopsy Kit 5-49 Assembling the Biopsy Kit 5-52 Cleaning and Disinfecting Biopsy Kits 5-57

[Page 226]

[Page 227] Probes A probe is a device that acquires image data by sending and receiving ultrasound. It is also called a transducer or scanhead. The system limits the maximum temperature that a patient can contact to 43 °C, and the output of ultrasound energy complies with US FDA regulations. A power protection fuse circuit protects against overcurrent conditions. If the power monitor protection circuit senses an over-current condition, then the drive current to the probe is shut off immediately, preventing the probe surfaces from overheating and limiting acoustic output.
Probe List The ultrasound image scanner uses probes to obtain graphic data of the human body and then displays it on the screen. Always use application-specific probes in order to obtain the best quality images. It is also recommended to use a preset that is best suited to the particular organ being scanned. NOTE: For the configuration of probes and presets that are not available in the US and Canada, please refer to ‘Chapter 5. Probes’ „ ‹ Thermal Index (TI) Table Thermal Index (TI) is displayed in the Title area of the screen and represents the probability of temperature rise in a particular area of the body. There are soft tissue (TIs), bone (TIb), and cranial bone (TIc) thermal indexes, depending on the body part. This product is configured to automatically display a thermal index according to the selected probe and application. Types of probes, applications, presets, and thermal indexes available in this product are as follows: 5-3

[Page 228] Small Parts Breast, Thyroid, Testicle TIs LA3-14AD OB Pediatric Ped Hip TIb Neo Head TIc LA2-9A OB 5-4

[Page 229] MSK General, Superficial, Deep TIs LA3-16AI 1st Trimester TIs OB Ped Abd, Ped Hip TIs LA4-18BD OB 5-5

[Page 230] LA3-16A OB OB CA1-7AD 5-6

[Page 231] OB CA2-9AD CA2-6BM Abdomen Abdomen, Renal TIs OB CF4-9 5-7

[Page 232] Cardiac Adult Echo, Echo Penetration, Ped Echo, Aortic Arch TIs PA1-5A Carotid, Arterial, Venous TIs Pediatric Ped Abd TIs Cardiac Adult Echo, Ped Echo, Aortic Arch TIs PA3-8B Carotid, Arterial, Venous TIs Pediatric Ped Abd TIs Cardiac Adult Echo, Echo Penetration, Ped Echo, Aortic Arch TIs PE2-4 Carotid, Arterial, Venous TIs Pediatric Ped Abd TIs OB EA2-11B OB ER4-9 5-8

[Page 233] OB CV1-8AD OB V5-9 Cardiac Adult Echo, Ped Echo TIs DP2B Carotid, Arterial, Venous TIs Cardiac Adult Echo, Ped Echo TIs CW6.0 Carotid, Arterial, Venous TIs MMPT3-7 Cardiac Adult Echo, Ped Echo, Aortic Arch TIs Cardiac Adult Echo, Ped Echo, Aortic Arch TIs PA4-12B Carotid, Arterial, Venous TIs Pediatric Ped Abd TIs 5-9

[Page 234] OB VR5-9 OB EVN4-9 Cardiac Ped Echo TIs DP8B Carotid, Arterial, Venous TIs OB CA3-10A OB EA2-11AR 5-10

[Page 235] X ‹ Besides the system-optimized presets, users can select preferred settings from User 1 to User 8. X ‹ For information on selection and settings of probes, please refer to ‘Chapter 6. Starting Modes of Operation.’ X ‹ The default thermal index may vary depending on the preset. X ‹ You can change the thermal index in Setup > Imaging > Application/Preset > Preset Settings > Thermal Index Type. 5-11

[Page 236] X ‹ CW6.0 Probe is not supported for XH50/XH60. X ‹ Probe CA2-6BM is not supported in the USA. X ‹ The applications and presets for the following probes are not supported in the USA. Abdomen Abdomen, Renal, Bowel, Aorta Vascular TCD LA3-14AD OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart Pediatric Neo Head, Ped Abd, Ped Hip Vascular TCD LA2-9A OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart Pediatric Neo Head, Ped Abd, Ped Hip Abdomen Abdomen, Renal, Bowel, Aorta Small Parts Breast, Thyroid, Testicle Vascular TCD LA3-16AI OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart GYN Uterus, Adnexa Pediatric Neo Head, Ped Abd, Ped Hip Abdomen Abdomen, Renal, Bowel, Aorta Vascular TCD LA4-18BD OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart GYN Uterus, Adnexa Pediatric Neo Head, Ped Abd, Ped Hip Abdomen Abdomen, Renal, Bowel, Aorta Vascular TCD LA3-16A OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart Pediatric Neo Head, Ped Abd, Ped Hip 5-12

[Page 237] Pediatric Neo Head, Ped Abd, Ped Hip CA1-7AD Vascular Carotid, Arterial, Venous, TCD Urology Prostate, Bladder MSK General, Superficial, Deep, Spine Pediatric Neo Head, Ped Abd, Ped Hip CA2-9AD Vascular Carotid, Arterial, Venous, TCD Urology Prostate, Bladder MSK General, Superficial, Deep, Spine CF4-9 Vascular TCD Urology Prostate, Bladder Vascular Carotid, Arterial, Venous PA1-5A Pediatric Ped Abd PA3-8B Vascular Carotid, Arterial, Venous Vascular Carotid, Arterial, Venous PE2-4 Pediatric Ped Abd MSK General, Superficial, Deep, Spine Pediatric Neo Head, Ped Abd, Ped Hip CV1-8AD Vascular Carotid, Arterial, Venous, TCD Urology Prostate, Bladder 5-13

[Page 238] X ‹ Probe CA2-6BM is not supported in Canada. X ‹ The applications and presets for the following probes are not supported in Canada. LA3-14AD Vascular TCD LA2-9A Vascular TCD Abdomen Abdomen, Renal, Bowel, Aorta OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart LA3-16AI GYN Uterus, Adnexa Vascular TCD Abdomen Abdomen, Renal, Bowel, Aorta OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart LA4-18BD GYN Uterus, Adnexa Vascular TCD OB 1st Trimester, 2nd Trimester, 3rd Trimester, Fetal Heart LA3-16A Pediatric Neo Head Vascular TCD Pediatric Neo Head CA1-7AD Vascular TCD MSK General, Superficial, Deep,Spine CA2-9AD Pediatric Neo Head Vascular TCD MSK General, Superficial, Deep,Spine CF4-9 Uroloy Prostate, Bladder Vascular TCD PA3-8B Vascular Carotid, Arterial, Venous PE2-4 Vascular Carotid, Arterial, Venous Pediatric Neo Head CV1-8AD Urology Prostate, Bladder MSK Superficial 5-14

[Page 239] „ ‹ Function List The functions available in this product for various probes and applications are as follows: MSK O O O X X O O General ( O ) Small Parts O O Breast ( O ), O X X O O LA3-14AD Thyroid ( O ) GYN O O X O X X O O Small Parts O O X O X X O O LA2-9A Vascular O O X O X X O O GYN O O X O X X O O Small Parts O O X O X X O O LA3-16AI Vascular O O X O X X O O GYN O O X O X X O O 5-15

[Page 240] MSK O O O X X O O General ( O ) Small Parts O O Breast ( O ), O X X O O LA4-18BD Thyroid ( O ) GYN O O X O X X O O MSK O O O X X O O General ( O ) Small Parts O O Breast ( O ), O X X O O LA3-16A Thyroid ( O ) GYN O O X O X X O O CA1-7AD GYN O O X O X X O O 5-16

[Page 241] CA2-9AD GYN O O X O X X O O CA2-6BM Abdomen O O X O X X O O CF4-9 GYN O O X O X X O O Abdomen X O X O X X O O Cardiac X O X O O O X X PA1-5A Vascular X O X O X X O O Pediatric X O X O X X O O Abdomen X O X O X X O O Cardiac X O X O O O X X PA3-8B Vascular X O X O X X O O Pediatric X O X O X X O O Abdomen X O X O X X O O Cardiac X O X O O O X X PE2-4 Vascular X O X O X X O O Pediatric X O X O X X O O 5-17

[Page 242] OB X O X O X X O O GYN X O O O X X O O EA2-11B Prostate ( O ), Urology X O O X X O O Bladder ( X ) OB X O X O X X O O GYN X O O O X X O O ER4-9 Prostate ( O ), Urology X O O X X O O Bladder ( X ) CV1-8AD GYN O O X O X X O O OB X O X O X X O O GYN X O O O X X O O V5-9 Prostate ( O ), Urology X O O X X O O Bladder ( X ) Cardiac X O X X X X X X DP2B Vascular X O X X X X X X Cardiac X O X X X X X X CW6.0 Vascular X O X X X X X X MMPT3-7 Cardiac X O X O O O X X Abdomen X X X O X X O O Cardiac X O X O O O X X PA4-12B X Vascular X Carotid X O X X O O ( O ) Pediatric X X X O X X O O 5-18

[Page 243] OB X X X O X X O O GYN X X O O X X O O VR5-9 Urology X X O X X O O Prostate ( O ) OB X X X O X X O O GYN X X O O X X O O EVN4-9 Urology X X O X X O O Prostate ( O ) Cardiac X O X X X X X X DP8B X Vascular X Carotid X X X X X X ( O ) Abdomen O X X O X X O O OB O X X O X X O O GYN O X X O X X O O CA3-10A MSK O X X O X X O O Pediatric O X X O X X O O Vascular O X X O X X O O Urology O X X O X X O O OB X O X O X X O O GYN X O O O X X O O EA2-11AR Prostate ( O ), Urology X O O X X O O Bladder ( X ) 5-19

[Page 244] Small Parts O X X O O O O LA3-14AD Vascular O X X O O O O GYN O X X O O O O Small Parts O X X O O O O LA2-9A Vascular O X X O O O O GYN O X X O O O O Abdomen X X X O O O O MSK X X X O O O O Small Parts X X X O O O O LA3-16AI Vascular X X X O O O O OB X X X O O O O GYN X X X O O O O Pediatric X X X O O O O Small Parts O X X O O O O LA4-18BD Vascular O X X O O O O GYN O X X O O O O 5-20

[Page 245] Small Parts O X X O O O O LA3-16A Vascular O X X O O O O GYN O X X O O O O CA1-7AD GYN O X X O O O O Vascular O X X O O O O CA2-9AD GYN O X X O O O O Vascular O X X O O O O CA2-6BM Abdomen X X X O O O O 5-21

[Page 246] Abdomen X X X O O X X MSK X X X O O X X OB X X X O O X X CF4-9 GYN X X X O O X X Pediatric X X X O O X X Vascular X X X O O X X Urology X X X O O X X Abdomen X X O X O O O Cardiac X O O X O O O PA1-5A Vascular X X O X O O O Pediatric X X O X O O O Abdomen X X O X O O O Cardiac X O O X O O O PA3-8B Vascular X X O X O O O Pediatric X X O X O O O Abdomen X X O X O O O Cardiac X O O X O O O PE2-4 Vascular X X O X O O O Pediatric X X O X O O O EA2-11B GYN O X X O O O O ER4-9 GYN O X X O O O O 5-22

[Page 247] CV1-8AD GYN O X X O O O O Vascular O X X O O O O V5-9 GYN O X X O O O O Cardiac X X O X X X X DP2B Vascular X X O X X X X Cardiac X X O X X X X CW6.0 Vascular X X O X X X X MMPT3-7 Cardiac X O O X O O O Abdomen X X O X O O O Cardiac X O O X O O O PA4-12B Vascular X X O X O O O Pediatric X X O X O O O VR5-9 GYN O X X O O O O EVN4-9 GYN O X X O O O O Cardiac X X O X X X X DP8B Vascular X X O X X X X 5-23

[Page 248] Abdomen X X X O O O O OB X X X O O O O GYN X X X O O O O CA3-10A MSK X X X O O O O Pediatric X X X O O O O Vascular X X X O O O O Urology X X X O O O O EA2-11AR GYN O X X O O O O X ‹ The meaning of each symbol in the table is described below: – Q Scan: Quick Scan – Har: Harmonic Imaging – S-Har: S-Harmonic Imaging – ECG: Electro Cardio Graph Imaging – CM: Color M – TDI: Tissue Doppler – PD: Power Doppler – S-Flow: Directional Power Doppler Imaging – TDW: Tissue Doppler Wave – CW: Continuous Wave X ‹ MultiVision is only available in 2D/C Mode. 5-24

[Page 249] Using Ultrasound Gel For successful acoustic signal transmission, please only use the ultrasound gels approved by Samsung Medison. X ‹ The use of inappropriate ultrasound gels could result in damage to the probe. Using damaged probes may result in electric shocks and other hazards to the patients and/or users. X ‹ Do not use ultrasound gels or coupling media that contain any of the following agents: – Oils such as mineral oil, cooking oil, gasoline, solvents, rust inhibitors, lanolin, paraffin-based grease, ester, and excessive silicon-based release agents; – Alcohols, such as acetone, methanol, and plasticizer (dioctylphtalate), or denatured alcohol; – Glacial acetic acid and iodine; or – All lotions or gels that contain aromatic substances X ‹ When applying the ultrasonic gel to the probe, make sure that the tip of the gel tube does not touch the surface of the probe lens. X ‹ The tip of the gel tube may cause damage to the probe lens. 5-25

[Page 250]
Gel Warmer (Option) The Gel Warmer keeps the ultrasound gel warm. Warming up the ultrasound gel takes approximately 5 minutes. X ‹ Always turn the Gel Warmer off when it is not in use. X ‹ Do not put your hands inside the Gel Warmer, as it may burn your skin. X ‹ Do not use the Gel Warmer for purposes other than to control the temperature of ultrasound gel. X ‹ Make sure that no items such as the probe slip into the Gel Warmer. X ‹ Do not touch the power terminal of the Gel Warmer while you are examining a patient. There is a risk of electric shock from leakage current. X ‹ Do not apply excessive force to the Gel Warmer, or you may damage its support parts. [Figure 5.1 Gel Warmer Label – Example] 5-26

[Page 251] Using Sheaths Sheaths are recommended for clinical applications of an invasive nature, including intraoperative, transrectal, transvaginal, and biopsy procedures. Using a sheath prevents contamination from blood or other bodily fluids during operations or biopsy. Since Samsung Medison does not supply protective sheaths, users must select and apply appropriate sheaths. X ‹ For more information about sheaths, please contact the manufacturer. X ‹ Always keep sheaths in a sterile state. X ‹ Sheaths are disposable. Do not reuse them. X ‹ Make sure to clean and disinfect probes before each use. X ‹ Check the exterior of a sheath before use. If a sheath is cut or contaminated, do not use it. X ‹ In neurosurgical applications, a disinfected probe must be used with sterile gel and a sterile pyrogen-free sheath. X ‹ If a sheath is used on a patient with Creutzfeldt-Jakob disease during a neurosurgical procedure, the probe that was used with it cannot be sterilized by any method whatsoever. X ‹ Some sheaths contain natural rubber latex and talc, which can cause allergic reactions in some individuals. Please refer to the FDA Medical Alert released on March 29, 1991.
Applying Sheaths 1. Remove a sheath from the package, and fill it with ultrasound gel. Be sure to put on sterilized surgical gloves. 2. Insert the probe into the sheath and pull the latex tip to cover the probe completely. If possible, cover the probe cable as well. 3. Ensure that there are no air bubbles trapped within the ultrasound gel. If necessary, secure the sheath to the probe and the probe cable. 4. Dispose of the sheath after use. 5-27

[Page 252] Probe Safety Precautions The probe can easily be damaged by improper use or by coming into contact with certain chemical substances. Always follow the instructions in the user manual to inspect the probe cable, case and lens before and after each use. Check the probe for cracks, broken parts, leaks and sharp edges. If there is any damage, stop using the probe immediately and contact the Samsung Medison Customer Support Department. Using damaged probes may result in electric shocks and other hazards to the patients and/or users. X ‹ The user is responsible for cleaning, disinfecting, and sterilizing probes. X ‹ Probes are not sterilized at the time of shipment. X ‹ Do not apply mechanical shock to the probe. X ‹ In case a probe is bumped against the ground or a hard surface, disconnect the probe immediately from the console of the ultrasound system. If damaged, the electrical insulation may cause an electrical shock. X ‹ Do not place the probe cable on the floor where the cable can be run over by equipment wheels, etc. Do not apply excessive force to bend or pull the cable. X ‹ Do not immerse the probe into any inappropriate substances such as alcohol, bleach, ammonium chloride, or hydrogen peroxide. X ‹ Do not expose the probe to temperatures of 50°C or higher. X ‹ 3D and 4D probes may make a slight noise if they are used for a long time or if a certain mode is in use. X ‹ Probes should be cleaned and disinfected prior to replacement or disposal. X ‹ Always inspect the lenses, cables, and connectors after using probes. If damaged, stop using them immediately. 5-28

[Page 253] Using and Infection Control of the Probe The ultrasonographic image scanner uses ultrasound, and makes direct contact with the patient when in use. Depending on the types of examinations, such contact can be made to a wide variety of locations, including the ordinary skin or the location of blood transfusion during a surgical procedure. The most effective method of preventing infection among patients is to use each probe only once. However, probes may need to be reused, as they are complex in design and expensive. Consequently, the safety instructions must be followed carefully in order to minimize the risk of infection among patients. WARNING: No neurosurgical treatments or examinations should be carried out on a patient with Creutzfeldt-Jakob disease. If the probe has been used on such a patient, it cannot be sterilized by any method whatsoever. If the probe or product is contaminated, dispose of it according to the local biohazardous waste disposal procedures. CAUTION: Sufficient washing and disinfecting must be carried out to prevent infection. This is the responsibility of the user who manages and maintains the disinfection procedures for the equipment. Always use legally approved cleaning solution and sheaths. 5-29

[Page 254] Risk of Electric Shock Since a probe uses electrical energy, if it touches conductive materials, there are risks of injury, such as electric shocks, to the patient or the user. X ‹ Have the system regularly inspected for electrical leakage by Samsung Medison’s Customer Service Department. X ‹ Do not immerse the probe in liquid. X ‹ Do not touch the probe connectors or the connection pins on the product. X ‹ Do not drop the probe or apply mechanical shocks. X ‹ Inspect the housing, strain relief, lens, and seal for damage, and check for any functional problem before and after each use. X ‹ Do not apply excessive force to twist, pull or bend the probe cable. X ‹ The power protection fuse protects the probe and the product from excess current. If the power monitoring protection circuit detects excess current, it immediately shuts off the current to the probe in order to prevent the overheating and to restrict the ultrasound power output. X ‹ The system limits the maximum temperature that a patient can contact to 43°C, and the maximum output of ultrasound energy (AP&I) complies with US FDA regulations. 5-30

[Page 255] Cleaning and Disinfecting Probes Probes must be cleaned and disinfected after each use. Cleaning is an important procedure that must be carried out before disinfecting probes. For information on cleaning probes, please refer to the relevant chapter. Using an inappropriate disinfectant may damage the probe. X ‹ Always use protective face mask and gloves when cleaning and disinfecting probes. X ‹ After cleaning and disinfecting probes, inspect their housing, strain relief, lens, and seal for damage, and check for any functional degradation. Using an inappropriate cleaning or sterilizing agent may damage probes.
Information of Detergent, Disinfectant, and Ultrasound Gel „ ‹ Classification of Disinfectants To maintain the performance of ultrasound probes, proper maintenance is required. As ultrasound probes are classified into critical, semi-critical or non-critical devices based on the standards of FDA guidance* and the Hygiene Requirements for the Reprocessing of Medical Devices from Germany guideline of Robert Koch Institute (RKI), proper cleaning and disinfection or sterilization methods for that classification should be used. Classification Criteria Contact Area Application Probe Level Selection C o nve x , Linear N o n-critical device Intact skin array, and sector Low level disinfectant transducers Mucous membrane, Semi-critical device Endocavity High level disinfectant damaged skin Blood, sterile High level disinfectant Critical device Intraoperative, TEE tissue, etc. or sterilization * Guidance for Industry and FDA Staff - Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers - Appendix D * It is recommended to use high level disinfectants only for endocavity probes. 5-31

[Page 256] An appropriate detergent, disinfectant, or ultrasound gel should be used for all probes. Please use an appropriate detergent, disinfectant, or ultrasound gel by referring to the Samsung Medison website and the User Guide. All probes have been tested in accordance with IPX 7 Criteria. X ‹ User Guide: A booklet is provided upon purchasing the product. X ‹ Website: http://www.samsunghealthcare.com The following is information about the manufacturers (or Distributors) of detergents, disinfectants, and ultrasound gels. Alkazyme Alkapharm UK Ltd. Anioxyde 1000 Laboratoires Anios Aquasonics 100 Parker laboratories, Inc. Asepti-Wipes Ecolab Asepti-Wipes II Ecolab Bleach 5.25% – CaviWipes Metrex Cidex Advanced Sterilization Products Cidex 2% Advanced Sterilization Products Cidex OPA Advanced Sterilization Products Cidex Plus Advanced Sterilization Products Cidezyme Johnson & Johnson Cleanisept Wipes Dr. Schumacher GmbH Clear Image NEXT Medical Products Enzol Johnson & Johnson Ethanol 75% – GE Ultrasound Contact Gel GE Accessories Gigasept Schulke & Mayr GmbH Gigasept AF Schulke & Mayr GmbH Gigasept FF Schulke & Mayr GmbH Hibitane Regent Medical 5-32

[Page 257] Incidin Foam Ecolab Isopropyl alcohol (70%) – Isopropyl alcohol (80%) – Kendall Tyco/Healthcare Klenzyme Steris McKesson McKesson Medical-Surgical Inc. Metricide 14 Metrex Metricide 28 Metrex Metricide 30 Metrex Metricide OPA Plus Metrex Metricide Metrex MetriWipes Metrex Metrizyme Metrex Milton Procter & Gamble Natural Image Sonotech Inc. Nuclean Alkapharm Omnicide - FG2 Coventry Chemicals Limited Omnicide 14NS Coventry Chemicals Limited Omnicide (28) Coventry Chemicals Limited PeraSafe ANTEC International Limited Salvanios pH 7 Laboratoires Anios Salvanios pH 10 Laboratoires Anios Sani-Cloth Active PDI Sani-Cloth AF Germicidal PDI Sani-Cloth AF3 Germicidal PDI Sani-Cloth Bleach Germicidal PDI Sani-Cloth Germicidal PDI Sani-Cloth HB PDI 5-33

[Page 258] Sani-Cloth Plus PDI Scan Parker laboratories, Inc. Sekusept Extra Ecolab Sekusept Plus Ecolab Septiwipes Dr. Schumacher GmbH Sonogel Sonogel Vertriebs GmbH Sporox DSHealthcare Inc. Sporox II DSHealthcare Inc. Steranios 2% Laboratoires Anios Ster-Bac Blu Ecolab Super Sani-cloth PDI Surfaces Hautes Laboratoires Anios Transeptic spray Parker laboratories, Inc. Tristel Duo Tristel Solutions Limited Tristel Sporicidal Wipe Tristel Solutions Limited Trophon Nanosonics Limited T-Spray Pharmaceutical Innovations, Inc. T-Spray II Pharmaceutical Innovations, Inc. Virkon DuPont Wavelength National Therapy Products Inc. Wavicide-01 National Therapy Products Inc. 5-34

[Page 259]
Cleaning Probes Probes must be cleaned and disinfected after each use. Cleaning is an important procedure that must be carried out before disinfecting probes. X ‹ Do not use brushes when cleaning probes. Even the use of soft brushes can damage the probe. X ‹ During cleaning and disinfection, keep the parts of the probe that must remain dry higher than the other parts during wetting until all parts are dry. 1. Disconnect the probe from the system. 2. Remove the biopsy adapter or needle guide. Collect the reusable parts, reusable biopsy adapter, or needle guide that need to be disinfected or sterilized, and discard the disposable parts in the clinical waste bin. (For cleaning and disinfection/sterilization of the reusable parts, please refer to the appropriate chapter.) 3. Remove and properly dispose of the medical sheath in the clinical waste bin. (Medical sheaths are disposables.) 4. Use a soft cloth or appropriate cleaning sheet lightly dampened with clean water or a cleaner to remove any foreign substances left on the probe, the edges, corners, and curved parts of the probe and cables. 5. Thoroughly rinse with water to remove any loose particles, soap, and detergent residue (up to the immersion point). 6. Wipe with a clean, dry, soft cloth. 7. If still wet, wipe with a clean water-dampened cloth, and again with a clean, dry, soft cloth. 8. Dispose of the used cloth in the clinical waste bin. 5-35

[Page 260]
Disinfecting Probes Probes must be cleaned and disinfected after each use. Disinfection of probes is an important step that must be carried out. NOTE: Disinfect to reduce pathogens to the level of 10 -6 . „ ‹ Disinfecting the probe with a fluid disinfectant Using an inappropriate disinfectant may damage the probe. X ‹ Always use a protective face mask and gloves when disinfecting the probes. degradation after disinfecting the probe. X ‹ Never use disinfectants after the expiration date. X ‹ The type of tissue the probe will contact during use dictates the level of disinfection required for a probe. Ensure that the solution strength and duration of contact are appropriate for disinfection. X ‹ Failing to use a recommended disinfectant or follow the recommended disinfection method may damage and/or discolor the probe. This could also void the product warranty. X ‹ Do not immerse non-sterilizable probes in disinfectant for one hour or longer. X ‹ Only use liquid solutions to sterilize probes. Do not sterilize by autoclaving or using EtO gas. 5-36

[Page 261] 1. Please refer to the user instructions of the disinfectant for details of proper storage, use, and disposal of the disinfectant. 2. Mix a disinfectant appropriate for your probe according to the strength of the solution specified in the disinfectant's user manual. 3. Immerse the probe into the disinfectant as shown in the illustration below. [Figure 5.2 Disinfecting a Probe] 4. Follow the instructions on the disinfectant to complete the immersion procedure for the probe and never leave the transducer immersed in the disinfectant solution for longer than the maximum immersion duration. Rinse the probe with clean water afterwards. 5. Air dry the probe and store it properly (e.g. in a sterile bag) to prevent any further contamination. 5-37

[Page 262] „ ‹ Disinfecting the probe with a disinfection wipe Using an inappropriate disinfection wipe may damage the probe. X ‹ Always use a protective face mask and gloves when disinfecting the probes. degradation after disinfecting the probe. X ‹ Never use disinfection wipes that have gone beyond their expiration date. X ‹ Ensure that the contact duration is appropriate for disinfection. CAUTION: Using a non-recommended disinfection wipe or not following the recommended disinfection method may damage and/or discolor the probe. This could also void the product warranty. 1. For more information on the correct use, storage, and disposal of the holder, please refer to the user instructions for the disinfection wipe. 2. Depending on the types of wipe, apply an active disinfectant to a dry wipe or use a ready-to-use wet wipe containing disinfectant. 3. Use the disinfection wipe to apply the active disinfectant all over the surface of the probe and ensure all areas are covered. 4. Discard the used disinfectant wipes as clinical waste. Do not re-use the disinfectant wipes. 5. Air-dry the probe for the amount of time specified in the user instructions for the disinfectant wipes and store the probe properly (e.g., in a sterile bag) to prevent any further contamination. 5-38

[Page 263] „ ‹ Disinfecting the probe with a disinfection system Using a non-approved probe/disinfection system combination may damage the probe. X ‹ Always use protective eyewear and gloves when disinfecting probes. problem after disinfecting the probe. X ‹ Ensure that the cycle duration is appropriate for the desired disinfection level. CAUTION: Using a non-approved probe/disinfection system combination or not following the recommended disinfection method can damage the probe. This could also void the probe warranty. 1. Refer to the user instructions of the disinfection device for details of proper use, storage and disposal of waste. 2. Place the probe head, a part of the cable and possible marker in the disinfection device, following the user instructions of the disinfection device. 3. Start the desired disinfection process and wait until the end of the cycle. 4. Remove the probe and possible marker at the end of the cycle from the disinfection device and store the probe properly (e.g. in a sterile bag), so that no new contamination may appear. 5. Register the disinfection data for traceability according to local regulations. 5-39

[Page 264] MPTEE Probe The Multi-Planar Transesophageal Echocardiography (MPTEE) probe is to be inserted into the body.
How to Use MMPT3-7 Probe 1 2 [Figure 5.3 MMPT3-7 Probe Dials] „ ‹ Lens Angle Adjustment The lens angle can be adjusted to from 0° to 180° by pressing buttons 3 and 4 . Button 3 rotates the lens angle counterclockwise. Button 4 rotates the lens angle clockwise. „ ‹ Scan Head Tilting Use dials 1 and 2 . Rotate dial 1 clockwise to tilt the lens forward. Rotate the dial counterclockwise to tilt the lens backward. Rotate dial 2 clockwise to tilt the lens sideways. [Figure 5.4 Scan Head Tilting] 5-40

[Page 265] „ ‹ Locked Mode Makes the lens movement less natural than when left open, preventing movement of the lens and head during use. If a red mark appears when you rotate the MMPT3-7 probe’s silver handle, it means it is locked. [Figure 5.5 Locked State] 5-41

[Page 266]
Precautions for Using the Probe DANGER: Do not use the product in a temperature outside the range of 25°C or lower and 42°C or higher. It may cause damage to the human body. X ‹ Do not transport the product while the MPTEE probe is placed in the probe holder. The probe is not secured, and it may fall. X ‹ To protect the patient and the probe, keep the probe in unlocked when you insert it. X ‹ The image obtained with the TEE probe may differ from the image displayed on screen. It is necessary to perform an inspection in advance to reduce the risk of difference in images. X ‹ Familiarize yourself with the use and safety instructions for the TEE probe completely before using it. X ‹ Only use the probe for its intended purpose of being inserted into the body. When the temperature of the MPTEE probe reaches 41℃ or higher, the following warnings are displayed: X ‹ 41.0°C ≤ TEE Temperature < 42.0°C: Estimated surface temperature of xx.x°C. X ‹ 42.0°C ≤ TEE Temperature < 42.5°C: Estimated surface temperature of xx.x°C. Please reduce the power value. X ‹ 42.5°C ≤ TEE Temperature < 43.0°C: Estimated surface temperature of xx.x°C. Please reduce the power value. Near the thermal limit of 43.0°C. X ‹ TEE Temperature = 43.0°C: Surface Temperature Reached: Currently 43.0°C. The power value has been automatically reduced. X ‹ 43.0°C < TEE Temperature ≤ 50.0°C: Scan head temperature critical. The system has stopped transmitting and returned to the Probe Selection dialog. When you reselect the probe, please reduce the power value if necessary. X ‹ 50.0°C < TEE Temperature or TEE Temperature < 5.0°C: Error condition detected. The System has stopped transmit and returned to the Probe Selection Dialog. Please contact a Service Representative. 5-42

[Page 267] For the MPTEE probe, the following warnings are displayed depending on the status of the circuit: X ‹ Short circuit or open circuit: Error condition detected. The System has stopped transmit and returned to the Probe Selection Dialog. Please contact a Service Representative. CAUTION: The probe is intended to be inserted into the human body; always keep it clean. Never place the probe on the floor. X ‹ When the probe is not in use, place it in the probe holder located on the left side of the console. The probe holder on the right side is not suitable for the MPTEE probe. X ‹ It is recommend to use pyrogen-free sheaths.
Maintenance Proper cleaning and disinfection prevent infectious diseases. Please learn how to properly clean and disinfect probes by referring to this user manual. CAUTION: Do not allow the handle or the probe connector to come in contact with cleaners or disinfectants. Clean the handle and the cable with a wet cloth; disinfect only the area between, and including, the scan head at the end of the probe and the area marked as 100 cm. „ ‹ Cleaning CAUTION: Never clean the probe with methanol or ethanol. Doing so may cause serious problems with the product. 1. Remove the parts that do not need to be cleaned, and clean the scan head and the cable with a gauze soaked in non-irritant cleansing solution. Mix a non-irritant cleaning agent in lukewarm water to prepare the cleansing solution; the recommended water temperature is 26°C or lower. 2. Rinse the product with lukewarm water until the cleansing solution is completely eliminated. 5-43

[Page 268] 3. Air-dry it or use a soft cloth to remove moisture. Cleaner Supplier Active Ingredient Concentration Cidezyme/Enzol ASP J&J Proteolytic enzymes <5% EMpower Metrex Proteolytic enzymes <2% Hycolin Coventry Alkyldimethylbenzylammonium 1-10% Chemicals chloride Tetrasodium EDTA 1-10% Alcohol ethoxylate 1-10% Metrizyme Metrex Proteolytic enzymes <2% Prolystica 2x Steris Ethanollamine 1-5% conc. Enzymatic Protease 0.1-1% Presoak & cleaner Ethoxylated alcohol 1-5% Polyalkylene glycol 1-5% Glycerine 1-5% T-spray Pharmaceutical N-alkyl-(C12-18)-n-N-dimethyl-N- Innovations Inc. Benzyl-ammonium-chloride; Alkyl- dimethyl-ethyl-benzyl-ammonium- chloride T-spray 2 Pharmaceutical Alkyl-dimethyl-benzyl-ammonium- Innovations Inc. chloride; Octyl-decyl-dimethyl- ammonium-chloride; Dioctyl- dimethyl-ammonium-chloride; Didecyl-dimethyl-ammonium- chloride 5-44

[Page 269] „ ‹ Disinfection WARNING: Do not use ethanol, iodine, steam, heat, or ethylene oxide for disinfection. X ‹ Do not leave the probe in disinfectant solution for more than one hour. X ‹ The probe must be rinsed immediately after disinfection. When necessary, disinfect the MPTEE probe with a liquid disinfectant. Cidex, Cidex-OPA, Metricide, Omnicide, and Giasept solutions are suitable for disinfecting the MPTEE probe. For the preparation methods and required immersion periods of the different disinfectant solutions, refer to the instructions provided by the manufacturers. 1. Immerse the clean and dry surface of the probe in the disinfectant solution. Immerse only the portion of the probe between the scan head at the end of the probe and the area marked as 100 cm. 2. Rinse away the disinfectant with water and dry the probe completely before storage. Disinfectance Supplier Active Ingredient Concentration Cidex ADS ASP J&J Gluteraldehyde 2.55% Cidex Plus ASP J&J Gluteraldehyde 3.40% Cidex OPA ASP J&J Ortho-phthaladehyde 0.55% Gigasept AF Schulke und Mayr Didecyldimethylammoniumchloride 15% Glycine, aminoalkyl derivs 6.9% Tridecylpolyethylenglycoether 15-30% N-(3-Aminopropyl)-N- <5% dodecylpropane-1, 3-diamine Gigasept FF Schulke und Mayr Formaldehyde 4.5% Dimethoxytetrohydrofurane 3.2% Succindialdehyde 4.5% Korsolex extra Bode Chemie Gluteraldehyde 5-10% Metricide Metrex Gluteraldehyde 2.60% Metricide 28 Metrex Gluteraldehyde 2.50% Metricide Plus 30 Metrex Gluteraldehyde 3.40% 5-45

[Page 270] Disinfectance Supplier Active Ingredient Concentration Metricide OPA Metrex Ortho-phthaladehyde 0.60% Plus Omnicyde 14 N.S. Coventry Gluteraldehyde 2.60% Chemicals Omnicide 28 Coventry Gluteraldehyde 2.50% Chemicals Perasafe Dupont Sodium Perborate 40-60% Sekusept Aktiv Ecolab Sodium Perborate monohydrate 30-50% Critic Acid 15-20% Fatty alcohol ethoxylate <5% Steranios 2%, 2% Anios Gluteraldehyde 2.00% N.G., 2% E.C.S. TD100 & TD5 CS Medical Gluteraldehyde 2.65% Totacide 28 Coventry Gluteraldehyde 2.00% Chemicals Virkon Dupont Potassium peroxymonosulphate <50% 5-46

[Page 271] Biopsy A biopsy is an examination method that surgically extracts tissue from the patient for examination. The probe and the biopsy kit are used together when conducting a biopsy with the ultrasonographic image scanner. The ultrasound imaging system shows the needle, which penetrates through the skin surface and veins, along with the examined body part, minimizing the potential risks to the patient. X ‹ Ultrasonographic studies using a biopsy kit must be conducted by a physician or qualified, experienced healthcare professional. Make sure that you comply with the preventive safety measures and sterilization procedure in all environments. X ‹ Do not use the biopsy kit for purposes other than ultrasonographic studies such as human anatomical dissection. X ‹ The user will be responsible for using the biopsy kit for ultrasonographic studies. X ‹ Please make sure to read the User Manual thoroughly. 5-47

[Page 272] Biopsy Kit Components The biopsy kit consists of the adapter, needle guide, and needle. The components vary depending on the probe type. Needle Guide Needle Biopsy Adapter [Figure 5.6 Biopsy Kit Components] X ‹ Adapter: Prevents the needle guide from shaking by securing it to the probe tightly. X ‹ Needle Guide: Guides the angle (direction) of the needle so that it may reach the biopsy target accurately. It also secures the needle so that the needle does not waver. X ‹ Needle: This is the needle that is inserted into the patient’s body. The biopsy kit supplied by Samsung Medison does not contain a needle. X ‹ Sheath: Prevents the probe and adapter from being contaminated by any unwanted substances (blood or other bodily fluids) discharged during examinations. X ‹ Ultrasound gel: Ensures the best quality images by filling the air space between the probe and the sheath with the ultrasound gel. 5-48

[Page 273] Using Biopsy Kit X ‹ Only use needles approved for use in your country. X ‹ Verify the condition of the biopsy needle before use. Do not use a bent biopsy needle. X ‹ The needle and guide must be sterilized before use. X ‹ The needle may bend while penetrating a tissue. Therefore, the precise location of the needle must be checked by monitoring the echo generated from the needle. CAUTION: For more information about conducting ultrasonographic studies using the biopsy kit, please contact the biopsy kit manufacturer.
Before Using Biopsy Kit X ‹ Biopsy kits not supplied by Samsung Medison may not be compatible with the probes. Always use biopsy kits supplied by Samsung Medison, since improper setup may adversely affect the patient. X ‹ Be sure to read the instructions for installing a sheath and aligning the needle guide thoroughly before performing a biopsy. X ‹ Always ensure that the probe and the needle guide are secured on both the left and the right sides. 5-49

[Page 274]
Biopsy Procedure The system generates a needle guideline through the displayed real-time ultrasound images to indicate the anticipated path of the needle. Use this guideline to ensure that the needle or other instrument follows the correct path. 1. Ready the patient according to the procedure appropriate for the examination objectives. 2. Install the sheath and the biopsy kit. 3. Set the system controls for the biopsy procedure. If necessary, apply acoustic gel to the patient. 4. Scan the patient. Adjust the patient so that the location for examination fits into the needle guideline on the screen. 5. Insert the needle into the needle guide. Perform the puncture by sliding the needle through the groove in the guide until the needle intercepts the target. To prevent the needle from shaking, press down on the top of the needle guide with your index finger during examinations. 6. When the examination site is reached, take the needle out of the needle guide. 7. Detach the needle guide, adapter, and sheath from the probe. 8. Dispose of the components that are not designed for reuse. X ‹ Dispose of non-reusable components according to infectious waste regulations. X ‹ Sterilize reusable components before disposing of them. 5-50

[Page 275]
Needle Guide Alignment Alignment of the needle guide displayed on the system is for the purpose of verifying whether the needle and the needle guide are properly installed. This must be done prior to biopsy. If the needle fails to follow an accurate path while verifying the alignment of needle guide, stop using the product and contact Samsung Medison Customer Support Department. Reverberation or other tissue artifacts may produce false needle images on the screen. Ensure the needle path is along the guideline and that you are not using a false needle image to locate the needle. X ‹ The needle used for alignment verification must not be used for the actual procedure. Always use a sterile needle for each biopsy procedure. X ‹ To assist in accurate projection of the needle, use a straight, new needle for each alignment procedure. X ‹ The needle guideline only displays the projected path of the needle. Since the default line may be different from the actual line, the actual location of the needle must be checked by monitoring the echo from the needle. 1. Attach the biopsy kit. 2. Set the system depth for the procedure to be performed and select the Biopsy menu. 3. Immerse the probe into the water bath, and insert the needle into the needle guide. 4. Confirm that the needle image is on the needle guidelines. If it is, then the needle guide is properly aligned. 5. If the needle image displayed on the screen is out of the needle guideline, check the needle guide or the probe adapter, etc. 5-51

[Page 276] Assembling the Biopsy Kit
Stainless Steel Biopsy Kit 1. Place a sheath up to the top of the probe’s handle. 2. Mount the adapter onto the probe. If the surface of probe is fluted, mount the adapter in accordance with it. 3. Insert the needle into the needle guide and start the exam. 5-52

[Page 277]
Plastic Biopsy Kit 1. Mount the adapter on the probe. 2. Cover the adapter and probe completely with the sheath. 3. Install the needle guide onto the adapter. 5-53

[Page 278] 4. Install the Needle Guide Clip if it is included in the components. 5. Insert the needle into the needle guide and start the exam. Using Multi Angle Use the angle adjuster. 5-54

[Page 279]
Biopsy Specifications Biopsy Probe Adapter Reusable/ Needle Multi Angle Model Name Components Material Disposable Gauge Depth Biopsy Adapter Reusable 14, 15, 16, Utra-Pro II Acetal 17, 18, 20, 1.5, 2.5, 4 LA4-18BD BP-KIT-069 Needle Guides Copolymer 21, 22, 23, (cm) Disposable & CIV-Flex 8.5FR Cover Biopsy Adapter Reusable 14, 15, 16, Utra-Pro II Acetal 17, 18, 20, 4, 5.5, 7 LA2-9A BP-KIT-043 Needle Guides Copolymer 21, 22, 23, (cm) Disposable & CIV-Flex 8.5FR Cover Biopsy Adapter Reusable 0.591, BP-KIT-053 Acetal 16, 18, 20, LA3-14AD 0.984, 1.575 Needle Guide & [BP-KIT-053-NG] Copolymer Disposable 22 (in) Probe Cover Biopsy Adapter Reusable 0.591, BP-KIT-068 Acetal 16, 18, 20, 0.984, 1.575 [BP-KIT-068-NG] Needle Guide & Copolymer 22 Disposable (in) Probe Cover LA3-16A Biopsy Adapter Reusable 0.591, BP-KIT-055 Acetal 16, 18, 20, 0.984, 1.575 Needle Guide & [BP-KIT-055-NG] Copolymer Disposable 22 (in) Probe Cover Biopsy Adapter Reusable 1.969, 3.937, BP-KIT-058 Acetal 14, 16, 18, CA1-7AD 5.906, 7.874 Needle Guide & [BP-KIT-058-NG] Copolymer Disposable 20, 22, 25 (in) Probe Cover Biopsy Adapter Reusable 2.362, BP-KIT-054 Acetal 16, 18, 22, CA2-9AD 3.150, 3.937 Needle Guide & [BP-KIT-054-NG] Copolymer Disposable 25 (in) Probe Cover Single BP-KIT-065 Needle Guide Stainless Reusable 16–18 Angle 2° EA2-11B Single BP-KIT-066 Needle Guide Abs Disposable 16–18 Angle 2° 5-55

[Page 280] Biopsy Probe Adapter Reusable/ Needle Multi Angle Model Name Components Material Disposable Gauge Depth Single BP-KIT-024-3 Needle Guide Stainless Reusable 16 Angle 1° ER4-9 Single BP-KIT-061 Needle Guide Abs Disposable 16–18 Angle 1° Biopsy Adapter Reusable BP-KIT-059 Acetal 14, 16, 18, 1.969, 3.937 CV1-8AD Needle Guide & [BP-KIT-059-NG] Copolymer Disposable 20, 22, 25 (in) Probe Cover BP-KIT-029 Needle Guide Stainless Reusable 18 – V5-9 Single BP-KIT-060 Needle Guide ABS Disposable 16–18 Angle 1.8° Acetal BP-KIT-079 Needle Guide Disposable 16–18 2° Copolymer BP-KIT-080 Needle Guide Stainless Reusable 16–18 2° EA2-11AR Acetal BP-KIT-081 Needle Guide Disposable 16–18 1° Copolymer BP-KIT-082 Needle Guide Stainless Reusable 16–18 1° 5-56

[Page 281] Cleaning and Disinfecting Biopsy Kits Reusable biopsy adapters must be cleaned and disinfected after each use. Disposable biopsy adapters and disposable biopsy kit parts must be disposed of as medical waste after each use. Cleaning is an important procedure that must be carried out before disinfecting or sterilizing reusable biopsy adapters. Read the biopsy kit user manual carefully before cleaning and disinfecting. WARNING: Always wear a protective face mask and gloves when cleaning and disinfecting biopsy kits. CAUTION: Disinfect to reduce pathogens to the level of 10 -6 .
Cleaning Biopsy Kits 1. After use, remove the biopsy kit from the probe. 2. Disassemble the biopsy kit into its component parts and discard the disposable parts in the medical waste bin. 3. Rinse with water to remove excess dust from the device. 4. Prepare an enzymatic solution (e.g. Enzol), following the manufacturer‘s instructions for proper dilution and immersion duration. Immerse the parts in the detergent and allow soaking for the prescribed time. 5. Brush the parts thoroughly using a soft bristle brush. Clean the inside using an appropriate sized brush. If any visible parts remain, continue brushing until clean. 6. Rinse the device thoroughly with water and dry the components. Dispose of the used drying cloths appropriately according to the local medical waste regulations. 5-57

[Page 282]
Disinfecting Biopsy Kits For the correct use, storage, and disposal of the disinfectant, please refer to the user manual for the disinfectant. X ‹ Always refer to the biopsy kit user manual for the latest information on the supported methods and disinfectants. X ‹ A stainless steel biopsy adapter is reusable; a plastic biopsy adapter may be reusable in some cases. In general, a plastic biopsy needle guide is disposable. X ‹ Plastic biopsy kits can only be disinfected by using a chemically compatible cold- disinfectant, either manually or with a medical washer-disinfector. Do not use an autoclave, gas or radiation. 1. Re-assemble the reusable parts of the biopsy adapter, if applicable. 2. Disinfect the biopsy adapter for the duration and at the temperature as specified in the user instructions for the adapter. 3. After disinfection, follow the proper post-disinfection procedure for the disinfection method used (Please refer to the user manuals for the disinfectant, disinfecting equipment, etc.). 4. Inspect the components for damage such as cracks, rust, or breakage; and if damage is found, stop using the device and contact Samsung Medison’s Customer Support Department. 5. Properly pack up the disinfected adapter and label it according to local regulations.
Sterilizing Stainless Steel Biopsy Kits 1. Reassemble the reusable parts of the stainless steel biopsy adapter, if applicable. 2. Sterilize the stainless steel adapter by using steam (autoclave) or gas (Ethylene Oxide). 3. After sterilization, follow the proper post-sterilization procedure for the sterilization method used (Please refer to the user manual for the sterilization equipment). 4. Inspect the components for damage such as cracks, rust, or breakage; and if damage is found, stop using the device and contact Samsung Medison’s Customer Support Department. 5. Properly pack up the sterilized adapter and label it according to local regulations. 5-58

[Page 283] Starting Modes of Chapter 6 Operation ‹ ‹ System Power 6-3 Turning the Power On 6-3 Shutting Down the System 6-4 ‹ ‹ Probes and Applications 6-5 Selecting Probes and Applications 6-6 Creating UserPreset 6-6 Modifying UserPreset 6-6 Deleting UserPreset 6-6 ‹ ‹ Patient Information 6-7 Patient Information for Each Application 6-11 Searching Patient Information 6-18

[Page 284]

[Page 285] System Power Boot up the system for use. X ‹ Installation and initial operation of the product must be performed by trained professionals only. X ‹ Avoid pressing buttons on the control panel or make sure that none of the buttons are being pressed while the system is booting, and connect the probe and all the peripheral devices to be used before powering up the system. X ‹ If you attempt to connect them while the system is in use, it may lead to patient injury or irreparable damage to the product. NOTE: Please read the safety information before using this product. Turning the Power On Press the On/Off button when the power is off. Booting begins, and the product logo appears on the screen. When booting is completed, the 2D mode screen appears in End Exam status. CAUTION: Before starting the diagnosis, you must register the patient information. X ‹ The product should turn on about 10 seconds after the power switch at the back of the product is turned on. X ‹ During system booting, do not press any key on the keyboard. It may cause product malfunction. X ‹ If you turn on the power after turning it off suddenly, the system may turn on and off momentarily. This is one of the characteristics of the Intel PC main board, not a system error. 6-3

[Page 286] Shutting Down the System Press the On/Off button while using the system to initiate shutdown. X ‹ When the system is not turned off, holding down the On/Off button for five seconds or longer forces the product to power off. X ‹ If the ultrasound system is unplugged while working or turned off by forcibly shutting down, the files may get corrupted and it may result in system down or data loss. X ‹ To ensure that the product is safely cut off from electrical power, set the power switch at the rear of the product to Off position after using the product. NOTE: Once turned off, please wait at least 15 seconds before turning back on. 6-4

[Page 287] Probes and Applications Before scanning, select a probe and an application. CAUTION: Refer to ‘Chapter 5. Probes’ for more information on probes and applications supported by the system.
Probe Selection Screen Press the Probe button on the Touchscreen to load the Probe Selection screen. In this screen, you can select/change probe or application you want to use and change the probe presets. The Probe Selection screen is divided into four lists. 1 Probe list: Displays a list of probes currently connected to the system. 2 Application list: Displays a list of applications the selected probe supports. 3 Preset list: Displays a list of presets the selected application supports. 4 UserPreset list: Displays a list of presets you can configure according to your preferences. [Figure 6.1 Probe Selection] 6-5

[Page 288] Selecting Probes and Applications The selected probe, preset, or userpreset appear in the screen area of the monitor screen. 1. Select the items in the following order: Probe → Application → Preset/UserPreset. 2. When you select Preset/UserPreset, the system automatically applies your selections and switches to Operation mode. 3. Press the Probe button to cancel. Creating UserPreset 1. Tap + on the touchscreen to create a UserPreset. 2. The Preset Setup window will open. 3. Enter the name you want to use and tap Save . Tap Close to cancel. Modifying UserPreset 1. Enter the Preset Setup by tapping Preset Setup on the touchscreen. 2. Select a Preset to rename and press Rename . 3. The Preset Setup window will open. 4. In the Preset Setup window, enter a new Preset name and press Save . To cancel it, tap Close . Deleting UserPreset 1. Enter the Preset Setup by tapping Preset Setup on the touchscreen. 2. Select a Preset to delete and press Delete . 3. The Preset Setup window will open. 4. Tap Delete to delete the UserPreset. Tap Close to cancel it. 6-6

[Page 289] Patient Information Press the Patient button on the control panel and the Patient Information screen will appear. In this screen, you can enter, search, or change patient information. Patient information includes basic information such as the patient ID, name, DOB, and gender, as well as additional information for applications. NOTE: ID is required information.
Basic Patient Information Entry Enter or change general patient information in General Information . Use the trackball to move the pointer to the desired entry field. Tap a button on the touchscreen to enter information using the touchscreen. When you are done entering information, click OK on the screen or tap OK on the touchscreen to save. Click Cancel or tap Cancel on the touchscreen to cancel. 6-7

[Page 290] [Figure 6.2 General Patient Information] [Figure 6.3 General Patient Information – Touchscreen] 6-8

[Page 291] „ ‹ Patient ID Enter a patient ID. „ ‹ Last Name Enter the patient’s last name. „ ‹ First Name Enter the patient’s first name. „ ‹ Middle Name Enter the patient’s middle name. NOTE: The name that you have entered will appear in the title area and reports. „ ‹ Date of Birth (Age) Enter the patient’s date of birth in the specified format. „ ‹ Gender Select the patient’s gender. „ ‹ Accession Number When viewing the worklist for a patient via the DICOM server, this information is automatically displayed in the appropriate fields. „ ‹ Diag. Physician Enter the name of the physician who diagnosed the patient. „ ‹ Ref. Physician Enter the name of the referring physician. „ ‹ Operator Enter the name of the operator who scanned the patient. Up to 20 persons may be entered. 6-9

[Page 292] „ ‹ Search Search through the information stored in the system. „ ‹ Worklist Perform a search by connecting to the DICOM Modality Worklist server in the hospital network. „ ‹ New Patient Enter new patient information. „ ‹ Auto ID Creation Create temporary patient information using a temporary ID. „ ‹ Keyboard Use the keyboard displayed on the touchscreen to enter text. „ ‹ Start EZ‑Exam+ This function helps you to link an exam with EZ - Exam+ when the exam starts. „ ‹ DICOM Destination Sends the saved images to the DICOM server when an exam ends. Select DICOM destination and press the Set button. You can choose a location from Group 1 to Group 10, and change the group name as well. „ ‹ RIS Browser Moves you to a Web Browser. X ‹ Please contact a service engineer for more information about the RIS Browser URL settings. X ‹ Samsung Medison shall not be responsible for any damage to the product if you have used RIS Browser for anything other than its intended purposes (e.g., accessing inappropriate websites). 6-10

[Page 293] Patient Information for Each Application In Study Information, enter additional patient information or change the existing patient information for each application. 1. Use Application on the monitor to select an application. 2. Enter additional information required for diagnosis.
OB Select OB from Application . Enter the additional obstetrical information. „ ‹ LMP Enter the last menstrual period for a patient. „ ‹ DOC Indicates the patient’s date of conception. „ ‹ EDD Indicates the patient’s expected date of delivery. „ ‹ GA (LMP) Indicates the gestational age of a patient. „ ‹ Ovulation Date Enter expected ovulation date in accordance with defined format „ ‹ Day of Cycle Enter length of menstrual cycle in days (Date). 6-11

[Page 294] „ ‹ Fetuses No. Enter the number of fetuses. Up to four may be entered. „ ‹ Gravida Enter the number of pregnancies. „ ‹ Para Enter the number of deliveries. „ ‹ Aborta Enter the number of miscarriages. „ ‹ Ectopic Enter the number of ectopic pregnancies. „ ‹ Description Enter a description of the diagnosis. X ‹ Refer to ‘Chapter 3. Utilities’ Setup > System > Patient > User Defined List . X ‹ Up to 20 persons may be entered per application. [Figure 6.4 Study Information – OB] 6-12

[Page 295]
GYN Select GYN from Application . Enter additional information for Gyn. This is the same information as for OB. [Figure 6.5 Study Information – GYN]
Urology Select Urology from Application . Enter urological information. „ ‹ PSA Enter the Prostate Specific Antigen (PSA) value. „ ‹ PPSA Coefficient 1 Enter predicted PSA coefficient 1. „ ‹ PPSA Coefficient 2 Enter predicted PSA coefficient 2. [Figure 6.6 Study Information – Urology] 6-13

[Page 296]
Vascular Select Vascular from Application . Enter vascular-related information. „ ‹ Left Systole Enter left systole blood pressure. „ ‹ Left Diastole Enter left diastole blood pressure. „ ‹ Right Systole Enter right systole blood pressure. „ ‹ Right Diastole Enter right diastole blood pressure. [Figure 6.7 Study Information – Vascular] 6-14

[Page 297]
Abdomen Select Abdomen from Application . [Figure 6.8 Study Information – Abdomen] „ ‹ Height Enter the patient’s height. Enter height in cm, ft, or in. „ ‹ Weight Enter the patient’s weight. Enter weight in kg, lb, or oz.
MSK Select MSK from Application . [Figure 6.9 Study Information – MSK] 6-15

[Page 298]
Pediatric Select Pediatric from Application . [Figure 6.10 Study Information – Pediatric]
Small Parts Select Small Parts from Application . [Figure 6.11 Study Information – Small Parts] 6-16

[Page 299]
Cardiac Select Cardiac in Application . [Figure 6.12 Study Information – Cardiac] „ ‹ Height Enter the patient’s height in cm, ft and in. „ ‹ Weight Enter the patient’s body weight in kg, lb and oz. „ ‹ BSA When the height and weight are entered, the BSA (Body Surface Area) is automatically calculated and displayed. 6-17

[Page 300] Searching Patient Information
Search Search through the information stored in the system. [Figure 6.13 Search] 1. When a search term is entered in the search field, the list of patients who match the criteria will be displayed. Click the Search By button to search patients by condition. 2. Double click a list where a desirable patient list is selected. The selected patient information will be applied to the system. „ ‹ Show/Hide Show/Hide buttons or lists in the search area. „ ‹ Search by User can enter a search criteria. 6-18

[Page 301] „ ‹ Exam List Show the exam list for a patient selected from the patient list. [Figure 6.14 Exam List] „ ‹ Back to Search Return to the search area. 6-19

[Page 302] „ ‹ Review Images Show the image of a selected exam on Review Images screen. 2 4 5 [Figure 6.15 Review Images] 1 Continue Exam: This is activated when an exam that is less than 24 hours old is selected. The page moves to 2D image screen of the selected exam. 2 Hide Annotation: Hide any annotations made to an image. 3 View Scale: Set the image size for review. Select either the Small , Mid , or Large buttons. 4 Favorite: Add/remove a selected image from Favorites. 5 Select/Deselect All: Select/deselect all images regardless of the exam date. 6-20

[Page 303] „ ‹ SonoView You can review a selected exam from SonoView. „ ‹ Review Exam The exams that were performed more than 24 hours before present, and their images, are displayed. When an exam is selected, the button is activated. When enabled, you can continue to view the exam images. „ ‹ Continue Exam Exams that were performed more than 24 hours ago can be edited. When an exam is selected, the button is activated. You can use this button to go to the edit exam page. „ ‹ EzCompare Press this button to view dual image of a selected exam image and a live scan image currently filming. „ ‹ Send Send images to the DICOM server. „ ‹ Delete Delete the exam. 6-21

[Page 304]
Worklist Search Perform a search by connecting to the DICOM Modality Worklist server in the hospital network. NOTE: A worklist search is available only when DICOM is enabled. You can select the worklist server in Setup > Connectivity > DICOM . Refer to the ‘DICOM Settings’ section of ‘Chapter 3. Utilities’ 1. Select Worklist from Patient on the monitor or touchscreen. 2. After entering at least one item out of Patient ID, Last Name, Worklist Number (Accession Number), Procedure ID, Exam Date, and/or name of the equipment being used for exam (AE Title), click Search . The list of patients who match the criteria will be displayed. X ‹ Clicking items such as Date/Time or Patient Name sorts entries into alphabetical or numerical order for the selected criteria. X ‹ Select Today, Last Week, Last Month, or Manual as Exam Date. X ‹ After running a search, the date of the last update is displayed in the bottom right corner. 3. Double click on the desired patient list. This applies the selected patient information to the system. [Figure 6.16 Search – Worklist] 6-22

[Page 305] Modes of Chapter 7 Operation ‹ ‹ Information 7-3 Types of Modes 7-3 Basic Use 7-5 ‹ ‹ Basic Mode 7-8 2D Mode 7-8 S-Detect 7-24 M Mode 7-34 Color Doppler Mode 7-37 Power Doppler Mode 7-42 PW Spectral Doppler Mode 7-44 CW Spectral Doppler Mode 7-50 TDI Mode 7-52 TDW Mode 7-53 ElastoScan Mode 7-54 ‹ ‹ Combined Mode 7-62 2D/C/PW Mode 7-62 2D/PD/PW Mode 7-62 2D/C/CW Mode 7-62 2D/C/M Mode 7-62 2D/TDI/TDW Mode 7-63 Dual Live Mode 7-63

[Page 306] Chapter 7 ‹ ‹ Multi-Image Mode 7-64 Dual Mode 7-64 Quad Mode 7-65 ‹ ‹ 3D/4D Mode 7-66 3D Stand By 7-74 3D View – MPR 7-78 Orientation Dot 7-88 Render Setup 7-88 VOCAL 7-92 3D XI 7-99 XI VOCAL 7-109 XI STIC 7-116 3D MXI 7-120 Realistic Vue 7-131 Crystal Vue 7-132 Chroma 7-134 Preset 7-135 5D NT 7-136 5D Follicle 7-139 5D Heart Color 7-142

[Page 307] Information Types of Modes This product supports a variety of Operation modes including Basic Mode, Combined Mode, Multi-Image Mode, and 3D/4D Mode. X ‹ Basic Mode: Consists of different modes, each of which has a specific usage and function. By default, 2D Mode is applied together with another mode. X ‹ Combined Mode: For an image, two or three Basic Modes are applied at the same time. By default, 2D Mode is applied together with another mode. An image is viewed in a single screen. X ‹ Multi-Image Mode: The screen is divided into two (dual) or four (quad) sub screens, each of which is used to view an image. Since each sub screen can display a different image, it can be a very useful feature, allowing multilateral views of an organ. X ‹ 3D/4D Mode: 3D and 4D images can be obtained. 7-3

[Page 308] The types of Operation mode that are available with the product are shown below: Mode Type 2D Mode Color Doppler Mode Power Doppler Mode M Mode Basic Mode PW Spectral Doppler Mode CW Spectral Doppler Mode TDI (Tissue Doppler Imaging) Mode TDW (Tissue Doppler Wave) Mode ElastoScan Mode 2D/C/PW Mode 2D/PD/PW Mode 2D/C/CW Mode Combined Mode 2D/PD/CW Mode 2D/C/M Mode 2D/TDI/TDW Mode Dual Live Mode Dual Mode Multi-Image Mode Quad Mode Freehand 3D Mode 3D/4D Mode 3D Mode 4D Mode NOTE: The functionalities for each mode may be restricted by the selected probe. 7-4

[Page 309] Basic Use The items that are commonly used in each Operation mode are shown below:
Using the Control Panel The items that can be used in each Operation mode are provided as menu items. You can change the image format or optimize an image to facilitate your diagnosis. „ ‹ Gain Use the dial-button on the control panel. The Gain button appears differently depending on the Operation mode, but it is usually in the form of a dial-button used to select an Operation mode. You can adjust the brightness of an image. If you rotate the Gain dial-button clockwise, its value increases. „ ‹ TGC (Time Gain Compensation) Tap the TGC button on the touchscreen to open the TGC window for use. In general, ultrasound penetration gets weaker with depth. TGC can be used to compensate for this effect. The product provides eight TGC sliders for varying depths, allowing you to adjust Gain by area. Among the eight sliders, the top slider represents the shallowest area, while the lower sliders represent the deeper ones. Move the slider to the right to increase Gain, brightening the image. When the TGC preset is selected, the TGC preset is applied to the system and then the system is switched to Operation mode. The user can adjust TGC as needed, and press Save to save it for use. „ ‹ Focus Use the Focus switch on the control panel to adjust the location of the focus. „ ‹ Depth Use the Depth switch on the control panel to adjust the image scanning depth. The allowable range for adjustment varies depending on the probe type. 7-5

[Page 310] „ ‹ Zoom Use the Zoom dial-button on the control panel. You can magnify an image. An image can be magnified by either Read Zoom or Write Zoom. X ‹ Read Zoom: This function is used for zooming in on images that are stored on the hard disk. 1. Rotate the Zoom dial-button on the control panel. 2. Adjust the position of the zoomed-in screen with the trackball. 3. Observe the magnified image. X ‹ Write Zoom: This function allows you to magnify and scan an image in real time. 1. Press the Zoom dial-button on the control panel. The Write Zoom box will appear on the screen. 2. Use the Change button to move and resize the Zoom box. 3. To finish Zoom mode, press the Zoom dial-button once again. Or press the Exit button on the control panel. „ ‹ Quick Scan Use the Q Scan button on the control panel. The ‘Q Scan’ mark will appear at the top of an image. In 2D Mode, it is used to optimize the contrast and brightness of an image by adjusting Gain and TGC automatically. In PW Spectral Doppler Mode, it is used to optimize the spectrum by adjusting Scale and Baseline automatically. To finish QuickScan mode, press the Exit button on the control panel. NOTE: The Quick Scan function is available in all probes' applications. 7-6

[Page 311]
Using Touchscreen Menus The items that can be used in each Operation mode are provided as touchscreen menu items. You can change the image format or optimize an image to facilitate your diagnosis. 1. In Operation modes, the menu for the Operation mode currently being used is displayed on the touchscreen. In a combined mode that uses more than one Operation mode, tap the relevant tab on the touchscreen to specify settings for each mode. 2. Select a value by pressing a button or by rotating the dial-button on the control panel. 7-7

[Page 312] Basic Mode 2D Mode This basic mode, also referred to as B Mode (Brightness mode), provides scan planes of organs. This is used to display two-dimensional anatomy images in the direction of scanning in real time.
Entering 2D Mode Press the 2D dial-button on the control panel. If you press the 2D dial-button in other Operation modes, it will switch to the basic 2D Mode. NOTE: Because 2D Mode is applied by default for all Operation modes, it cannot be terminated.
2D Mode Menu [Figure 7.1 2D Mode – Touchscreen] 7-8

[Page 313] „ ‹ Harmonic Turn this function on or off by tapping Harmonic on the touchscreen. The image information will show the ‘Har’ mark . This product provides the OHI (Optimal Harmonic Imaging) high frequency function to optimize images. NOTE: The Harmonic function only works with certain probes. „ ‹ Frequency Tap Frequency on the touchscreen. This enables you to configure the probe’s frequency. The selected frequency is displayed in the image area of the monitor, allowing you to easily determine the state of the current frequency. X ‹ Res2 (Resolution): The highest frequency X ‹ Res1 (Resolution): High frequency X ‹ Gen (General): General frequency X ‹ Pen1 (Penetration): Low frequency X ‹ Pen2 (Penetration): The lowest frequency „ ‹ Line Density Tap Line Density on the touchscreen. Set the scan line density. Select Low, Med, or High by tapping the button. Selecting High increases the number of scan lines and improves the image resolution. However, the frame rate is reduced. „ ‹ L/R Flip (Left/Right Flip) Tap L/R Flip on the touchscreen. Pressing this button flips the image horizontally (Left/Right Flip). The direction marker on the top of the image indicates the orientation of the current image. 7-9

[Page 314] „ ‹ S-Harmonic Turn this function on or off by tapping S-Harmonic on the touchscreen. The ‘S-HAR’ mark will be displayed in the Image Information. Tap the S-Harmonic button on the touchscreen. S-Harmonic inverts the pulses to sharpen the displayed image. If it is On, the phrase ‘S-Harmonic’ will be shown in the image information. X ‹ The Harmonic and S-Harmonic functions are only available for specific probes. X ‹ S-Harmonic function may show lines in the near field of certain probes when non-scan mode is used. This is due to the technical features that improve the sensitivity and resolution of the ultrasound images and does not cause any problems in scan mode. „ ‹ ClearVision Tap ClearVision on the touchscreen. When turned on, ClearVision removes noise from the image and enhances outlines to help show the image more clearly. The ‘ClearVision’ mark will be displayed in the Image Information. Tap the touchscreen button to select an Index from 1 to 5. Select Off to turn off the feature. „ ‹ HQ Vision Press HQ Vision on the touchscreen to turn it on or off. The HQ Vision mark will be displayed in the Image Information. HQ Vision improves the definition and quality of images. Select an Index using the button on the touchscreen. X ‹ HQ Vision is an optional feature of the HS60/XH60. X ‹ HQ Vision is available in 2D Mode and 2D/C Mode, and also in Write Zoom state. 7-10

[Page 315] „ ‹ Biopsy Guide Tap Biopsy Guide on the touchscreen. NOTE: Make sure to adjust the biopsy guideline before using the biopsy feature. [Figure 7.2 Biopsy Guide] Setting the Biopsy Guideline X ‹ If the system is rebooted, the biopsy guideline settings are restored to the default. X ‹ Make sure to adjust the biopsy guideline before using the biopsy feature. X ‹ Support for Multiple Guidelines If the probe supports multiple biopsy angles, the user may select the biopsy guide angle as desired. X ‹ Starting and Finishing a Biopsy 1. Tap Biopsy Guide on the touchscreen. 2. Insert the needle along the guideline. And then perform the biopsy as desired. 3. When all procedures are complete, tap Biopsy Guide again to turn this Off. Biopsy will end. 7-11

[Page 316] Biopsy Guide Edit Mode X ‹ Only available in 2D mode and Single mode. X ‹ Not available in Dual Live or Freeze state. X ‹ Not available in Write Zoom or Read Zoom state. X ‹ Starting and Ending Biopsy Guide Edit Mode 1. Tap Biopsy Guide on the touchscreen. 2. Use the Angle dial-button on the control panel to enter Biopsy Guide Edit mode. 3. When you enter Biopsy Guide Edit mode, Angle Offset appears. 4. Rotate the Angle dial-button to select Angle Offset or Lateral Offset. – Angle Offset: This is the angle for the currently selected biopsy guide; the maximum adjustable offset is the guideline’s outer line angle. Adjustments can be made in 0.1° increments. – Lateral Offset: This is the lateral direction for the currently selected biopsy guide. Adjustments can be made in 0.1 mm increments. 5. Press the Angle dial-button to exit Biopsy Guide Edit mode. „ ‹ U/D Flip (Up/Down Flip) Tap U/D Flip on the touchscreen. Each press of the button flips the image vertically. „ ‹ Dual Live Tap Dual Live on the touchscreen and select On or Off. View the 2D/Color Doppler images of the scanned area simultaneously in real time. When viewing Cine images in Dual Live mode, various settings are applied only to the Cine image on the right side, allowing you to compare it with the unaffected Cine image on the left side. 7-12

[Page 317] „ ‹ MultiVision Tap MultiVision on the touchscreen. MultiVision uses a multi-beam to improve the image quality displayed on the screen. When this feature is turned on, the ‘MultiVision’ mark will be displayed in the image information. Tap the button on the touchscreen to set MultiVision to Low, Med, or High. Note that MultiVision can only be set to Low in 2D/C Mode. Select Off to turn off the feature. NOTE: This feature only works with certain probes. For more information, refer to ‘Probe List’ in ‘Chapter 5. Probes’. „ ‹ Trapezoid Tap Trapezoidal on the touchscreen to turn it on or off. The rectangular frame provided by a Linear Probe is changed to a trapezoidal shape. This allows a wider view of an image. NOTE: Trapezoid function only works with Linear probes. „ ‹ 2D NT You can use the ROI box to measure the NT more easily. Press the 2D NT button on the touchscreen to select On or Off. Press the Switch button to adjust the size of the ROI box, and then use the trackball to move the ROI box. At a desired position, press the Set button on the control panel to display the measurement value on the left side of the screen. If you want to measure a different location after an initial measurement, press the Set button on the control panel to finish the current measurement and then press the Set button again. Press the Reset button on the touchscreen to remeasure the NT. Press the Exit button on the touchscreen or press it on the control panel, or press the 2D button on the control panel to exit 2D NT. 7-13

[Page 318] X ‹ 2D NT is enabled under the following conditions: – 2D Freeze Mode – Measurement Item: OB X ‹ While conducting 2D NT, changing the image, such as by using Zoom, is not possible. X ‹ The 2D NT measurements will be saved and displayed in the report. CAUTION: The measurement value may have a margin of error of ±5%. „ ‹ Rotation Tap Rotation on the touchscreen to rotate a 2D image. Select a rotation angle to among 0°, 90°, 180°, and 270°. „ ‹ ElastoScan Tap ElastoScan on the touchscreen. For more information, please refer to ‘ElastoScan Mode’ in this chapter. X ‹ ElastoScan is an optional feature of this product. X ‹ This feature only works with certain probes. For more information, refer to ‘Probe List’ in ‘Chapter 5. Probes’. „ ‹ Panoramic Tap Panoramic on the touchscreen. For more information, please refer to ‘Panoramic’ in this chapter. X ‹ Panoramic is an optional feature of this product. X ‹ This feature only works with certain probes. For more information, refer to ‘Probe List’ in ‘Chapter 5. Probes’. 7-14

[Page 319] „ ‹ NeedleMate+ Tap NeedleMate+ on the touchscreen. NeedleMate+ is a feature that helps visualize the biopsy needle clearly in an ultrasound image. Choose the direction to optimize the image between From Left and From Right. Select Off to turn off the feature. From Left From Right From the upper left to lower right or From the upper right to lower left or Description from the lower right to upper left. from the lower left to upper right. Select this if the needle is being Select this if the needle is being inserted from the upper left to lower inserted from the upper right to lower Purpose right or from the lower right to upper left or from the lower left to upper left. right. When turned on, Needle Enhance and Needle Angle are enabled. X ‹ NeedleMate+ is an optional feature of this product. X ‹ This feature only works with certain probes. For more information, refer to ‘Probe List’ in ‘Chapter 5. Probes’. „ ‹ Needle Enhance This feature only works when NeedleMate+ is on. Select 1, 2, 3, or 4 by tapping the button on the touchscreen to select the degree of needle enhancement. X ‹ 1: The needle is thin with weak enhancement. X ‹ 2: The needle is thin with strong enhancement. X ‹ 3: The needle is thick with weak enhancement. X ‹ 4: The needle is thick with strong enhancement. „ ‹ Needle Angle Sets the entry angle of the biopsy needle in images. Tap this button on the touchscreen to select Shallow, Medium, or Steep. 7-15

[Page 320] „ ‹ DR (Dynamic Range) Select a value from 30 to 256 by using the DR dial-button on the touchscreen. TheDynamic Range function adjusts contrast by changing the ratio of the minimum and maximum values of the input signals. When this value increases, the image is displayed more smoothly. „ ‹ Frame Average Tap the Frame Average dial-button on the touchscreen. Select a value from 0 to 9 by using the dial-button on the touchscreen. Use this to minimize the appearance of speckles in updated images when the same location is scanned repeatedly. „ ‹ Focus Number Change the number of focus points at the target location you wish to study. Select a value from 1 to 4 by using the dial-button on the touchscreen. „ ‹ Reject Use the Reject dial-button on the touchscreen to select a value from 0 to 30. This function is used to eliminate noise or low level echo for clearer signals. „ ‹ Image Size Select a value from 70 to 100 by tapping the Image Size button on the touchscreen. Used to specify 2D image size. „ ‹ Gray Map Select a value from 1 to 12 by tapping the Gray Map dial-button on the touchscreen. This changes the 2D Post Curve. „ ‹ Chroma Map Use the Chroma Map dial-button on the touchscreen to select either Off or a value from 1 to 11. 7-16

[Page 321] „ ‹ Edge Enhance Allows you to view more accurate images of organ or tissue boundaries. A higher value provides more accurate images of boundaries. Select a value from -3 to 3 by tapping the touchscreen button or using the Soft Menu dial- button on the control panel. „ ‹ Power Use the Power dial-button on the touchscreen to select a value from 2 to 100 for the power of the ultrasound output. „ ‹ Scan Area Use the Scan Area dial-button on the touchscreen to select a value from 40 to 100 as the image width (%). Increasing the image width reduces the frame rate. You may also press the Change button on the control panel to change the trackball state to ROI Size and then use the trackball to adjust the view area. „ ‹ Steer Angle You can adjust the angle of the ultrasound beam without moving the probe by using the Steer Angle dial-button. NOTE: The Steer function only appears on the soft menu when a linear probe is used. „ ‹ Free Angle Plane You can adjust the ScanHead of the 3D probe to a desired angle by using the dial-button. 7-17

[Page 322]
CEUS+ This mode is used for imaging the contrasting effect within blood vessels by infusing an ultrasound contrast agent. X ‹ CEUS+ is supported in all countries except the USA. X ‹ CEUS+ is an optional feature of HS60/XH60. [Figure 7.3 CEUS+ – Touchscreen] Tap CEUS+ on the touchscreen to select on or off. When ‘On’ is selected, the touchscreen is switched to the CEUS + screen. CEUS+ Mode X ‹ CEUS stands for Contrast Enhanced Ultrasound, and aids the diagnosis by enhancing the contrast on the ultrasound image. X ‹ When entering CEUS+ mode, Dual mode is displayed by default. X ‹ Functions such as Harmonic and S-Harmonic are not available. 7-18

[Page 323] „ ‹ Timer 1/Timer 2 Starts or resets the timer. Press the button to start the timer. When the button is re-tapped, the timer stops and the time is reset. If you don’t tap the button again, the timer will keep running even when the CEUS+ On/Off state is changed. „ ‹ Dual Live Tap Dual Live on the touchscreen and select On or Off. When ‘On’ is selected, Dual Live mode is activated to display both Contrast and 2D images side-by-side. When ‘Off’ is selected, Single mode is activated. „ ‹ Ref. Line This option displays the Ref. Line on an image. Select On or Off by tapping Ref. Line on the touchscreen. The Ref. Line in CEUS+ mode is used to indicate the same location on the Agent and Tissue images in Dual Live mode. „ ‹ Contrast Select a CEUS+ type. Tap the button on the touchscreen to select either Contrast or 2D. X ‹ Contrast: It displays contrast-applied images. X ‹ 2D: Displays image in 2D Mode. „ ‹ Flash Tap the button on the touchscreen and select On or Off. For the defined frames in Frame , brighter images are produced. „ ‹ Flash Frame Set a value from 3 to 100 frames to specify the period of time during which the Flash function will operate. „ ‹ MI Control Select a value for the mechanical index by tapping the touchscreen button or by using the Soft Menu dial-button on the control panel. 7-19

[Page 324] „ ‹ Frame Average Frame Avg averages the present image and the previous image when an image is updated. Select a value from 0 to 9 by tapping the touchscreen button or using the Soft Menu dial- button on the control panel. „ ‹ Reject This function reduces noises or echoes from an image in order to make the image clearer. Select a value from 0 to 30 by tapping a button on the touchscreen or using the dial- button. „ ‹ Cine Play Play or stop Cine images. „ ‹ Trim Start After specifying the position of the first frame by rotating the dial-button or using the trackball, tap the dial-button to save it. „ ‹ Trim End After specifying the position of the last frame by rotating the dial-button or using the trackball, press the dial-button to save it. „ ‹ Cine Speed Rotate the dial-button to adjust the auto playback speed. „ ‹ Frame Limit Select the total frame rate. Press the button on the touchscreen or use the Soft Menu dial- button on the control panel to select a value from 2 to the maximum frame rate for the current scan mode. NOTE: For more information on other touchscreen items, refer to the ‘2D Mode’. (The setting values may vary depending on the selected probe type, application, and other settings.) 7-20

[Page 325]
Panoramic Panoramic Imaging is the function that acquires images over a wider range by using continuous ultrasonographic images. Up to 1,000 frames can be used. NOTE: This feature only works with certain probes. For more information, refer to ‘Probe List’ in ‘Chapter 5. Probes’. „ ‹ Acquiring a Panoramic Image 1. Tap Panoramic on the touchscreen. The touchscreen will be switched to the Panoramic Ready screen. 2. Tap Start/Stop on the touchscreen. The system will begin to acquire a panoramic image. 3. Press Start/Stop to finish acquiring the panoramic image. The touchscreen will switch to the Panoramic Review screen. Things to remember when acquiring a Panoramic image X ‹ When scanning a curved surface, ensure that the scan surface and the contact surface of the probe are always at right angles. X ‹ Moving in the opposite direction while acquiring an image erases the previously saved frames and saves new frames. X ‹ The image quality may deteriorate if the contact surface of the probe loses contact with the scan surface. X ‹ If the scan speed is fast or the angle of the contact surface of the probe changes, artifacts may occur. 7-21

[Page 326] „ ‹ Reviewing a Panoramic Image NOTE: L/R Flip , U/D Flip , and Zoom are available only when the Layout is set to Full Screen. [Figure 7.4 Panoramic Review – Touchscreen] X ‹ L/R Flip: Flip the panoramic image horizontally. X ‹ U/D Flip: Flip the panoramic image vertically. X ‹ Ruler: Press this button to turn this option on or off. When turned on, a ruler is displayed on the panoramic image. X ‹ Layout: Specify how the panoramic image will be displayed on the screen. – Full Screen: Display the panoramic image in full screen mode. – Up/Down: Display the 2D and panoramic images at the top and bottom of the screen, respectively. – Side by side: Display the 2D and panoramic images on the left and right of the screen, respectively. X ‹ Return: Return to the Panoramic Ready screen. X ‹ Tap the Panoramic button again on the touchscreen to exit Panoramic Imaging. 7-22

[Page 327]
BiometryAssist This obstetric diagnosis function helps you measure fetal growth indices (Measurement items: BPD, HC, AC, and FL). NOTE: BiometryAssist can only be executed in 2D Mode. „ ‹ Executing BiometryAssist When selecting BPD, HC, AC, or FL in 2D Mode, position the Caliper on the section of the screen that appears to correspond to the measurement position. Then the measured value will be displayed on the screen. Press the Set button to confirm the measured value displayed on the screen. Follow the BiometryAssist Operation Guideline to determine measurement positions more accurately. BiometryAssist Operation Guideline X ‹ Position the target at the center of the screen using Image Panning, not Rotation or Left/ Right Flip. X ‹ To determine measurement positions more easily, resize the target using Image Size or Zoom so that it takes up 40% to 80% of the screen, and then take a measurement. NOTE: You can configure the relevant settings in Setup > Measurement > Additional Options . X ‹ Select a measurement item from BPD , HC , AC , and FL to display the selected item on the screen. X ‹ The measurement standard for the BPD Method can be set to either Outer-Inner or Outer-Outer . 7-23

[Page 328] S-Detect S-Detect for Breast is the function to help ultrasound breast exams. It includes functionalities for selecting a lesion, dividing the area of a lesion, describing the characteristics of a lesion, and recommending the benignity and malignity of a lesion, which assist in the diagnosis process. X ‹ S-Detect for Breast is an optional feature of HS60/XH60. X ‹ S-Detect for Breast is not supported in Canada.
Run S-Detect for Breast Acquire an image in 2D Mode and press the Freeze button on the control panel. Press S-Detect on the touchscreen to open S-Detect for Breast. „ ‹ S-Detect for Breast Execution Conditions To execute S-Detect for Breast, the following conditions need to be met: X ‹ Preset: Breast X ‹ Operation mode: 2D (Freeze state) X ‹ Image Mode: Single Mode X ‹ Patient information has been entered Cases when S-Detect for Breast Cannot be Executed S-Detect for Breast cannot be executed in the following cases: X ‹ Zoom is currently on; X ‹ You have panned the image (2D Image Panning). 7-24

[Page 329]
S-Detect for Breast Screen The S-Detect for Breast screen is divided into the following four areas: [Figure 7.5 S-Detect for Breast] 1 Ultrasound image area Shows the study image that has been acquired in 2D Mode. 2 Position information area This displays information about the position of the test area and lesion size. The user can manually enter Position and Left/Right before or after taking measurements; Depth, Height, Width, and Area are automatically calculated when the contour of the lesion is extracted. X ‹ Position: Use the mouse to drag the point located in the center of the coordinates and specify the location on the breast from which the image has been acquired. X ‹ Left/Right: Choose the left or right breast. X ‹ Distance: Shows the distance from the center of the breast. X ‹ Angle: Shows the clockwise angle from the center of the breast. X ‹ Depth: Shows the depth from the skin surface to the location of the lesion. X ‹ Width: Shows the horizontal length of the lesion. X ‹ Height: Shows the vertical length of the lesion. X ‹ Area: Shows the area of the lesion. 7-25

[Page 330] 3 BI-RADS Lexicon Classification Area This area provides the BI-RADS Lexicon Classification for the lesion finally selected by the user. The auto determination result is displayed in blue and text will appear in yellow with an asterisk (*) if the user modifies the classification result. 4 BI-RADS Assessment Category Score S-Detect for Breast recommends the benignity or malignity of the lesion selected by the user; the user makes a final decision on the BI-RADS Assessment Category Score. Based on the determined BI-RADS Assessment Category Score, S-Detect for Breast provides the call text. Call Text You can choose not to display the call text on the screen to protect the patient. For more information, refer to Setup > Imaging > S-Detect in ‘Chapter 3. Utilities.’
S-Detect for Breast Measurement Use either Target Point or Target Ellipse to specify the area of the suspected lesion. Use the trackball and Set button on the control panel. NOTE: Target Point and Target Ellipse are not supported in China. „ ‹ Target Point Analyze the area of the suspected lesion based on the point specified by the user. „ ‹ Target Ellipse Analyze the area of the suspected lesion based on the ellipse specified by the user. The ellipse size can be adjusted by using the convert button on the control panel. „ ‹ Manual Contour Analyze the area of the suspected lesion by arbitrarily selecting a point. 7-26

[Page 331] „ ‹ Hide Contour Turns On or Off Hide Contour button on the touchscreen. When On is selected, the user defined area is not displayed on the screen. „ ‹ Distance Shows the length of a specific area that is included in the study image. „ ‹ Annotation You can enter text in the study image. „ ‹ Initialize Reset all results and re-specify the Seed Point or Seed Ellipse. „ ‹ Point Edit Contour Modifies the area of the suspected lesion based on the point specified by the user. „ ‹ Line Edit Contour Modifies the area of the suspected lesion based on the line specified by the user. NOTE: Length and annotation may be used before and after extracting the contour of the lesion. 7-27

[Page 332]
S-Detect for Breast Analysis „ ‹ Extracting the Area of the Lesion The contour of the area of the suspected lesion is extracted and up to 6 candidates are shown on the touchscreen. Each image shows the Shape, Orientation, and Risk of the lesion. The user may select one of the candidates as the final area of the lesion. NOTE: The area of the lesion is extracted differently depending on the Seed Point or Seed Ellipse entered by the user; in some circumstances, no area of lesion may be extracted. [Figure 7.6 S-Detect – Extracting Suspected Lesion] 7-28

[Page 333] „ ‹ Classification (BI-RADS Lexicon Classification) The area of the lesion selected by the user is analyzed and then the analysis items are ® ® displayed. Two types, BIRADS 2003 and BIRADS 2013, are provided, and each item is divided as follows: Lexicon Classification Description Note Shape Oval, Round, Irregular Orientation Parallel, Not Parallel Circumscribed, Indistinct, Angular, Margin Microlobulated, Spiculated Lesion Abrupt Interface, Echogenic Halo Boundary Posterior No Posterior Findings, Enhancement, Feature Shadowing, Combined Pattern Anechoic, Hyperechoic, Complex BIRADS ® Echo Pattern Echogenicity, Hypoechoic, Isoechoic 2003 Macrocalcifications, Micro. Out of Mass, Calcification Micro. In Mass Duct Changes, Cooper Ligament Chg., Surrounding Edema, Architectural Distortion, Skin Tissue Thickening, Skin Retraction Recommended Functions Excluded None, In Lesion, Adjacent To Lesion, Vascularity Diffuse Vascularity Clustered Microcysts, Complicated Cyst, Special Case Mass in or on Skin, Foreign Body, Intrama. Lymph Node, Axillay Lymph Node 7-29

[Page 334] Lexicon Classification Description Note Shape Oval, Round, Irregular Orientation Parallel, Not Parallel Circumscribed, Not Circumscribed, Margin Indistinct, Angular, Microlobulated, Spiculated Posterior No Posterior Features, Enhancement, Feature Shadowing, Combined Pattern Anechoic, Hyperechoic, Complex cystic Echo Pattern and solid, Hypoechoic, Isoechoic, Heterogeneous BIRADS ® 2013 Calcification In Mass, Outside Of Mass, Intraductal Architectural Distortion, Duct Changes, Skin Thickening, Skin Retraction, Edema, Associated Vascularity, Absent, Internal Vascularity, Features Vessels In Rim, Elasticity Assessment, Soft, Intermediate, Hard Recommended Functions Excluded Clustered Microcysts, Complicated Cyst, Mass in or on Skin, Foreign Body + Implants, Intrama. Lymph Nodes, Axillay Special Cases Lymph Nodes, Simple Cyst, Vascular Abnormalities, AVMs, Mondor Disease, Post-surg. Fluid Coll., Fat Necrosis 7-30

[Page 335] „ ‹ BI-RADS Assessment Category Score Recommends the benignity or malignity of the area of the lesion selected by the user. When the user selects a BI-RADS Assessment Category Score, call text is provided accordingly. BI-RADS ® Assessment Description Category Score 0 Analysis not possible (Unknown) 1 Negative Possibility of 2 Benign Benignancy 3 Probably benign 4a Low suspicion of Malignancy 4b Intermediate suspicion of malignancy Possibility of 4c Moderate concern, but not classic for malignancy Malignancy 5 Highly suggestive of malignancy 6 Known biopsy – proven malignancy X ‹ Classification items and BI-RADS ® Score functionality may be applied differently in certain regions. X ‹ In the USA, Lexicon Classification is supported by an automatic recommendation feature for the Shape and Orientation items, which can also be directly entered by the user. The other items under Lexicon Classification and the Assessment Category Score must be entered by users only. X ‹ In the United States, Canada, and China, the recommendation feature for the benignity or malignancy of a lesion is not supported. Modification of BI-RADS ® Lexicon Classification and BI-RADS ® Assessment Category Score The user may manually modify the BI-RADS ® Lexicon Classification items and the BI-RADS ® Assessment Category Score. X ‹ Modification of BI-RADS ® Lexicon Classification Select the title of each item on the monitor screen. Or press Classification on the touchscreen and select Classification for the item. X ‹ Modification of BI-RADS ® Assessment Category Score The BI-RADS Assessment Category Score at the bottom of the monitor is changed. When the Category Score is changed, the verdict also changes accordingly. 7-31

[Page 336]
S-Detect for Breast Sensitivity Setting This allows users to adjust the sensitivity and specificity levels for lesion analysis. This option can be selected in Setup > Imaging > S-Detect > S-Detect for Breast > Sensitivity Setting . X ‹ High Sensitivity: Increases the chance of detecting malignancy as its sensitivity is higher than that of the default mode (High Accuracy). X ‹ High Accuracy: This is the default mode. It can distinguish between benignity and malignancy more accurately than the High Sensitivity and High Specificity modes. X ‹ High Specificity: Increases the chance of detecting benignity as its specificity is higher than that of the default mode (High Accuracy). NOTE: The Sensitivity Setting is not supported in the USA, Canada, and China.
Displaying S-Detect for Breast Reports Once the area of the lesion selected by the user has been analyzed, press Assign on the touchscreen. Then, the analysis result is displayed as a patient report. The S-Detect for Breast analysis result is categorized as an S-Detect for Breast Report, which is a separate category in the report; the information included in the report is as follows: X ‹ Patient Information: The patient information entered by the user when the exam began X ‹ Position Information: Position, Distance, Angle, Depth, Height, Width, Area X ‹ BI-RADS Lexicon Version Information X ‹ BI-RADS Lexicon Classification X ‹ BI-RADS Score X ‹ S-Detect for Breast Screen Image X ‹ When displaying a report, the S-Detect for Breast screen image is automatically displayed. Once the area of the lesion selected by the user has been analyzed, press Assign on the touchscreen to display up to 10 reports (5 on the left and 5 on the right). X ‹ In each image, you can enter the location information (Left/Right) and description. 7-32

[Page 337] [Figure 7.7 S-Detect for Breast Report]
Closing S-Detect for Breast Press the Close button on the touchscreen to exit S-Detect. You may also exit S-Detect by disabling Freeze or by pressing the 2D Mode button on the control panel. 7-33

[Page 338] M Mode The M Mode is used to specify an observation area in a 2D image with the M Line, and display changes over time. This mode is appropriate for the observation of organs with a lot of movement, such as cardiac valves. The 2D Mode image is also shown, allowing the marking and adjustment of an observation area within the entire image. [Figure 7.8 M Mode – Touchscreen] 7-34

[Page 339]
Entering & Exiting M Mode „ ‹ Entering M Mode 1. Press the M dial-button on the control panel. 2. Configure settings relating to M image acquisition on the touchscreen. 3. Press the M dial-button again to enter M Mode and display the M image on the screen. „ ‹ Exiting M Mode Press the M dial-button while the M image is being displayed. You can also press the 2D dial-button to exit M Mode.
M Mode Screen „ ‹ M Line Use the trackball on the control panel to move the line to the right or left. The M Line indicates the relative position of the M Mode image in the 2D image. Therefore, you can move the M Line to change the observation area.
M Mode Menu „ ‹ Anatomical M Tap the Anatomical M dial-button on the touchscreen to turn it on or off. If it is ‘On’, position and angle of AMM Line can be adjusted. X ‹ AMM Angle: Use the touchscreen dial-button to rotate the cursor line for Anatomical M. You can select an angle from 0 to 179. NOTE: Available only with the phased array probe or the cardiac application. 7-35

[Page 340] „ ‹ Sweep Speed Tap Sweep Speed on the touchscreen. Allows the user to adjust the sweep speed so that he can view various spectrums in a screen. „ ‹ Display Format Tap Display Format on the touchscreen. Select either Up/Down, Side by Side, or M Only using the touchscreen button. „ ‹ Display Size Size can be selected among 30/70, 40/60, 50/50, 60/40 and 70/30 by pressing a corresponding button on the touchscreen. This option is not enabled if Display Format is set to M Only. „ ‹ M Mode Map Used to configure the post curve in M. Select a value from 1 to 12 by using the dial-button. „ ‹ Steer Angle Adjust the angle of the ultrasound beam. Steered M line can be selected by rotating Steer Angle dial-button. NOTE: The Steer function appears on the soft menu only when a linear probe is used. NOTE: For more information on other soft menu options and functions, refer to the ‘2D Mode’ section. 7-36

[Page 341] Color Doppler Mode This mode displays the colored blood flow pattern of the ROI (Region of Interest) within the 2D image. It is appropriate for examining the presence of blood flow, its average speed, and its direction. The 2D Mode image is also shown, allowing the marking and adjustment of the ROI within the entire image. [Figure 7.9 Color Doppler Mode – Touchscreen]
Entering & Exiting C Mode Press the Color dial-button on the control panel. Press this button again to exit Color Doppler mode and return to 2D mode. 7-37

[Page 342]
C Mode Screen „ ‹ ROI Box ROI stands for Region of Interest. The ROI Box outlines the area of the 2D image where color (blood flow) information is displayed in Color Doppler Mode. Use the Change button to reposition or resize the ROI box. Each time you press the Change button, the current state of the ROI box is displayed in the lower middle of the screen. X ‹ ROI Position: In this state, the position of the ROI box can be changed. Use the trackball to move and position the ROI Box. X ‹ ROI Size: In this state, the size of the ROI box can be changed. Use the trackball to move the ROI Box and specify its size. „ ‹ Color Bar In Color Doppler mode, the color bar indicates the direction and speed of blood flow. Based on the Baseline at the middle, red indicates the direction and speed of blood flow toward the probe. By contrast, the blue color indicates the direction and speed of blood flow away from the probe. Adjusting the color bar baseline: Use the Baseline dial-button on the touchscreen. If you rotate the Baseline dial-button clockwise, the baseline on the color bar rises.
C Mode Menu „ ‹ Hide Color Select C mode to use. If you tap Hide Color on the touchscreen, the Color mode image will not be displayed in the Color ROI area, and only the B mode image will be displayed. Tap this button again to cancel the selection and return to Color + B/W mode. „ ‹ Frequency Tap Frequency on the touchscreen. This enables you to configure the probe’s frequency. The selected frequency is displayed in the title area, allowing you to determine the state of the current frequency easily. 7-38

[Page 343] „ ‹ Line Density Select the density of the scan line. Select Low, Med, or High by tapping the button on the touchscreen or using the dial-button. Selecting High increases the number of scan lines and improves the image resolution. However, the frame rate is reduced. „ ‹ Invert Tap Invert on the touchscreen. The color bar is inverted each time this button is tapped. When the color bar is inverted, the color displayed on the image is also inverted. „ ‹ Vel + Var Tap Vel + Var on the touchscreen to turn it on or off. It expresses the blood flow velocity in green on the Color Bar. Vel and Var stand for Velocity and Variance respectively. NOTE: Vel + Var feature is available in the following applications and presets: X ‹ Cardiac - Adult Echo, Ped Echo, Arotic Arch X ‹ OB - Fetal Heart X ‹ Vascular - Carotid, Arterial, Venous „ ‹ TDI Change to TDI mode. TDI stands for Tissue Doppler Imaging. X ‹ This can only be used when the cardiac application is selected in Phased Array Probe. X ‹ For more information on TDI, refer to ‘TDI Mode’. „ ‹ Auto Gain Tap Auto Gain on the touchscreen to turn it on or off. If it is turned on, the brightness of an image will be adjusted automatically. NOTE: Auto Gain is applied only when the mode is live for the Carotid and Arterial presets of the linear probe. 7-39

[Page 344] „ ‹ Steer Invert Tap Steer Invert on the touchscreen. Pressing the button inverts the angle of the ROI. NOTE: Steer Invert is only enabled when using a linear probe. „ ‹ Scale Use by rotating the Scale dial-button on the touchscreen. Rotating Scale dial-button clockwise increases the scale, extending the range of blood flow speed. Rotating the dial- button in the counter-clockwise decreases the scale, displaying a narrower range of blood flow speed. „ ‹ Sensitivity It enhances sensitivity and accuracy or frame rate of color images. Adjust the Sensitivity value from 0 to 5 by using the Sensitivity dial-button on the touchscreen. „ ‹ Filter Select Filter on the touchscreen or use the dial-button on the control panel to select a value from 1 to 4. This is an electric filter to remove the low-frequency doppler signals generated by the movement of blood vessel walls. Adjust the Cutoff Frequency to remove doppler signals whose frequency is lower than the cutoff frequency. „ ‹ Baseline Rotating the dial-button clockwise increases the Baseline. In Color Doppler mode, the color bar indicates the direction and speed of blood flow. Based on the Baseline at the middle, red indicates the direction and speed of blood flow toward the probe. By contrast, the blue color indicates the direction and speed of blood flow away from the probe. 7-40

[Page 345] „ ‹ Color Map Used to configure the post curve in a color image. Select a value from 1 to 12 by using the Color Map dial-button on the touchscreen. This can help to display blood flow with greater clarity. „ ‹ Steer Angle Adjust the angle of the ultrasound beam. Loss of color information resulting from the angle of the ultrasound beam is minimized. You can adjust the angle of the ultrasound beam by using the Steer Angle dial-button on the touchscreen. NOTE: The Steer function only appears on the soft menu when a linear probe is used. „ ‹ Balance Select a balance value from 0 to 16 by using the Balance dial-button on the touchscreen. The range of a color image is adjusted by comparing the gray levels of 2D images with the doppler signal values of color images. When the Balance value increases, the color image also appears in the part where the gray level of a 2D image is high (the bright part), increasing the range of the color image. „ ‹ Smoothing (Spatial Filter) Select a smoothing value from 0 to 5 by using the Smoothing dial-button. This allows smoother display of color images. NOTE: For more information on other touchscreen items, refer to the ‘2D Mode’. (Different values can be selected.) „ ‹ Alpha Blending Superimposes a color image over a 2D image in the color image area. 7-41

[Page 346] Power Doppler Mode This mode displays the color intensity of blood flow within the ROI in the 2D image. It is appropriate for examining the presence and amount of blood flow. The 2D Mode image is also shown, allowing the marking and adjustment of the ROI within the entire image. [Figure 7.10 Power Doppler Mode – Touchscreen]
Entering & Exiting PD Mode Press the PD button on the control panel to enter PD mode. Press this button again. PD Mode will be terminated and the mode will switch to 2D. 7-42

[Page 347]
PD Mode Screen „ ‹ Color Bar In PD mode, the color bar displayed varies depending on the Power Doppler mode display method that is in use. The color bar indicates the presence of blood flow and its amount. The top of the color bar is the brightest section, where the amount of blood flow is at its highest. „ ‹ ROI Box The ROI (Region of Interest) outlines the area of the 2D image where color (blood flow) information is displayed in Power Doppler Mode.
PD Mode Menu „ ‹ S-Flow Tap S-Flow on the touchscreen. The direction of the blood flow will be displayed. „ ‹ Auto Gain Tap Auto Gain on the touchscreen to turn it on or off. If it is turned on, the brightness of an image will be adjusted automatically. NOTE: Auto Gain is applied only when the mode is in live for the Carotid and Arterial presets of the linear probe. NOTE: The description of touchscreen menu items is the same as for 'Color Doppler Mode'. „ ‹ DR Shows the difference between the maximum volume and minimum volume that can be played for each image. 7-43

[Page 348] PW Spectral Doppler Mode PW stands for Pulse Wave. This mode displays the blood flow speed at a specific blood vessel location within a specific time frame. Distance (depth) information can also be obtained by transmitting pulses over particular time frames. This mode is useful for measuring low-speed blood flow, such as in the abdomen and peripheral vessels. The 2D Mode image is also shown, allowing the marking and adjustment of an observation area within the entire image. [Figure 7.11 PW Spectral Doppler Mode – Touchscreen]
Entering & Exiting PW Spectral Doppler Mode „ ‹ Entering PW Spectral Doppler Mode 1. Press the PW button on the control panel to enter PW Spectral Doppler Mode. 2. Configure settings relating to Doppler image acquisition on the touchscreen. 3. Press the PW dial-button again to enter PW Spectral Doppler Mode and display the Doppler image on the screen. 7-44

[Page 349] „ ‹ Exiting PW Spectral Doppler Mode Press the PW dial-button while the Doppler image is being displayed. You can also press the 2D dial-button to exit PW Spectral Doppler Mode. Press the Set button on the control panel to acquire a spectral doppler image. NOTE: The doppler image can only be obtained in the D Only or Simultaneous states. „ ‹ PW Spectral Doppler Mode Screen Sample Volume The doppler spectrum is displayed when the Sample Volume is located above the blood flow on the 2D image. The size of the Sample Volume is displayed in mm units. Use the trackball to adjust the position of the Sample Volume. X ‹ Moving Sample Volume: Use the trackball on the control panel. X ‹ Resizing Sample Volume: Using the touchscreen: Select the SV Size dial-button on the touchscreen. X ‹ Adjusting Sample Volume Angle: Rotate the Angle dial-button on the control panel to select a value from -80 to 80 degrees. Press the Angle dial-button to select either -60, 0, or 60 degrees. „ ‹ Adjusting Doppler Baseline Adjust the Baseline by rotating the dial-button on the touchscreen. 7-45

[Page 350] „ ‹ HPRF (High PRF) Function Adjust the blood flow above the speed limit at a specific depth. The scale is increased; this can only be used in PW Spectral Doppler mode (D Only). NOTE: Setup > Imaging > Common > HPRF X ‹ Activating HPRF Increasing the scale at a specific depth to a certain point automatically activates HPRF. The Phantom Gate will appear on the D Line at a position higher than the sample volume. Once HPRF starts, PRF does not increase even if you increase the scale value. X ‹ Finishing HPRF While HPRF is in use, decrease the scale value by one step to finish HPRF. Here, the PRF value becomes the maximum value in the current PW Spectral Doppler mode. X ‹ Moving Sample Volume To move the Sample Volume position in the D Only state, the system calculates PRF values and the Phantom Gate position, and updates them on the PW Spectral Doppler image. HPRF is terminated when HPRF cannot be activated. When Sample Volume is moved in the 2D Only state, the PRF values don’t change. X ‹ The Phantom Gate position can be located outside the 2D image area in Zoom Mode. X ‹ Make sure that sample volume and Phantom Gate are not placed together in the measuring area. If more than two Sample Volumes are located in the vessels, all Doppler components will appear in the spectrum, causing noise. 7-46

[Page 351]
PW Spectral Doppler Mode Menu „ ‹ Simultaneous Tap Simultaneous on the touchscreen. Each time you tap the button, the Simultaneous function turns on or off. If the Simultaneous option is turned on, you can view real-time 2D and spectral Doppler images at the same time. If the option is not turned on, however, you will only be able to view the image from one of the modes. The Simultaneous function decreases Doppler PRF, thus decreasing the measurable speed range. „ ‹ Invert Tap Invert on the touchscreen. Each time the button is tapped, the speed indicator (+/–) for a spectrum is inverted. „ ‹ Steer Invert Press Steer Invert on the touchscreen. Pressing the button inverts the angle of the sample volume. NOTE: The Steer Invert button is only enabled when using a linear probe. „ ‹ Auto Calc Tap Auto Calc on the touchscreen to select Off, Live, or Frozen. X ‹ Live setting: The PS, ED, MD, PI, RI, PS/ED, ED/PS, HR, TAmax, and TAmean are calculated after acquiring the Doppler Trace. X ‹ Frozen setting: The PS, ED, MD, PI, RI, PS/ED, ED/PS, HR, TAmax, and TAmean are calculated when the image is frozen. Values that are displayed on screen are selected at Setup > Measurement > AutoCalc. For selecting displayed values, refer to the measurement settings in ‘Chapter 3. Utilities’. CAUTION: The measurements carried out by Auto Trace under Measure and Real Time Automatic Doppler Trace (Automatic Calculator) may be different from each other. This is because the algorithms for these two methods are different. It is recommended that you use Auto Trace under Measure for more accurate measurement. 7-47

[Page 352] Things to Consider when using Real Time Automatic Doppler Trace 1. Aliasing occurs because PRF is too low in comparison to the image speed, or the spectrum is clustered around the baseline because PRF is too high. 2. Peak is indistinctive or intermittent such as in Spectral waveforms for veins. 3. Meaningful spectrum distinction becomes difficult because Doppler Gain is set too high or too low. 4. An index is displayed during the transition time after Sample Volume is moved with the trackball. 5. The major spectral signals are cut off because Doppler Wall Filter is set too high. 6. Peak Trace is interrupted due to abnormal Doppler noise or artifact, and the heart rate is above approximately 140 bpm. If any of the above apply, Real Time Automatic Doppler Trace may not produce an accurate trace or results. In addition, during auto calculation, results will not be displayed if the Freeze function is run against inaccurate values. „ ‹ Sensitivity Specify the minimum range of Sensitivity. It can be adjusted from 1 to 5 by using the touchscreen button. Sensitivity Sensitivity is a function to adjust Trace Line in the Auto Trace or Limited Trace. Increase the value to capture a wider area, use a smaller value to make the waveform clearer. „ ‹ Trace Method Tap Trace Method on the touchscreen. Max or Mean Trace for the selected spectrum is performed. It will not be performed if set to Off. „ ‹ Trace Direction Tap Trace Direction on the touchscreen. Select the part of the spectrum to calculate with AutoCalc from Both, Above, or Below. „ ‹ Sound Adjusts the doppler volume. Select a value from 0 to 100 by rotating the Sound dial- button. 7-48

[Page 353] „ ‹ Display Format Tap Display Format on the touchscreen. Select either Up/Down, Side by Side, or Doppler Only by using the button on the touchscreen. „ ‹ Doppler Map Used to configure the post curve in doppler mode. Select a value from 1 to 12 by using the Doppler Map dial-button on the touchscreen. „ ‹ TDW Switches to TDW Mode. TDW stands for Tissue Doppler Wave. For more information on TDW, refer to ‘TDW Mode’. NOTE: This can only be used when the cardiac application is selected in Phased Array Probe. NOTE: For more information on other touchscreen menu items, refer to ‘2D Mode’ and ‘Color Doppler Mode’ sections. 7-49

[Page 354] CW Spectral Doppler Mode CW stands for Continuous Wave. This mode displays the blood flow speed and direction at a specific blood vessel location within a specific time frame. Unlike PW Spectral Doppler Mode, it does not provide Sample Volume. X ‹ CW Spectral Doppler mode is an optional feature of this product. X ‹ This dial-button can be used with the Phased Array or Static CW probes. „ ‹ Steered CW Spectral Doppler Mode This mode can only be used if the Phased Array probe is used. The 2D Mode image is also shown, allowing the marking and adjusting of an observation area within the entire image. „ ‹ Static CW Spectral Doppler Mode This mode is only available with a Static CW Probe. The 2D image is not displayed.
Entering & Exiting CW Spectral Doppler Mode „ ‹ Entering CW Spectral Doppler Mode 1. Press the CW button on the control panel to enter CW Spectral Doppler Mode. 2. Configure settings relating to Doppler image acquisition on the touchscreen. 3. Press the CW dial-button again to enter CW Spectral Doppler Mode and display the Doppler image on the screen. „ ‹ Exiting CW Spectral Doppler Mode Press the CW dial-button while the Doppler image is being displayed. You can also press the 2D dial-button to exit CW Spectral Doppler Mode. 7-50

[Page 355]
CW Spectral Doppler Mode Menu [Figure 7.12 CW Spectral Doppler Mode – Touchscreen] NOTE: The menu for CW Spectral Doppler Mode is identical to that of PW Spectral Doppler Mode. 7-51

[Page 356] TDI Mode TDI stands for Tissue Doppler Imaging. It visualizes the movement of rapidly moving tissues such as the heart. It is available in Color Doppler Mode. In Color Doppler Mode, TDI provides color information for cardiac tissues. NOTE: Appears on the Soft Menu only when using the phased array probe and the cardiac application.
Starting and Ending TDI Mode In Color Doppler Mode, tap TDI on the touchscreen. Pressing the button once more switches the mode from TDI to C. NOTE: For information about the touchscreen menu, refer to ‘Color Doppler Mode’. 7-52

[Page 357] TDW Mode TDW stands for Tissue Doppler Wave. It visualizes the movement of rapidly moving tissues such as the heart. TDW Mode is available in the PW Spectral Doppler Mode. If it is used in Spectral Doppler Mode along with Color Doppler mode, changes in cardiac tissues over time can be observed. NOTE: This can only be used when the cardiac application is selected in Phased Array Probe.
Starting and Ending TDW Mode Tap TDW on the touchscreen in PW Spectral Doppler Mode to run it. Pressing the button once more switches the mode from TDW to PW Spectral Doppler. NOTE: For information about the touchscreen menu, refer to the ‘PW Spectral Mode’ section. 7-53

[Page 358] ElastoScan Mode The elasticity of ROI in a 2D image is shown in color. The 2D Mode image is also shown, allowing the marking and adjustment of the ROI within the scanned image. X ‹ ElastoScan mode is an optional feature of this product. X ‹ The probes, applications, and presets that support ElastoScan are as follows: MSK General LA3-14AD Small Parts Breast, Thyroid MSK General LA4-18BD Small Parts Breast, Thyroid GYN Uterus, Adnexa EA2-11B Urology Prostate GYN Uterus, Adnexa ER4-9 Urology Prostate GYN Uterus, Adnexa V5-9 Urology Prostate MSK General LA3-16A Small Parts Breast, Thyroid GYN Uterus, Adnexa VR5-9 Urology Prostate GYN Uterus, Adnexa EVN4-9 Urology Prostate GYN Uterus, Adnexa EA2-11AR Urology Prostate X ‹ This function is not available in E mode. Angle, View Area, ECG 7-54

[Page 359] ElastoScan X ‹ An elastogram is the elasticity imaging of an object, based on continuous ultrasound images. The function that measures the elasticity of an object and converts it to images is called ElastoScan. ElastoScan visualizes the presence of a solid mass or stiffness in tissue. X ‹ It is already well known that lesions such as tumors are different from healthy tissue in terms of their stiffness. Up until now, palpation has been used for examination, but this method has certain depth limitations. „ ‹ E Dual Mode In this mode, the elastogram and the 2D image are displayed together on the screen. It can be selected by tapping Single on the control panel and Dual on the touchscreen. To facilitate comparative observation, the 2D image is shown on the left and an E image is shown on the right. X ‹ For ElastoScan, Wide Dual View is set as default. X ‹ For details about Wide Dual View setting, refer to Setup > Imaging > Display Settings in the ‘Chapter 3. Utilities’. [Figure 7.13 E Dual Mode] 7-55

[Page 360] „ ‹ E Single Mode In E Single Mode, only an E image is displayed in the screen. It can be selected by pressing the Single button on the control panel. [Figure 7.14 E Single Mode] 7-56

[Page 361] „ ‹ ROI Mode ROI stands for Region of Interest. In E Mode, the ROI Box represents the area where elasticity information is processed and shown. Tap ROI Mode on the touchscreen to turn ROI Mode on or off. It is important that only the effective tissues are included in ROI by avoiding ineffective components such as bone and air to obtain a good elasticity image. If a ratio of effective image is insufficient, no elasticity image can be displayed even when tissues are pressured. To scan the breast, it is best to set as wide as possible in the lateral direction and to include subcutaneous layer and muscle in the axial direction to obtain a good- quality elasticity image, but it can be flexible to adjust the real situation. You can adjust the position and size of the ROI box by using the Change button on the control panel. Each time the Change button is pressed, the current status of the ROI Box is shown in the User Information area of the screen. X ‹ ROI Position: The position of the ROI Box can be changed. Move the ROI Box with the trackball to confirm the new position. X ‹ ROI Size: The size of the ROI Box can be changed. Resize the ROI Box with the trackball and press the Change button to confirm the new size. [Figure 7.15 ROI Mode] NOTE: ROI Mode is available in E Single Mode as well as in E Dual Mode. 7-57

[Page 362]
Starting and Closing E Mode In 2D Mode, tap ElastoScan on the touchscreen. Press the button again to return to 2D Mode.
E Mode Screen „ ‹ Color Bar In E Mode, the color bar indicates the stiffness of a tissue. Regardless of the color, the lower section of the bar indicates that the target area is stiffer than the surrounding tissues and the upper section indicates that the target area is less stiff than the surrounding tissues. „ ‹ Compression Guide Bar The strength and status of compression are shown in different number of blocks and colors from Step 0 to 7. All blocks are empty at Step 0 which appears when the probe is almost stationary, the ROI has insufficient region, or matching between images is poor. Step 1 – Step 2 (in grey) mean inadequate compression and from Step 3 to 7 (in blue or green) mean adequate compression; the number of blocks filled represents the number of step level.
Performing a Scan When using E mode, place a probe onto the surface of an area to observe and position the ROI appropriately on a lesion to observe. Then use the probe to periodically compress the region. When the compression guide is supported, refer to this guide to adjust the size of the compression. If the region being examined is quite deep, it is best to increase the compression. Precautions for Scanning X ‹ To closely observe the location of the lesion, minimize the movement of tissues. X ‹ A breast is a complex organ which consists of lactiferous ducts, lactiferous glands, fatty tissue, fibrous tissue, and chest muscles. An axial movement of the probe may cause an unintended movement of the tissues. X ‹ The prostate and the thyroid consist of tissues that are simpler than those of a breast and there are relatively fewer unintended movements. 7-58

[Page 363]
E Mode Menu [Figure 7.16 ElastoScan Mode – Touchscreen] „ ‹ Invert Tap this button on the touchscreen to invert the Color Bar. Inverting the color bar also inverts the color displayed on the image. „ ‹ Dual Live The elastogram and the 2D image are displayed together on the screen. Pressing Single on the control panel displays the E image only on the screen. „ ‹ E Gain Adjust the brightness of the elastogram image. Use the dial-button to select a setting from 0 to 100%. „ ‹ Persistence Level Specify the speed of change between frames. Use the dial-button to select a setting from 0 to 100%. Selecting a higher value increases the rate of frame change. 7-59

[Page 364] „ ‹ Contrast Adjust the contrast of the elastogram. Use the dial-button to select a setting from 0 to 100%. „ ‹ Color Map Select the color of the elastogram. Select a value from 1 to 6 by using the dial-button on the touchscreen. If you change the Color Map, the color bar will also change accordingly. „ ‹ Blending Level Adjust the blending level between a color image over a 2D image. Change the 2D image ratio using the knob. „ ‹ Enhancement Adjusts the enhancement of the image. Use the dial-button to select a setting from 0 to 100%. A higher setting provides more clearly defined boundaries, at the expense of increased noise. 7-60

[Page 365]
E-Strain This is the function for breast lesion exam. It calculates the strain ratio between the area of the suspected lesion (ROI) and normal breast fat and displays the results. X ‹ E-Strain is an optional feature of this product. X ‹ E-Strain is supported in countries except the USA and Canada. X ‹ The E-Strain button is only activated on the touchscreen when the following conditions are satisfied: – Application: Breast, Thyroid – Freeze state „ ‹ E-Strain 1. Press the Freeze button on the control panel and then press the E-Strain button. 2. Specify the position and size of the ROI in the area of suspected lesion. X ‹ Make sure that the fat tissue is visible at the same level as, or above, the ROI. X ‹ Adjust the size of the ROI by using the trackball and the Change button. 3. Press the Set button. The calculation is automatically performed and the results will be displayed on the screen. X ‹ Target Strain: Mean strain value inside the ROI (Supported in all countries except the USA and Canada) X ‹ Ref. Strain: Mean strain value of areas considered normal outside the ROI (supported in all countries except the U.S.A. and Canada). X ‹ Strain Ratio: Ratio of Strain values (Target Strain/Ref. Strain) „ ‹ E- Strain Reset When you tap this button on the touchscreen, the E-Strain measurements will be reset. 7-61

[Page 366] Combined Mode In Combined Mode, three different modes are combined, including the default 2D Mode. Note that, in 2D/C Live Mode, only two modes are combined: 2D and Color Doppler Modes. 2D/C/PW Mode Color Doppler Mode and PW Spectral Doppler Mode are displayed simultaneously. In Color Doppler Mode, press the PW dial-button on the control panel. Or, in PW Spectral Doppler Mode, press the C dial-button on the control panel. 2D/PD/PW Mode Power Doppler Mode and PW Spectral Doppler Mode are displayed simultaneously. In Power Doppler Mode, press the PW dial-button on the control panel. Or, in PW Spectral Doppler Mode, press the PD button on the control panel. 2D/C/CW Mode Color Doppler Mode and CW Spectral Doppler Mode are displayed simultaneously. This mode is available only with certain probes. In Color Doppler Mode, press the CW dial-button on the control panel. Or, in CW Spectral Doppler Mode, press the C/Z dial-button on the control panel. 2D/C/M Mode Color Doppler Mode and M Mode are displayed simultaneously. 7-62

[Page 367] 2D/TDI/TDW Mode NOTE: This can only be used when the cardiac application is selected in Phased Array Probe. TDI Mode and TDW Mode are displayed simultaneously. In PD mode or Color Doppler mode, press the TDI , and then press the PW dial-button. Dual Live Mode 2D Mode and Color Doppler Mode are displayed simultaneously. In either 2D mode or C mode, select Dual Live on the touchscreen.
Changing Combined Mode Format „ ‹ Changing Trackball State In Combined Mode, more than two image modes are used at the same time. Depending on the trackball’s state, you can change the position or size of: ROI on the active image; the Sample Volume; M line, etc. Press the Change button on the control panel to change the state of the trackball. Note that when frozen, you can press the Change button to select the type of Cine image. „ ‹ Changing the Menu You can change the menu and touchscreen menu items without changing the active image mode. The functions of the buttons on the control panel vary depending on the active image mode. For example, when the touchscreen menu for 2D mode is displayed on the screen in 2D/C/ PW mode, you can select another mode from the touchscreen menu to switch to that mode. NOTE: For information on optimizing an image in Combined Mode, please refer to ‘Basic Mode’. 7-63

[Page 368] Multi-Image Mode The product supports Dual Mode and Quad Mode. In Multi-Image Mode, an image can be displayed in different combined modes. Button operations in an active area are the same as in Combined Mode. Dual Mode Press the L or R button on the control panel. You can compare two independent images with each other. Each time you press the L or R button, one of the two images is selected. The currently active image mode is indicated by a blue marker at the top of the image. The buttons and menu operate according to the image mode that is currently in use. To exit from Dual mode, press the 2D dial-button. [Figure 7.17 Dual Mode] 7-64

[Page 369] Quad Mode Press the Quad button on the control panel to enter Quad Mode. You can compare four different images at the same time. Each time you tap the Quad or Set button, one of the four images is selected. The currently active image mode is indicated by a blue marker at the top of the image. The buttons and menu operate according to the image mode that is currently in use. To exit Quad mode, press the Single button or the 2D dial-button on the control panel. 1 2 3 4 [Figure 7.18 Quad Mode] Multi-Image Mode Screen Layout In Multi-Image Mode, recent Cine images are displayed on the screen by default. X ‹ Dual Mode Press the L or R button on the control panel to display the current Cine image and the most recent Cine image in order of 1 → 2 . X ‹ Quad Mode Press the Quad button on the control panel to display the current Cine image and the three most recent Cine images on the screen. You can specify the method of displaying images in Setup > Imaging > Common > Quad: Active Window Sequence . – Zigzag: Set in the order of 1 → 2 → 3 → 4 . – Clockwise: Set in the order of 1 → 2 → 4 → 3 . NOTE: For information on optimizing an image in Multi-image mode, please refer to ‘Basic Mode’. 7-65

[Page 370] 3D/4D Mode These modes show 3D images of the region being examined. NOTE: 3D Mode and 4D Mode provide additional options per product. HS50 X ‹ 4D: SFVI, FAD, VSI, Smooth Cut, Volume Compounding XH50 X ‹ 3D XI: Multi Slice View, Oblique View, Multi OVIX, XI Vocal X ‹ 4D: SFVI, FAD, VSI, Smooth Cut, Volume Compounding HS60 X ‹ 3D XI: Multi Slice View, Oblique View, Multi OVIX, XI Vocal XH60 X ‹ 3D MXI: Volume Slice, Mirror View
3D Mode This product can be used with 3D probes, and provides 3D Mode and XI STIC Mode. [Figure 7.19 3D Mode] 7-66

[Page 371] „ ‹ 3D This mode uses a 3D probe to acquire 3D images. Freehand 3D Mode X ‹ A 3D mode where 3D probes are used is referred to as Static 3D Mode, while a mode where general probes are used is called Freehand 3D Mode. X ‹ That is, a mode where general probes, not 3D probes, are used is referred to as Freehand 3D Mode. Please note the following: Only applicable to Convex and Linear probes. Probe Preset CA1-7AD OB, Abdomen LA3-14AD Small Part, Vascular (TCD excluded) X ‹ Available in MPR Mode only. X ‹ Cannot be used with 2D Steer, Trapezoid, or Write Zoom. „ ‹ XI STIC In this mode, fetal cardiac cycle and STIC volume data can be obtained with 3D probes. For more information, please refer to 'XI STIC' in this chapter. NOTE: XI STIC is an optional feature of this product.
Entering and Exiting 3D/4D Mode Press the 3D/4D button on the control panel. Press the button again to exit 3D/4D mode and return to 2D mode. 7-67

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3D/4D Mode Screen „ ‹ ROI Box In 3D/4D mode, the ROI box is also referred to as the volume box. The box is used to indicate 3D/4D conversion areas. You can adjust the position and size of the ROI box by using the Change button on the control panel. Each time the Change button is pressed, the state of the ROI box is displayed in the lower middle part of the screen as follows: X ‹ ROI Position: In this state, the position of the ROI box can be changed. You can move the ROI box by using the trackball. X ‹ ROI Size: In this state, the size of the ROI box can be changed. After resizing the ROI box with the trackball, press the Change button to confirm the new size.
3D Cine The 3D images saved temporarily in the system can be reviewed. The 3D Cine Define screen is displayed on the touchscreen. 3D Cine Define Specify the settings needed for creation of a Cine image. „ ‹ Rotate Angle Set the overall rotation angle by tapping the corresponding button on the touchscreen. Select a value from 30, 45, 60, 90, 180 or 360°. „ ‹ Step Angle Set the rotation angle for a single step in an image by tapping the corresponding button on the touchscreen. Select a value from 1, 3, 5, or 15°. The Difference between Rotate Angle and Step Angle A Cine image rotates to the angle specified under Rotate Angle. During this process, each rotational step is equivalent to the angle specified under Step Angle. For example, if Rotate Angle is set to 360˚ and Step Angle is set to 15˚, a 3D Cine image rotates to 360˚ in 25 steps, each of which involves a rotation of 15˚. 7-68

[Page 373] „ ‹ Rotate Axis Set the rotational axis by tapping the corresponding button on the touchscreen. „ ‹ Generate Cine images are generated by applying the current settings. Once images are generated, the touchscreen switches to Cine Review. „ ‹ Review Review previously generated Cine images. The touchscreen switches to Cine Review. „ ‹ Start Angle Use the dial-button to set the start angle of a Cine image. When Start Angle is set, Rotate Angle is cancelled. „ ‹ End Angle Use the dial-button to set the end angle of a Cine image. When End Angle is set, Rotate Angle is cancelled. [Figure 7.20 3D Cine Define – Touchscreen] 7-69

[Page 374] Cine Review Specify the settings needed for review of a Cine image. [Figure 7.21 Cine Review] „ ‹ Play Mode Select the play mode for Cine images. Select from Loop or Yoyo by using knob button. X ‹ Loop: Repeats playback in one direction. X ‹ Yoyo: Plays until the end in one direction, and then plays in the reverse direction. „ ‹ Cine Play Tap this button on the touchscreen to turn this feature on or off. Cine images are played when this is on. If it is turned off, Cine Frame will appear on the touchscreen. „ ‹ New Cine Clears the current Cine image and creates a new one. The system switches to the 3D Cine Define screen. „ ‹ Speed Use the dial-button to select the playback speed of a Cine image. Select from Very Slow, Slow, Normal, Fast, or Fastest. 7-70

[Page 375] „ ‹ Trim Start After specifying the position of the first frame by using the dial-button, tap the dial-button to save it. „ ‹ Trim End After specifying the position of the last frame by using the dial-button, tap the dial-button to save it. „ ‹ Cine Frame Select a Cine frame to review. Use the dial-button or move the trackball left or right to select. NOTE: This option is available when Play is turned off. It can be adjusted by as many as the total number of Cine frames by using the knob button with the ‘current Cine frame number’ being shown on the monitor screen. 7-71

[Page 376]
4D Mode In 4D Mode, 3D images can be obtained in real time with 3D probes. This mode is also called Live 3D Mode. Smart 4D Smart 4D collectively refers to the 4D, 3D XI, and 3D MXI functions. [Figure 7.22 4D Mode]
4D Mode Screen Press the Freeze button on the control panel to switch to the 4D Cine screen. NOTE: In 4D, only MPR, MSV, and Oblique View Modes are available. For more information, please refer to 3D View-MPR and 3D XI. 7-72

[Page 377]
4D Cine The 4D images saved temporarily in the system can be reviewed. The 4D Cine screen is displayed on the touchscreen. NOTE: You can also press the Freeze button in 4D Mode to execute 4D Cine. „ ‹ Play Mode Select the play mode for Cine images. Use the touchscreen to select either Loop or Yoyo. X ‹ Loop: Repeats playback in one direction. X ‹ Yoyo: Plays until the end in one direction, and then plays in the reverse direction. „ ‹ Cine Type Select the Cine image type by tapping the corresponding button on the touchscreen. X ‹ Volume: This button appears when Cine images are played. The MPR , MSV , or Oblique buttons are enabled, depending on the state before the 4D Cine was started. Cine images can be played by changing Display Format, etc. X ‹ Image: This is the general Cine playing method. „ ‹ Cine Play X ‹ Volume: Tap the Play button on the touchscreen to play; tap the Freeze button to freeze. X ‹ Image: Tap the Play button on the touchscreen to play; tap Play again to freeze. „ ‹ Cine Speed Set the speed at which Cine images are played. Use the dial-button to select Very Slow, Slow, Normal, Fast, or Fastest. „ ‹ Vol.Index Move the trackball or use the dial-button to select an Index. ‘The current volume data number/total number of volume data’ is displayed. 7-73

[Page 378] 3D Stand By This screen is displayed on the touchscreen when 3D/4D Modes are entered. Set the required parameters to specify how 3D images are acquired. [Figure 7.23 3D StandBy – Touchscreen]
Menu Tab Select a tab for 3D/4D Modes. Different tabs are displayed on the touchscreen depending on the probe currently being used. Adjusting 2D Images in 3D/4D Modes X ‹ Tap the 2D Menu tab on the touchscreen to optimize a 2D image before acquiring the corresponding 3D image. X ‹ Once the 2D image is optimized, tap 3D Menu on the touchscreen to return to 3D StandBy mode.
View Mode Select a view mode to use after 3D images are acquired. „ ‹ 3D View The standard view mode for 3D image review. Press MPR to select. 7-74

[Page 379]
Rendering Preset Selects a Preset for 3D images. For more information, refer to the preset information contained in the ‘3D View - MPR Mode’ section.
Curved ROI Press the Curved ROI button to turn it On or Off. If set to On, adjust the ROI Line in the form of a curve to select the rendering area. X ‹ It cannot be used concurrently when OH (Orientation Help) is on. X ‹ It is supported when the Render Direction value is ‘C+.’ X ‹ It is supported in Dual and Quad modes.
Breech Sweep You can also scan a breech baby from its head to abdomen without changing the probe direction.
Scan Quality Selects the quality of 3D images. Select Low, Med, or High by tapping the button on the touchscreen or using the dial-button. X ‹ High: Image quality is high, but the speed of capturing (or rendering) 3D image is low. X ‹ Med2: Provides better image capturing speed and lower image quality than the High setting. X ‹ Med1: Provides better image capturing speed and lower image quality than the Med2 setting. X ‹ Low: Provides the highest 3D image capturing speed and the lowest image quality. NOTE: Scan Quality is not available in the XI STIC menu tab. 7-75

[Page 380]
Volume Angle Set the scan angle by tapping the touchscreen or using the dial-button. The setting range varies depending on the selected probe. NOTE: In XI STIC, set the scan angle from 10° to 60°.
Scan Time Set the image acquisition time. Select a value from 7s to 15s by clicking the corresponding button or using the dial-button on the touchscreen. The button is enabled in XI STIC only. NOTE: For more information, please refer to the ‘XI STIC’ section.
Trimester Set the pregnancy trimester. Select from 1st, 2nd, and 3rd by clicking the corresponding button or using the dial-button on the touchscreen. The button is enabled in XI STIC only. NOTE: For more information, please refer to the ‘XI STIC’ section. 7-76

[Page 381]
Acquiring 3D/4D Images 1. Specify the location and size of the ROI Box as desired. 2. Configure various settings in the 3D Stand By screen on the touchscreen. Select a menu tab, and then configure settings in order of View Mode → Rendering Preset → Soft Menu. 3. Press the Freeze or Set button on the control panel. The system will begin acquiring 3D images. To cancel the acquisition of a 3D image in progress, press the Exit button. 4. Once 3D images are acquired, the 3D View or 3D XI screen is displayed depending on the setting. If a left/right-reversed 3D image is obtained, the image will also be shown left/right reversed in 3D View or 3D XI . 5. You can perform diagnosis by optimizing images. Press the 3D/4D button to acquire 3D images again. How to Acquire High Quality 3D Images X ‹ Consider the direction, size and section of the viewpoint as well as the visibility of an object. X ‹ Before acquiring 3D images, adjust the contrast in 2D Mode. X ‹ The bigger the ROI box, the slower the rendering speed. Therefore, set an appropriate ROI box size. X ‹ To see the 3D image of a fetus in frontal view, position the fetal head in the direction of the Direction Mark, putting it in the coronal plane. Then scan the fetus from back to abdomen. X ‹ The 3D image of a fetal face can be more easily located in the coronal plane than in the existing sagittal plane. X ‹ To determine the surface contour for lesions that do not generate echoes, such as amniotic fluid, make sure that they are surrounded by hypoechoic tissues. X ‹ After acquiring a 3D image, you can adjust the low-threshold level to clean up the image. In general, it is recommended that you leave the High Threshold value at the maximum value of 255 rather than adjusting it. 7-77

[Page 382] 3D View – MPR This view mode is enabled upon acquisition of images when MPR is selected in 3D StandBy . You can optimize 3D images, perform diagnosis, and take measurements. Changing View Mode Select the 3D Menu tab on the touchscreen to change the view mode.
Basic Operating Instructions „ ‹ Zooming In to/Out of Images Turn the Zoom dial-button on the control panel to zoom in to/out of images. The current zoom factor appears on the bottom side of the screen. „ ‹ VCT Zoom After tapping VCT Zoom on the touchscreen, press the Zoom dial-button on the control panel to convert it to VCT Zoom function. Turn the dial-button to zoom in to/out of VCT images. The current VCT Zoom factor appears at the bottom of the screen. NOTE: This option is available with VCT . „ ‹ Post Gain You can adjust the value using the 2D knob button. Works independently from 2D Gain, with a separate value. The initial value is 0, but this value can be set to any value from -255 to 255. In 4D mode, Post Gain works during Freeze. „ ‹ Rotating Image Around X Axis Use the M/x dial-button on the control panel. „ ‹ Rotating Image Around Y Axis Use the PW/y dial-button on the control panel. 7-78

[Page 383] „ ‹ Rotating Image Around Z Axis Use the Color/z dial-button on the control panel. „ ‹ Ref. Slice Use the Marker/Ref dial-button on the control panel. It moves the Reference Slice in a straight line horizontally. „ ‹ Calculations by Application Press the Calculator button on the control panel. The measurement methods are same as application measurement and 5D NT of ‘Chapter 8. Measurements’. X ‹ In the 4D mode, measurements of XI STIC and VOCAL are not available. X ‹ In MSV mode, measurement is not available if the display format is 2x3 or higher. „ ‹ Basic Measurement Press the Calculator button on the control panel. For more information, refer to ‘Basic Measurement’ in ‘Chapter 8. Measurements’. Tap Save on the touchscreen to finish saving. To cancel it, press the Exit button on the control panel. „ ‹ Entering Text Press the Text button. With the Quick Text function enabled, pressing any key on the keyboard immediately switches the mode to Text Mode. For more information, please refer to the ‘Entering Text’ section of ‘Chapter 9. Image Management.’ „ ‹ Entering Arrows Press the Text button and then the Arrow button on the touchscreen. For more information, please refer to the ‘Entering Arrows’ section of ‘Chapter 9. Image Management.’ 7-79

[Page 384] „ ‹ Saving Images NOTE: If volume data contains both 4D and 3D Cine images, choose either 4D or 3D for saving. 1. Press the Store/Print mapping button on the control panel. The touchscreen will show the 3D Data Save screen. 2. Specify settings such as Data Type, Save Item, and Volume Format. 3. Tap Save on the touchscreen to finish saving. To cancel it, press the Exit button on the control panel. Volume Data X ‹ If volume data contains a Cine image, it is saved at the same time. X ‹ If images are saved with volume data, they can be converted to new 3D rendering images with SonoView. „ ‹ Printing Images Go to Setup > Customize > Buttons and customize U1 , U2 , U3 , U4 , U5 , and U6 buttons as you want. 7-80

[Page 385]
Basics of 3D View „ ‹ Screen Layout 1 2 3 4 [Figure 7.24 3D View] 1 A Plane: The slice image of the axial section. 2 B Plane: The slice image of the sagittal section. 3 C Plane: The slice image of the coronal section. 4 3D Image 5 Trackball state indication: The current state of the trackball is displayed at the bottom of the monitor screen. You can select Pointer, Move, or ROI for trackball. Press the Change button on the control panel to change the trackball state. The trackball state changes sequentially each time the button is pressed. X ‹ Pointer: Re-adjusts the position of ROI Box. Pressing the Pointer button on the control panel switches to Pointer state. You can rotate the ROI box around the image axis by using the pointer while pressing the Set button. Press the Change button again to switch to another state. X ‹ Move: Moves the 3D image with the trackball. The acquired 3D image moves as you move the trackball. X ‹ ROI: You can resize the ROI box with the trackball. The ROI box on the 3D image is resized as you move the trackball. 7-81

[Page 386] „ ‹ Touchscreen Layout Only those buttons that are available in the current mode are enabled. Use the arrow buttons to navigate between pages. [Figure 7.25 3D View Menu] 7-82

[Page 387]
Mode Select the display format in which 3D images are presented. „ ‹ Render Axial, Sagittal, or Coronal plane images are displayed together with the 3D image. „ ‹ 2D Axial, Sagittal and Coronal plane images, along with OH (Orientation Help), are displayed on the screen. OH indicates the relative position of the currently selected plane in regard to volume data. Tips! Tap Single on the touchscreen for a more detailed view. „ ‹ VCT Axial, Sagittal and Coronal plane images and combinations of them are displayed. Each plane is displayed with a different colored frame. VCT is an abbreviation for Volume CT. NOTE: Accept ROI is available in Render. Tap the touchscreen to turn it on or off. If it is turned on, ROI is not shown.
Display Format You can change the display format by using the touchscreen. The display format varies for each mode. X ‹ Single: Switches to Full screen. X ‹ Dual: Switches to 2D/3D screen. X ‹ Quad: Switches to ROI 3D screen. NOTE: In 2D or VCT mode, only Single or Quad Format can be used. 7-83

[Page 388]
Ref. Image Tap the corresponding button on the touchscreen to select a reference image from among A, B, and C. The selected image will be highlighted with blue borders. X ‹ A: Axial Section X ‹ B: Sagittal Section X ‹ C: Coronal Section X ‹ OH (Orientation Help): Tap the corresponding button on the touchscreen to turn it on or off. If it is turned on, a 3D image will be displayed along with OH. NOTE: This option may be used in 2D and Render . „ ‹ ClearVision ClearVision removes noise from the image and enhances outlines to help show the image more clearly. You can select off or adjust the index from 1 to 5 by tapping the touchscreen.
3D Rotation Select -90°, 90°, or 180° by tapping the button on the touchscreen. The coordinate system rotates based on the current 3D image. NOTE: Mix, Th.Low, and Transparency are available in Render mode.
Init When you tap the touchscreen, the position information of the 3D image is initialized.
FAD This automatically detects the face of the fetus and removes the images of any limbs that obscure the face. FAD stands for Fetal Face Auto Detection. 7-84

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VSI It displays a realistic image by using the Depth and Intensity values. When Surface or Surface Smooth is enabled in Render Mode 1, Shading is enabled in Render Mode 2. VSI stands for Volume Shading Imaging.
Accept ROI Press this button on the touchscreen to turn it On or Off. If this is turned On, no ROI will be displayed. NOTE: Available in Render and Mirror View .
Mix Configure the mix of Render modes 1 and 2. Use the dial-button to select a ratio between 0:100(%) and 100:0(%). NOTE: For details on Render mode, refer to ‘Render Setup’ in ‘3D Utility Menu’.
Th. Low Specify the minimum range of Threshold. Use the dial-button to select a value from 0 to 254. Threshold This option allows you to adjust the threshold value in order to eliminate unnecessary data from images. As the number increases, cyst elements become more apparent. As the number decreases, bone elements become more apparent.
Select Select Post Curve. Use the dial-button to select 2D, 3D, 2D Color, or 3D Color. 7-85

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Position Set the position of the post curve selected under Select . Use the dial-button to select a value from 0 to 100.
Bias Set the bias of the post curve selected under Select . Use the dial-button to select a value from -100 to 100.
Transparency Set the transparency of a 3D image. Use the dial-button to select a value from 20 to 250. The lowest value (20) is for complete transparency, and the highest value (250) is for complete opacity.
ClearVision You can obtain a clearer image by eliminating noise and enhancing boundaries. Five predefined indices are available. NOTE: For more information on ClearVision and ClearVision Index, please refer to the 2D Mode Menu section of ‘Chapter 7. Modes of Operation.’
HDVI Filters 3D images to express outlines more vividly and improve images. Five predefined indices are available. NOTE: HDVI is an optional feature of this product.
HDVI Index Tap HDVI Index on the touchscreen. Select an index from 1 to 5 by tapping the button on the touchscreen. 7-86

[Page 391]
HDVI Type Tap the touchscreen button or use the dial-button to select the part to measure among Face, Brain, Early OB, Heart, Spine, Gyn, Breast, Thyroid, Carotid, Abdomen, Kidney, and Surface and adjust the image. NOTE: The ClearVision and HDVI options are enabled in MPR, MSV, Oblique View mode. NOTE: The following are enable MPR mode: Crystal Vue, MagiCut, Realistic Vue, 3D Cine, 4D Cine, Render Setup, Preset, Post Processing, Curved ROI, Chroma.
Geometry Move, magnify, or rotate an image rendered in 3D Mode. X ‹ Rotation: Use the X/Y/Z button to rotate the rendered image. X ‹ Magnification: Use the Zoom button to magnify the rendered image. X ‹ Move: Use the trackball to move the rendered image. 7-87

[Page 392] Orientation Dot Tap the corresponding button on the touchscreen to turn the Orientation Dot on or off. When this is on, a dot appears at the center of the reference image. Render Setup The Render Setup screen appears on the touchscreen. You can specify the image rendering method. After selecting the Render Mode tab on the touchscreen, configure the required settings including Render Direction and Render Mode. The specified settings will be displayed in the image information area. This product provides four Render modes: Gray, Inversion, Color, and SeeThru. NOTE: In Oblique View Mode, this option is available only when OVIX is On. [Figure 7.26 Render Setup – Touchscreen] 7-88

[Page 393] Gray Specify how volume data acquired with the gray method should be rendered into 3D images. „ ‹ Render Direction Set the rendering direction by clicking the corresponding button on the touchscreen. „ ‹ Render Mode 1, 2 Enter Render Modes 1 and 2 by tapping the corresponding buttons on the touchscreen. X ‹ Surface: Represents 3D images in the Ray-Casting method, which shows the shell of an image with curved surfaces. X ‹ Smooth: Represents 3D images that are smoother than those created by the Surface method. X ‹ Max: Represents 3D images at maximum intensity. It can be useful for the observation of bone structures in a human body. X ‹ Min: Represents 3D images at minimum intensity. It can be useful for observation of vessels or hollow parts in a human body. X ‹ Light: Represents the depth of 3D images in terms of brightness. X ‹ X-Ray: Represents 3D images in terms of average intensity. This shows images that are similar to X-ray images. NOTE: For descriptions of other menu items, see 'Render Setup'. „ ‹ Mix Configure the mix of Render modes 1 and 2. Use the dial-button to select a value from 0 to 100. „ ‹ Th.High Used to specify the maximum threshold range. Use the dial-button to select a value from 1 to 255. 7-89

[Page 394] „ ‹ Th.Low Specify the minimum threshold range. Use the dial-button to select a value from 0 to 254. Threshold This option allows you to adjust the threshold value in order to eliminate unnecessary data from images. As the number increases, cyst elements become more apparent. As the number decreases, bone elements become more apparent. „ ‹ Th.Power Specify the color threshold. Select a value from 0 to 255 by using the dial-button. As this value increases, more color is removed from an image. Color Specify how the volume data acquired with the Angio/CFM method are rendered into 3D images. Other settings are configured in the same way as Gray Render Mode. See Thru Set the method for rendering the data from Gray+Angio, Gray+CFM combinations as a 3D image. Settings other than Render Mode 1 and 2 are configured in the same way as Gray Render Mode. „ ‹ Transparent-Transparent Adjust the transparencies of both Gray and Color data, so that the Color data inside the Gray data may be studied. The parts that are obscured by the Gray data are displayed slightly darker. „ ‹ Transparent-Surface Adjust the transparency of Gray data, so that the Color data inside the Gray data may be studied. The parts that are obscured by the Gray data are displayed slightly darker. „ ‹ Max-Transparent Set Gray data to ‘Max’, and Color data to ‘Transp’, to study Color data. The parts that are obscured by the Gray data are displayed slightly lighter. 7-90

[Page 395] „ ‹ Max-Surface Set Gray data to ‘Max’, and Color data to ‘Surface’, to study Color data. The parts that are obscured by the Gray data are displayed slightly lighter. „ ‹ Inversion This option shows inverted images when the volume data acquired by the gray method is rendered into 3D images. Other settings can be specified in the same way as with Gray Render Mode. 7-91

[Page 396] VOCAL Measure the volume of tissues within the human body. VOCAL is an abbreviation for Virtual Organ Computer Aided anaLysis. VOCAL can be performed in the following order: VOCAL Define → VOCAL Edit → VOCAL [Figure 7.27 VOCAL] VOCAL Define Specify the settings required for VOCAL execution.
Contour Type Select the contour line type. A contour line is automatically created for all types except Manual . „ ‹ Solid Used for object data with many echoes. „ ‹ General Draw a contour line based on a typical object. This is faster than other automatic contour types but less accurate. 7-92

[Page 397] „ ‹ Prostate Used for prostate data. „ ‹ Cystic Used for object data with fewer echoes. „ ‹ Sphere After creating a spherical object, edit its contour to make it into the desired shape. „ ‹ Manual Create the desired shape of an object manually.
Ref. Image Tap the corresponding button on the touchscreen to select a reference image from among A, B, and C. The selected image will be highlighted with blue borders.
Step Angle Set the rotation angle. Select 12 , 18 or 30 by tapping the corresponding button on the touchscreen.
Pole Point Move Using Trackball Set the range to perform VOCAL in a reference image. In a reference image, Pole 1 indicates the position of the upper arrow and Pole 2 indicates the position of the lower arrow. Adjust by using either the trackball and Set button on the control panel or the dial-button on the touchscreen.
Init When you tap the touchscreen, the position information of the 3D image is initialized. 7-93

[Page 398]
Next Tap the touchscreen to begin creation of VOCAL data. When Contour Type is Set to Manual 1. Tap Next on the touchscreen. The Image Position screen will be displayed on the touchscreen. 2. After tapping the Set button over an image, move the trackball to contour. X ‹ Tap Next to move to the next frame. X ‹ Tap Previous to move to the previous frame. 3. Tap Done on the touchscreen. Start VOCAL. If you tap Done without contouring, VOCAL is performed over a sphere. [Figure 7.28 VOCAL Define – Touchscreen] 7-94

[Page 399] VOCAL Edit Once VOCAL data is created, volume information will be displayed on the screen. In VOCAL Edit Mode, you can modify or redo the existing contour lines.
Shell Mode Set the shell of an object based on its contour line. „ ‹ Off Do not use Shell Mode. The created contour and the shell overlap. „ ‹ Inside The shell is drawn inside the contour generated by the Shell Thick. specified. „ ‹ Outside The shell is drawn outside the contour generated by the Shell Thick. specified. „ ‹ Symmetric Half the shell is drawn inside the contour and the other half of the shell is drawn outside the contour, with each drawn at half of the Shell Thick. specified.
Shell Thick. Set the shell thickness of an object. Use the dial-button to select a value from 1 to 20mm. This option appears on the touchscreen only when Shell Mode is used.
Image Position Review contour lines for each frame. Use Previous and Next to move through frames. 7-95

[Page 400]
Multi Edit Modify more than one contour line at once. Tap this button on the touchscreen to turn this feature on or off. If it is turned on, up to 6 contour lines can be displayed simultaneously on the screen. When there are more than 6 lines, use the MEV Page dial-button to navigate through pages. MEV is an abbreviation for Multi Edit View. Use Pole 1 and Pole 2 to edit contour lines. You can also use the trackball and the Set button on the control panel to edit contour lines. Once editing is complete, tap Exit Multi Edit again to turn it off.
Clear Contour When you tap this button on the touchscreen, the VOCAL data are deleted, the settings are maintained, and the system returns to the VOCAL Define step.
New Contour Tap the button on the touchscreen to move from VOCAL Manual page to VOCAL Setup page. This button only appears if Contour Type is set to Manual.
Accept Contour Tap the button on the touchscreen to apply changes. The screen will switch to the VOCAL data review screen. [Figure 7.29 VOCAL Edit – Touchscreen] 7-96

[Page 401] VOCAL Optimizes VOCAL data for review.
VOCAL Mode Specify how VOCAL data are presented. „ ‹ ROI 3D Shows images in the Axial, Sagittal and Coronal planes, together with VOCAL data. „ ‹ Fixed 3D Shows images in the Axial, Sagittal and Coronal planes, together with 3D images for VOCAL data. „ ‹ VCT Shows actual combinations of images in the Axial, Sagittal and Coronal planes and VOCAL data. Use the VCT Type dial-button to select one from Type 1-Type 8.
Display Format When you tap this button on the touchscreen and select Single or Quad , the VOCAL data are displayed in full screen. This can be used in every mode. When you press this button again, the display returns to the previous screen.
Ref. Image Tap the corresponding button on the touchscreen to select a reference image from among A, B, and C. The selected image will be highlighted with blue borders 7-97

[Page 402]
VOCAL Edit Tap the corresponding button on the touchscreen to return to the VOCAL Edit stage.
Init When you tap the touchscreen, the position information of the 3D image is initialized.
Mode Specify how the surface of VOCAL data is presented. Use the dial-button to select Surface or Wireframe. X ‹ Surface: VOCAL data are represented using the method of expressing the exterior of images by curves. X ‹ Wireframe: VOCAL data are represented by dots and lines. NOTE: This option is available with ROI 3D . [Figure 7.30 VOCAL – Touchscreen] 7-98

[Page 403] 3D XI This is the view mode used to review 3D XI images. Select MSV or Oblique View . X ‹ 3D XI (MSV, Oblique View, Multi OVIX, and XI Vocal) is an optional feature of this product. X ‹ 3D XI is only available when 3D probes are used. This view mode is enabled if 3D image acquisition is completed when MSV or Oblique View is selected in 3D StandBy . An image can be viewed in multiple slices. MSV An image can be viewed in multiple slices. MSV is an abbreviation for Multi-Slice View. [Figure 7.31 Multi Slice View] NOTE: Available options are Calculator , Caliper , Text and Arrow . 7-99

[Page 404]
MSV Screen The images sliced at the thickness set in Slice Thick . are displayed on the screen. Slice Number/Total Number of Slices is shown at the bottom of each slice image. The currently selected slice image is indicated by an blue contour. The image information displays the current mode, Ref. Image, and Slice Thick. „ ‹ Rotating Image Rotating the reference plane affects all other planes. X ‹ X-axis Rotation: Use the M / X dial-button on the control panel. If the trackball is in Pointer mode, place the Pointer near the X-axis in an image and then move the trackball while pressing the Set button. X ‹ Y-axis Rotation: Use the PW / Y dial-button on the control panel. If the trackball is in Pointer mode, place the Pointer near the Y-axis in an image and then move the trackball while pressing the Set button. X ‹ Z-axis Rotation: Use the Color / Z dial-button on the control panel. If the trackball is in Pointer mode, place the Pointer near the Z-axis in an image and then move the trackball while pressing the Set button. „ ‹ Moving Image Set the trackball in Move Mode, and then move it up/down/left/right. The image will move along the X and Y axes. [Figure 7.32 Multi Slice View – Touchscreen] 7-100

[Page 405]
Display Format Set the layout of slice images. Select from 1x1, 2x1, 2x2, 3x2, 3x3 or 4x3 by tapping the corresponding button on the touchscreen. The number of indices that can be displayed simultaneously on the screen varies depending on this setting. If the layout is changed, the selected slice image moves to the first position on the screen.
Ref. Image Tap the corresponding button on the touchscreen to select a reference image from among A, B, and C. „ ‹ MSV OH Tap the ON button on the touchscreen button to turn it on or off. If this function is turned on, the A, B, and C planes of the selected slice image will be displayed on the screen. The selected slice and reference images will be highlighted with blue borders. „ ‹ ClearVision ClearVision removes noise from the image and enhances outlines to help show the image more clearly. You can select off or adjust the index from 1 to 5 by tapping the touchscreen.
Page Change the page on the screen. This option can be useful when the total number of slice images exceeds what is specified in Display Format . Select a page by tapping the Previous and Next buttons on the touchscreen.
Selected Slice Select a slice image to observe. Use the dial-button to select an Index. The selected index will be highlighted with blue borders. 7-101

[Page 406]
Slice Thick. Set the cut depth of images. Use the dial-button to select 0.5, 1.0, 2.0, 3.0, 4.0, 5.0, or 10.0mm. Depending on your selection, the number of indices and pages will vary. NOTE: The Slice Thick. represents the slice width in volume data, rather than the actual anatomical position.
Position Set the position of the post curve. Use the dial-button to select a value from 0 to 100.
Bias Set the bias of the post curve. Use the dial-button to select a value from -100 to 100.
Ruler Set the position of the ruler. Use the dial-button to select None, Right, Left, Top, Bottom or All.
Select Select Post Curve. Use the dial-button to select 2D or 2D Color. X ‹ The following 3D Utility Menu items are enabled in MSV mode: Orientation Dot, Chroma, 4D Cine, Post Processing, Preset. X ‹ For more information on 3D Utility, see ‘3D Utility Menu’. 7-102

[Page 407] Oblique View After drawing a straight or curved line in the selected image in MSV Mode, you can study the related oblique image. To do this, follow the procedure below: 1. Select Display Format and then specify the number of oblique images to study. 2. Set the Cut Type . 3. Draw a straight or curved line in a reference image by using the trackball and the Set button. An oblique image will appear with the start (S) and end (E) points shown. If the trackball is in Move state, the position of the line can be changed. 4. Optimize the image for observation by using other buttons on the touchscreen. X ‹ Functions such as Text and Arrow can be used. X ‹ When Display Format is 2x1, measurement functions such as Calculator and Caliper can be used. [Figure 7.33 Oblique View] 7-103

[Page 408]
Oblique View Screen The reference image that is selected in MSV Mode is displayed on the screen. The reference image is highlighted with blue borders and always placed in the top left corner of the screen. When more than one line is used for observation, each line is indicated by a different color and number. The image information displays the current mode, Ref.Image, Oblique Cut Type, and Plumb Size (or Slice Thick.). NOTE: When OVIX is used, the image information also displays OVIX Line Offset, Mix, Threshold Low, and Render Mode 1, 2. Direction of View of Oblique Image The observer is located perpendicular to the section of a reference image. Please see the view direction below: View Direction End point Start point Start point End point View Direction
Display Format Set the layout of oblique images. Select 2x1, 3x2 or 3x3 by tapping the corresponding button on the touchscreen. Depending on this setting, the number of oblique images and the Oblique Cut Type will vary. 7-104

[Page 409]
Cut Type Specify how images are cut by tapping the corresponding button on the touchscreen. „ ‹ Line The oblique image of a straight line can be studied. „ ‹ Contour The oblique image of a curved line or contour line can be studied. Multi Line & Multi Contour If Display Format is set to 3x2 or 3x3, enable Auto Increment to draw more than one line. „ ‹ Parallel The oblique image of a straight line and its parallel lines can be studied. If a straight line is drawn, its parallel lines are automatically shown on the screen. NOTE: This cannot be used when Display Format is 2x1. „ ‹ Plumb The oblique image of a straight line and its perpendicular lines can be observed. If a straight line is drawn, its perpendicular lines are automatically shown on the screen. NOTE: This cannot be used when Display Format is 2x1. „ ‹ ClearVision ClearVision removes noise from the image and enhances outlines to help show the image more clearly. You can select off or adjust the index from 1 to 5 by tapping the touchscreen. 7-105

[Page 410]
Image Rotation Specify the direction of an oblique image. Select 90°, 180° or -90°, by tapping the button on the screen. Select the oblique image that you wish to change the direction of from Selected Slice .
Clear Line Tap the touchscreen to delete an oblique image.
Selected Slice Use the dial-button to select a line. The oblique image of the selected line is indicated by white contour. NOTE: This cannot be used when Display Format is 2x1.
Plumb Size Use the dial-button to adjust the length of the perpendicular line. The length of the centermost line may be adjusted by 1mm; its current length is displayed in image information. NOTE: This is used only when Cut Type is Plumb.
Slice Thick. Use the dial-button to adjust the interval between the perpendicular lines. The length of the centermost line may be adjusted by 1mm; its current length is displayed in image information. NOTE: This is used only when Oblique Cut Type is Parallel. 7-106

[Page 411]
Rotate Line Use the dial-button to rotate a line. When the line is rotated, the oblique image is also changed accordingly. NOTE: This cannot be used when: X ‹ Cut Type is Contour; or X ‹ When the Selected Slice is Selected Slice Select All.
OVIX OVIX is the abbreviation for Oblique View eXtended, which sets the cross-sectional thickness of an oblique image and shows the image in 3D. Tap the corresponding button on the touchscreen to turn it on or off. When this is on, an OVIX Line appears in the reference image, which indicates the cross-sectional thickness of the oblique image of the reference image. The thickness of the OVIX Line can be adjusted with OVIX Thick. To change the 3D image settings, select and adjust Setting or OVIX Post Curve from the 3D Utility Menu. NOTE: This cannot be used when Cut Type is Contour. Multi Ovlx This means that the OVIX function is enabled when the Layout value is set to 3×2 or higher in Oblique View.
OVIX Thick. Use the dial-button to adjust the thickness of OVIX. The 3D image for the set thickness appears.
Select Select Post Curve. Use the dial-button to select 2D, OVIX, 2D Color, or OVIX Color. 7-107

[Page 412]
Init Tap the touchscreen to delete the Oblique image and reset the position information for Ref. Image. X ‹ The following 3D utility menu items are enabled in Oblique View mode: Orientation Dot, 4D Cine, Post Processing, Render Setup, Chroma, Preset X ‹ For more information on 3D Utility, refer to ‘3D Utility Menu’. [Figure 7.34 Oblique View – Touchscreen] 7-108

[Page 413] XI VOCAL Measure the volume of tissues in 3D XI Mode. NOTE: XI VOCAL is one of the 3D XI features. It is available as an optional feature of this product. [Figure 7.35 XI VOCAL] VOCAL vs XI VOCAL X ‹ VOCAL: Measures the volume of an object in a general 3D image. Uses rotating slices. X ‹ XI VOCAL: Measures the volume of an object in the selected reference image in MSV Mode by using parallel slices. Uses parallel slices. Calculates the volume of an object by cutting it into multiple slices. XI VOCAL is performed in the following order: XI VOCAL Define → XI VOCAL Edit → XI VOCAL 7-109

[Page 414] XI VOCAL Define Specify how slice and contour lines are extracted. Reference images and slice lines are displayed on the left side of the screen. Slice images with the start (S) and end (E) points of a slice line are displayed on the right side of the screen. [Figure 7.36 XI VOCAL Define] 7-110

[Page 415]
Contour Type Select the contour line type. A contour line is automatically created for all types except Manual . „ ‹ Solid Used for object data with many echoes. „ ‹ Cystic Used for object data with fewer echoes. „ ‹ General Draw a contour line based on a typical object. This is faster than other automatic contour types but less accurate. „ ‹ Manual Create the desired shape of an object manually. A contour line can be specified in the XI VOCAL Edit screen.
Ref. Image Tap the corresponding button on the touchscreen to select a reference image from among A, B, and C. The selected image will be highlighted with blue borders. „ ‹ Ref. Contour Tap this button on the touchscreen to turn this feature on or off. If it is turned on, a contour line can be drawn by using the trackball and the Set button.
Slice Direction Set the direction of a slice line. Select from Vertical or Horizontal by tapping the corresponding button on the touchscreen. Changing the direction of a slice line also changes the slice image displayed on the screen. 7-111

[Page 416]
Init When you tap the touchscreen, the position information of the 3D image is initialized.
Next Tap the touchscreen to switch to the XI VOCAL Edit screen. NOTE: If Contour Type is set to Manual, the system switches to the XI VOCAL screen when Next is pressed.
# of Slices Specify the number of slice images. Use the dial-button to select 5, 10, 15, or 20. Depending on the selected number of images, the interval between slices will vary. [Figure 7.37 XI VOCAL Define – Touchscreen] 7-112

[Page 417] XI VOCAL Edit Specify the contour extraction range or run XI VOCAL. Based on slice lines, slice images and pole points will be displayed on the screen. A pole point is a reference point against which an object contour is extracted. Two pole points appear in each slice image. The selected slice image is highlighted with blue borders. ‘The image number/the total number of slice images’ is shown at the bottom of each image. Reference Image and Slice Line These always appear in the bottom right corner of the XI VOCAL Edit screen. They can be useful when the position of a slice image needs to be considered. [Figure 7.38 XI VOCAL Edit]
Ref. Page Use the dial-button to change the screen page.
New Contour Tap the corresponding button on the touchscreen to delete the current data and return to the XI VOCAL Define stage. 7-113

[Page 418]
Accept Contour Tap the button on the touchscreen to apply changes and run XI VOCAL. The system will switch to the XI VOCAL screen. When Contour Type is Set to Manual Use the Set button and the trackball to draw a contour line before pressing Accept Contour . If you press Accept Contour without drawing a contour line, a general type contour line will be extracted. [Figure 7.39 XI VOCAL Edit – Touchscreen] 7-114

[Page 419] XI VOCAL Optimize XI VOCAL data for review. Slice images with their contour line shown and 3D reference images are displayed. The 3D reference image is highlighted with blue borders, and the calculated volume is shown at the bottom of the image. 3D Reference Image Use XI VOCAL to display an object for which volume has been obtained in 3D. Use the Zoom , M/x , PW/y or Color/z dial-buttons on the control panel to zoom or rotate for observation.
View All Slices Tap this button on the touchscreen to turn this feature on or off. If it is turned on, all XI VOCAL data – including reference image, slice line and slice image – will be displayed simultaneously on the screen.
Edit Contour Tap the touchscreen to return to the XI VOCAL Edit screen. You can edit the contour line by using the trackball and the Set button. [Figure 7.40 XI VOCAL – Touchscreen] 7-115

[Page 420] XI STIC This option can be used to obtain the fetal cardiac cycle with volume data on the fetal cardiac area, and to recompile the volume data for display. STIC is an abbreviation for Spatio-Temporal Image Correlation. X ‹ XI STIC is an optional feature of this product. X ‹ XI STIC is only available when 3D probes are used. X ‹ This only appears when the Application is set to OB . X ‹ When you enter 3D Standby in Fetal Heart Preset, the system will automatically switch to STIC. [Figure 7.41 XI STIC] 7-116

[Page 421]
Acquiring XI STIC Images 1. Select the XI STIC tab in the 3D Stand By screen on the touchscreen. 2. Set the various parameters as you would for acquisition of standard 3D images. 3. Press the Freeze or Set button on the control panel. The system will begin acquiring 3D images. 4. When image acquisition is complete, XI STIC is displayed on the monitor screen and the XI STIC Confirm screen appears on the touchscreen. Check the fetal cardiac cycle calculated. 5. Tap Yes on the touchscreen to continue. Tap No to cancel and acquire the images again. 6. You can perform diagnosis by optimizing images. NOTE: If the motion artifacting is severe, data does not contain the cardiac cycle, or the heart rate cannot be calculated for any other reason, you will be returned to the XI STIC image preparation screen. To Obtain Superior STIC Volume Data X ‹ Volume Angle: If the size of the fetal heart is small, use a smaller Volume Angle. X ‹ ROI Position: Adjust the scan position so that the center of the Volume Angle and the fetal heart are aligned properly. X ‹ ROI Box: Adjust the size of the volume box so that it nearly fits the size of the fetal heart.
Volume Angle Set the scan angle. Select a value from 10 to 60 by using the dial-button.
Scan Time Set the image acquisition time. Use the dial-button to select from 7 to 15 seconds. 7-117

[Page 422]
Trimester Set the pregnancy trimester. Use the dial-button to select 1st, 2nd, or 3rd. Trimester If 1st-3rd are selected, the recommended scan time and STIC angle are automatically set for the specified trimester. Please see the following table: Trimester 1st 2nd 3rd Scan Time 10 seconds 12 seconds 15 seconds Volume Angle 20˚ 25˚ 30˚ If a scan time and Volume Angle other than those in the above table are set, the trimester is displayed as User Set. NOTE: For information on other usage, please refer to ‘3D Stand By’ section.
Reviewing XI STIC Image XI STIC image is played as a Volume Cine; on the left side of the screen XI STIC information including HR, Scan Time, Img. Angle, Vol. Angle, and Volume Index are displayed. NOTE: During Volume Cine, only MPR, MSV, and Oblique View Modes are available. Press the Freeze button on the control panel to stop Volume Cine playback.
Speed Select the playback speed for XI STIC images. Use the dial-button to select Very Slow, Slow, Normal, Fast, or Fastest. This rate is based on the fetal heart rate (100%). 7-118

[Page 423]
Vol. Index Use the dial-button to select an Index. X ‹ This option is only available when Freeze is enabled. X ‹ Refer to 3D View-MPR and 3D XI for further information on its use. [Figure 7.42 XI STIC – Touchscreen] 7-119

[Page 424] 3D MXI X ‹ 3D MXI (Mirror View, Volume Slice) is an optional feature of HS60/XH60. X ‹ 3D MXI is only available when 3D probes are used.
Mirror View 3D images can be viewed in multiple directions. The Mirror View screen appears on the touchscreen. NOTE: If you press Mirror View in modes other than Render Mode, Mirror View will start after the mode switches to Render Mode. Therefore, the settings configured in Render Mode will be applied to Mirror View images. „ ‹ Mirror View Screen The front, top, left and right sides of a 3D image are displayed on the screen. In addition, a reference image appears in the upper right corner of the screen, indicating the direction of images. 1 Reference image for Mirror View 2 Image that views the reference image from the left side 3 Image that views the reference image from the top 4 Image that views the reference image from the right side 5 Reference image indicating the direction of each image 7-120

[Page 425] 2 4 [Figure 7.43 Mirror View] „ ‹ Trackball State The current state of the trackball is displayed at the bottom of the monitor screen. You can use the trackball's features by selecting Pointer, Move, or ROI. Press the Change button on the control panel to change the trackball state. The trackball state changes sequentially each time the button is pressed. X ‹ Move: You can move a 3D image with the trackball. The acquired 3D image moves as you move the trackball. X ‹ ROI: You can resize the ROI box with the trackball. The ROI box on the 3D image is resized as you move the trackball. X ‹ Pointer: You can re-adjust the position of the ROI box. Pressing the Pointer button on the control panel switches to the Pointer state. You can resize an image or the ROI box in this state. Press the Change button again to switch to another state. 7-121

[Page 426] „ ‹ Center View Select an image by pressing the button on the touchscreen. The selected image will be displayed as the front image. Select Top , Left , or Right . „ ‹ Display Format When you press this button on the touchscreen, the front image is displayed in full screen. NOTE: ‘Center View’ cannot be changed when Display Format is set to Single. „ ‹ Position Set the position of the post curve. Select a value from 0 to 100 by pressing the button on the touchscreen or using the dial-button. „ ‹ Bias Set the bias of the post curve. Select a value from -100 to 100 by pressing a button on the touchscreen or using the dial-button. „ ‹ Transparency Set the transparency of a 3D image. Select a value from 20 to 250 by pressing the button on the touchscreen or using the dial-button. The lowest value (20) is for complete transparency, and the highest value (250) is for complete opacity. „ ‹ Mix Configure the mix of Render modes 1 and 2. Select a value from 0:100 to 100:0(%) by pressing the button on the touchscreen or using the dial-button. „ ‹ Th.Low Specify the minimum threshold range. Select a value from 0 to 254 by pressing the button on the touchscreen or using the dial-button. When you press this button on the touchscreen, the front image is displayed in full screen. 7-122

[Page 427] „ ‹ Init Resets the position information of the image. NOTE: To reset the settings except for the position information, press Preset and then Default . Performing Mirror View Again To perform Mirror View again based on a certain Mirror View image: 1. While the trackball is in Pointer mode, use the trackball and the Set button to select a Mirror View image. 2. Double-click the selected Mirror View image. Mirror View will be performed again based on the selected image. The selected image will be displayed as the front image. [Figure 7.44 Mirror View – Touchscreen] 7-123

[Page 428]
Volume Slice Volume data can be viewed in multiple slices. The Volume Slice screen appears on the touchscreen. NOTE: If you press Volume Slice in modes other than Render Mode, Volume Slice will start after the mode switches to Render Mode. Therefore, the settings configured in Render Mode will be applied to Volume Slice images. MSV vs. Volume Slice MSV allows you to divide a 3D image into multiple slices that can then be viewed in 2D images. On the other hand, Volume Slice lets you view slice images in 3D. Volume Slice also allows you to adjust the settings of each slice image separately. „ ‹ Volume Slice Screen Nine images are displayed on the screen. In the center row, reference images are displayed in order of 2D, 3D, and OH. In the remaining rows, Volume Slice images created based on those reference images are displayed. On the 3D reference image and the Volume Slice images, the ROI position and slice numbers are displayed. On the 2D reference image, the ROI box and slice line are displayed. [Figure 7.45 Volume Slice] Slice Number Because three slice images are created before and after each reference image, the slices are numbered from -3 to 3. 7-124

[Page 429] „ ‹ Ref. Image Press the button on the touchscreen to select a reference image among A, B, and C. The selected image is displayed in 2D Image. X ‹ A: Axial Section X ‹ B: Sagittal Section X ‹ C: Coronal Section „ ‹ 3D Rotation Set the orientation of a Volume Slice image. Select -90, 90, or 180 by pressing the button on the touchscreen. „ ‹ Slice Thick. Specify the slice line thickness. Make a selection by pressing the button on the touchscreen or using the dial-button. The Volume Slice images are updated according to the setting. 7-125

[Page 430] „ ‹ Selected Slice Select a slice line. Select a value from -3 to 3 by pressing the button on the touchscreen or using the dial-button. The selected slice line can also be found on the 2D reference image. In addition, the Volume Slice image corresponding to the selected slice line is highlighted with an orange border. NOTE: For more information on other menu items, please refer to the menu in ‘3D Mode’ section. Performing Volume Slice Again To perform Volume Slice again based on a certain Volume Slice image: 1. While the trackball is in Pointer Mode, use the trackball and the Set button to select a Volume Slice image. 2. Double-click the selected Volume Slice image. Volume Slice will be performed again based on the selected image. The selected image will appear as the reference image. [Figure 7.46 Volume Slice – Touchscreen] 7-126

[Page 431]
Post Processing The Post Processing screen is displayed on the touchscreen. [Figure 7.47 Post Processing – Touchscreen] „ ‹ Gradient Mask Adjust the brightness of a specific area in an image. Make a selection by tapping the corresponding button on the touchscreen. „ ‹ Flip Image Inverts the position of an image. NOTE: This option is only available in MSV Mode. Tap the image on the touchscreen and flip the image left and right or up and down. „ ‹ Clear SFVI Press the button on the touchscreen to turn this On or Off. The touchscreen switches to the Post Processing screen. Turning it on reduces noise. SFVI stands for Smart Filter Volume Imaging. 7-127

[Page 432] „ ‹ Detailed SFVI Press the button on the touchscreen to turn this on or off. The touchscreen switches to the Post Processing screen. When this is turned On, select a value from 0 to 100 by using the Strength dial-button on the touchscreen. „ ‹ VC Press the VC button to turn this on or off. When this is turned on, use the dial-button to select a value from 1 to 5. VC stands for Volume Compound. „ ‹ Negative Tap this button on the touchscreen to turn this feature on or off. If it is turned on, the brightness of an image will be inverted. „ ‹ Auto Contrast Tap this button on the touchscreen to turn this feature on or off. If it is turned on, the contrast of an image will be adjusted automatically. „ ‹ Threshold Tap this button on the touchscreen to turn this feature on or off. If it is turned on, the Th.Low or Th.High dial-buttons can be used to adjust the threshold. „ ‹ Sharpen Tap this button on the touchscreen to turn this feature on or off. If it is turned on, the boundary of an image will become more apparent. Select a value from 100 to 400 by using the Sharpen dial-button. „ ‹ 3D CI Tap this button on the touchscreen to turn this feature on or off. 3D CI is an abbreviation for 3D Compound Imaging. If set to On, images are compounded to reduce noise and enhance image quality. Use the 3D CI Offset dial-button to select a value from 1 to 10 as the distance between images used for 3D CI. 7-128

[Page 433]
MagiCut The MagiCut screen is displayed on the touchscreen. You can cut the parts that are not relevant to diagnosis away from 3D images. Set the area to cut by using the trackball and the Set button. X ‹ Select this in MPR mode. X ‹ If MagiCut is enabled, Accept ROI is turned on automatically. X ‹ After MagiCut is enabled, if the system is switched to a mode other than MPR Mode, MagiCut is disabled. „ ‹ Mode Set how parts are cut by tapping the corresponding button on the touchscreen. X ‹ Inside Contour: Cuts the inside of the selected area. X ‹ Outside Contour: Cuts the outside of the selected area. X ‹ Inside Box: Cuts the inside of the box. X ‹ Outside Box: Cuts the outside of the box. X ‹ Small Eraser: Cuts the selected contour line. X ‹ Big Eraser: Cuts the selected contour line. This uses a thicker contour line than Small Eraser. „ ‹ Full Depth Tap the corresponding button on the touchscreen to turn Full Depth on or off. If it is turned on, the entire area will be cut. If it is turned off, Depth will appear on the touchscreen. „ ‹ Depth Set the cut depth. Use the dial-button to select a value from 1 to 100. 7-129

[Page 434] „ ‹ Undo Cancel the previous task(s). X ‹ Undo: Cancel the last task. X ‹ Undo All: Cancel all tasks that have been done so far. „ ‹ SmoothCut Mode X ‹ Erase Small: Erases areas clicked and dragged with the trackball. X ‹ Erase Big: Erases a larger area. X ‹ Recovery Small: Restores the volume image in a desired area. X ‹ Recovery Big: Restores the image in a larger area. „ ‹ Mix Configure the mix of Render modes 1 and 2. Use the dial-button to select a ratio from 0:100(%) to 100:0(%). „ ‹ Th.Low Specify the minimum range of Threshold. Use the dial-button to select a value from 0 to 254. [Figure 7.48 MagiCut – Touchscreen] 7-130

[Page 435] Realistic Vue Semi-translucent rendering is used for a realistic display of fetal images. When you press the Realistic Vue button, Clear SFVI, HDVI, and VC are turned on. X ‹ Realistic Vue is an optional feature of this product. X ‹ HDVI is an optional feature of this product and only available for HS60/XH60. „ ‹ Light Direction Use the touchscreen or the trackball to reposition the direction of the light that is applied to volume. NOTE: You need to press the Move Light button to enter trackball mode. „ ‹ Set Color Use the dial-button to select the Set Color applied to Realistic Vue. NOTE: You can set color by using the Hue , Saturation , and Lightness dial-buttons [Figure 7.49 Realistic Vue Setup – Touchscreen] 7-131

[Page 436] Crystal Vue It renders the context information on the user-defined area. X ‹ Crystal Vue is an optional feature of HS60/XH60. X ‹ Available in MPR Mode only. X ‹ It is available in the Gray Mode tab in the Render Setup screen ((Render Mode1: Surface, Render Mode2: Surface Smooth) and (Render Mode1: Surface, Render Mode2: VSI)). It is available in the Inversion Mode tab in the Render Setup screen ((Render Mode1: Surface, Render Mode2: Surface Smooth) and (Render Mode1: Surface, Render Mode2: VSI)). X ‹ Realistic Vue Setup can be executed in Crystal Vue. „ ‹ Crystal Vue Set up Press the button on the touchscreen to select this option. „ ‹ Context Renders the volume data of the selected context for regions such as heart, spine, ventricle, umbilical cord, liver, long bone, and follicle. „ ‹ ROI Contour The context information is displayed as rendered images for the user-defined areas only; for other areas, only the surface information is displayed. „ ‹ ROI Circle The user selects a circular area for which the context information should be displayed. The context information is displayed as rendered images for the user-defined circular area only; for the other areas, only the surface information is displayed. „ ‹ Strength Select a Strength value from 0 to 100 by pressing the touchscreen or using the dial-button. At higher Strength values, the context information becomes clearly visible and turns opaque. At higher Strength values, the image has a wider range of complexity. 7-132

[Page 437] „ ‹ Complexity Select a Complexity value from 0 to 600 by pressing the touchscreen or using the dial- button. If the Complexity value is 0, only the surface information is displayed; at higher Complexity values, however, the context information is shown as rendered images. „ ‹ Crystal Vue Transparency Select a value from 20 to 250 by pressing the button on the touchscreen or using the dial- button. The lowest value (20) is for complete transparency, and the highest value (250) is for complete opacity. „ ‹ Circle Type In this mode, select ROI Circle and resize the circular area for which the context information should be displayed. Use the dial-button to select Small, Medium, or Large. [Figure 7.50 Crystal Vue Setup – Touchscreen] 7-133

[Page 438] Chroma The Chroma Map screen is displayed on the touchscreen. Set the color of 2D and 3D images by tapping the corresponding button on the touchscreen. [Figure 7.51 Chroma Map – Touchscreen] 7-134

[Page 439] Preset The Preset screen appears on the touchscreen. You can set the currently selected Preset or rename the Rendering Preset. Default is the default value of the system. [Figure 7.52 Preset – Touchscreen] „ ‹ Default Use the default setting (General Preset) for the probe. „ ‹ Load When you tap this button on the touchscreen, the currently selected Preset is applied to the system. Then the Preset screen is closed. „ ‹ Save Tap Save . When you tap this button on the touchscreen, the current Preset is saved. „ ‹ Rename Change the name of the selected Rendering Preset. When you tap this button on the touchscreen, the Name screen appears. After changing the name, tap Save to save the changed name. Tap Close to cancel the change. „ ‹ Reset When you tap this button on the touchscreen, the Preset is reset to its default value. 7-135

[Page 440] 5D NT This feature locates the Mid-Sagittal View and measures the thickness of the nuchal translucency (NT) of the fetus. The 5D NT window appears on the touchscreen. Use the trackball to place NT Seed in NT area, and press the Set button to display the NT measurement on the A Plane. X ‹ 5D NT is an optional feature of this product. X ‹ These options are only available in MPR mode. How To get good results X ‹ You can get better results when the Sagittal View of the fetus is captured as accurately as possible. X ‹ The higher the contrast between the fetus's palate and nasal bone, the better. X ‹ It is preferable to have the lateral direction of the probe be parallel to the body orientation of the fetus. X ‹ It is preferable to have the probe's angle to the fetus's nasal bone as close to 30 degrees as possible. 7-136

[Page 441] „ ‹ NT Caliper Placement Tap the touchscreen to select the NT measurement type. X ‹ On to On: Measure by placing the cursor on the NT’s inner-inner. Cursor X ‹ On to Max Brightness: One side of the cursor is placed on the outside of the NT, and measurement is taken with inner-outer. This method is used when Harmonic is used and one side of the nuchal translucency is blurred. Cursor X ‹ In to In: Similar to On to On, this method takes measurement with inner-inner, albeit with a narrower cursor interval. Cursor „ ‹ Items X ‹ NT: The acquired A, B, and C plane images and the automatically measured NT are displayed in the 3D View screen. X ‹ IT: Locates mid-sagittal view and tests the fetus for spina bifida. 7-137

[Page 442] „ ‹ Assign Tap the touchscreen to include the selected items in the OB report. „ ‹ 5D NT This function helps the user to easily see the NT measurement process. This assigns a certain thickness to A, B and C sections of the image and displays 3D Rendering image. „ ‹ Init The image’s position information is reset. „ ‹ Hide All Pressing this button will hide the marker and the measurements for NT and IT from the screen. „ ‹ Auto Tap the corresponding button on the touchscreen to turn this feature on or off. If set to On, automatically locates Mid-Sagittal View. To calculate NT, place the cursor on NT area and press the Set button on the control panel. „ ‹ Edit Edit markers for each item that is displayed as a result. If the trackball’s state is Cursor, move the cursor near a + marker. Press the Set button and move the trackball to edit the marker as desired. „ ‹ ROI Height Use the dial-button to adjust the ROI Line’s Height to define the scope of the application. The ROI Height may be adjusted while measurements are being taken or in Edit mode. „ ‹ Marker Size Tap on the touchscreen or use the dial-button to select Small, Medium, or Large. 7-138

[Page 443] 5D Follicle NOTE: 5D Follicle is an optional feature of this product. This feature assists with diagnosis by estimating the size and volume of a follicle in the ovary. Tap this button on the touchscreen to switch to the 5D Follicle screen. Press Exit to finish 5D Follicle. Run 5D Follicle, and the touchscreen will switch to the 5D Follicle screen. 1. Specify the position of scanning. Use the Position dial-button on the touchscreen to select between Left Ovary and Right Ovary. 2. Select a measurement method. X ‹ Auto: The follicle is located and measured automatically. X ‹ Manual: The user manually locates and measures the follicle. 3. When the measurement is finished, its result is shown on the screen. The scanned parts are color-coded and numbered. [Figure 7.53 5D Follicle] 7-139

[Page 444]
Editing Results Edit the results of measurement. Tap Edit on the touchscreen to turn on or off. Select a task you need to perform by pressing the Change button on the control panel or by tapping the button on the touchscreen. In Edit Mode, the Single and Quad options of Display Format will be disabled. „ ‹ Slice Review An image can be viewed in multiple slices. You can search for follicles that have not been found yet. „ ‹ Delete Delete the detected target. 1. Select Delete by pressing the Change button on the control panel or by tapping the button on the touchscreen. 2. Use the Set button to click the target. 3. The selected target will be deleted from the image and the results table. „ ‹ Add Seed A measurement target will be added based on the seed positions entered by the user. Use this if you find an undetected follicle. 1. Select Add Seed by pressing the Change button on the control panel or by tapping the button on the touchscreen. 2. Click the discovered target by using the Set button and then use Growth to specify its size. 3. The specified size will be calculated again and displayed in the results table. 7-140

[Page 445] „ ‹ Add Contour A measurement target will be added based on the Contours entered by the user. Use this if you find an undetected follicle. 1. Select Add Contour by pressing the Change button on the control panel or by tapping the button on the touchscreen. 2. Using the Set button, specify the contour for the detected target. 3. The specified size will be calculated again and displayed in the results table. „ ‹ Growth Specify the size of the target to measure. Tap the Increase ( ) or Decrease ( ) button on the touchscreen to adjust the size. In Edit Mode, the button will be enabled only when an additional Follicle is manually detected using Add Seed or Add Contour. „ ‹ Assign Measurement results will be saved to the report. [Figure 7.54 5D Follicle Edit – Touchscreen] 7-141

[Page 446] 5D Heart Color This feature assists with diagnosis of fetal heart conditions by using the STIC data of the fetus. X ‹ 5D Heart Color is an optional feature of HS60/XH60. X ‹ 5D Heart is only available in the following circumstances. – 3D probe – Application: OB
Acquiring 5D Heart Color Images NOTE: If the motion artifact is severe or the heart rate cannot be calculated due to reasons such as missing cardiac cycle data, you will be returned to the initial 5D Heart screen. 1. Select the 5D Heart tab on the 3D Stand By screen on the touchscreen. 2. Configure various parameters on the touchscreen. X ‹ Rendering Preset: Select a preset for 3D images. For more information, please refer to ‘Preset’ in the ‘3D View-MPR Mode’ section. Rendering Preset The selected preset will be maintained in XI STIC. However, the preset will be reset if you move to the 3D or 4D tab. You cannot change the preset after acquiring a 3D image. NOTE: For information on the remaining items, please refer to ‘XI STIC’. 3. Specify the location where you will acquire images. STIC Volume Data The standard view acquired using 5D Heart Color is affected by the quality of obtained STIC data. Follow the guide displayed on the left side of the screen to adjust the location where you will acquire images. 7-142

[Page 447] 4. Press the Freeze or Set button on the control panel. The system will begin acquiring 3D images. X ‹ Breech Sweep: You can also scan a breech baby from its head to abdomen without changing the probe direction. 5. Since a fetus moves frequently, if it is in an ideal position during a cardiac scan, you can choose to resume scanning immediately after saving data in order to obtain as much data as possible. Users can press the following buttons on the touchscreen: X ‹ 5D Heart Color Acquisition – Save: Saves acquired data and returns to 3D Stand by Mode. – Discard: Returns to 3D Stand by Mode without saving invalid data resulted from the fetus movement. – Process: After saving acquired data, enters 5D Heart Mode with the scanned data. NOTE: If no Patient ID has been created, pressing the Save or Process button will open the Patient screen. In this case, selecting the Cancel button will not delete the data; it will function like the Process button. 7-143

[Page 448]

[Page 449] Chapter 8 Measurements ‹ ‹ Measurement Accuracy 8-3 Causes of Measurement Errors 8-3 Optimization of Measurement Accuracy 8-5 Measurement Accuracy Table 8-7 ‹ ‹ Basic Measurements 8-9 Distance Measurement 8-13 Circumference and Area Measurement 8-23 Volume Measurement 8-26 ‹ ‹ Measurements by Application 8-29 Things to Note 8-29 Common Measurement Methods 8-33 OB Measurements 8-37 Fetal Heart Measurements 8-46 Gynecology Measurements 8-49 Cardiac Measurements 8-52 Abdomen Measurements 8-66 Pediatric Hips Measurements 8-68 Urology Measurements 8-70 Small Parts Measurements 8-71 Musculoskeletal Measurements 8-75 Vascular Measurements 8-76

[Page 450] Chapter 8 ‹ ‹ Reports 8-85 Viewing Reports 8-85 Report Preview 8-86 Editing Report (Worksheet) 8-89 Adding Comments 8-92 Print Reports 8-94 Saving Reports 8-94 Store SR 8-95 Images 8-95 OB Graph 8-97 Description 8-102 Closing Reports 8-104

[Page 451] Measurement Accuracy Measurement values can vary depending on the nature of the ultrasound wave, the body’s response to ultrasound waves, the measurement tools, algorithms, product settings, probe type, and the actions performed by the user. Before using this product, make sure to read and understand the following information regarding the causes of measurement errors, and measurement optimization. Causes of Measurement Errors
Image Resolution The resolution of an ultrasound image may be limited by spatial causes. X ‹ Errors caused by signal range may be minimized by adjusting the focus settings. Optimizing the focus settings increases the resolution of the measurement area. X ‹ In general, the lateral resolution is lower than the axial resolution. Therefore, measurements should be performed along the axis of the ultrasound beam to obtain accurate values. X ‹ Gain has a direct impact on the resolution. Gain can be adjusted by using the Gain button for each mode. X ‹ In general, increasing the frequency of ultrasound enhances resolution.
Pixel Size X ‹ This product’s ultrasound images consist of pixels. X ‹ Since a single pixel represents the basic unit of an image, a measurement error may result in the displacement of approximately ±1 pixel when compared to the original image size. X ‹ However, this error becomes significant only when a narrow area in an image is measured. 8-3

[Page 452]
Ultrasound Velocity X ‹ The average velocity of ultrasound used for measurement is usually 1,540 m/s. X ‹ The velocity of ultrasound used varies depending on the cell type. X ‹ The possible range of error is approximately 2-5% depending on the structure of cells (about 2% for typical cells and about 5% for fatty cells).
Doppler Signal Adjustment X ‹ During velocity measurement, an error may occur, depending on the cosine angle between the blood flow and the ultrasound beam. X ‹ For Doppler velocity measurements, the most accurate results can be ensured by aligning the ultrasound beam in parallel with the blood flow. X ‹ If that is not possible, the angle between them should be adjusted by using the Angle option.
Aliasing X ‹ PW Spectral Doppler Mode uses a signal sampling technique to calculate the frequency (or velocity) spectrum. X ‹ Adjust the baseline or the velocity scale to minimize aliasing. A lower frequency probe can also be used to reduce aliasing.
Calculation Equation X ‹ Some of the calculation equations used for clinical purposes originate from hypotheses and approximation. X ‹ All calculation equations are based on medical reports and articles.
Human Error X ‹ Human error may occur due to inappropriate use or lack of experience. X ‹ This can be minimized through compliance with and thorough understanding of the manuals. 8-4

[Page 453] Optimization of Measurement Accuracy
2D Mode X ‹ Resolution is in proportion to the frequency of the probe. X ‹ Penetration is inversely proportional to the frequency of the probe. X ‹ The highest resolution can be obtained at the focus of the probe where the ultrasound beam is narrowest. X ‹ The most accurate measurements can be obtained at the focus depth. As the distance from the focus increases, the beam width increases, which results in lower accuracy. X ‹ Using the zoom function or minimizing the depth display makes distance or area measurements more accurate.
M Mode X ‹ The accuracy of time measurements can be increased by setting the sweep velocity and the display format to higher values. X ‹ The accuracy of distance measurements can be increased by setting the display format to a higher value.
Doppler Mode X ‹ Using lower frequency ultrasound is recommended for measurement of faster blood flows. X ‹ The size of the sample volume is limited by the axial direction of the ultrasound. X ‹ Using lower frequency ultrasound increases penetration. X ‹ The accuracy of time measurements can be increased when the sweep velocity is increased. X ‹ The accuracy of velocity measurements can be increased when the vertical scale is set to smaller values. X ‹ It is most important to use an optimal Doppler angle to enhance the accuracy of velocity measurements. 8-5

[Page 454]
Color/Power Doppler Mode X ‹ A protocol has not been specified for images in Color Doppler Mode or Power Doppler Mode. Therefore, the same limitations imposed on measurements taken in B/W images also apply to the accuracy of measurements taken in Color Doppler and Power Doppler Modes. X ‹ Using Color/Power Doppler Mode images to measure accurate blood flow velocity is not recommended. X ‹ The amount of blood flow is calculated based on the average velocity rather than the peak velocity. X ‹ In all applications, the amount of blood flow is measured in PW Spectral Doppler mode.
Cursor Position X ‹ All measurements are affected by input data. X ‹ Adjust the images on the screen so that they are displayed at maximum granularity. X ‹ Use the front edge or boundary point of a probe to make the start and end points of a measurement object more distinct. X ‹ Make sure that the probe direction remains aligned during measurement. 8-6

[Page 455] Measurement Accuracy Table The following tables show the accuracy of the measurements that can be taken using this product. Ensure that the results of measurement accuracy checks are kept within the ranges specified in the table. Except for certain applications or probes, the following accuracy ranges should be maintained for measurement of distance on a straight line. NOTE: In case of doubt in the measurements, please contact your local Samsung Medison Service Department for an accuracy test.
2D Mode Accuracy Test Accuracy Measurements Range (Whichever is Greater) Methodology Based on Axial Distance < ± 4% or 1 mm Phantom Acquisition Full Screen Lateral Distance < ± 4% or 2 mm Phantom Acquisition Full Screen Area < ± 8% or 4 mm 2 Measurement Equation Full Screen Volume < ± 12% or 8 mm 3 Measurement Equation Full Screen Angle < ± 4% or 1° Measurement Equation Full Screen
M Mode Accuracy Test Accuracy Measurements Range (Whichever is Greater) Methodology Based on Time < ± 5% or 1 ms Signal Generator Acquisition 0.01 – 11.3 sec Slope < ± 8% or 4 mm/ms Measurement Equation Full Screen 8-7

[Page 456]
PW/CW Spectral Doppler Mode Doppler Accuracy Test Accuracy Test Range Measurements (Whichever is Greater) Methodology Based on PW: 30, 50, 70, 90 cm/sec Velocity < ± 15% Phantom Acquisition CW: 110 cm/sec Signal Time < ± 5% Acquisition 10 ms – 9.44 s Generator Heart Rate < ± 5% or 1 bpm Measurement Equation 1 – 43,200 bpm Tips! Accuracy of ±1 least significant displayed digit (e.g. XX.X will be ±0.1mm, XX% will be ±1%) 8-8

[Page 457] Basic Measurements Press the Caliper button on the control panel. NOTE: Take basic measurements of distance and area regardless of the application. For information on measurements for each application, please refer to the ‘Measurements by Application’ section of this chapter. The available measurement methods vary depending on the current Operation modes. Please refer to the following table: Measurement Category Operation Modes Measurement Method Distance Trace Length Open Spline 2D, M, D 3 Points Angle 2 Lines Angle %Stenosis(D) Distance(M) Slope HR(M) Time(M) Velocity Distance measurement Accel RI Manual Trace Limited Trace HR(D) VolumeFlow(D) VolumeFlow(A) Time(D) Auto Trace S/D Ratio D/S Ratio 8-9

[Page 458] Measurement Category Operation Modes Measurement Method Ellipse Circumference and Area Trace 2D, M, D measurement Closed Spline %Stenosis(A) 1 Dist. Volume 2 Dist. Volume 3 Dist. Volume Volume measurement 2D, M, D Ellipse Volume Ellipse + Dist.Vol Disk Volume [Table 8.1 Basic Measurements by Operation Modes]
Basic Measurement Operations The following is the information on common button operations for basic measurements: „ ‹ Selecting/Changing Measurement Method Select a measurement method using the touchscreen. The menu items that can be selected on the touchscreen vary according to the Operation modes. The selected measurement method is displayed in the User Information area. „ ‹ Adjusting Font Size Go to Setup > Measurement > General > Result > Font Size and either enter the font size to be used in the measurement results, or use the ‘Font Size’ knob button to select a desirable size from 8 to 20. 8-10

[Page 459] „ ‹ Canceling Measurement Results Delete Last: Tap Delete Last on the touchscreen to delete the last measurement taken. The value displayed on the corresponding application report will also be deleted. „ ‹ Specifying the Measurement Result Position Place the pointer over the measurement and press the Set button. Use the trackball to move the measurement to the desired location, and press the Set button to place the movement at that location. „ ‹ Resetting Measurement Result Position Go to Setup > Measurement > General Page , and change the value for Position on 2D Mode or Position On M/D in Result to reset the position of the measurement results as desired. NOTE: You may select Left-Top , Left-Bottom , Right-Bottom , Right-Top , or Custom . „ ‹ Deleting Measurement Results Clear: Tap Clear on the control panel or the touchscreen to delete the measurement. „ ‹ Printing Measurement Results Press the established U Key with the Store/Print button on the control panel. NOTE: Go to Setup > Customize > Buttons and choose a button to set as Store/Print from the U1 U2 U3 U4 U5 and U6 buttons. 8-11

[Page 460] „ ‹ Exiting Basic Measurement After completing (or canceling) all in-progress measurements, press the Exit button on the control panel. NOTE: To change measurement units and other settings, select Setup > Measurement > General on the keyboard. For more information, refer to ‘Chapter 3. Utilities’ in this manual. [Figure 8.1 Caliper] 8-12

[Page 461] Distance Measurement
Distance This is a basic measurement that is available in all Operation modes. Specify two points on a 2D image and measure the length of the straight line between the points. 1. Select Distance on the monitor or touchscreen. Use the trackball and the Set button on the control panel to specify the end points of the measurement. Use the trackball to place the cursor at the desired position and then press the Set button. Repositioning a Point Instead of pressing the Set button to confirm the point position, you can press the Change button to reset it. 2. Specify both end points and then the distance between them will be measured. 3. When the distance has been measured, the result is shown on the screen.
Trace Length This is a basic measurement that is available in all Operation modes. Specify a point on a 2D image and trace a curve from that point to measure its length. 1. Select Trace Length on the monitor or touchscreen. Use the trackball and the Set button on the control panel to specify the start point of the measurement. Use the trackball to place the cursor at the desired position and then press the Set button. 2. Use the trackball to draw the desired curve and then press the Set button to set the end point. 3. Specify both end points and then the length of the curve will be measured. Editing Curves Before specifying the end point by pressing the Set button, you can delete part of the curve being traced by rotating the soft menu dial-button 5 counter-clockwise. To restore the deleted curve, rotate the dial-button clockwise. 8-13

[Page 462]
Open Spline This is a basic measurement that is available in all Operation modes. Specify mulle points on a 2D image to measure the length of the resulting Open Spline curve. 1. Select Open Spline on the monitor or touchscreen. Use the trackball and the Set button on the control panel to specify as many points as desired. After specifying the last point of the Open Spline, press the Set button twice to finish measuring the Open Spline. At least two points must be specified before the Open Spline can be measured. 2. The length of the Open Spline curve created with the points you have specified will be calculated and displayed on screen.
3 Points Angle This is a basic measurement that is available in all Operation modes. Place three points on a 2D image and measure the angle formed by the points. 1. Tap 3 Points Angle on the touchscreen. 2. Specify three points. 3. The angle formed by the three points will be calculated and displayed on the screen.
2 Lines Angle This is a basic measurement that is available in all Operation modes. Specify two straight lines on a 2D image to measure the angle between the two lines. 1. Tap 2 Lines Angle on the touchscreen. 2. Draw two straight lines. Refer to ‘Distance’ for instructions on how to draw a straight line. 3. The angle between two lines will be calculated and displayed on the screen. When two angles are calculated, the smaller angle is displayed. 8-14

[Page 463]
%Stenosis(D) StD stands for Stenosis Distance, which is a basic measurement available in all Operation modes. The diameter of a blood vessel is measured on a 2D image to calculate its stenosis ratio (%). 1. Select %Stenosis(D) on the monitor or touchscreen. 2. Measure the total diameter of a blood vessel using the Distance measurement method. 3. When the second cursor appears, measure the diameter of the vessel’s inner wall under stenosis. 4. Calculate %StD using the following equation: %Stenosis(D) = (Outer Distance – Inner Distance) / Outer Distance x 100
Distance(M) This is a basic measurement that is only available in M mode. Specify two points on an M image, and measure the distance between the two points 1. Select Distance(M) on the monitor or touchscreen. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. 2. When the distance has been measured, the result is shown on the screen.
Slope This is a basic measurement that is only available in M mode. Specify two points on an M image, and measure the velocity between the two points 1. Select Slope on the monitor or touchscreen. 2. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. 3. When the distance has been measured, the result is shown on the screen. 8-15

[Page 464]
HR(M) This is a basic measurement that is only available in M mode. Specify two bars on an image and measure the heart rate between the two bars. 1. Select HR(M) on the monitor or touchscreen. 2. Use the trackball and the Set button on the control panel to select two bars.
Time(M) This is a basic measurement that is only available in M mode. Specify two bars on an M image and measure the time between the two bars. 1. Select Time(M) on the monitor or touchscreen. 2. Use the trackball and the Set button on the control panel to select two bars.
Velocity This is a basic measurement that is only available in Spectral Doppler mode. Specify one point on a Spectral Doppler image to measure the velocity. NOTE: In a Spectral Doppler image, the X- and Y-axes represent time and velocity, respectively. 1. Select Velocity on the monitor or touchscreen. 2. Specify a point. 8-16

[Page 465]
Accel This is a basic measurement that is only available in Spectral Doppler mode. Specify two points on a Spectral Doppler image and measure the velocity at each point to calculate the time and acceleration. 1. Select Accel on the monitor or touchscreen. 2. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. The following equation is used for Accel measurement: X ‹
RI This is a basic measurement that is only available in Spectral Doppler mode. Specify two points on a Spectral Doppler image and measure the velocity at each point to calculate the Resistivity Index (RI). 1. Tap RI on the touchscreen. 2. Specify two points on a Spectral Doppler image, and measure the velocity at each point. The equations used for D RI measurement are as follows: X ‹ 8-17

[Page 466]
Manual Trace This is a basic measurement that is only available in Spectral Doppler mode. You can specify a point on a Spectral Doppler image and trace a curve from that point to calculate the blood flow velocity, mean velocity, RI and Pulsatility Index(PI). 1. Select Manual Trace on the monitor or touchscreen. 2. Trace the curve. When the measurement has been taken, the result is shown on the screen. The measurement results displayed will vary, depending on the settings you have selected in Setup > Measurement > Library > Caliper > D > Manual Trace . X ‹ PS: Peak Systolic Velocity X ‹ PI: Pulsatility Index X ‹ MD: Min Diastolic Velocity X ‹ RI: Resistivity Index X ‹ ED: End Diastolic Velocity X ‹ PS/ED: PS ED Ratio X ‹ TAmax: Time Averaged Max Velocity X ‹ ED/PS: ED PS Ratio The equations used for Trace measurement are as follows: VTI X ‹ V mean = Duration of flow PS − ED X ‹ RI = PS PS − ED X ‹ PI = Vmean 8-18

[Page 467]
Limited Trace This is a basic measurement that is only available in Spectral Doppler mode. Specify two bars on a Spectral Doppler image to calculate the mean velocity between the bars, RI and Pulsatility Index(PI). 1. Select Limited Trace on the monitor or touchscreen. Use the trackball and the Set button on the control panel to select two bars. 2. When the measurement has been taken, the result is shown on the screen. X ‹ PS: Peak Systolic Velocity X ‹ PI: Pulsatility Index X ‹ MD: Min Diastolic Velocity X ‹ RI: Resistivity Index X ‹ ED: End Diastolic Velocity X ‹ PS/ED: PS ED Ratio X ‹ TAmax: Time Averaged Max Velocity X ‹ ED/PS: ED PS Ratio X ‹ TAMEAN: Time Average Mean Velocity X ‹ HR The equations used for D Limited Trace measurement are as follows: VTI X ‹ V mean = Duration of flow PS − ED X ‹ RI = PS PS − ED X ‹ PI = Vmean V 1 X ‹ V / V = 1 2 V 2 8-19

[Page 468]
VolumeFlow(D) This is a basic measurement that is only available in Spectral Doppler mode and 2D Image Mode. Specify two bars on a Spectral Doppler image, and specify two points in 2D Image mode, to calculate the VolumeFlow. 1. Select VolumeFlow(D) on the monitor or touchscreen. 2. Use the trackball and the Set button on the control panel to select two bars. This measurement is taken in the same way as ‘M Time’. This can only be done in the Loop area. 3. Use the trackball and the Set button on the control panel to select two points. 2D Image Mode will activate automatically so that you can measure the distance. This measurement is taken in the same way as ‘Distance’.
Time(D) This is a basic measurement that is only available in Spectral Doppler mode. Place two bars on a Spectral Doppler image to calculate the time between the bars. 1. Tap D Time on the touchscreen. 2. Set two bars on the spectrum with the trackball and the Set button.
HR(D) This is a basic measurement that is only available in Spectral Doppler mode. Place two bars on an image and measure the heart rate between the two bars. 1. Select HR(D) on the monitor or touchscreen. 2. Use the trackball and the Set button on the control panel to select two bars. 8-20

[Page 469]
Auto Trace Spectrum is traced automatically. This can be enabled in the measurement menu in Spectral Doppler mode. 1. Press Auto Trace in the Measurement menu. 2. The system traces the spectrum automatically. 3. When the Trace is complete, the measurement results are displayed on the screen. Things to Consider when using Doppler Spectrum Auto Trace The state of a Doppler Spectrum may affect the measurement results. Please pay attention to the following: X ‹ Causes for Trace Failure – If the Gain is changed while a Doppler image is in Freeze state, Contour Trace and Peak Trace will not work. – If there is little or no noise in an image without a spectrum, Contour Trace will not work. – If there is severe noise in an image, Contour Trace will not work. – If the Clutter Filter is set too high, Auto Trace and Limited Trace may not work. X ‹ Possible Causes of Inaccurate Peak Trace – If the PRF (Pulse Repetition Frequency) is lower than the velocity at the site being examined, aliasing may occur. If the original signals are separated from aliasing, a Trace can be carried out, but the peak measurement may not be accurate. – If the peak of a spectral waveform is not clear or occurs intermittently, a Trace can be carried out, but the peak measurement may not be accurate. – If the Doppler Gain is set too high or too low, it becomes difficult to distinguish spectra. This may result in measurement error. – If the Wall Filter is set too high, the spectrum will only be partially displayed. In this case, a Trace can be carried out, but Peak measurement may not be accurate. – If abnormal noise or artifacts occurs, a Trace can be carried out, but Peak measurement may not be accurate. X ‹ Other – Use of the CW Probe may result in measurement error(s). – Limited Trace is supported only for two-peak spectrums, such as Mitral Valve Inflow and Tricuspid Valve Inflow in the cardiology application. 8-21

[Page 470]
S/D Ratio, D/S Ratio This is a basic measurement that is only available in Spectral Doppler mode. After designating two points in a Spectral Doppler image, calculate the velocity ratio by measuring the velocity at each point. NOTE: In a Spectral Doppler image, the X- and Y-axes represent time and velocity, respectively. 1. Tap the S/D button on the touchscreen. 2. After designating two points, measure the velocity at each point. The measurement method is same as ‘RI’. 8-22

[Page 471] Circumference and Area Measurement
Ellipse This is a basic measurement that is available in all Operation modes. Measure the circumference and area of circle (ellipse)-shaped objects on a 2D image. 1. Click Ellipse on the monitor or tap Ellipse on the touchscreen. 2. Use the trackball and the Set button on the control panel to specify the diameter (axis) of the measurement area. Use the trackball to place the cursor at the desired position and then press the Set button. Repositioning Point Before pressing the Set button to confirm the position, you can press the Change button to reset the position of the point. 3. Specify the size of the circle (ellipse). Adjust the size using the trackball and then press the Set button. The following equation is used for Ellipse measurement: X ‹ , (a: Half Long axis, b: Half Short axis) X ‹ Area = , (a, b: Axis) 8-23

[Page 472]
Trace This is a basic measurement that is available in all Operation modes. Measure the circumference and area of an irregularly shaped object on a 2D image. 1. Select Trace on the monitor or touchscreen. 2. Use the trackball and the Set button on the control panel to specify the start point for tracing over the contour of the measurement area. Use the trackball to place the cursor at the desired position and then press the Set button. 3. Trace the curve so that the measurement cursor returns to the start point, and then press the Set button. NOTE: The Trace Line must be a closed curve. If you press the Set button before tracing is complete, a straight line will be traced between the current position and the start point, resulting in a significant error. The equations used for Trace measurement are as follows: X ‹ , (N = 1, 2… last point) X ‹ , (N = 1, 2… last point) Editing Curves Before specifying the end point by pressing the Set button, you can delete part of the curve being traced by rotating the soft menu dial-button 5 clockwise. To restore the deleted curve, rotate it counter-clockwise. 8-24

[Page 473]
Closed Spline This is a basic measurement that is available in all Operation modes. Specify multiple points on a 2D image to measure the circumference and area of the resulting closed spline. 1. Select Closed Spline on the monitor or touchscreen. Use the trackball and the Set button on the control panel to specify as many points as desired. After specifying the last point of the Spline, press the Set button twice to finish measuring the Spline. At least three points must be specified before spline can be measured. 2. The circumference and area of the closed spline created with the points you have specified will be calculated and displayed on screen.
%Stenosis(A) StA stands for Stenosis Area, which is a basic measurement available in all Operation modes. The area of a blood vessel is measured on a 2D image to calculate its stenosis ratio (%). 1. Select % Stenosis(A) on the monitor or touchscreen. Measure the area of the vessel outer wall using the ‘Ellipse’ measurement method. 2. When the second cursor appears, measure the area of the stenosed vessel’s inner wall. This measurement is taken in the same way as ‘Trace’. 3. Calculate %Stenosis(A) with the following equation: %Stenosis(A) = (Outer Area – Inner Area) / Outer Area x 100
VolumeFlow(A) This is a basic measurement that is only available in Spectral Doppler mode and 2D Image mode. Specify two bars on a Spectral Doppler image and specify an ellipse in 2D Image mode to calculate the VolumeFlow. 1. Select VolumeFlow(A) on the monitor or touchscreen. Use the trackball and the Set button on the control panel to select two bars. This measurement is taken in the same way as ‘M Time’. This can only be done in the Loop area. 2. Use the trackball and the Set button on the control panel to select an ellipse. 2D Image Mode will activate automatically so that you can measure the ellipse. This measurement is taken in the same way as ‘Ellipse’. 8-25

[Page 474] Volume Measurement NOTE: Since Dual Mode simultaneously displays two images on the screen, you don’t have to return to the Operation modes to measure volume in Dual Mode.
1 Distance Volume an object by using only one straight line on a 2D image. 1. Select 1 Distance Volume on the monitor or touchscreen. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. 2. When the measurement has been taken, the result is shown on the screen. The volume (Vol.) will be calculated along with the length of the line. The equations used for 1 Distance measurement are as follows: X ‹ , (D: distance)
2 Distance Volume an object by using two straight lines on a 2D image. 1. Select 2 Distance Volume on the monitor or touchscreen. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. 2. Measure the length of the last remaining straight line using the same method as above. 3. When the measurement has been taken, the result is shown on the screen. The volume (Vol.) will be calculated along with the length of each line. The equations used for 2 Distance measurement are as follows: π 2 X ‹ D1 > D2, Vol = ⋅ D 1 ⋅ D 2 , (D: distance) 8-26

[Page 475]
3 Distance Volume an object by using three straight lines on a 2D image. 1. Select 3 Distance Volume on the monitor or touchscreen. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. 2. Measure the length of the remaining two straight lines using the same method as above. 3. When the measurement has been taken, the result is shown on the screen. The volume (Vol.) will be calculated along with the length of each line. The equations used for 3 Distance measurement are as follows: X ‹ , (D: distance)
Ellipse Volume This is a basic measurement that is available in all Operation modes. Measure the volume of a cone-shaped object by using one circle (ellipse) on a 2D image. 1. Tap Ellipse Volume on the touchscreen. Specify the size of the circle (ellipse). This measurement is taken in the same way as ‘Ellipse’. 2. When the measurement has been taken, the result is shown on the screen. The following equation is used for Ellipse measurement: X ‹ 8-27

[Page 476]
Ellipse+Dist Vol. an object by using one straight line and one circle (ellipse) on a 2D image. 1. Tap Ellipse+Dist Vol. on the touchscreen. Specify the size of the circle (ellipse). This measurement is taken in the same way as ‘Ellipse’. 2. Specify two points and measure the length of the straight line between the points. This measurement is taken in the same way as ‘Distance’. The equation for measuring Ellipse+Dist Vol. is as follows: X ‹ ,
Disk Volume This is a basic measurement that is available in all Operation modes. Calculate the volume of an irregularly shaped object by measuring the area and the length of its long axis on a 2D image. 1. Select Disk Volume on the monitor or touchscreen. Draw the contour of the area to be measured. This measurement is taken in the same way as ‘Trace’. 2. Measure the length of the long axis. This measurement is taken in the same way as ‘Distance’. X ‹ D: The length of a straight line X ‹ Area: The area of a circle X ‹ Volume: Volume Editing Curves Before specifying the end point by pressing the Set button, you can delete part of the curve being traced by rotating the soft menu dial-button 5 counter-clockwise. To restore the deleted curve, rotate it clockwise. 8-28

[Page 477] Measurements by Application Press the Calculator button on the control panel. Things to Note
Before Starting Measurement „ ‹ Register Patient X ‹ Make sure the currently registered patient information is correct. If the patient is not registered, press the Patient button on the control panel to register the patient. X ‹ Use the Study Information tab to enter or change a patient’s information per diagnosis item. X ‹ For information on the Patient Information menu and how to enter the information, refer to ‘Patient Information’ in ‘Chapter 6. Starting Modes of Operation’. „ ‹ Check the Probe, Application, and Preset X ‹ Check the name of the probe and the application displayed in Title area. To use a different probe or application, press the Probe button on the control panel. X ‹ In the Probe Selection screen, check the Preset settings. „ ‹ Measurement Menu Settings Set the related menus for convenient measurement. For menus related to measurement and their settings, refer to the ‘Measurement Settings’ in ‘Chapter 3. Utilities’ of this manual. 8-29

[Page 478]
Measurement Operations The following gives information on the common button operations for measurements: „ ‹ Select Measurement Item Select from the measurement item menu on the touchscreen. „ ‹ Change Measurement Method If the current measurement may be taken in more ways than one, the measurement method may be changed. While taking a measurement, you may rotate the dial-button below the Change Tool menu on the touchscreen to change the measurement method. „ ‹ Delete Trace Line X ‹ While taking Trace Length or Trace measurements, rotating the touchscreen Undo/ Redo dial-button clockwise will delete the traced curve. To restore the deleted curve, rotate it counter-clockwise. X ‹ Move the trackball in the opposite direction to delete the traced line. You can only delete the line while you are manually tracing the Doppler Spectrum. „ ‹ Deleting Measurement Results Press the Clear button on the control panel. NOTE: The measurement results are deleted from the screen, but still shown on the report for the corresponding application. „ ‹ Printing Measurement Results Press the established button with the Store/Print button on the control panel. 8-30

[Page 479] „ ‹ Exiting Measurement After completing (or canceling) all in-process measurements, press the Exit button on the control panel. „ ‹ End Diagnosis Press the End Exam button on the control panel. The study for the currently registered patient will end, and all measurement results will be saved. „ ‹ Fetus Either click the Fetus button displayed at the top of the left menu, or rotate the dial- button 1 to select the fetus to measure among A , B , C , and D . „ ‹ Direction Either click the Direction button displayed at the top of the left-hand menu or rotate the dial-button 2 to select the direction of the object to measure between left and right. This is only displayed in specific packages. „ ‹ Location Either click the Location button displayed at the top of the left-hand menu or rotate the dial-button 3 to select the location of the object to measure from Prox , Mid , and Distal . „ ‹ Trace Direction Tap Trace Direction on the touchscreen to set the trace direction of the Doppler Spectrum. This is activated only after Limited Trace has been performed in Spectral Doppler mode. X ‹ Above: Only the + part of the Doppler waveform is traced. X ‹ Below: Only the – part of the Doppler waveform is traced. X ‹ Both: All parts of the Doppler waveform are traced. 8-31

[Page 480] „ ‹ Measured Frame Save the measurement frame. Rotate dial-button 1 to go to the measurement frame. „ ‹ Threshold Adjust elimination of weak signals at measurement of trace in the Spectral Doppler mode. „ ‹ HR Cycle Settings may be configured for each application at Setup > Measurement > Applications . In Heart Rate , the number of cycles for heart rate (HR) may be specified at Heart Rate Cycle. „ ‹ Specifying Measurement Result Position Place the pointer over the measurement and press the Set button. Use the trackball to move the measurement to the desired location, and press the Set button to place the movement at that location. „ ‹ Deleting Recent Measurement Item Tap Delete Latest on the touchscreen to cancel the last measurement taken. „ ‹ Report Press the Report button on the control panel to switch to the Report screen. 8-32

[Page 481] Common Measurement Methods This section provides information on the common measurement methods used for applications.
Measurements in Spectral Doppler mode In general, if you trace a Doppler Spectrum, you obtain results for various measurement items automatically. There are 3 ways to trace a Doppler Spectrum. Also, HS50/HS60/XH50/XH60 can select a specific item under the measurement menu and take measurements individually without tracing a Doppler Spectrum. „ ‹ Auto Trace Spectrum is traced automatically. This can be enabled in the measurement menu in Spectral Doppler mode. 1. Press Auto Trace in the measurement menu. 2. The system traces the spectrum automatically. 3. When the Trace is complete, the measurement results are displayed on the screen. „ ‹ Limited Trace Specify a measurement range, and a spectrum will be traced automatically. This can be enabled in the measurement menu in Spectral Doppler mode. 1. Select Limited Trace in the measurement menu. A bar will appear, with which you can specify range. 2. Specify the measurement range. Place the bar at a desired position with the trackball, and press the Set button. 3. The system traces spectrums within the specified range automatically. 4. When the Trace is complete, the measurement results are displayed on the screen. 8-33

[Page 482] „ ‹ Manual Trace A spectrum is traced manually. This can be enabled in the measurement menu in Spectral Doppler Mode. 1. Select Manual Trace in the measurement menu. The measurement cursor will appear over the spectrum. 2. Trace the spectrum. 3. When the Trace is complete, the measurement results are displayed on the screen. „ ‹ Measurement by Item In the Measurement menu, select an individual item and take a measurement. 1. Press the Calculator button on the control panel after obtaining a desired image. 2. Select the item you want from the Measurement menu. The + cursor will appear over the spectral waveform. 3. Position the “+” cursor and press the Set button. 4. The measurement results for the selected item are displayed on the screen. Item Category Unit Formula PSV (Peak Systolic Velocity) Velocity cm/s ED (End Diastolic Velocity) Velocity cm/s MD (Minimum Diastole Velocity) Velocity cm/s PI (Pulsatility Index) Measurement Ratio (PS-ED)/TAMAX RI (Resistivity Index) Measurement Ratio (PS-ED)/PS or (PS-MD)/PS PS/ED (Ratio of PS to ED) Measurement Ratio PS/ED ED/PS (Ratio of ED to PS) Measurement Ratio ED/PS TAMAX (Time Average Max Velocity) Velocity cm/s TAMEAN (Time Average Mean Velocity) Velocity cm/s 8-34

[Page 483] Taking Measurements via AutoCalc. You can use Auto Calc to take measurements on predetermined item(s). Measurement items are as follows. For information on setting measurement item(s), please refer to ‘Measurement’ in ‘Chapter 3. Utilities’. X ‹ Peak Systolic Velocity (PS) X ‹ End Diastolic Velocity (ED) X ‹ Min Diastole Velocity (MD) X ‹ Time Averaged Peak Velocity (TAMAX) X ‹ Time Averaged Mean Velocity (TAMEAN) X ‹ Resistive Index (RI) X ‹ Pulsatility Index (PI) X ‹ Systole/Diastole Ratio (PS/ED) X ‹ Diastole/Systole Ratio (ED/PS) X ‹ Heart Rate (HR) X ‹ Max Pressure Gradient (PGmax) X ‹ Mean Pressure Gradient (PGmean) X ‹ Velocity Time Integral (VTI) X ‹ Peak A (Peak A)
Volume Flow Measurement Select Volume Flow in the measurement menu. Volume Flow can be calculated by measuring an area or distance. For information on measuring distance or area, refer to ‘Basic Measurement’. TAMEAN (Time Avg. Mean Velocity) value is measured automatically. „ ‹ Vesl. Area (Vessel Area) Measure the area of a blood vessel to calculate TAMEAN and Volume Flow. X ‹ „ ‹ Vesl. Dist. (Vessel Distance) Measure the width of a blood vessel to calculate TAMEAN and Volume Flow. X ‹ 8-35

[Page 484]
Stenosis Measurement You can measure the stenosis of each blood vessel system by measuring and calculating an area or distance. „ ‹ %Stenosis(A) Measures the area of the inner wall and the outer wall of the blood vessel. %Stenosis(A) stands for Stenosis Area. 1. Select the %Stenosis(A) menu and the first cursor will appear in 2D Mode. 2. Measure the area of the vessel’s outer wall using the Circ/Area measurement method. 3. When the second cursor appears, measure the area of the stenosed vessel’s inner wall. %Stenosis(A) = (Outer Area – Inner Area) / Outer Area x 100 „ ‹ %Stenosis(D) Measure the diameter of the blood vessel. Stenosis(D) stands for Stenosis Distance. 1. Select the %Stenosis(D) menu and the first cursor will appear in 2D Mode. 2. Measure the total diameter of a vessel using the Distance measurement method. 3. When the second cursor appears, measure the diameter of the vessel’s inner wall under stenosis. %Stenosis(D) = (Outer Distance – Inner Distance) / Outer Distance x 100
Heart Rate Measurement „ ‹ HR (Heart Rate) You can calculate heart rates for a certain period of time. 1. Select HR from the Measurement menu. A bar will appear, with which you can specify range. 2. Specify the measurement range. Place the bar at a desired position with the trackball, and press the Set button. 3. The system will automatically measure the heart rate within the measurement range. The measurement result is displayed on screen. 8-36

[Page 485] OB Measurements X ‹ Ductus Venosus and Fetal HR can only be measured in Doppler Mode. ‘Common Measurement Methods' in this chapter. X ‹ For references on measurement items, see 'Reference Manual Part 1'.
Before Taking OB Measurements „ ‹ OB Basic Information Enter the information required for OB diagnosis in the Patient Information screen. The basic OB information includes LMP (Last Menstrual Period) and Number of Fetuses. Once LMP is entered, EDD (Estimated Delivery Date) and GA (Gestational Age) are calculated automatically. LMP is required for the calculation of values such as EDD and SD in obstetrics measurement. X ‹ EDD (LMP) = LMP + 280 days X ‹ GA (LMP) = Current System Date – LMP X ‹ LMP = Ovul. Date –14 The physician may choose to override the LMP and manually enter the EDD into ‘EDD (LMP)'. Once the expected delivery date is entered, GA (Gestational Age) is automatically calculated and displayed. EDD (LMP) is renamed to EDD, while GA (LMP) is renamed to GA (EDD). Once DOC is entered, EDD (Estimated Delivery Date) and GA (Gestational Age) are calculated automatically. EDD (LMP) is renamed to EDD (DOC), while GA (LMP) is renamed to GA (DOC). Once GA is entered, EDD (Estimated Delivery Date) is entered automatically. EDD (LMP) is renamed to EDD (GA), while GA (LMP) is renamed to GA (Clin). A maximum of four fetuses can be entered as Number of Fetuses. The default value is ‘1’. In the case of twins, enter ‘2’. For further information about patient information menus and how to input patient information, refer to ‘Patient Information’ of ‘Chapter 6. Starting Modes of Operation’. 8-37

[Page 486] „ ‹ OB Measurement Menu Settings Set up the GA Equation, GA Table, and OB measurement menus that are used in obstetrics measurements. The user can manually write, back up or restore GA Tables. For more information on the GA Equation and Table, refer to the Reference Manual Part 1. NOTE: For twins, distinguish fetuses by specifying them as Fetus A and Fetus B in the Measurement menu. Either click the Fetus button displayed at the top of the left-hand menu or rotate the dial-button 1 to select the fetus to measure among A , B , C , and D . For menus related to measurement and their settings, refer to the ‘Measurement Settings’ in ‘Chapter 3. Utilities’ of this manual.
1 Trim. Measurement Menu When the measurements for the selected items are complete, the measurements and gestational age are displayed on the screen. The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. GS All Distance measurement cm YS All Distance measurement cm CRL All Distance measurement cm Fetal Biometry BPD All Distance measurement cm FL All Distance measurement cm AC All Circumference measurement cm NT All Distance measurement mm Fetal Cranuim IT All Distance measurement mm NB All Distance measurement cm 8-38

[Page 487] D Vmax PW Velocity measurement cm/s Ductus Venosus PS PW Velocity measurement cm/s Fetal HR PW Heart Rate bpm
Automatic Calculation Some items in the measurement menu are automatically calculated based on measurements of other items. NOTE: For reference, the Osaka University/Tokyo University methods are mainly used in Asia, the Merz method in Europe, and the Shepard/ Hadlock methods on the American continent. 8-39

[Page 488]
2-3 Trim. Measurement Menu When the measurements for the selected items are complete, the measurements and gestational age are displayed on the screen. The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. GS All Distance measurement cm CRL All Distance measurement cm YS All Distance measurement cm BPD, OFD All Continuous measurement BPD All Distance measurement cm OFD All Distance measurement cm HC All Circumference measurement cm APAD, TAD All Continuous measurement APAD All Distance measurement cm Fetal Biometry TAD All Distance measurement cm AC All Circumference measurement cm FTA All Area measurement cm 2 FL All Distance measurement cm SL All Distance measurement cm APTD, TTD All Continuous measurement APTD All Distance measurement cm TTD All Distance measurement cm ThC All Circumference measurement cm EFW All – – 8-40

[Page 489] HL All Distance measurement cm ULNA All Distance measurement cm TIB All Distance measurement cm Fetal Long Bones RAD All Distance measurement cm FIB All Distance measurement cm CLAV All Distance measurement cm LV All Distance measurement cm NT All Distance measurement mm IT All Distance measurement mm NB All Distance measurement cm NF All Distance measurement cm CEREB All Distance measurement cm Fetal Cranium CM All Distance measurement cm Lat Vent All Distance measurement cm OOD All Distance measurement cm IOD All Distance measurement cm HW All Distance measurement cm FMF angle All Angle calculation degree Foot All Distance measurement cm Ear All Distance measurement cm Lt. Fetal Others MP All Distance measurement cm Rt. Fetal Others Renal L All Distance measurement cm Renal AP All Distance measurement cm Pelvis All Distance measurement cm 8-41

[Page 490] Q1 All Distance measurement cm Q2 All Distance measurement cm AFI Q3 All Distance measurement cm Q4 All Distance measurement cm MVP All Distance measurement cm ThD ap All Distance measurement cm ThD trans All Distance measurement cm HrtD ap All Distance measurement cm CTAR HrtD trans All Distance measurement cm ThA All Area measurement cm 2 HrtA All Area measurement cm 2 Cervix L All Distance measurement cm Maternal Others Placenta Thick All Distance measurement cm PLI D Vmax PW Velocity measurement cm/s 8-42

[Page 491] Umbilical A Auto Trace PW Doppler spectrum trace Lt. Mid Cereb A Limited Trace PW Doppler spectrum trace Rt. Mid Cereb A Manual Trace PW Doppler spectrum trace Lt. Uterine A Rt. Uterine A Placenta A ED PW Velocity measurement cm/s Lt. Fetal Carotids Rt. Fetal Carotids Fetal Aorta Lt. Renal A Rt. Renal A S/D PW Continuous measurement VF(D) PW ml/min VF(A) PW ml/min Fetal HR Fetal HR M, PW Heart Rate bpm D Vmax PW Velocity measurement cm/s Limited Trace PW Doppler spectrum trace Manual Trace PW Doppler spectrum trace Ductus Venosus 8-43

[Page 492]
AFI (Amniotic Fluid Index) Measure the amniotic fluid index. Measurements are performed by dividing the pregnant woman’s abdomen into four parts. The distance between the fetus and the farthest point of each area is measured. To obtain a specific image from each quadrant plane, press the Freeze button to go to the Operation mode. After obtaining the image, press the Freeze button again to return to the measurement mode.
Calculating Estimated Fetal Weight (EFW) When measurements for the following items are complete, the system uses the results to calculate the estimated fetal weight automatically. For an equation for calculating fetal weight, please refer to ‘Estimated Fetal Weight Formula’ in the Reference Manual Part 1. X ‹ BPD and AC X ‹ AC and FL X ‹ BPD, FL, and FTA X ‹ BPD, AC, and FL X ‹ BPD, APTD, TTD, and FL X ‹ HC, AC, and FL X ‹ BPD, APTD, TTD, and SL X ‹ BPD, HC, AC, and FL X ‹ BPD and TTD X ‹ AC
Continuous Measurement/Review for EFW Calculation You can measure a series of OB items to calculate the EFW. Before starting measurement X ‹ Make sure that the User Key has been set for EFW continuous measurements. You can configure the User Key for EFW continuous measurements at Setup > Customize > Buttons > User Key > EFW Measure . For more information, refer to 'Peripheral Device Settings' in ‘Chapter 3. Utilities’. X ‹ Check EFW Reference. If it is not set, or if you want to change it, select it at Setup > Measurement > Author > Estimated Fetal Weight . NOTE: This function is not available in 3D mode. 8-44

[Page 493] „ ‹ Measurement Method 1. Press User Key 1 (or User Key 2, 3, 4, 5, 6 ) on the control panel. The OB Measurement menu will be displayed on screen. 2. Measure the items for EFW calculation by using the trackball and the Set button. 3. Use the trackball and the Set button on the control panel again to start the measurement of the following items. 4. Once all measurements have been taken, the EFW is displayed on screen. The EFW measurements taken and the order in which they are measured are as follows: Reference Measure Item (by Order) Campbell AC Hadlock AC→BPD Hadlock1 AC→FL Hadlock2 BPD→AC→FL Hadlock3 HC→AC→FL Hadlock4 BPD, HC→AC→FL Hansmann BPD→TTD Merz BPD→AC Osaka BPD→FL→FTA Persson BPD→FL→APAD→TAD Schild HC→AC→FL Shepard AC→BPD Shinozuka1 BPD→FL→AC Shinozuka2 BP→APTD, TTD→SL Shinozuka3 BPD→APTD, TTD→FL Tokyo BPD→APTD, TTD→FL „ ‹ Review the Result of EFW Calculation 1. Press User Key 1 (or User Key 2 , 3 , 4 , 5 , 6 ) on the control panel. The measured items taken for calculating EFW will be displayed on screen together with the result. 2. To remove the results from the screen, press the Clear button on the control panel. 8-45

[Page 494] Fetal Heart Measurements The measurement method for each item is the same as for basic measurement. In addition, measurement items are similar to those of cardiology measurements (Cardiac Measurements). Measured items are automatically entered into the report. ‘Common Measurement Methods’ in this chapter. X ‹ For references on measurement items, see ‘Reference Manual Part 1’. LVEDV A2C All Dist 20 ml LVESV A2C All Dist 20 ml LV Vol. (Simpson) LVEDV A4C All Dist 20 ml LVESV A4C All Dist 20 ml Asc Ao All Distance measurement cm MPA Diam All Distance measurement cm Duct Art All Distance measurement cm LA Diam All Distance measurement cm RA Diam All Distance measurement cm RVDd All Distance measurement cm 2D Echo IVS All Distance measurement cm LVIDd All Distance measurement cm LVIDs All Distance measurement cm LVPW All Distance measurement cm HrtC All Circumference measurement cm ThC All Circumference measurement cm 8-46

[Page 495] ThD ap All Distance measurement cm ThD trans All Distance measurement cm HrtD ap All Distance measurement cm CTAR HrtD trans All Distance measurement cm ThA All Area measurement cm 2 HrtA All Area measurement cm 2 Fetal HR Fetal HR M, PW Heart Rate bpm IVSd M Distance measurement cm LVIDd M Distance measurement cm LVIDs M Distance measurement cm M Echo LVPWd M Distance measurement cm IVSs M Distance measurement cm LVPWs M Distance measurement cm RVDd M Distance measurement cm Limited Trace PW Doppler spectrum trace Manual Trace PW Doppler spectrum trace MPA Duct Arteriosus IVC ED PW Velocity measurement cm/s Asc Aorta Dsc Aorta Duct Venosus D Vmax PW Velocity measurement cm/s 8-47

[Page 496] E PW Velocity measurement cm/s MV A PW Velocity measurement cm/s TV Vmax PW Velocity measurement cm/s PLI D Vmax PW Velocity measurement cm/s TST PW Time measurement ms TEI ET PW Time measurement ms „ ‹ CTAR (Cardio-Thorax Area Ratio) This measurement compares the size of the fetus’ heart in relation to the size of its thorax. ThD ap, ThD trans, HrtD ap, and HrtD trans values are acquired to obtain the comparative value. X ‹ 8-48

[Page 497] Gynecology Measurements ‘Common Measurement Methods’ in this chapter. X ‹ For references on measurement items, refer to the Reference Manual Part 2.
Before Taking GYN Measurements Enter the information required for GYN diagnosis in the Patient Information screen. Basic information for gynecology includes Gravida, Para, Aborta, and Ectopic.
Measurement Menu The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. Uterus Endo.Thick All Distance measurement cm Cervix Lt. Cyst Rt. Cyst Width All Distance measurement cm Lt. Ovary Rt. Ovary 8-49

[Page 498] Follicle #1 All Volume measurement ml Follicle #2 All Volume measurement ml Follicle #3 All Volume measurement ml Follicle #4 All Volume measurement ml Follicle #5 All Volume measurement ml Follicle #6 All Volume measurement ml Lt. Follicle Rt. Follicle Follicle #7 All Volume measurement ml Follicle #8 All Volume measurement ml Follicle #9 All Volume measurement ml Follicle #10 All Volume measurement ml Follicle #11 All Volume measurement ml Follicle #12 All Volume measurement ml Limited Trace PW Doppler spectrum trace Lt. Ovarian A Manual Trace PW Doppler spectrum trace Rt. Ovarian A Lt. Uterine A Rt. Uterine A Pericystic Endometrial PI PW Velocity measurement – 8-50

[Page 499] Mass1 Mass2 Mass3 Endo. Polyp Limited Trace PW Doppler spectrum trace Lt. Ovarian Mass Manual Trace PW Doppler spectrum trace Rt. Ovarian Mass Uterine Fibroid1 Uterine Fibroid2 ED PW Velocity measurement cm/s Uterine Fibroid3 Cervical Fibroid Ectopic Most of the gynecology measurements are distance measurements and volume measurements based on the distance measurement results. If mulle images, such as long axis images and transverse axis images are needed, press the Freeze button to switch to Scan Mode and obtain images from another perspective. 8-51

[Page 500] Cardiac Measurements NOTE: Cardiac measurement is an optional item. The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. ‘Common Measurement Methods’ in this chapter. X ‹ ‘For references on measurement items, refer to the Reference Manual Part 2. All LV (2D) All Continuous measurement All LVd (2D) All Continuous measurement IVSd All Distance measurement cm LVIDd All Distance measurement cm LVPWd All Distance measurement cm LV (2D) All LVs (2D) All Continuous measurement IVSs All Distance measurement cm LVIDs All Distance measurement cm LVPWs All Distance measurement cm LV(2D) HR All Heart Rate bpm RVAWd All Distance measurement cm RVIDd All Distance measurement cm RVAd All Area measurement cm 2 RVAWs All Distance measurement cm RV (2D) RVIDs All Distance measurement cm RVAs All Area measurement cm 2 RV Major All Distance measurement cm RV Minor All Distance measurement cm 8-52

[Page 501] All LV/RV (M) M Continuous measurement All LV (M) M Continuous measurement LV EF(M) M Continuous measurement IVSd M Distance measurement cm LVIDd M Distance measurement cm LVPWd M Distance measurement cm IVSs M Distance measurement cm LV (M) LVIDs M Distance measurement cm LVPWs M Distance measurement cm LVET M Time measurement ms LVPEP M Time measurement ms LV(M) HR M Heart Rate bpm Time Septal to PW M Time measurement ms MAPSE M Distance measurement cm All RV (M) M Continuous measurement RVAWd M Distance measurement cm RVIDd M Distance measurement cm RVAWs M Distance measurement cm RV (M) RVIDs M Distance measurement cm RVPEP M Time measurement ms RVET M Time measurement ms TAPSE M Distance measurement cm LVEDV A2C All Dist 20 ml LVESV A2C All Dist 20 ml LV Vol. (Simpson) LVEDV A4C All Dist 20 ml LVESV A4C All Dist 20 ml BP HR All Heart Rate bpm 8-53

[Page 502] LVEDV A2C AL All Dist 20 ml LVESV A2C AL All Dist 20 ml HR A2C All Heart Rate bpm LV Vol. (A/L) LVEDV A4C AL All Dist 20 ml LVESV A4C AL All Dist 20 ml HR A4C All Heart Rate bpm LVAd SAX MV All Area measurement cm 2 LVAs SAX MV All Area measurement cm 2 LV Vol. (Bullet) LVLd Apical All Distance measurement cm LVLs Apical All Distance measurement cm HR Bullet All Heart Rate bpm All LV Mass All Continuous measurement - LVAd SAX PM Epi All Area measurement cm 2 LVAd SAX PM All Area measurement cm 2 LV Mass LVLd apical All Distance measurement cm LV TE a All Distance measurement cm LV TE d All Distance measurement cm Ao Diam (2D) All Distance measurement cm Ao Diam(M) M Distance measurement cm Asc Ao Diam All Distance measurement cm Desc Ao Diam All Distance measurement cm Aorta Ao Arch Diam All Distance measurement cm Ao Isth Diam All Distance measurement cm Ao ST Junct Diam All Distance measurement cm Ao Sinus Diam All Distance measurement cm 8-54

[Page 503] All LA Vol. All Continuous measurement LA/Ao (2D) All Distance measurement cm LA Diam (2D) All Distance measurement cm LA/Ao(M) M Distance measurement cm LA/Diam(M) M Distance measurement cm LA LA Major All Distance measurement cm LA Minor All Distance measurement cm LAAd A2C All Area measurement cm 2 LAAs A2C All Area measurement cm 2 LAAd A4C All Area measurement cm 2 LAAs A4C All Area measurement cm 2 LAEDV A2C All Dist 20 ml LAESV A2C All Dist 20 ml LA Vol. (Simpson) LAEDV A4C All Dist 20 ml LAESV A4C All Dist 20 ml RA Diam (2D) All Distance measurement cm RA Major All Distance measurement cm RA Minor All Distance measurement cm RA RAAd All Area measurement cm 2 RAAs All Area measurement cm 2 RAEDV All Dist 20 ml RAESV All Dist 20 ml 8-55

[Page 504] LVOT LVOT Diam All Distance measurement cm LVOT Vmax PW Velocity measurement cm/s LVOT VTI PW Doppler Spectrum trace cm LOVT HR PW Heart Rate bpm RAEDV A2C All Dist 20 ml RAESV A2C All Dist 20 ml RA Vol. (Simpson) RAEDV A4C All Dist 20 ml RAESV A4C All Dist 20 ml RVOT RVOT Diam All Distance measurement cm RVOT Vmax PW Velocity measurement cm/s RVOT VTI PW Doppler Spectrum trace cm RVOT HR PW Heart Rate bpm 8-56

[Page 505] AV Auto Trace PW Doppler Spectrum trace AV Limited Trace PW Doppler Spectrum trace AV Manual Trace PW Doppler Spectrum trace AV Cusp All Distance measurement cm AV Cusp(M) M Distance measurement cm AV Diam All Distance measurement cm AVA Planimetry All Area measurement cm 2 Q to AV Open M Time measurement ms AV AV Vmax PW Velocity measurement cm/s AV PHT PW Time measurement ms AV VTI PW Doppler Spectrum trace cm AV AccT PW Time measurement ms AV ET PW Time measurement ms AV AccT/ET PW Continuous measurement AV DecT PW Time measurement ms Desc. Ao Vel. PW Velocity measurement cm/s AR Auto Trace PW Doppler Spectrum trace AR Limited Trace PW Doppler Spectrum trace 8-57

[Page 506] AR Manual Trace PW Doppler Spectrum trace AR VCW All Distance measurement cm AR Vmax PW Velocity measurement cm/s AR ed Vmax PW Velocity measurement cm/s AR PHT PW Time measurement ms AR VTI PW Doppler Spectrum trace cm AV AR AccT PW Time measurement ms AR DecT PW Time measurement ms AR PISA Rad C PISA-Radius cm AVO PW Time measurement ms AVC PW Time measurement ms AR Jet Diam All Distance measurement cm AR Jet Area All Area measurement cm 2 All MV(M) M Continuous measurement - MV D-E Excursion M Distance measurement cm MV E-F Slope M Velocity measurement cm/s MV A-C Interval M Time measurement ms MV EPSS M Distance measurement cm MV Vp M Velocity measurement cm/s MV MV Ann Diam All Distance measurement cm MV Diam1 All Distance measurement cm MV Diam2 All Distance measurement cm MVA Planimetry All Area measurement cm 2 MV Auto Trace PW Doppler Spectrum trace MV Limited Trace PW Doppler Spectrum trace MV Manual Trace PW Doppler Spectrum trace 8-58

[Page 507] MV E-DT-A PW Continuous measurement MV E/A PW Continuous measurement - MV Peak E PW Velocity measurement cm/s MV Peak A PW Velocity measurement cm/s MV VTI PW Distance measurement cm MV Vmax PW Velocity measurement cm/s MV PHT PW Time measurement ms MV AccT PW Time measurement ms MV DecT PW Time measurement ms MV A Dur PW Time measurement ms MV ET PW Time measurement ms MV R-R Int M, PW Heart Rate bpm MR Auto Trace PW Doppler Spectrum trace MR Limited Trace PW Doppler Spectrum trace MR Manual Trace PW Doppler Spectrum trace MR VCW All Distance measurement cm MR Vmax PW Velocity measurement cm/s MR VTI PW Doppler Spectrum trace cm MR dp/dt PW Continuous measurement mmHg/s MV IVRT PW Time measurement ms MR PISA Rad C PISA-Radius cm MV HR PW Heart Rate bpm E/E’ PW Continuous measurement 8-59

[Page 508] TV D-E Excursion M Distance measurement cm TV E-F Slope M Velocity measurement cm/s TV A-C Interval M Time measurement ms TV Auto Trace PW Doppler Spectrum trace TV Limited Trace PW Doppler Spectrum trace TV Manual Trace PW Doppler Spectrum trace TV Ann Diam All Distance measurement cm, mm TV Diam1 All Distance measurement cm TV Diam2 All Distance measurement cm TVA Planimetry All Area measurement cm Q to TV Open M Time measurement ms TV Vmax PW Velocity measurement cm/s TV VTI PW Doppler Spectrum trace cm TV TV E/A PW Continuous measurement - TV Peak E PW Velocity measurement cm/s TV Peak A PW Velocity measurement cm/s TV PHT PW Time measurement ms TV AccT PW Time measurement ms TV DecT PW Time measurement ms TV A Dur PW Time measurement ms TR Auto Trace PW Doppler Spectrum trace TR Limited Trace PW Doppler Spectrum trace TR Manual Trace PW Doppler Spectrum trace TR VCW All Distance measurement cm TR Vmax PW Velocity measurement cm/s 8-60

[Page 509] TR VTI PW Doppler Spectrum trace cm Calculation after time TR dp/dt PW mmHg/s TV TR PISA Rad C PISA-Radius cm RAP M, PW RAP mmHg TV HR PW Heart Rate bpm PV Auto Trace PW Doppler Spectrum trace PV Limited Trace PW Doppler Spectrum trace PV Manual Trace PW Doppler Spectrum trace PV Ann Diam All Distance measurement cm PVA Planimetry All Area measurement cm 2 PV Vmax PW Velocity measurement cm/s, m/s PV PHT PW Velocity measurement cm/s PV VTI PW Doppler Spectrum trace cm PV AccT/ET PW Continuous measurement PV AccT PW Time measurement ms PV PV ET PW Time measurement ms PV DecT PW Time measurement ms Q to PV Open M Time measurement ms Q to PV Close M Time measurement ms PR Auto Trace PW Doppler Spectrum trace PR Limited Trace PW Doppler Spectrum trace PR Manual Trace PW Doppler Spectrum trace MPA Vmax PW Velocity measurement cm/s PR VCW All Distance measurement cm PR Vmax PW Velocity measurement cm/s 8-61

[Page 510] PR PHT PW Time measurement ms PR VTI PW Doppler Spectrum trace cm PR AccT PW Time measurement ms PV PR DecT PW Time measurement ms PR End Vel. PW Velocity measurement cm/s PR PISA Rad C PISA-Radius cm All LV Tei Index PW Continuous measurement LV TST PW Time measurement ms MV ET PW Time measurement ms LV IVCT PW Time measurement ms LV IVRT PW Time measurement ms Tei Index All RV Tei Index PW Continuous measurement RV TST PW Time measurement ms RV ET PW Time measurement ms RV IVCT PW Time measurement ms RV IVRT PW Time measurement ms P Vein S/D PW Continuous measurement P Vein S Vmax PW Velocity measurement cm/s Pulm. Veins P Vein D Vmax PW Velocity measurement cm/s P Vein A Vmax PW Velocity measurement cm/s P Vein A Dur PW Time measurement ms H Vein S/D PW Continuous measurement H Vein S Vmax PW Velocity measurement cm/s Hepatic Veins H Vein D Vmax PW Velocity measurement cm/s H Vein A Vmax PW Velocity measurement cm/s H Vein A Dur PW Time measurement ms 8-62

[Page 511] LV E’-A’-S’ PW Continuous measurement LV Peak E’ PW Velocity measurement cm/s LV Peak A’ PW Velocity measurement cm/s LV Peak S’ PW Velocity measurement cm/s LV AccT PW Time measurement ms LV DecT PW Time measurement ms RV E’-A’-S’ PW Continuous measurement RV Peak E’ PW Velocity measurement cm/s RV Peak A’ PW Velocity measurement cm/s Tissue Doppler RV Peak S’ PW Velocity measurement cm/s RV AccT PW Time measurement ms RV DecT PW Time measurement ms LV Lat E’-A’-S’ PW Continuous measurement LV Lat Peak E’ PW Velocity measurement cm/s LV Lat Peak A’ PW Velocity measurement cm/s LV Lat Peak S’ PW Velocity measurement cm/s LV Lat AccT PW Time measurement ms LV Lat DecT PW Time measurement ms Systemic VTI PW Doppler Spectrum trace cm Systemic HR PW Heart Rate bpm Qp/Qs Pulmonic VTI PW Doppler Spectrum trace cm Pulmonic HR PW Heart Rate bpm 8-63

[Page 512] MPA Diam All Distance measurement cm LPA Diam All Distance measurement cm RPA Diam All Distance measurement cm SVC Diam, Exp All Distance measurement cm SVC Diam, Insp All Distance measurement cm SVC S/D PW Continuous measurement SVC S Vmax PW Velocity measurement cm/s SVC D Vmax PW Velocity measurement cm/s Shunts SVC A Vmax PW Velocity measurement cm/s SVC A Dur PW Time measurement ms IVC S/D PW Continuous measurement IVC S Vmax PW Velocity measurement cm/s IVC D Vmax PW Velocity measurement cm/s IVC A Vmax PW Velocity measurement cm/s IVC A Dur PW Time measurement ms PEd All Distance measurement cm PEs All Distance measurement cm IVC Diam, Exp All Distance measurement cm IVC Diam, Insp All Distance measurement cm IVC IVC Diam, Exp(M) M Distance measurement cm IVC Diam, Insp(M) M Distance measurement cm 8-64

[Page 513] „ ‹ Dist 20 Trace the circumference of the heart and then draw the axis of the heart. The system automatically draws 20 lines perpendicular to the axis to calculate the volume. X ‹ MR dp/dt can be measured only at 1-3 m/s. X ‹ In Dual 2D Mode, two images can be viewed simultaneously. X ‹ For RVAWd , RVIDd , RVAWs , and RVIDs , see the LV measurement method. X ‹ MPA Diam , RPA Diam , and LPA Diam are measured under Aortic Valve Level in Parasternal Short Axis. X ‹ C Mode is mainly used for measuring reverse cardiac blood flow. X ‹ Since velocity data is required for measuring PISA-Radius or PISA-Alias Vel. , set color display to Velocity or Vel + Var in C mode. For relevant settings, please refer to ‘Color Doppler Mode’ in ‘Chapter 7. Modes of Operation’. X ‹ Tissue Doppler can be measured in TDI Mode. 8-65

[Page 514] Abdomen Measurements The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. X ‹ It is convenient to calculate each measurement value on the Spectral Doppler image. ‘Common Measurement Methods’ in this chapter.
Abdomen Measurement Menu CBD All Distance measurement cm GB Wall All Distance measurement cm Gallbladder Length All Distance measurement cm Head All Distance measurement cm Body All Distance measurement cm Pancreas Tail All Distance measurement cm Duct All Distance measurement cm Stomach Wall All Distance measurement cm Bowel Small Bowel Wall All Distance measurement cm Large Bowel Wall All Distance measurement cm Lt. Kidney Vol. Length All Distance measurement cm Rt. Kidney Vol. Liver Spleen 8-66

[Page 515] Aorta measurement Lt. RA Rt. RA Lt. Seg.A Rt. Seg A Manual Trace PW Doppler Spectrum trace Lt. Arc.A Rt. Arc A Celiac A Splenic A C Hepatic A PI PW Velocity measurement – R Hepatic A L Hepatic A SMA IMA Calculate after measuring Vol. Folw(D) PW ml/min IVC VMax PW Velocity measurement cm/s Renal V R Potal V M Potal V Dur T PW Time measurement ms L Potal V R Hepatic V M Hepatic V Vesl. Dist. PW Distance measurement cm L Hepatic V SMV IMV Vesl. Area PW Area measurement cm 2 Splenic V 8-67

[Page 516] Pediatric Hips Measurements
Measurement Menu The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. NOTE: For information on basic measurement methods, refer to ‘Basic Measurements’ and ‘Common Measurement Methods’ in this chapter. Calculation of angle after Hip Angle Type ALL degree measurement of three straight lines 8-68

[Page 517]
Measurement Methods 1. Specify the first straight line by using the trackball and the Set button. Use the trackball to place the cursor at the desired position and then press the Set button. Repositioning a Point Before pressing the Set button to confirm the position, you can press the Change button to reset the position of the point. 2. Repeat the above process to specify two other straight lines. 3. The angle between them will be calculated automatically. X ‹ α: The angle between the first and the second straight lines X ‹ β: The angle between the first and the third straight lines See the table below for Hip Joint Type information: Type α β 1a 60 ≤ α < 90 0 < β < 55 1b 60 ≤ α < 90 55 ≤ β < 90 2a/b 50 ≤ α < 60 0 < β < 90 2c 43 ≤ α < 50 77 ≤ β < 90 d 43 ≤ α < 50 0 < β < 77 3/4 0 < α < 43 [Table 8.2 Hip Joint Type] 8-69

[Page 518] Urology Measurements
Before Taking Urology Measurements Set the related menus for convenient measurement. Refer to the ‘Setting Measurements’ section in ‘Chapter 3. Utilities’ for additional information.
Measurement Menu The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. ‘Common Measurement Methods' in this chapter. X ‹ For references on measurement items, refer to the Reference Manual Part 2. „ ‹ 3 Distance Calculate a volume by measuring three distances. WG Prostate T-Zone Bladder Height All Distance measurement cm Pre Residual Post Residual Lt. Renal Height All Distance measurement cm Rt. Renal Width All Distance measurement cm Renal Pelvis All Distance measurement cm 8-70

[Page 519] Small Parts Measurements The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. X ‹ It is convenient to calculate each measurement value on the Spectral Doppler image. ‘Common Measurement Methods’ in this chapter..
Thyroid Measurement Menu Lt. Thyroid Vol. Rt. Thyroid Vol. %StA All Calculation after area measurement % Lt. Thyroid Flow ED PW Velocity measurement cm/s Rt. Thyroid Flow Calculate after measuring TAmean, Vesl., and Dist. Calculate after measuring TAmean, Vesl., and Area 8-71

[Page 520]
Breast Measurement Menu Lt. Mass 1–10 Rt. Mass 1–10 Lt. Breast Flow Rt. Breast Flow 8-72

[Page 521]
Testis Measurements Lt. Testis Vol. Rt. Testis Vol. D1 All Distance measurement cm Epididymis D2 All Distance measurement cm Lt. Testis Flow Rt. Testis Flow 8-73

[Page 522]
Superficial Measurements Lt. Superficial Vol. Rt. Superficial Vol. Lt. Superficial Flow Rt. Superficial Flow Vel A PW Velocity measurement cm/s Vel B PW Velocity measurement cm/s 8-74

[Page 523] Musculoskeletal Measurements
Measurement Menu The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. NOTE: For information on basic measurement methods, refer to ‘Basic Measurements’ and ‘Common Measurement Methods’ in this chapter. Measurement Menu Item Method Unit Lt. Shoulder #1 – #10 Distance measurement cm Rt. Shoulder Lt. Wrist #1 – #10 Distance measurement cm Rt. Wrist Lt. Knee #1 – #10 Distance measurement cm Rt. Knee Lt. Ankle #1 – #10 Distance measurement cm Rt. Ankle 8-75

[Page 524] Vascular Measurements The measurement method for each item is the same as for basic measurement. Measured items are automatically entered into the report. ‘Common Measurement Methods’ in this chapter. X ‹ For references on measurement items, see ‘Reference Manual Part 1’.
Carotid Measurement Menu IMT All Distance measurement mm Average calculation after IMT Mean All mm distance measurement Lt. CCA Auto Trace PW Doppler Spectrum trace Rt. CCA Lt. Bulb Rt. Bulb Lt. ICA PS PW Velocity measurement cm/s Rt. ICA ED PW Velocity measurement cm/s Lt. ECA Rt. ECA 8-76

[Page 525] Limited Trace PW Doppler spectrum trace Manual Trace PW Doppler spectrum trace Lt. Subclavian A Rt. Subclavian A Lt. Vertebral A Rt. Vertebral A Calculation after measurement of TAmean, Vesl. Dist Calculation after measurement of TAmean, Vesl. Area 8-77

[Page 526]
Auto IMT+ This function allows you to take IMT measurements easily and quickly. X ‹ Auto IMT+ is an optional feature of this product. X ‹ Auto IMT+ is available only under the following conditions: – Probe: Linear Probe – Application: Vascular – Operation mode: 2D Freeze Mode Auto IMT+ Screen [Figure 8.2 Auto IMT+] „ ‹ Auto IMT+ Measurement 1. After checking the probe and the application, start a carotid scan. 2. Press Freeze to obtain the desired image. Use the trackball to select the image you want to measure the IMT on. 3. Tap Auto IMT+ on the touchscreen. The Auto IMT+ screen will appear. 8-78

[Page 527] 4. Use the trackball and the Set button to set a location for IMT measurement. X ‹ Measure the length of a specific section. Press and hold the Set button at the starting point and use the trackball to specify the end point. X ‹ You can change the Near and Far positions of the measured area by using the Change button on the control panel. 5. Once the measurement finishes, measurement values will be listed in a table. 6. Use the touchscreen, or the dial-button to select the measurement label, the location of the blood vessel, and the direction of blood flow. „ ‹ Setting Up Measurement Items On the touchscreen menu, you may set up the measurement item, the location of the blood vessel, and the direction of blood flow. X ‹ Measurement item: Select measurement items among CCA, Bulb, ICA, and ECA. Use the touchscreen button. X ‹ Direction: Select the blood flow direction either left or right. Use dial-button 2 . X ‹ Location: Select Prox(Proximal), Mid(Middle), or Dist(Distal) as the location of the blood vessel to measure. Use dial-button 3 . NOTE: Exit Auto IMT+ using following functions: X ‹ Change Image Mode and Zoom X ‹ Annotation, BodyMarker, Patient, SonoView, Report, Setup, Help „ ‹ Measurement Result X ‹ Max: The maximum thickness of the Intima/Adventitia pair. X ‹ Mean: The average thickness of the Intima/Adventitia pair. X ‹ SD: Standard Deviation X ‹ QI: The distance ratio of the measured point in a distance for Quality Index measurement. NOTE: Location of measurement result window cannot be changed and it is displayed in the position established before Auto IMT+ measurement. 8-79

[Page 528] „ ‹ Applying to the Report Auto IMT+ measurement results are automatically applied to the report. Report/Auto IMT+ measurement results can be checked. „ ‹ Auto IMT+ Measurement Analysis 1. Tapping the Analysis on the touchscreen opens Analysis screen. 2. Select the desired analysis from Framingham/CHD , Risk Factor , Normal IMT , or User Graph by using the trackball and the Set button. The bar that corresponds to the measurement will be displayed on each graph. However, if the measurement is smaller than Framingham/CHD, or Risk Factor, no bar will be displayed. User Graph You can use User Graph to adjust the graph and analyze the measurement results as you want. 3. To finish analyzing, tap the Exit button on the touchscreen. 4. The following materials were referred to when analyzing the measurements of Auto IMT+. „ ‹ Framingham/CHD Correlation between the Framingham Risk Score and Intima Media Thickness: the Paroi Arterielle et Risque Cardio-vasculair (PARC) Study. Pierre-Jean Touboul, EricVicaut, Julien Labreuche, Jean-Pierre Belliard, Serge Cohen, Serge Kownator, Jean-Jacques Portal, Isabelle Pithois-Merli, Pierre Amarenco. On behalf of PARC Study participating physicians. „ ‹ Risk Factor Mannheim Carotid Intima-Media Thickness Consensus (2004–2006) P.J. Touboul, M.G. Hennerici, S.Meairs, H.Adams, P.Amarenco, N.Borstein, L.Csiba, M.Desvarieux, S.Ebrahim, M.Fatar, R.Hermandez Hernandez, M.Jaff, S.Kownator, P.Prati, T.Rundek, M.Sitzer, U.Schiminke, J.C. Tardif, A.Taylor, E.Vicaut, K.S.Woo, F.Zannad, M.Zureik „ ‹ Normal IMT Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J: Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. Journal of Hypertension 20:159-169, 2002 8-80

[Page 529]
UE Artery Measurement Menu Lt. Subclavian A Rt. Subclavian A Lt. Axillary A Rt. Axillary A Manual Trace PW Doppler Spectrum trace Lt. Brachial A Rt. Brachial A Lt. Radial A Rt. Radial A Lt. Ulnar A PI PW Velocity measurement – Rt. Ulnar A Lt. SPA Rt. SPA 8-81

[Page 530]
UE Vein Measurement Menu Lt. Internal Jugular V Rt. Internal Jugular V Vmax PW Velocity measurement cm/s Lt. Innominate V Rt. Innominate V Lt. Subclavian V Rt. Subclavian V Lt. Axillary V Dur T PW Time measurement ms Rt. Axillary V Lt. Brachial V Rt. Brachial V Lt. Cephalic V Vesl. Dist PW Distance measurement cm Rt. Cephalic V Lt. Basilic V Rt. Basilic V Lt. Radial V Rt. Radial V Vesl. Area PW Volume measurement cm 2 Lt. Ulnar V Rt. Ulnar V 8-82

[Page 531]
LE Artery Measurement Menu Lt. CIA, Rt. CIA Calculation after distance Lt. IIA, Rt. IIA Lt. EIA, Rt. EIA Calculation after area Lt. CFA, Rt. CFA measurement Lt. SFA, Rt. SFA Auto Trace PW Doppler Spectrum trace Lt. DF, Rt. DF Lt. Popliteal A Rt. Popliteal A Lt. ATA, Rt. ATA Lt. PTA, Rt. PTA ED PW Velocity measurement cm/s Lt. Peroneal A Rt. Peroneal A Lt. DPA, Rt. DPA Lt. MPA, Rt. MPA Lt. LPA, Rt. LPA S/D PW Continuous measurement Lt. Metatarsal A Calculate after measuring Rt. Metatarsal A TAmean, Vesl., and Dist. Lt. DigitalA Rt. Digital A TAmean, Vesl., and Area 8-83

[Page 532]
LE Vein Measurement Menu Lt. CIV, Rt. CIV Lt. IIV, Rt. IIV Lt. EIV, Rt. EIV Vmax PW Velocity measurement cm/s Lt. CFV, Rt. CFV Lt. PFV, Rt. PFV Lt. SFV, Rt. SFV Lt. GSV, Rt. GSV Lt. Popliteal V Dur T PW Time measurement ms Rt. Popliteal V Lt. LSV, Rt. LSV Lt. ATV, Rt. ATV Lt. PTV, Rt. PTV Lt. Peroneal V Vesl. Dist PW Distance measurement cm Rt. Peroneal V Lt. MPV, Rt. MPV LT. LPV, Rt. LPV Lt. Metatarsal V Rt. Metatarsal V Vesl. Area PW Volume measurement cm Lt. Digital V Rt. Digital V 8-84

[Page 533] Reports The measurement results are summarized by application, and shown on the screen in a report format. Viewing Reports Press the Report button on the control panel to switch to the Ultrasound Measure Report screen. The measurement results are summarized by application, and shown on the screen in a report format. NOTE: Reports are displayed only for the applications that have measurement results. „ ‹ Page Pages are divided into Worksheet, Description, Comment, and image for each application; opening a report will show the Preview screen by default. You can go to each section from the Left Menu or Touch; if a section contains large amount of data to display, it will be divided into mulle pages, which you may navigate pages using Touch or dial-button. 8-85

[Page 534] Report Preview It provides report preview before print-out.
Property „ ‹ Print Set the type of Printer, Application, Print color, and Page. „ ‹ Settings You can set Header & Footer, Logo, Title, Patient Info, and Table Form of a report. [Figure 8.3 Report Preview] „ ‹ Printer Select a USB Printer connected to the equipment. „ ‹ Range Set a page to save the print-out or images. Current Page selects the currently active page and All Applications selects all pages. 8-86

[Page 535] „ ‹ Application Set application to save the Preview screen, printout, or images. Current Application will select applications established in the worksheet, while All Application will select all applications. „ ‹ Color (Print) Set the color of report in printout. „ ‹ Color (Store) Set the color of image to save images. „ ‹ Page Set pages to save the Preview screen, printout, or images. Echo Page will select a landscape-formed report. „ ‹ Header & Footer Set the header and footer. Checking Show Date in Footer will display date in the bottom of the right-hand side. [Figure 8.4 Header & Footer] 8-87

[Page 536] „ ‹ Logo Set a logo on the top of the report. It can be changed once it is connected to a USB. „ ‹ Title Set the title. User-selected title or a title set in the Patient will be shown. „ ‹ Patient Info. Set Patient information shown on the page. Only 1st Page shows the Patient information only on the first page. „ ‹ Table Form Set the report form. Selection of Brief will show the results only, while selection of 2 Columns will show measure items in the two columns. [Figure 8.5 Columns] 8-88

[Page 537] Editing Report (Worksheet) When you move the focus to a value that can be edited on a Worksheet, the borders of the edit window will be marked in blue, and Edit mode will start by clicking. [Figure 8.6 Worksheet] [Figure 8.7 Worksheet – Touchscreen] 8-89

[Page 538]
Modify Measurements After you have edited a value and moved the focus away from the value or press Enter in the keyboard, the edited value will be applied. Edited values will be indicated with '*' in front of them. To delete a value, click the value that you wish to delete; the Delete button will be activated on the touchscreen. Press this button to delete the value immediately. „ ‹ Default Author Reverts to the author of Setup settings. „ ‹ Delete Cell Select and delete a measurement value. „ ‹ Delete Line Delete all values with the same label as the selected value. NOTE: If you change the Author in a Worksheet, the GA value will be changed. The Author you change in a Report is only valid within the Report; the Author of the Setup will be used for calculating the GA when you are taking measurements in Measurement mode. „ ‹ AV.US If Composite GA is Average, you may select or exclude GA values from each Label Av.US that have been used for calculation. 8-90

[Page 539]
Measurement Display Method The product allows you to measure one measurement item mulle times. However, only the first three measurement results are saved in a report. When taking measurements for the same item more than once, measurements can be displayed in four ways. On the Edit Report screen, you can specify or change the measurement display method. Go to Setup > Measurement > Application > Doppler > Display Absolute Value and select ‘On’ to display absolute values in the report. „ ‹ Average Obtain the average of the measurements and display it on the screen. „ ‹ Last Display the last measurement on the screen. „ ‹ Max Display the largest value of the measurements on the screen. „ ‹ Min Display the smallest value of the measurements on the screen. 8-91

[Page 540] Adding Comments Tap Comment on the touchscreen or click Comment in the left-hand menu on the Ultrasound Report screen. A screen in which you can enter opinions will appear. Tap the bottom of the entry window or the Comment button on the touchscreen and a window will open to let you select a comment you have previously entered in Setup. Select Comment in the window and the selected text will be entered at the location of the cursor in the comment entry window. NOTE: Comments may be added at Setup > Report > Comment . For more information, refer to ‘Report’ in ‘Chapter 3. Utilities’. 8-92

[Page 541] [Figure 8.8 Comment] [Figure 8.9 Comment – Touchscreen] 8-93

[Page 542] Print Reports In the Preview screen, tap the Print button on the touchscreen or press Print in the left-hand menu on Report screen. The measurement report for the selected application will be printed on a connected printer. NOTE: You can change the printer settings for printing measurement reports at Report > Preview > Property > Print . For more information, refer to ‘Peripheral Device Settings’ in ‘Chapter 3. Utilities’. Saving Reports In the Preview screen, tap Export on the touchscreen. Or press Export in the left-hand side of Report screen. Export button is activated only when it is connected to a USB. Export window will appear and save the report in the external storage media. Export window will appear and specify the directory, drive, file name, and file format. Click OK on the screen to save the report. Tap Cancel to cancel. [Figure 8.10 Export] 8-94

[Page 543] Store SR Tap Store SR on the touchscreen or the Left Menu to save the Measure SR Information. Images Select this if you want to attach images to the report. Tap the Image button on the touchscreen or press Image in the Left Menu on the Ultrasound Report screen to open a window where you can select images. [Figure 8.11 Image] 8-95

[Page 544] [Figure 8.12 Image – Touchscreen] 1. Select images from the thumbnail on the right. 2. When images are selected, the Add button becomes active on the touchscreen. Tap the Add button to attach the selected images to the report. Alternatively, double-click selected images among the thumbnails to attach the associated images. 3. If you select images attached to a report, the Delete button becomes active so that you may delete attached images. Press the Delete All button to delete all attached images. 4. You may select 1x1, 2x2, 3x3, or 4x4 for layout. 8-96

[Page 545] OB Graph After taking OB measurements, press Report on the touchscreen or control panel. Tapping OB Graph on the touchscreen displays the Graph screen. Click/tap the Single or Quad button on the screen/touchscreen. Select the layout on the graph screen. You can review the graph and trends. To return to the Report screen, tap Preview on the touchscreen or the Left Menu. NOTE: The graph function can only be used with OB reports. The list of measured items appears on the right side of the screen. If you select an item, a graph for the selected item will appear on the screen. X ‹ To execute the graph function, at least one Label containing a Growth Table must be measured, and only a Label that has been measured may display graphs. X ‹ A graph is created based on the patient ID, LMP and measurement date. [Figure 8.13 OB Graph] 8-97

[Page 546] [Figure 8.14 OB Graph – Touchscreen] „ ‹ Select a Graph Use the Trackball and the Set button to select an item from the list. „ ‹ Single A graph representing one obstetrics measurement will be displayed. „ ‹ Quad A graph representing four obstetrics measurements will be displayed. „ ‹ Hide Grid Erase the grids on a graph. 8-98

[Page 547] „ ‹ All Fetus Display graphs for all measured fetuses. „ ‹ Current Fetus Display graphs for the fetus currently being measured. „ ‹ Trend Tap Trend on the touchscreen. The past and present measurement values for a fetus are displayed in the order of study date. It is shown on the graph with different markers for different study dates. „ ‹ Current Tap Current on the touchscreen. The current measurements for a fetus are displayed by study date. „ ‹ User History The past and present measurement values for the fetus are displayed in a table format. „ ‹ Manual Trend Display the measurement values-manually entered by the user-which are to be displayed on the OB Growth Curve in Trend. Enter manually in Patient window. „ ‹ Prev Return to the previous page. „ ‹ Next Move on to the next page. 8-99

[Page 548] Standard Deviation & Percentile Among the OB information, the Growth table and the typical fetal distribution, for the same number of weeks, are used to determine the following information: X ‹ The normal distribution curve. X ‹ The measurements for an actual fetus or a position in EFW distribution. X ‹ Whether or not a distribution point is within the normal range. The number of weeks referenced for the Growth table can be set to LMP, Estab., DD, or Average US GA, under Pctl. Criteria ; the typical setting is LMP. When the LMP is not known or uncertain, or when the difference between the LMP and the Average US GA is substantial, care must be taken, as selecting different Pctl. Criteria can result in a significant difference. The distribution of the number of weeks in the Growth table for the selected reference is a normal distribution. It is laterally symmetrical around 50% (the average) and it shows the distance from the average as a deviation. The deviation can be represented by Standard Deviation (SD) or Percentile terms. 68.3% 68.3% 95.5% 99.7% [Figure 8.15 Distribution of Growth Table for the Selected Week (m: mean, σ : standard deviation)] 8-100

[Page 549] When represented by SD, a point near to the average indicates a value closer to ±0 SD and a point further away from the average indicates a value closer to the maximum or minimum value. The greater part of the range falls within ±3 SD, with ±1 SD representing 68.3% of the entire range. Thus it can be seen that most fetal measurements are tightly clustered around the average value. The Percentile represents a point in distribution from 0 to 100 inclusive. Therefore, the average point is represented as 50 Percentile. As shown in the figure, the average point corresponds to 0 SD (that is, the 50th Percentile). If a point is in the range from -1 SD to +1 SD, it falls within 68.3% of the entire range. This means that the point falls within the range from 16 to 84. Further, if a point is in the range from -2 SD to +2 SD, it falls within 95.5% of the entire range. Thus, the point falls in the range from 3 to 97. The SD and Percentile are interchangeable. Percentile can be used when a fetal measurement ranking is desired while SD can be used when the distance between actual fetal measurements and the average measurement is sought. While the range of Growth table references that are primarily used with OB measurement data varies depending on the user, the typical range accepted by most users is as below: X ‹ When references are created based on SD: – -2.0 SD – +2.0 SD (when converted to Percentile: 2.28 Percentile – 97.72 Percentile) – -1.5 SD – +1.5 SD (when converted to Percentile: 6.68 Percentile – 93.32 Percentile) – -1.0 SD – +1.0 SD (when converted to Percentile: 15.87 Percentile – 84.13 Percentile) X ‹ When references are created based on Percentile: – 2.5 Percentile – 97.5 Percentile (when converted to SD: -1.96 SD – 1.96 SD) – 5.0 Percentile – 95.0 Percentile (when converted to SD: -1.645SD – 1.645 SD) – 10.0 Percentile – 90.0 Percentile (when converted to SD: -1.288 SD – 1.288 SD) 8-101

[Page 550] Description Tap Description on the touchscreen. OB and Gyn applications have their own preset items; for other applications, only user-added items are available. „ ‹ General OB This item only becomes active when OB measurement is available. Tap the General OB button on the touchscreen and you can select a description for the selected item. „ ‹ Early OB This item only becomes active when OB measurement is available. Tap the Early OB button on the touchscreen and you can select a description for the selected item. „ ‹ Biophysical Profiles 5 items of Breathing, Movement, Tone, AFV, and NST may be left blank or set as 0, 1, or 2; the sum of each item will be displayed as Total. NOTE: Biophysicial Profile is activated only when OB measurement values exist. „ ‹ Default This value has been preset in advance by the user. „ ‹ Save as Default Save the values currently set on the screen as default values. „ ‹ Clear Delete all items. 8-102

[Page 551] „ ‹ Fetus Compare In the OB Study Information screen, select the Number of Fetuses to enable measurement for each fetus when taking OB measurement. Tap the Fetus Compare button on the touchscreen and measurement for each fetus is displayed. [Figure 8.16 Description] [Figure 8.17 Description – Touchscreen] 8-103

[Page 552] Closing Reports Tap Exit on the touchscreen or in the Left Menu. Alternatively, press the Report button on the control panel. 8-104

[Page 553] Image Chapter 9 Managements ‹ ‹ Cine/Loop 9-3 ‹ ‹ Annotating Images 9-5 Annotation 9-5 BodyMarker 9-10 ‹ ‹ Saving, Playing and Transferring Images 9-12 Saving Images 9-12 Playing Images 9-13 Transferring Images 9-14 ‹ ‹ Printing Images 9-15 Printing Images 9-15 ‹ ‹ SonoView Mode 9-16 Exam List 9-17 Review – Exam Mode 9-19 Review – Compare Mode 9-23 DICOM Q/R 9-29

[Page 554]

[Page 555] Cine/Loop Images are automatically saved in the memory during scanning. The saved images are useful for patient diagnosis and review. The saved images can be in Cine or Loop, depending on the Operation modes. X ‹ 2D Cine: These are images temporarily saved in all Operation modes except M Mode and Spectral Mode. X ‹ Trace Cine: Images that are saved in M Mode and Spectral Mode. [Figure 9.1 Cine]
Starting and Finishing Image Review During scanning, press the Freeze button on the control panel. The scanning is stopped and the system switches to the image review mode screen. Press the Freeze button again to return to the scan mode.
How to Review Images Move the cursor to the Cine or Bar in the user information area to review an image. You can search through saved images by moving the cursor with the trackball. The total number of saved images and the number of the image currently being reviewed are shown next to the bar. 9-3

[Page 556] „ ‹ Selecting Loop Select an image to play by pressing the Change button in the control panel. The touchscreen menu is changed when images are reviewed. [Figure 9.2 Reviewing Images – Touchscreen] „ ‹ Cine Play Tap Cine Play on the touchscreen. You can stop or resume playback of an image by tapping the button. „ ‹ Cine Speed Use the Cine Speed button on the touchscreen to adjust the automatic playback speed of 2D Cine or Trace Cine. Speed may be adjusted from 6 to 300%. NOTE: For an explanation of the other items on the touchscreen, refer to Basic Mode in ‘Chapter 7. Modes of Operation’.
Reviewing Image in Multi-image Mode Only the images in an active area can be reviewed. To review images in another area, change the active area by using the Dual or Quad button on the control panel. 9-4

[Page 557] Annotating Images Annotation Enter or display text, Arrow, or BodyMarker on an image. This function is useful for differentiating or marking a diagnosis area.
Starting Annotation Mode Press the Text or Arrow button on the control panel. [Figure 9.3 Annotation Mode]
Typing Text Press the Text button in the control panel and enter text directly with the keyboard, or select predefined text on the touchscreen. You can move the cursor by using the trackball. 9-5

[Page 558]
Text Mode in Soft Menu [Figure 9.4 Screen Keyboard] „ ‹ Change App. Tap the touchscreen or use the dial-button to change application. The text list will change depending on the selected application. „ ‹ Keyboard Tapping the button on the touchscreen opens the on screen keyboard. „ ‹ Arrow You can enter an arrow in a place you want over an image. „ ‹ Delete Last Word Erase the last entered text. Alternatively, use the Annotation key on the keyboard. 9-6

[Page 559] „ ‹ Delete All Words All of the entered text has been erased. Alternatively, use the Delete All key on the keyboard. NOTE: Selecting Setup > Annotation > Library allows you to edit the entire page. For a more detailed description, refer to ‘Chapter 3. Utilities’. „ ‹ Set as Home Position You can set the initial cursor position when Annotation Mode starts. Place the cursor on any position of the screen and press Set as Home Position on the touchscreen. „ ‹ Home Position Pressing the Home button on the touchscreen moves you to the cursor position specified by using the Home Position button. „ ‹ Layer Set Layer A and B. „ ‹ Font Size Select the font size to use. Select a value from 8 to 72 by using the dial-button on the touchscreen.
Deleting Text Press the Clear button on the control panel. All the text entered on the screen will be deleted.
Exiting Text Mode Press the Exit button on the control panel or tap the Exit button on the touchscreen. 9-7

[Page 560]
Arrow Mode You can enter an arrow over an image. This function is useful for differentiating or marking a diagnosis area. [Figure 9.5 Arrow Mode]
Entering Arrow 1. When pressing the Arrow button on the control panel, it is converted to the entry mode. Or press the Arrow button in the keyboard. 2. Use the dial-button’s Arrow Type to select the type of arrow you want. 3. Move the arrow to the desired position by using the trackball. 4. To adjust the size of the arrow, use the dial-button’s Arrow Size . 5. To adjust the rotation angle of the arrow, use the dial-button’s Rotate Arrow . 6. Press the Set button to finish. Press Exit to cancel. Arrow and Pointer Button Pointer function is available in Annotation mode. 9-8

[Page 561]
Deleting Arrows Press the Clear and Delete All Arrows button on the control panel to delete all arrows displayed on the screen. To delete the last arrow entered, tap Delete Last Arrow on the touchscreen.
Exiting Arrow Mode Press the Exit button on the touchscreen or control panel. 9-9

[Page 562] BodyMarker Enter a BodyMarker over an image. This function is useful for differentiating or marking a diagnosis area.
Entering BodyMarker Mode When pressing Marker/Ref Knob on the control, it is converted to BodyMarker entry mode and the touchscreen shows BodyMarker. [Figure 9.6 BodyMarker Mode]
Inserting BodyMarker 1. BodyMarkers will appear on the touchscreen. X ‹ The types of BodyMarker shown on the touchscreen vary depending on the selected application. X ‹ Up to 19 BodyMarkers can be listed on the screen at one time. When more BodyMarkers are provided, use > button on the touchscreen to navigate the pages 2. Tap the touchscreen button or dial button for the BodyMarker you want; the BodyMarker will then be displayed on the image. 9-10

[Page 563] 3. When pressing Change Lib , it can be immediately changed to a desirable application. 4. Select a desirable probe shape by using Probe Type dial-button. 5. Adjust cursor angle by using the Rotate Probe dial-button or the Angle button on the control panel. 6. Adjust the cursor size by using Size dial-button. 7. Set the initial cursor position when BodyMarker starts. Place the cursor on the screen and tap Store Probe Position on the touchscreen. 8. To finish entering BodyMarkers, press the Set or Exit button on the control panel. To cancel it, press Clear on the touchscreen or tap the Delete button on the touchscreen.
Changing BodyMarker Position 1. Press the Change button on the control panel. 2. Move the BodyMarker to a desired position by using the Trackball. 3. Press the Set button on the control panel again to confirm the new position.
Deleting a BodyMarker Press Clear on the touchscreen or tap the Delete button on the touchscreen.
Exiting BodyMarker Mode Tap the Exit button on the control panel or touchscreen. NOTE: Go to Setup > BodyMarker > Library to set the library of BodyMarker. For a more detailed description, refer to ‘Chapter 3. Utilities’. 9-11

[Page 564] Saving, Playing and Transferring Images Saving Images The saved images are displayed in the thumbnail area. WARNING: You must always enter the patient ID, because all images are saved according to patient ID. Failure to enter a patient ID may result in a loss of and/or critical errors in previously saved images.
Saving Images If no patient information has been entered, a Temp ID will be created and saved . The saved images can then be edited and managed in SonoView mode.
Saving (Still Image/Multi Frame Image) Use the Store Clip function of U1–6 button to save it. For a detailed description for Store/ Send/Print settings, refer to ‘Chapter 3. Utilities’. X ‹ When frozen, specify the range of the image you want to save by using the trackball or the Trim Start and Trim End buttons on the touchscreen, then tap the configured U1–6 buttons to save the Cine image. X ‹ Live Mode works as shown below according to settings. For information about the settings, please refer to ‘Chapter 3. Utilities’. If patient information does not exist, saving Cine in Freeze Mode will create a Temp ID for saving. If all frames are saved in Live Mode, the saving process is automatically finished according to a predefined time. The saved images are added to the thumbnail list on the right side of the screen. 9-12

[Page 565] Playing Images You can play the saved images in SonoView and Operation modes.
Playing Images in SonoView NOTE: Refer to ‘SonoView’ in this chapter.
Viewing Images in Operation Modes Use the Pointer button on the control panel. Note that this function is available only when there are images saved in the thumbnail list. Press the Pointer button and the cursor will appear on the screen. 9-13

[Page 566] Transferring Images You can transfer images to a PACS system that supports DICOM. You can transfer all saved images automatically, or select a desired image and transfer it manually. For information on the DICOM server settings and DICOM operations, please refer to ‘Connectivity Settings' in ‘Chapter 3. Utilities’.
Transferring Images in Operation Modes You can transfer images automatically. Images are transferred by using the storage server transmission method in Setup > Connectivity > DICOM . Please refer to ‘‘Connectivity Settings' in ’Chapter 3. Utilities’ of this manual.
Transferring Images in SonoView You can transfer images manually. The following two methods are available: „ ‹ Sending Exam Send all images for an exam. 1. Select an exam from the Exam List. 2. Click the Send button on the left side of the screen. All images for the selected exam will be sent. „ ‹ Sending Selected Images Select a desired image from among the images for an exam and send it out. 1. Select the image in the SonoView screen. 2. Click the Send button on the left side of the screen. The selected images will be sent. 9-14

[Page 567] Printing Images X ‹ Use it after establishing functions in Setup > Peripherals > Printer . X ‹ Configure the Store/Send/Print functions in Setup > Customize > Buttons before use. Printing Images Press the U1–6 buttons on the control panel. Images are printed via an echo printer. For information on how to set up a printer, please refer to ‘Chapter 3. Utilities’. 9-15

[Page 568] SonoView Mode This is the HS50/HS60/XH50/XH60’s integrated image management program. It provides image saving/filing, preview, delete, and other PC-compatible export features. The image file types used in this product follow the international standard DICOM (Digital Imaging and Communication in Medicine). As a result, the PACS (Picture Archiving Communication System) can be implemented without any additional costs, and it’s easy to exchange image files with other hospitals or equipment. This product supports the Bitmap file format (.bmp), which is commonly used on standard PCs, ensuring easier exchange of image data.
Launching SonoView Mode Press the SonoView button on the control panel. This will launch the SonoView screen. If there are saved images available for the current exam, the information and saved images for the exam will appear when SonoView Mode starts. X ‹ Before saving images or using SonoView Mode, you must register the patient information. X ‹ All diagnosis information in the product is saved and managed for each patient ID. As a result, saving images without entering a patient ID may result in a loss of and/or critical errors in previously saved images. 9-16

[Page 569] Exam List Appears when the SonoView button is pressed. Or tap Exam List in Review Mode to see the exam list. [Figure 9.7 Exam List] Enter search criteria at the top of the Exam List screen, and press Search . Search results will be listed on the screen. You can select an exam from the list and examine, delete, or send it. Refer also to ‘Printing Images’ and ‘Transferring Images via DICOM’ later in the document. You can select the data storage location. HDD, Media, and Q/R are provided.
Hide Search Hides the Exam list.
Show Search Shows hidden Exam list. 9-17

[Page 570]
Backup Exam Gets activated when selecting an exam in HDD. Continue to back up the selected exam. Select a drive to back up to and press Yes to continue the backup process. X ‹ If you select the Delete Patient Information checkbox, then the patient information will be deleted after backup.
Restore Exam Gets activated when selecting an exam from USB storage or CD/DVD. Load the selected exam to HDD.
Review When one or more exams are selected, the button is activated. The review screen for the selected exams will open. For a more detailed description, refer to ‘Review Exam Mode’.
Continue Is activated when an exam from the last 24 hours is selected. This allows you to modify the exam. 9-18

[Page 571] Review – Exam Mode Press Exam in the upper left corner of the screen. In the Exam Mode, you can review the current or saved exam. The image that is selected on the screen will be highlighted with a white border.
Exam Mode Screen Exams for each patient ID are displayed by date in a tree structure on the left-hand side of the screen. The number represents the number of saved images. To show or hide exams, use the trackball and the Set button to select a desired ID. [Figure 9.8 Exam Mode] 9-19

[Page 572] [Figure 9.9 Exam Mode – Touchscreen]
Exam Select Use the trackball and the Set button to select a desired exam from the list on the left-hand side of the screen. The selected exam will be marked on the list in blue. The saved image will also be displayed on screen. „ ‹ Reviewing the Current Exam Click Current Exam . The current exam and its images are displayed on the screen. This button is only enabled when the patient ID is registered. Exams brought from the ExamList can be closed by using Close or Close All button. „ ‹ Reviewing Exams Performed Within the Last 24 Hours Double-click an image. The exams that were performed within the last 24 hours and their images, are displayed. The first performance date of the exam appears in the feedback area. You can place measurements, annotations, and BodyMarkers on the loaded exam screen. In addition, you can update the exam with new image scans. „ ‹ Reviewing Exams Performed Prior to the Last 24 Hours Double-click an image. The exams that were performed prior to the last 24 hours and their images, are displayed. The first performance date of the exam appears in the feedback area. You can place measurements, annotations, and BodyMarkers on the loaded exam screen. However, you cannot update the exam with new image scans. 9-20

[Page 573]
Exam Scroll The image of the previous or next page is displayed on the screen. Access by rotating the Page dial-button on the touchscreen. Rotating the dial-button to the left displays the previous page image, while rotating it to the right displays the next page image. However, this button may not be used when the number of exams saved is less than the number of images that appear on a page under the current layout.
Closing Exam Review Tap Close on the touchscreen. To close all exams in the list, click the Close All button.
Pan You can use the Set button to move the image or scan within the selected image layout.
Reset Reset the selected image or scan to the initially saved screen.
Select All All images in the current exam will be selected.
Unselect All All images in the selected exam will be deselected.
Favorite After selecting an image in the Exam SonoView Mode, you'll be able to use the Favorite button on the touchscreen. When you select a Favorite, it will be displayed as in the top right-hand corner of the thumbnail image.
Delete Delete the selected image. 9-21

[Page 574]
Zoom Use by rotating the Zoom dial-button on the touchscreen. You can adjust the selected images from 3 to 200. This appears when an image is selected.
Page Run by rotating the Page dial-button on the touchscreen. Move images of the selected exam.
Layouts You can adjust the number of images displayed on the screen. Use the touchscreen button that represents the layout. Up to 9 images (3×3) can be compared at the same time. The numbers shown in the layout section indicate the column and row of where an image will be displayed on the screen. You can change the numbers shown in the layout section to customize the layout.
Displaying in Full Screen Place the cursor on the image and double click the Set button to display the thumbnail loading screen in Scan Mode.
Reviewing 3D Images If the saved image is 3D, the 3D indicator will appear at the bottom of the image. Double clicking the screen will start 3D View for image review.
Cine play Tap the Cine Play button on the touchscreen if the saved image is Cine. You can use Play, Pause, and Stop to navigate the image forwards and backwards. 9-22

[Page 575] Review – Compare Mode Press Compare in the upper left corner of the screen. In Compare Mode, you can select the images related to an exam to compare and review them. The image that is selected on the screen will be highlighted with a blue border.
Compare Mode Screen As in Exam Mode, exams for each ID appear on the screen. In addition, images for the selected exam are displayed in thumbnail format. [Figure 9.10 Compare Mode] 9-23

[Page 576] [Figure 9.11 Compare Mode – Touchscreen] * All functions except the Page and the details below are the same as those in Exam Mode.
Select an Image Use the trackball and the Set button to select an image from the thumbnail list. The selected image is highlighted in blue in the list. Select a location on the screen where the image will be displayed and then the selected image will appear. NOTE: Only scanned data can be loaded into the image area.
Thumbnail Scroll Images of the previous or next pages are displayed in the thumbnail list. Select the desired image by scrolling with the trackball or using the Thumbnail Scroll dial-button on the touchscreen. Rotating the dial-button to the left displays the previous page's images in the thumbnail list. Rotating it to the right displays the next page’s images in the thumbnail list.
Image Scroll The image of the previous or next page is displayed on the screen. Select the desired image by using the trackball or using the Image Scroll dial-button on the touchscreen. 9-24

[Page 577]
Mobile Export 4 5 6 [Figure 9.12 Exam Mode – Mobile Export] 1 Selected Files: It shows types of selected images. When selecting SR checkbox, it will only be transferred when the file to be transferred contains an SR. 2 Connection Status: The phone number of the connected smartphone (if connected via Wi - Fi) will be displayed. 3 Stand by: Displays data conversion and transfer status. 4 QR Code: Use the smartphone’s QR code scanner to download the Mobile Export application. 5 Send: Send the selected images to the smartphone. 6 Close: Close Mobile Export. X ‹ Mobile Export is an optional feature of this product. X ‹ Images that can be transferred through the Mobile Export are available only for acquired still image or recorded video. X ‹ Enter the clinic name in the system setting. The clinic’s name will be displayed at the bottom of the application screen when you run the Mobile Export application. 9-25

[Page 578] Preparation X ‹ To use Mobile Export, the system and your smartphone need to be connected over Wi-Fi. X ‹ You can use the USB Wi-Fi Dongle Key to set up Wi-Fi on the system.
Printing Images 1. Press the Print button. The Print window will be displayed. 2. Select the type, printing direction, and options for the printer. 3. Click the Print button to print the image. Click Close to cancel. Canceling a Print Job in Progress To cancel a print job in progress, use Setup > Peripherals > Peripherals > Printer > Printer Setting . Select the printer with the print job you want to cancel, and press the Clear Print Setting button. For more information, refer to ‘Chapter 3. Utilities’ in this manual. NOTE: If Thermal Printer is selected, Include Header and Include Page Numbers will be inactive, and headers and page numbers will not be printed on the pages. [Figure 9.13 Image Print] 9-26

[Page 579]
Transferring Images via DICOM Transfer the selected image and measurement data via DICOM. The icon is enabled only when an image is selected. The icon is disabled in a system where DICOM is not enabled. 1. Select an image and click the Send button on the screen. The DICOM Storage window will appear. 2. Press the Send button to transfer the selected image to the DICOM server. Click Close to cancel. [Figure 9.14 DICOM Storage] 9-27

[Page 580]
Saving Images 1. Press the Export button. Export window will open. 2. Specify the various parameters, such as directory, drive, filename and file format. X ‹ Select the Create Patient Folder(s) checkbox to automatically create folders using patient information. X ‹ If the Hide Patient Information checkbox has been selected, patient information is not displayed. X ‹ You can select Low, Mid, or High for Image Quality. 3. Click the Export button to start saving. Click the Close button to cancel. [Figure 9.15 Image Export]
Exiting SonoView Click the Exit button on the screen. Alternatively, you can press the SonoView button or the Exit button on the control panel to exit SonoView Mode. 9-28

[Page 581] DICOM Q/R At least one server should be registered in the DICOM Q/R settings. NOTE: Before using this feature, make sure that DICOM Q/R is properly configured. To configure DICOM Q/R, please refer to ‘Chapter 3. Utilities’ and configure Setup > Connectivity > DICOM functions before use. There is no limit on the number of DICOM Q/R servers you can register.
Run DICOM Q/R Retrieve an image from the selected server by following this process: 1. After entering the ID in the Patient window, register or start an exam. In the SonoView mode, enter an Exam List and select the combobox to Q/R. 2. Enter the Patient ID, Accession Number, or Last Name as a search term. X ‹ Alternatively, search by selecting the modality you wish to find. You may select MR, CT, Mammo, US, DR, or PET for the modality. X ‹ You may search by designating a period. Select Period. Select either Today, Last Week, Last Month, or Manual in the combo box. If Manual is selected, you do not have to select date separately. 3. Press the Search button to search. 4. Patient ID, Patient Name, Modality, Exam Date, Accession Number, Description, and Series Count will appear on the Study List search result. 5. Up to three studies can be selected from the Study List of the same Patient ID. 6. Select a study on the Study List to search within a series. Modality, Exam Date, Description, Series No., Image Count, and Status will appear on the Series List search result. 9-29

[Page 582] 7. After searching for Series, select the Series you wish to retrieve. You may select or deselect up to 10 series by using the Select All checkbox. Click Retrieve . If 10 series are selected, no additional series can be selected. [Figure 9.16 DICOM Q/R] 9-30

[Page 583]
Retrieval Data Manager 1. Press Retrieval Data Manager to display the Retrieved Data Manager window. 2. In the Retrieved Data Manager window, select the series by using the checkbox. NOTE: If you have not started the diagnosis, select the series in the Data Manager window by using the checkbox and press Delete to delete. Locked exams cannot be deleted by using the checkbox. 3. Press the SonoView button to view the selected exam image in the SonoView window. 4. This function can be used to compare data by pressing Compare . 5. Checking Show Only Selected will show the selected exams only. 6. Tap Close on the screen. [Figure 9.17 Retrieval Data Manager] 9-31

[Page 584]